Obesity is a medical condition in which excess body fats get accumulated which impart negative impact on the body. In general it is said that when body mass index goes above 23 it is called as overweight and body mass index above 27 is called as obese. Obesity increases the chances of various dreadful disorders like cardiovascular disease, type 2 diabetes, sleep apnea osteoarthritis, cancer and depression.
It is clearly evident that excess consumption of food, sedentary Lifestyle , lack of exercise, genetic predisposition, social and environmental changes are the main cause of obesity. Apart from above causes there are certain other important causes which are ignored by the people. Those are:
Easy food availability, adopting convenience in food, in the food farming patterns, has made a great change in food industry. Packed food, easy to cook food has increased the food consumption than the limits. Availability of bigger size pack food sweetsweetened carbohydrates, sweetened beverages account for almost one fourth of food consumption. Consumption of high glycemic index food like potato chips, soft drinks, ice tea, fruit juices, energy rich drinks, has increased the prevalence of obesity.
Consumption of fried food, excess consumption of non vegetarian food, and energy dense food has made people landing into metabolic syndrome, vitamin D deficiency and obesity.
Sedentary lifestyle in childrens is one of the cause for childhood obesity as well as adult obesity. Has been a large shift towards no physical work, less outdoor games and more screen time.
Increase in automotization, mechanical transport, and automobile has made people spend less amount of calories.
In Indian scenario genetic obesity is less prevalent. Ayurveda has mentioned about genetic obesity 2000 years ago. Expression of genetic obesity is again link between genetic and environmental factors. It has been seen that number of Human Genome have been connected to the development of obesity in certain environmental conditions.
Several syndromes like prader- willi syndrome, Barde -Biedl syndrome, cohen syndrome are linked with genetic obesity. This obesity is found in childrens below 10 years of age.
Apart from food habits, genetics and lifestyle other diseases are also responsible for obesity. This includes hypothyroidism, cushing syndrome, growth hormone deficiency handsome eating disorders like binge eating disorder and night eating syndrome.
Certain medications like antipsychotic drugs, antidiabetic drugs from sulphonylurea group, insulin, contraceptive pills, and certain herbs like liquorice and those of sweet testing herbs can also cause obesity
As per Ayurveda theories all the diseases starts from abdomen or gut. The vitiation in the status of agni is said to be the main cause of the disease. Modern science has also found that disturb gut flora also one of the important causes of obesity. There is a Definite change between the gut Flora of lean and obese person. Obese people harbour more firmicutes bacterias which has more energy harvesting capacity. This leads to change in the metabolic potential leading to obesity. It has been observed by our centre that use of antibiotics and anti-inflammatory drugs contribute to change in the gut flora creating inflammation at the level. Hence while on management of obesity antibiotics and anti inflammatory drugs are to be prohibited.
Classification of obesity.
Obesity has been classified in different ways.
Obesity can also be classified as potbelly and pear shaped obesity.
It is also classified as exogenous and endogenous obesity.
Obesity is a complex hormonal disorder in which accumulation of fat is the outcome. Number of systems are involved pathogenesis of obesity in this central nervous system plays an important role which decides the status of satiety and hunger centre. Increased appetite hanger banks is related with the disturbed secretion of leptin and ghrelin hormone. These are appetite related hormones acts on hypothalamus.
Neuropeptide y and a geo UTI related peptide hayden stimulatory effect on lateral hypothalamus and inhibitory effect on ventromedial hypothalamus. Pro oppo melanocortin and cocaine amphetamine regulated transcript hello stimulatory effect on ventromedial hypothalamus. Apart From the above pathophysiology, mitochondrial dysfunction, inflammation, insulin resistance, nonalcoholic fatty liver disease, are the other pathologies which contribute for obesity like diseases.
Obesity can be managed buy different methods. Mainly the following methods are used to manage obesity.
Before going for any management of obesity mental preparation of the patient is the most essential component of the treatment.
Before starting any treatment of obesity it is very important let the patient should be prepared mentally physically for the dietary regime s and physical activity. Treatment of obesity should should start with a very perfect lifestyle management which includes proper personalized diet along with behaviour modification.
Other factors also playing very important role in weight reduction and relapse prevention.
Obese person when on weight reduction program should set goal and also decide duration to achieve that goal.
All the stimulatory conditions should be kept under control when on Obesity management. Support should be taken on the professionals motivated for the diet controls. A person who is on diet control for weight reduction should take motivation from highly dedicated person who has undergone substantial weight loss. Support should also be taken from a sychologist, exercise trainer dietitians and obesiticians to achieve targeted weight loss. These types of support can help person to reduce ten to twenty percent weight loss.
When patient is having morbid obesity initial diet control and weight reduction helper person to improve physical activity which can help for the further weight loss.
When targeted weight loss is on the higher side medications come to help which has a varied mode of action. Medications can definitely help in morbid obesity to achieve the target.
Patient who are having essential hypertension or diabetes mellitus should check there blood pressure blood sugar levels frequently to ensure that they should not land into hypertension or hyperglycemia.
Phases of obesity and weight reduction management.
People who are having moderate or morbid obesity has to undergo through the phases like...
If all these phases are address to properly then a smooth weight loss can happen which can have very positive impact on the overall health of the person.
As discussed earlier this phase is important 2 screen ourselves for the fitness for weight reduction program. In this phase blood sugar control, blood pressure, cardiac activity, liver functions, uric acid levels should be screened which ensures about the fitness during weight loss.
