Ayurveda Concept of Medoroga with Special Reference to Obesity and Related Complication and their Medical Management

Obesity or medoroga is the only disease that is gaining more and more attention at the global level. This disease is prevalent in developing as well as in developed countries, in both sexes, across all ages and socioeconomic groups. Obesity is one of the prices we have to pay for rapid urbanization and a sedentary lifestyle. Obesity has been described in Ayurveda texts as medoroga or Sthaulya. Acharya Charaka has described eight varieties of impediments known as ashta nindita Purusha. Ati Sthaulya comprises one of them. Obesity is the risk factor for many diseases like diabetes, CVA, hypertension, etc. It is difficult to prevent and treat lifestyle diseases like obesity with the modern system of medicine alone. Ayurvedic science has great potential in preventing and treating lifestyle disorders like obesity. The presenter's view deals with aetiopathogenesis, symptomatology prevention, and management of Sthaulya as given in the Ayurveda classics. Review Article Ghanawat et a.; JPRI, 33(41A): 295-304, 2021; Article no.JPRI.72766 296


INTRODUCTION
Sedentary lifestyles and poor eating habits, particularly ready-to-eat fast food, have made man the victim of numerous ailments in today's society. Sthaulya (obesity) is one of these disorders that has wreaked havoc on the health of a whole generation. Obesity is becoming a major health issue in India as well. Obesity (Sthaulya) is a disease that can lead to a variety of illnesses, including hypertension, ischemic heart disease, diabetes, osteoarthritis, infertility, impotency, and psychological problems such as stress, anxiety, and depression. As a result, obesity can be considered a substantial contributor to health decline. Sthaulya is mentioned in practically every extant literature in Ayurveda. Atisthool purusha is one of Charaka's "Ashta Nindit Purusha"  As well as Samtarpanajanita roga  Sthaulya is a Sleshma Dosha illness that is seated in Medodhatu  Ati Sthula is defined as a person "who is disfigured with pendulous buttocks, belly, and breasts due to an abnormal growth in fat and flesh, and whose increased weight is not matched by a proportionate gain in energy."  Obesity is described as a condition in which there is an excess of adipose tissue mass.  Obesity epidemics have erupted in various Asian nations as a result of dietary changes combined with an increase in inactive lifestyle [1][2][3][4][5].
There has been a large increase in fat and dense food consumption, accompanied by a decrease in physical activity. With the quick speed of industrialization and economic advancement, an increasing number of employment are becoming sedentary, and dietary patterns are changing as well, with a decrease in cereal consumption and an increase in sugar and fat consumption. As a result of all of this, the incidence of obesity and its accompanying disorders has increased. According to a poll conducted by India's Nutrition Foundation, 45

PATHOGENESIS OF OBESITY (MODERN PERSPECTIVE)
Adipose cell hypertrophy with the least amount of hyperplasia is the hallmark of adult-onset obesity. In addition to the increase in the size of conventional depots (e.g. In obesity, subcutaneous tissue, omentum, retroperitoneal tissues, and epicardium, as well as adipose tissue, may be extensive to tissues where it is not normally present [18]. The three primary components in the aetiology of obesity are excessive lipid accumulation, decreased lipid mobilisation, and decreased lipid consumption. Increased food intake, hypothalamic abnormalities, adipose cell hyperplasia, or hyper lipogenesis can all cause excessive lipid accumulation. By metabolic development, increased food consumption in the form of carbs, proteins, and fats eventually transforms to fats and is stored in fat depots [19]. Reduced lipid metabolism is caused by a decrease in lipolytic hormones, abnormalities of autonomous innervating thyroxine, and adrenaline, which stimulates the mobilisation of unsaturated fatty acids from adipose tissue. Abnormalities of these two causes reduce lipid mobilisation, increase lipid authentication, and ultimately lead to obesity. Aging, inefficient lipid oxidation, inadequate thermogenesis, and immobility all contribute to reduced lipid exploitation. The major pathophysiology in middle-aged obesity is decreased lipid utilisation [20-24].

