A Review Article on the Management of Childhood Obesity in Ayurveda

Introduction

In Ayurveda, Brihatrayi and Laghutrayi have described obesity as sthaulya. Sthaulya is a medoroga (a disorder of meda dhatu), santarapanajanya vikara [1] (an overnutritional disorder) and rasanimiatja vikara [2] (a disorder of lymph or plasma). Acharya Kashyapa has considered sthaulya as one of the aprashasta (not appreciable) sharira during explaining the anthropology [3]. Acharya Sushruta has considered it as darun (typical) vyadhi and has established relation of sthaulya and karshya (emaciation) with quality and production of rasa dhatu_. Bhela_ Samhita has described it as medovyapattijanya roga [4]. Acharya Charaka has described Sthaulya roga among the astaunindita (not appreciable) purusha [5], santarapanajanya vikara, kapha nanatmaja diseases [6] and samsodhana yogya vyadhi [7].

WHO defines childhood obesity as one of major public health problem of 21st century [8]. Obesity means excess accumulation of fat in body [9]. In childhood period if child is significantly overweight for his or her age and height, he/ she suffers from childhood obesity. The estimation of weight can be done with the help of BMI (body mass index). Weight is earliest parameter used for definition of obesity; weight appropriate for height is defined as body mass index (BMI) [10].

Obesity can occur too due to many reasons including diet habit, sedentary lifestyle, genetic factors, and sedentary lifestyle during pregnancy and use of certain medications. Prevalence of Obesity among children and adolescent is still too high that is children and adolescents aged 2-19 years the prevalence of obesity was 18.5% and affected about 13.7 million children and adolescents as observed in survey in 2017-2018 [11].

Acharya Charaka defined [12] sthaulya as “Owing to an excessive increase of fat and muscle tissue particularly in the breast, buttock and abdomen become pendulous and strength thereof is rendered disproportionate with the physical growth.

Clinical Features

Obese child becomes incapable of all activities due to excess and disproportionate collection of fat in certain body parts viz buttocks, breasts, face, waist etc. Breast, buttock, abdomen and waist become large in size, bulky and pendulous and strength thereof is rendered disproportionate with the physical growth. Chin of obese child appears like double chin. Anthropological parameters like weight, height, mid arm circumference are observed excess to their normal limits. Laziness, restricted body movements, lethargy on little physical work, increased sleep hours, excessive hunger are among other features of obesity. Obstruction of the channels /srotas by kapha and meda, further worsens the condition as remaining other dhatus do not receive sufficient nourishment resulting in poor strength and stamina of the body resulting in decreased performance in all activities like outdoor games, swimming, walking, exercise etc. Child may also be suffered from diabetes, fever, abscess, diseases of vata origin and such other diseases (as intensity of all diseases may be severe in 11prevailing condition of obstruction of medo dhatu). This results in declined immunity due to obstruction of channels (Srotas).

Shamshodhana Therapy

• Shamshodhana includes Panchkarma therapy.
• In obesity langhana therapy indicated. Langhana refers to the procedure which brings about lightness in the body langhana therapy includes emesis, purgation, niruha basti, nasya etc.
• Drugs are used in enema hot, sharp, ununctuous drugs use which is called lekhaniya basti [21].

Nidan-parivarjana

The nidan-parivarjana is best way for reduce weight. So All cause which produce obesity should be avoided.

Ahara

• Madhura, Sheeta (Cold drinks and cold food), Snigdha (oily food), Guru ahaara(heavy food), Atiahara sought be avoided.
• Avyayama and Diwvaswapna after intake of food sought are avoided.
• Before meal drink water (lukewarm water) beneficial for obese person according to Acharya sushruta [22].
• After taking food sought not drink water within half hour due to its diluted digestive enzymes.
• Fiber rich fruits and food are beneficial for obese person e.g: salad, papaya, apple, orange, soybeans, pulses, yava, wheat, mudga, koradusaka, syamaka etc.

Anupana

Lukewarm water, honeywater, triphala kwatha with honey, takra, cumin water and juice of aginimanth (clerodendrum philomidis [23] linn. F) and alcoholic preparations that help to reduce fat, kapha like-cumin preparation, dasmularista etc that help to reduce fat and kapha.

Vihara

• Healthy lifestyle is beneficial for all health problems. Vyayama offers relief in obese condition but children should not perform very tough exercise.
• Physical and mental exercises should be gradually increased.
• The dynamic series of Asanas. i.e. Surya Namaskar (Sun salutation) is the best way to burn calories and reduce weight in obesity and other way are running outdoor games, swimming

Divaswapna

Day time sleep increases kapha dosha also imbalances agni which increases medha dhatu or body fat [24]. Day time sleep, excessive sleep, stress should are avoided.

Discussion and Conclusion

Ayurveda is a science which deals about the life. There are three causes described in Ayurveda that is asatmyaindiyaartha, prgyaapradha and parinam. In simple language we can say it's as aharinya, viharjinya and Kalaja causes. Health and diseases depend upon above these. If we use them in adequate quantity and quality, we shall be healthy. Obesity is a lifestyle disorder and have numerous treatment options in modern system of medicine but they reduce the patients’ weight partially in sometime. Beside in Ayurveda we can treat them on Ayurvedic principles which is not only reduce weight but also maintain it forever.

In classical texts of Ayurveda Obesity is mentioned as Sthaulya. Sthaulya has been included by asthtauninditiya purusha, medoraga (excess fat accumulates in body), santarapanajanya vikara and rasapradoshaja vikara. Sthaulya is abnormal and excess accumulation of medadhatu in various body parts. Obesity means having too much body fat.

In modern system of medicine, treatment for obesity is however available but has limitations. Clinical study of childhood obesity is the need of time for protection from various health hazards caused by the obesity. So children and parents prefer Ayurvedic management. Ayurveda explain two main therapies for the treatment of Sthaulya viz: Shamshodhana & Samshamana with nidanprivarjana.