In this phase diet and physical activities as advised should be followed to get proper speed for weight reduction.
In maintenance phase the weight reduction which is achieved should be maintained at least for 72 weeks. In this phase compensations regarding food, compensations regarding exercises, compensations regarding alcohol consumption should be learnt and followed properly. If the person puts on weight buy 10% of reduce weight then he should consult the respected medical professional for diet counselling and maintenance counselling.
The treatment developed by Jeevanrekha Ayurved Chikitsalaya an exclusive center for Obesity management has multi targeted activity. In obesity multiple pathologies takes place at a single given time hence the management and the treatment should be multi targeted. Apart from inhibiting the pathologies of obesity the treatment also imparts activity of Vayasthapana which can be called as Age restricting activity.The treatment is designed by using medicines along with calorie restriction. It has been seen by some workers that therapeutic calorie restriction reduces the aging effect on the body. This was seen at our center by a clinical trail on Argeriya speciosa and analyzing di hydro epi endosteron with some dietary controls.
The first six days diet is a high fat , low carbohydrate and low proteins diet which is called as ketogenic diet. This may induced mild ketosis which burns the fats as fuel for brain. This treatment consists of specially processed sesame oil which consists very high % of sesamol which is potent anti oxidant , and may increase all the three endogenous anti oxidant like GPX, CAT and SOD at a same given period. It has been seen that the action of this processed sesame oil is very specific that it may not reduce any after 6 days. Thus, we claim that processed sesame oil may be working on only oxidized fats which are present on the body. This will reduce the risk of lipid peroxidation which leads to further metabolic disorder like microangiopathy , aconthosis nigricans, hypertension, diabetes and insulin resistance. This treatment is also useful in obesity induced other disorders like arthritis, coronary diseases, diabetes , hyper cholesterol and high lipid levels where lipid per oxidation plays a important role.
After six days herbal tablets are advocated to the patients in a specified dose. This is a herbal blend having herbs which exert diverse mode of actions. After six days treatment high protein, low carbohydrate and low fat diet is recommended for the patients as per the WHO guidelines. More focus is given on fat, sugar, milk and non veg consumption. Fruits are totally stopped as fructose is known to stimulate hormone ghrelin which is known to stimulate appetite. Substances which are categorized in Abhishyandi group by Ayurved are totally restricted. Vidhur anna like sprouts are also restricted during the treatment.
The formulation exerts varied mode of action like...
Potent antioxidant,Insulin sentisizer, Anti inflammatory which reduces pre inflammatory cytokines like interlukines which are raised in obesity. It is also known to reduce ultra sensitive CRP levels.
Regulates fat metabolism and is seen to stimulate satiety center at a hypothalamus level.
Immnomodulatory activity - Formulation contains phytochemicals like berberin and Tinocardin from Tinospora cordifolia apotent alkaloid which is having immuno modulatory and anti inflammatory property.
Thermogenesis Induces thermo genesis and some of the herbs in the formulation are known bio availability enhancer which increases the rate of absorption of other herbs in the formulation.
Some herbs are known to inhibit NF kappa B and TNF alpha which are raised in obesity.
The formulation contains low molecular wt . tannins which is known to regulate fat metabolism . Tannins are also known to regulate intestinal hormones like cholecystokinine which plays an important role in obesity. Cholecystokinin (CCK) is a polypeptide hormone, widely distributed in the gastrointestinal tract and nervous system (both peripheral and central); it plays a major role in the digestive process. CCK also occurs in the brain, where it acts as a neurotransmitter and neuromodulator. CCK exists as several different molecular species: CCK-58, CCK-39, CCK-33, CCK-8, and CCK-4. The octapeptide CCK-8, for example, predominates in the brain. Also, there are at least two types of CCK receptors.
Over the past 10-15 years, there has been much activity in the development of potent and selective CCK agonists and antagonists because these agents may lead to novel therapy for the treatment of disorders such as gastrointestinal disturbances, pancreatitis, gastric and pancreatic carcinomas, obesity, and cognition dysfunction, in which CCK has been implicated. Several such molecules are under active development. There are also satiety agents, fashioned after CCK, which may fight obesity.
Many a times, in weight reduction programs lean body mass decreases which lead to loss of muscle mass. Some herbs in the formulations are known to increase the lean body mass and hence restores the muscular strength of patients who are on weight reduction programs .The herbs stimulate the synthesis of cyclic AMP, which among other outcomes, triggers the release of fat from fat cells and speeds up metabolism by increasing thermogenesis (the rate at which the body burns calories at rest, emitting it as heat to the environment.) It is able to increase the release of stored fats, elevate metabolism and increase lean mass by increasing the synthesis of cyclic AMP, without stimulating the central nervous system.
It has been seen that the above formulation has a multi dimensional effect on the pathology of obesity. It might be exerting its effect on the fat derived peptides like leptin, ghrelin , metabolic hormones like TSH, and insulin and intestinal hormones like cholecystokinin. The herbal formulation also works as an immuno modulator and antioxidant which are most important effects in the management of obesity.
As obesity is a multi factorial disorder it is very important to rule out the under laying cause of obesity. Management must be designed in such a manner which will target the main cause and exert regulatory effects on fat and lipid metabolism, hormones concerned with obesity and maintain the lean body mass of the patient. In this study is has been seen that a significant weight loss can be achieved in a bigger group of patients with a pure Ayurvedic management.