2. Obesity
State of excess adipose tissue mass
Heterogenous complex disorder of multiple etiology
characterized by excess body fat that threatens or affects
socio-economic, mental or physical health
Overweight and obesity kills more people than underweight
Body weight regulation depends on complex interplay of
hormonal and neural signals
3. Epidemeology
Worldwide obesity has nearly tripled since 1975.
39% of adults were overweight,13% were obese.
39 million children under the age of 5 were overweight or
obese in 2020.
Over 340 million children and adolescents aged 5-19 were
overweight or obese in 2016.
Prevalence of obesity 14.9% among women and 10.8%
among men globally
4. Epidemeology
More than 1 in 3 adults are overweight or obese
1 in 13 adults were considered to have extreme obesity
1 in 6 children & adolescent ages were considered to have
obesity
India ranks 3rd in Global Obesity index
9. Intra-abdominal & abdominal
subcutaneous fat have more
significance than that in the
buttocks & lower extremities
This can be determined by waist-
hip ratio
Abnormal WHR : >0.9 in women, >1
in men
14. Appetite
Influenced by factors integrated by brain – within the
hypothalamus
Neural afferents : Vagal inputs (gut distention)
Hormones : Leptin, insulin, cortisol, gut
peptides, ghrelin, cholecystokinin, peptide YY
Metabolites : Glucose
Psychological & cultural factors : Availability,
composition of diet, levels of physical activity
15. Energy Expenditure
1. Resting or BMR
2. Energy cost of metabolizing & storing
food
3. Thermic effect of exercise
4. Adaptive thermogenesis
5. Non – exercise activity
thermogenesis (NEAT)
16. Factors affecting BMR
Muscle mass
Body size
Physical activity
Environmental factors
Drugs
Diet
Age
Gender
Genetics
Hormonal factors
48. Conclusion
Motivation and Consistency
Trayopasthambha - Ahara, Nidra , Vyayama
Breakfast like a king, lunch like a prince, dine
like a pauper
Females need special care
Always maintain BMI less than 25
Editor's Notes
Second leading cause of preventable death in US
At a similar BMI, women have more body fat than men
Both sexes show rapid increase in their weight in mid 20s. Males tend to become progressively heavier until they reach 50s.
In women, weight remains statically until menopause when there is a substantial weight gain
By the age of 25, 30% of males & females were overweight. By 60, half have a weight problem – risk for health
Volume of an object is measured indirectly by determining the volume of air it displaces inside an enclosed chamber
Mass/Volume = density
Density of fat is constant, fat free mass is variable by age
BMI of 30 is most commonly used as a threshold of obesity in both sexes. Epidemeologic syudies suggest that all cause, metabolic, cancer&cardiovascular morbidity begin to rise when BMI>25, cut off for obesity should be lowered. BMI bw 25-30 should be viewed as medically significant& worthy of therapeutic intervention esp. in presence of risk factors influenced by adiposity eg. HTN, glucose intolerance
Chance for medodushti more in Asians
Distribution of adipose tissue in diff. anatomical depots has substantial implications for morbidity
Intra – abd adipocytes are lipolyticallymore active than others. Release of free fatty acids into portal circulation has adverse metabolic actions esp. on liver
At a similar BMI, women have more body fat than men
Obesity : Swelling of abdomen either due to
A) Deposit of fat in the abdominal wall
B) Adipose tissue in the mesentery, omentum & extra-peritoneal layer
seating after meal
is mentioned as predisposing factor for development of Tunda (abdominal adiposity),
and to drink water after meal is also a cause for increase Sthulata.
