Changes

Serious diseases are the outcome of excessive obesity due obstruction of body channels by the [[meda dhatu]]. This indicates ancient wisdom of [[Ayurveda]] scientists, which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group.  </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span is stated to be an important consequence of obesity in [[Ayurveda]]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiology: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref>  <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024.  </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601.  </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088.  </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease  and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84.  </ref>.[verse 5-8]

Serious diseases are the outcome of excessive obesity due obstruction of body channels by the [[meda dhatu]]. This indicates ancient wisdom of [[Ayurveda]] scientists, which is comparable to the impact of obesity on health perspectives of biomedical science<ref>Mishra, L.C. (2003). Scientific Basis of Ayurvedic therapy, Chapter 9 Obesity (Medoroga) in [[Ayurveda]]; eBook, published by CRC press, Taylor & Francis Group.  </ref>. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span is stated to be an important consequence of obesity in [[Ayurveda]]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis<ref>Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiology: A cellular and molecular approach. Philadelphia: Saunders. p. 1227. ISBN 0-7216-3256-4 </ref>. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management<ref> Kuniko Takagi, Romain Legrand, Akihiro Asakawa, Haruka Amitani, Marie François, Naouel Tennoune, Moïse Coëffier, Sophie Claeyssens, Jean-Claude do Rego, Pierre Déchelotte, Akio Inui, Sergueï O. Fetissov. Anti-ghrelin immunoglobulins modulate ghrelin stability and its orexigenic effect in obese mice and humans. Nature Communications, 2013; 4 DOI: 10.1038/ncomms3685, site on 08/02/2014. </ref>  <ref>Grundy SM (2004). "Obesity, metabolic syndrome, and cardiovascular disease". J. Clin. Endocrinol. Metab.89 (6): 2595–600. doi:10.1210/jc.2004-0372. PMID 15181029. </ref> <ref>Foster, W.R. and Burton, B.T.(1985). Health implication of obesity, Ann. Intern.Med., 103, 1024.  </ref> <ref>Grunstein, R.R. and Widcox, I. (1994). Sleep-disordered breathing and obesity, Clin.Endocrinol.Metab. Baillier’s, 8, 601.  </ref> <ref>Daugero, K.D. (2001). A new perspective on glucorticoid feedback: relation to stress, carbohydrate feeding and feeding behavior, J. Neuroendocrinol., 13, 1088.  </ref> <ref>Larsson, B. et al (1984), Abdominal adipose distribution, obesity and risk of cardiovascular disease  and death: 13 year follow up of participants in the study of men born in 1913, Br. Med. J., 288, 1401. </ref> <ref>Esposito K. et al (2004). "Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial". JAMA, 291 (24): 2978–84.  </ref>.[verse 5-8]

=== Etiology, features, and consequences of ''atikrisha'' (emaciation) ===

=== Etiology, features, and consequences of [[atikrisha]] (emaciation) ===

The etiological factors for ''atikrisha'' may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in ''atikrisha''. In the pathogenesis of ''krishata'', ''vayu'' plays an important role. Most of the etiological factors observed in the case of ''krisha'' and ''atikrisha'' provoke ''vata'' vitiation. Thus, vitiated ''vata'' may be considered the most important factor in the pathogenesis of ''krisha''. In ''sthaulya'' there is excessive formation and under-utilization (due to sedentary habit) of the ''rasa dhatu''. On the other hand, in ''krishata'' there is less formation of ''rasa'' due to diseases or due to undernourishment. Further, Charak and Sushruta both have categorized ''krishata'' as a ''rasa pradoshaja vyadhi''. [Cha.Sa.[[Sutra Sthana]]28/10], [Su.Sa.Sutra Sthana 15/37]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>,[Su.Sa.Sutra Sthana 24/8]<ref name=Susruta/> In this way, ''rasa dhatu dushti'' mainly in the form of ''kshaya'' is found in extremely lean or emaciated people. The other ''dhatu'' involved in the pathogenesis of obesity as well as ''atikrisha'' is [[meda dhatu]] since it is mentioned that ''medokshaya'' (or the deficiency of [[meda dhatu]]) cause ''krisanga''. [A.H.Sutra Sthana 11/18]<ref>Munshi, V.D. (translator) (1952). Ashtang Hridaya,Sastum Sahityavardhak Mudranalaya, Ahmedabad, India, p. 135, Sutrasthana-24/5, 11/18. </ref>   

