OBESITY

‘Obese’ or ‘obesity’ is a word commonly heard these days, thanks to the growing awareness among the population and its risk factors and the need to change one’s status from ‘obese’ or ‘overweight’ to ‘fit and healthy’. But how much do we actually know about ‘obesity’ and the possible causes, prevention, and the available treatments, which are actually effective. Like all other developing and developed countries, India is also following the trend where people are steadily becoming more obese. Unhealthy, processed food has become much more accessible and even children are exposed to these foods at a very early age which is a major cause for childhood obesity. Hence, it’s high time we pause from our fast pace life and take into account our lifestyle so as to prevent and/or check further increase in weight gain.

What is Obesity?

Obesity is a medical condition in which excess body fat has accumulated to the extent that it has an adverse effect on health. Obesity is also defined as having a BMI of 30 or more.

BMI is a calculation that takes into account a person’s weight and height. However, according to CDC [Centre for Disease Control], “factors such as age, sex, ethnicity and muscle mass can influence the relation between excess fat, muscle, or bone mass. In India, due to genetic tendency towards abdominal obesity and its associated risk of related lifestyle diseases like diabetes and heart disease, guidelines for diagnosis of obesity and abdominal obesity for India have been published in JAPI [2009] that a BMI over 23kg/m2 is considered as overweight, normal BMI being 18.0-22.9kg/m2,overweight is 23.0-24.9 kg/m2, obese >25 kg/m2. Other measurements of fat distribution include the waist-hip ratio and body fat percentage. ‘Normal weight obesity’ is a condition of having normal body weight, but a high body fat percentage with the same health risks of obesity.

Note: waist-hip ratio is the circumference of the waist divided by that of the hips. >0.9 for men >0.85 for women are used to define central obesity.

Body fat percentage=1.2xBMI+0.23x age-5.4-10.8xgender (where gender is 0 if female and 1 if male)

What causes Obesity?

Changing diet and decreasing physical activities are the 2 most important causes for the recent increase in the rate of obesity. Because of the increase in the use of technology and sedentary lifestyles and because of the occupations where people are required to sit in a place for a longer time, fewer calories are burnt than the calories consumed. This in the long term causes accumulation of these extra calories resulting in weight gain.

Causes can be classified as, 

• Primary cause, which is mainly due to lifestyle 
• Secondary cause, which is due to an underlying condition

Primary cause, due to lifestyle

• sedentary /inactive lifestyle
• eating foods high in fats and calories, fast foods like pizza, burgers, chats, sweets
• Preserved/ canned foods, ready to eat meals, which have high amounts of various salts used for preservation purposes and artificial flavors.
• Not sleeping enough, which can lead to hormonal changes that makes you feel hungrier and consumption of beverages like coffee, alcohol, aerated drinks in excess amounts.

Secondary causes, which are due to an underlying condition-medical

• Genetics, which can affect how your body processes food into energy and how fat is stored and factors that make it difficult for people to lose weight.
• PCOS, imbalance of female reproductive hormones.
• Hypothyroidism, a condition where thyroid gland does not produce enough of certain hormones.
• Osteoarthritis or any other conditions or injury which may lead to inactivity.

Physiological

• Growing old, metabolism rate is slower making it easier to gain weight.
• Pregnancy, weight gained during pregnancy can be difficult to lose and may eventually lead to obesity.

Psychological

• Depression / Stress, sometimes lead to weight gain as individuals turn to food for emotional comfort, binge eating.

Other factors

• Medications, certain medications such as steroids, and certain antidepressants or birth control pills can also cause weight gain.

Diagnosis

• As described earlier by measuring weight (in kg) and height (in m), BMI is calculated [kg /m2]
• Other measurements like waist-hip ratio, body fat percentage, body fat analysis
• In conditions where an underlying cause is present relevant investigations are done, which may include blood tests to examine cholesterol levels, glucose levels, LFT, diabetes screening, thyroid tests, ECG to rule out any heart conditions and so on.
• A measurement of the fat around the waist is a good predictor of risks of obesity related diseases.

Common conditions related to obesity, complications

Obesity has been linked to a number of health complications some of which are as follows

• Diabetes- type 2
• Heart conditions 
• High blood pressure
• Stroke, paralysis
• Fatty liver disease
• High cholesterol
• Arthritis 
• Infertility
• Sleep apnea and other breathing problems

So take those half-serious new-year resolutions seriously and make it as a year round commitment to stay fit and healthy. Well, then what can be done? What are the treatments available? Watch for this page to know more about it..!

Now, let’s know what are the treatments available to tackle this growing epidemic of obesity. Before looking into it, let’s first understand how Ayurveda explains obesity.

In Ayurveda, obesity is explained as ‘atisthuolya’ and also as a ‘medoroga’, which is mainly caused due to excess accumulation of meda dhatu or fat tissue in the body. The major causes for sthoulya are ahitakara ahara, vihara i.e., improper food and lifestyle, bija dosha [hereditary factor], manasa nidana [mental faculty disturbances], because of all these or some of these causative factors, there will be formation of madhura annarasa, improperly digested food, which leads to accumulation of meda dhatu in the body. Thus there will be improper formation of further dhatus [tissues] in the body viz., asthi [bone], majja [marrow] and shukra [reproductive tissue].