In some people (eg. Athlets), BMI higher than normal not because of fat deposits, but because of muscles
Physiological - Sukhasadhya,
Simple – Sukhasadya, Yapya – Satvavajaya chikitsa
Pathological – Krichrasadya , Asadya
All these predisposes to end organ failure, development of MS & death
Life expectancy of a moderately obese individual could be shortened by 2- 5 years
Signals impinging hypothalamic centre
Ghrelin stimulates feeding
Hypoglycemia to induce hunger
Leptin - Adipokines secreted by adipose tissue
Acts primarily through Hypothalamus
Its level of production provides an index of adipose energy stores
Suppress appetite & increase energy expenditure
Obesity ass. With partial leptin resistance and hyperleptinemia
BMR – 70% of daily energy expenditure
Active physical activity – 5-10%
Significant component of daily energy consumption – fixed
Adaptive thermogenesis – regulated production of heat in response to environmental changes in temperature & diet
NEAT _ Physical activities other than volitional exercises, ADL, fidgeting, spontaneous muscle contraction, maintaining posture
Accounts for about 2/3rd of increased daily energy expenditure induced by overfeeding
Adoptees closely resemble their biological parents rather than adoptive parents w.r.t obesity
Identical twins have very similar BMI when reared together or apart
Famine prevents obesity even in most obesity prone individual
Sleep deprivation – increased obesity
Potential changes in gut flora – capacity to alter energy balance – obesigenic viral infections
Kayagni is mainly concerned with chemical processes involved in gastro-intestinal digestion and is having two aspects– general and special. The general aspect relates to factors which are directly concerned with the digestion of food materials, corresponding to gastric and intestinal digestion. The special aspect relates to the humoral or hormonal mechanisms located in the duodenal mucosa, which are responsible for exciting the secretion of the digestive juices – gastric, pancreatic and hepatic – necessary for ensuring intestinal digestion
Obesity – state of chronic low grade inflammation
Inflammation markers - IL 6, CRP, TNF alpha elevated
Sthoulya – Ashta nindita purusha
Santarpana janya vyadhi, kaphaja nanatmaja vyadhi, Samsodhana yogya
Increased Meda, Agni, Vayu
Sthaulya is counted as a disorder of Shleshma Dosha seated in Medo dhatu(AS. Su abdominal adiposity is stated as the result of placement of Shlesma in Koshtha (AS. Su. 19/28. Flabbiness of Dhatu caused by Ama is main pathogenesis of Sthaulya as highlighted in (Su.24/23).
Vitiation of Meda in pathogenesis of Arsha is observed by Vagbhatta Ni. 7/2. Line of treatment of Prameha, Medoroga and Vatavikara is implied to use on patient of Adhyavata in Chi 22/60. In pathogenesis of Mukhadusika vitiation of Meda is first time observed by Vagbhatta (Ut. 31/5) over indulgence in Brihmana is a cause of Ati Sthaulya.
50-100% increased risk of deathfrom all causes compared to normal weight individuals, mostly due to CVS disorders.
Obesity & overweight together second leading cause of preventable death in US
Mortality rate rises as obesity increases, esp. when obesity is ass. With increased intra abd fat.
Life expectancy of a moderately obese individual could be shortened by 2-5 yrs
Satvavajaya Rx
Assessment of patient’s readiness to adopt life style changes
Counselling for behaviour modification
Group activities
Initiaton and maintenance of lifestyle modification programmes
Seetajala Snana
Ksheera
Ikshuvikriti
Meat, fish
Breakfast like king, lunch like prince, dine like pauper
Overweight & Class I obesity – Kshut trishna nigraha
Class II obesity – Pachana,Deepana
Class III obesity - Samsodhana
Main trt – Langhana(Nitya)
Sodhana only if necessary
Avamya
Virechana – no indi or C/I
Vasti – Asthapya, not anuvasya, do yoga, karma,kala etc
Guru Property helps to alleviate Kshudha while Apatarpana Property helps to reduce Meda. (Cha. Su. 21/1- 20)
Production of Meda Dhatu, by passing the Rakta and Mansa Dhatu. He has also given the characteristics of Krathana symptoms, status of Vatavikara in a Sthula person (Meda Krita Marga Avarana Nimita) and line of treatment by interpreting Viruksna as Medoghna and Chhedaniya as Srotovisodhana, through his commentary on Sushruta Samhita (Su. Su. 15/32).
Sthoulyachikitsa – Saktu, lohodaka pulaka (AS 24/20)
Takraprayoga
Agnimantha, Yavakshara