The etiological factors for [[atikrisha]] may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in [[atikrisha]]. In the pathogenesis of emaciation (karshya) , [[vata]] [[dosha]] plays an important role. Most of the etiological factors observed in the case provoke [[vata]] [[dosha]] vitiation.  

 

In [[sthaulya]] there is excessive formation and under-utilization (due to sedentary habit) of the [[rasa dhatu]]. On the other hand, in [[krishata]] there is less formation of [[rasa dhatu]] due to diseases or due to undernourishment. Further, Charak and Sushruta both have categorized ''krishata'' as a ''rasa pradoshaja vyadhi''. [Cha.Sa.[[Sutra Sthana]]28/10], [Su.Sa.Sutra Sthana 15/37]<ref name=Susruta>Sushruta. Sushruta Samhita. Edited by Jadavaji Trikamji Aacharya. 8th ed. Varanasi: Chaukhambha Orientalia;2005.</ref>,[Su.Sa.Sutra Sthana 24/8]<ref name=Susruta/> In this way, ''rasa dhatu dushti'' mainly in the form of ''kshaya'' is found in extremely lean or emaciated people. The other [[dhatu]] involved in the pathogenesis of obesity as well as [[atikrisha]] is [[meda dhatu]] since it is mentioned that ''medokshaya'' (or the deficiency of [[meda dhatu]]) cause ''krisanga''. [A.H.Sutra Sthana 11/18]<ref>Munshi, V.D. (translator) (1952). Ashtang Hridaya,Sastum Sahityavardhak Mudranalaya, Ahmedabad, India, p. 135, Sutrasthana-24/5, 11/18. </ref>   

In biomedical terms, emaciation is the outcome of loss of the fatty contents or loss of adipose tissue component of subcutaneous fat, which is lying beneath the outer covering of the body<ref>Gray D.S., Fujioka K. (1991). "Use of relative weight and Body Mass Index for the determination of adiposity". J Clin Epidemiol, 44 (6): 545–50. </ref>. It is also known as extreme weight loss, leanness, or thinness. In general term, it is also known as wasting, which is caused by hampered nutritional requirement at the tissue level and excessive starvation. Wasting or leanness is an important symptom of improper nourishment, which is commonly seen in various clinical conditions such as poverty, a variety of gastrointestinal disorders, various eating disorders, prolonged fever, malignant diseases, endocrine disorders, chronic infections, autoimmune disorders as well as parasitic infections. The malnourished person faced a lot of problems related to cardiovascular, integumentary and urogenital systems. Disturbances in blood circulation, serum electrolyte, and serum protein are commonly observed in emaciated person. Such type individuals are more to suffer from infections due to deranged immune power and swelling in general<ref>"Emaciation". Medical-Dictionary.TheFreeDictionary.com. Retrieved February 19, 2014. </ref>.   