Diagnosis
Specific criteria for diagnosis of obesity:

Classification of Sthaulya (Obesity)
The demonstration of sthaulya can be elaborated based on contributory factors, demonstration, etc.

Hina Sthaulya (BMI 25-30-kg/m 2 ) -Overweight
A mild degree of overweight without any complications or secondary diseases with less than 1-year duration is considered as Hina [28].

Madhyama Sthalya (BMI 30-40 kg/m 2 ) -Obese
A reasonable degree of flabby with the least complications lacking secondary diseases having a period of 1 to 5 years can be considered as Madhyama Sthaulya [29].

Adhika Sthaulya (BMI > 40 kg/m 2 ) -Morbid Obese
Excessive stage of overweight with complications and secondary diseases, with all 8 detrimental effects and having a period of more than 5 years can be considered as Adhika Sthaulya [30].

Android
Male type of obesity where surplus fat is marked in the upper half of the body. The lower portion of the body is thinner beyond percentage and judgment with the upper part. It is common in females too:  Undergone hormone treatment.  Around menopause due to thyroid gland's disturbance Vital organs affected -Heart, Liver, Kidney & Lungs Major risk factor for heart diseases [31].

Gynaecoi
Ordinary in both sexes but females more affected. Excess fat declaration is in the lower part of the body. The spine is never erect due to heavy hips and thighs.
 Vital organs affected: Kidneys, uterus, intestines, bladder.  These organs may affect the heart.

Neither Android nor Gynoid
The whole body is affected. The fat tissues in their body hinder the movement of all the internal organs and consequently affect their functioning [32].

Upadrava (Complications)
Chronic steadiness of Obesity leads to the deformity of several systems, and organs thus eventually leading to death. The following complications are described in Ayurveda Sushruta has described that the complications happen due to grave impediment of various body channels particularly Medovaha Srotas [33] (A body channel that regulates fatty tissue in the body).

Sadhyasadhyata (Prognosis)
Krichchrasadhya (Difficult to cure) nature of Obesity has been described by most of the Ayurvedic classics. Furthermore, lack of immune power is mentioned as a general characteristic as well as a somber drawback of Obesity [34]. The bad prognosis of Sahaja (Congenital) diseases is described in Charakasamhita [35]. Therefore prognosis of Obesity can be constructed based on general principles of prognosis depicted in Ayurvedic classics [36] which is as follows:

Sukhasadhya
Jatottara Hina Sthaulya having a chronicity of 1 to 5 years and without complications and having BMI between 25 to 30 kg /m 2 .

Jatottara
Madhyama Sthaulya having the chronicity of 5 to 10 years with the least complications and having BMI between 30 to 40 kg/m 2 .

Asadhya
Sahaja (Congenital) Sthaulya is Asadhya, Jatottara Adhika Sthaulya having chronicity of more than 10 years and with all the complications and having BMI of more than 40 kg/m 2 .

Diet
Diet must be nutritionally sufficient but must be lesser in calories, with vitamins and mineral supplements. A mixed balanced diet is a reasonable move toward to long-term weight reduction. The protein should be of soaring quality so that necessary amino acids can be utilized to maintain lean body mass. Food, high in fiber should be used generously because of its low caloric density. persons are more flat to Sthaulya so they should be advised of appropriate diet regimens and work out. In Society, the Percentage of the inhabitants anguish from Sthaulya is increasing day by day so they should be made aware of the disease and its severe complications before it reaches its epidemic level. Reducing on the whole energy intake is key to losing weight. Increasing physical activity can also be helpful together with calorie reduction in achieving weight loss and sustaining a healthy body weight, as well as improving overall health. Conglomerate food and drink corporations, physical activity and sports organizations, NGOs, employers, and local NHS staff all need to work collectively to help communicate the messages about why we need to look at our lifestyles, but also to modify the environment so the healthier alternative becomes the easier choice. Avoidance is the most important key factor for this disease. Patients should be educated to follow the lifestyle changes recommended by Ayurveda. The use of Biopurification methods along with drugs can give better results in obesity.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.