Due to blocking of fat tissues, vata dosha increases within the koshta [alimentary tract]. Increased vata aggravates the Agni, the digestive fire, causing early digestion of food which in turn leads to excessive hunger and the person indulges in overeating. The signs and symptoms of an ‘atisthula’ person are, pendulous and sagging of hip/gluteal region, abdomen and breasts with decreased levels of energy to involve in any physical activities. Along with these are excessive thirst, hunger, perspiration, foul body odour, shortness of breath and decreased reproductive functions.

Treatment

As per allopathic science

Now that we know obesity as per Ayurveda, let’s move on to the treatments available in allopathic or modern medical science. To treat any condition, co-operation from the patient is key to achieve desired results, wherein the patient is required to follow the diet, exercise advised along with other medications, if any. And all these have to be followed with much dedication in weight loss treatment, failing which the desired results will be far from achieving!

When you consult a doctor for reducing weight, you’ll also be directed to a dietician who will work with you and help adapt healthy eating habits and schedule workouts. Medications will be prescribed if needed, i.e., by determining any underlying cause like hypothyroidism, PCOD, where you’ll be started on appropriate medications.

Prescription weight loss medications are advised only if the BMI is above 27 kg/m2 and if other methods fail. These medicines either suppress appetite or prevent absorption of fat. But be warned, these drugs can have unpleasant side effects, ex., frequent bowel movements, bowel urgency and gas. Hence, close monitoring while taking these medicines is necessary.

Weight loss surgery may also be advised if BMI is 40 or above or have BMI of 35-39.9 along with serious obesity related health problems. Weight loss surgery is commonly called as ‘bariatric surgery’ which requires serious commitment from patients that they will change their lifestyles. It is a major surgery with risks involved. Patients may require counselling for their emotional support and that they are willing to make necessary changes in lifestyle.

The following are the types of procedures included 

• Gastric bypass surgery
• Laparoscopic Adjustable Gastric Banding [LAGB]
• Biliopancreatic diversion with duodenal switch which removes most of your stomach
• Gastric sleeve- removal of part of your stomach

The major complications and risks are metabolic bone disease manifesting as osteopenia and secondary hyperparathyroidism due to the mal-absorption of calcium, reduced bone mass leading to increased risk of fractures. Rapid weight loss may lead to development of gallstones and nutritional derangements due to deficiencies of micronutrients like iron, vitamins, thiamine, folate, etc,.

As per Ayurveda

Ayurveda treats diseases based on the doshic predominance. The tridoshas or the humors of the body when in normalcy maintains health, when imbalanced causes ill health or diseased condition. As explained earlier, in obesity, the doshas involved are vata and kapha along with vitiated agni. Kapha and meda dhatu are inter-related hence meda dhatu vitiation also causes kapha vitiation. Ayurveda explains a combination of Panchakarma treatments, which normalizes vata, kapha and deepana pachana [drugs which enhances and corrects digestive functions] drugs to correct the agni [digestive fire]. The line of treatment for obesity is “guru cha tharpanam”[cha. Su,21] which means the food which is heavy for digestion is advised from which the agni is controlled so that there won’t be frequent hunger leading to excess food intake and also which does not nourish the meda dhatu but instead causes shoshana[depletion]. The food that nourish other dhatus without causing increase in meda dhatu are to be given, like ragi, barley, honey, and drugs like amalaki [Indian gooseberry], haridra [turmeric] ,musta[nut grass], Triphala, guduchi [Indian tinospora], have been mentioned. Tikshna, ushna bastis [enemas which contain drugs of hot and penetrating properties], udvartana are to be administered. Avoid the foods that are cold, sleeping at day time etc,. 

We at guduchi, have specific treatment plans planned out for specific individuals based on the cause for obesity.

• Apatarpana – for people who want to reduce around 2-3 kgs and only by an external medication but not take medicines internally, who usually have next to nil physical activity.
• Rookshana – for people who are looking for complete detoxification and thereby reduce weight, can be taken by healthy individuals too as it builds immunity.
• Medohara – suggested for new moms to counter the post-partum problems, when the baby is older than 6 months.
• Sthoulyahara – for women whose weight gain is associated with PCOD, hypothyroidism
• Nirbhayam – for individuals with obesity who have BMI between 30-39.9 and extreme obesity with BMI greater than 40
• Bahirparimarjan – for individuals who specifically want to reduce fat from specific body parts while maintaining a healthy body weight.

These treatments with a few dietary changes and exercises help achieve to have a healthy and fit body that you always dreamed of!

• Get the bone density test done, before you break the bone. 
• learn if you have weak bones or osteoporosis before you break a bone
• predict your chance of breaking a bone in the future
• see if your bone density is improving, getting worse or staying the same
• find out how well an osteoporosis medicine is working.

A bone density test tells you if you have normal bone density, low bone density (osteopenia) or osteoporosis. It is the only test that can diagnose osteoporosis. The lower your bone density, the greater your risk of breaking a bone. A bone density test can help you and your healthcare provider:Having low bone density or osteopenia does not mean you will get osteoporosis,It means you have a greater chance of developing osteoporosis if you lose bone in the future. While we’ve known that people with osteoporosis should consider treatment to reduce the risk of broken bones, it hasn’t always been clear when to treat people who have low bone density.