In biomedical terms, emaciation is the outcome of loss of the fatty contents or loss of adipose tissue component of subcutaneous fat, which is lying beneath the outer covering of the body<ref>Gray D.S., Fujioka K. (1991). "Use of relative weight and Body Mass Index for the determination of adiposity". J Clin Epidemiol, 44 (6): 545–50. </ref>. It is also known as extreme weight loss, leanness, or thinness. In general term, it is also known as wasting, which is caused by hampered nutritional requirement at the tissue level and excessive starvation. Wasting or leanness is an important symptom of improper nourishment, which is commonly seen in various clinical conditions such as poverty, a variety of gastrointestinal disorders, various eating disorders, prolonged fever, malignant diseases, endocrine disorders, chronic infections, autoimmune disorders as well as parasitic infections. The malnourished person faced a lot of problems related to cardiovascular, integumentary and urogenital systems. Disturbances in blood circulation, serum electrolyte, and serum protein are commonly observed in emaciated person. Such type individuals are more to suffer from infections due to deranged immune power and swelling in general<ref>"Emaciation". Medical-Dictionary.TheFreeDictionary.com. Retrieved February 19, 2014. </ref>.   

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness (C.Su. 23/3-34). The patients of ''atikrisha'' and ''sthaulya'' perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because ''sthula'' (or the obese) suffers more in comparison to ''atikrisha'' (the emaciated) (Su.Su. 15:42). Further, it is mentioned that ''atikṛisha'' is a grave disease, but is considered better than ''atisthula'' from treatment aspect because there is no treatment for ''sthaulya''. For proper treatment of ''sthulya'' the drugs must have ''medohara, agnihara'' and ''vatahara'' action at the same time, which is neither possible from ''karshaṇa'' nor ''brimhana''. Recent evidence also suggests that Charak had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity<ref>Bose, Bholanoth (1877, 2009). A new system of medicine, entitled recognizant medicine; or, The state of the sick. London: J. & A. Churchill. pp. 192–199. Retrieved February 19, 2014. </ref> <ref>Lusky A, Barell V, Lubin F, Kaplan G, Layani V, Shohat Z, et al. Relationship between morbidity and extreme values of body mass index in adolescents. Int J Epidemiol 1996;25(4):829-834. </ref> <ref>Lake JK, Power C, Cole TJ. Women's reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997;21(6):432-438. </ref> <ref> Kopp W, Blum WF, von Prittwitz S, Ziegler A, Lubbert H, Emons G, et al. Low leptin levels predict amenorrhea in underweight and eating disordered females. Mol Psychiatry 1997;2(4):335-340. </ref> <ref> He Q, Karlberg J. BMI in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res 2001;49(2):244-251. </ref>

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness [Cha.Sa. [[Sutra Sthana]] 23/3-34]. The patients of [[atikrisha]] and [[sthaulya]] perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because [[sthula]] (or the obese) suffers more in comparison to [[atikrisha]] (the emaciated) [Su. Sa. [[Sutra Sthana]] 15/42]<ref name=Susruta/>. Further, it is mentioned that [[atikṛisha]] is a grave disease, but is considered better than [[atisthula]] from treatment aspect because there is no treatment for [[sthaulya]]. For proper treatment of [[sthaulya]] the drugs must have ''medohara, agnihara'' and ''vatahara'' action at the same time, which is neither possible from [[karshaṇa]] nor [[brimhana]]. Recent evidence also suggests that Charak had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity<ref>Bose, Bholanoth (1877, 2009). A new system of medicine, entitled recognizant medicine; or, The state of the sick. London: J. & A. Churchill. pp. 192–199. Retrieved February 19, 2014. </ref> <ref>Lusky A, Barell V, Lubin F, Kaplan G, Layani V, Shohat Z, et al. Relationship between morbidity and extreme values of body mass index in adolescents. Int J Epidemiol 1996;25(4):829-834. </ref> <ref>Lake JK, Power C, Cole TJ. Women's reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997;21(6):432-438. </ref> <ref> Kopp W, Blum WF, von Prittwitz S, Ziegler A, Lubbert H, Emons G, et al. Low leptin levels predict amenorrhea in underweight and eating disordered females. Mol Psychiatry 1997;2(4):335-340. </ref> <ref> He Q, Karlberg J. BMI in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res 2001;49(2):244-251. </ref>

=== Management of the Morbidly Obese  ===

=== Management of the Morbidly Obese  ===