Topic for BAMS

1. Presented By - Somya Gupta
Batch 2017-18
It is more complex then you think

2. Index
1. Introduction
2. Definition of obesity
3. Measurement of Obesity
4. Epidemiology
5. Type of obesity
6. Etiology
7. Pathogenesis
8. Complications
9. Childhood Obesity
10. Management
11. Concept of Sthaulyata
12. Conclusion

3. Introduction
• The world is facing with many lifestyle disorders.
These are being raised because of unbalanced highly
refined food, sedentary lifestyle and stressful mental
conditions. Over nutrition is a form of malnutrition
in which the intake of nutrients exceeds the amount
required for normal growth, development and
metabolism.
• It can be of two types obesity and oversupplying a
specific nutrient.
• Obesity is one of the commonest lifestyle disorder.

4. What is Obesity?
• The term obesity is derived from the Latin
word “obseus” which means to eat
excessively.
• Obesity is a metabolic disorder in which
excess body fat has accumulated to the extent
that it my lead to major health problems. It is
the result of taking in more calories in the
diet than are expected by the body’s energy
consuming activities.

5. Measurement of Obesity
Body Mass
Index
(BMI)
Waist
Circumference
Waist to-hip
ratio
Skinfold
Thickness

6. Body Mass Index (BMI)

7. According to World Heath Organisation
(WHO).

9. Waist Circumference
• Waist circumference is the simplest and most
common way to measure “abdominal obesity”, the
extra fat found around the middle that is an
important factor in health, even independent of
BMI
• It’s the circumference of the abdomen, measured at
the natural waist (in between the lowest rib and the
top of the hip bone,) the umbilicus (belly button),
or at the narrowest point of the midsection.

10. A waist circumference of >102cm in men or >88cm in women indicates
that the risk of metabolic and cardiovascular complications of obesity
is high.

11. Waist to-hip ratio
• Like the waist circumference, the waist-to-
hip ratio(WHR) is also used to measure
abdominal obestiy.
• It is calculated by measuring the waist and
the hip(at the widest diameter of the
buttocks), and then dividing the waist
measurement by the hip measurement.

13. Skinfold Thickness
• In this method, researchers use a special
caliper to measure the thickness of a “Pinch” of
skin the fat beneath.
• It is apply at specific areas of the body.
• Such as the area of triceps, chest, abdominal,
suprailiac and thigh.

14. Measurement of Skinfold Thickness

16. • According to WHO obesity is one of the most
common, yet among most neglected, public
health problem in both developing and
developed countries.
• India has the third highest obese population in
the world, according to a study by the
University of Washington.

20. Type of obesity

21. Etiology

25. Pathogenesis

27. Regulation of Energy Balance
• Body weight regulation(Regulation of energy
balance) or dysregulation depends on a complex
interplay of both humoral (endocrine) and neural
mechanism that control appetite and regulation.
• Neurohumoral mechanisms can be subdivided into
three components:
• 1 Peripheral or Afferent system
• 2 The central processing unit
• 3 The efferent system

28. 1. Peripheral or Afferent system
• Generate signals from various sites
• Composed of
a) Peripheral appetite suppressing signals
• Leptin
• Adiponectin
Gut hormones
• Insulin
• peptide YY(PYY)
• Amylin
b) Peripheral appetite stimulating signals
• Gut hormones
• Ghrelin
• Obestatin

29. Leptin

30. Adiponectin

31. Gut hormones
• Insulin :- It is secreted by cells of the pancreas
and act centrally to activate the appetite
suppressing pathway.
• peptide YY(PYY) :- It is secreted by the endocrine
cells (L cells) in the ileum and colon. It reduces
appetite.
• Amylin :- It is a peptide secreted with insulin
from pancreatic ß-cells.

32. Peripheral appetite stimulating signals
• Ghrelin:- It is produced by the oxyntic cells of the
stomach and in the arcuate nucleus of the
hypothalamus.
Increases food intake(0rexigenic effect).
Stimulates appetite by activating the central appetite
stimulating NPY/AgRP pathway.
• Obestatin:- It is a peptide produced by the same gene that
encodes gherlin. It counteracts the increase in food intake
induced by ghrelin.

33. 2.

36. Energy Imbalance Effects in the body
• The lipid storing cells, adipocytes comprise the adipose tissue,
and are present in vascular and stromal compartment in the
body.
• Adipose mass is increased due to enlargement of adipose cells
due to excess of intracellular lipid deposition as well as due to
increase in the number of adipocytes.
• The most important environmental factor of excess
consumption of nutrients can lead to obesity.
Genes responsible for obesity
• Obesity is familial and is seen in identical twins.
• Recently, two obesity genes have been found: ob gene and its
protein product leptin, and db gene and its protein product
leptin receptor.

37. Complications
• Morbidity or Mortality
• Metabolic complications
• Endocrine Manifestation of obesity
• Mechanical complication of obesity
• Pulmonary diseases
• Cancer
• GIT Disorder
• Fatty Liver (Steatosis) and Non Alcoholic
steato hepatitis (NAFLD)

38. • Obesity has many adverse effects on health and is
associated with an increase in mortality and
morbidity. Obese individuals are risk of early death,
mainly from diabetes, coronary heart disease and
cerebrovascular disease.
Morbidity or Mortality

39. • Central obesity or
upper body fat
distribution is
associated with
increased
concentration of FFA
which can produce
several metabolic
complications of
obesity.
Metabolic complications

40. Insulin resistant and Type 2 diabetes mellitus
• Insulin resistance is the decrease/failure of target
(peripheral) tissues to insulin action.
• Normally, insulin promotes glucose utilization (i.e.
glucose uptake, oxidation and storage) as well as
to inhibit the release of glucose into the
circulation.
• Insulin resistance can develop in obesity and may
produce type 2 diabetes mellitus.
• Central/ upper body/ visceral obesity are found in
more than 80 % of patients with type 2 diabetes
mellitus.

42. Dyslipidemia
• Upper body obesity and type 2 diabetes mellitus are
associated with an antherogenic lipid profile.
• Dyslipidemia includes –
• Increased triglycerides
• Increased low density lipoprotein(LDL)
• Increased very low density lipoprotein(VLDL)
• Decreased high density lipoprotein(HDL)
• Decreased levels of the vascular protective adipokine
adiponectin.
Dyslipidemia increases the risk of cardiovascular
diseases(atherosclerosis, cardiomyopathy) in the
metabolic syndrome.

43. Endocrine Manifestation of obesity
• Women:- Polycystic ovarian
syndrome(PCOS) and menstrual
abnormalities.
• Men:- Reduced plasma testosterone and
sex hormone binding globulin(SHBG),
increased estrogen levels and
gynecomastia.

44. Mechanical complication of obesity
1. Osteoarthritis:- Excessive body weight in obesity
pre disposes to degenerative joint disease
(osteoarthritis) and also gout.

45. 2. Venous stasis/ varicose veins
Mechanical complication of obesity

46. 3. Increased friability of skin:- Especially in
skinfolds thereby increasing the risk of fungal and
yeast infections.
4. Urinary incontinence:- Obesity and
overweight are directly associated with urinary
incontinence. It is the most important risk factor
for daily urinary incontinence compared to any
other factor.
Mechanical complication of obesity

47. 5. Acanthosis nigricans:- It manifests as darkening
and thickening of the skinfolds on the neck, elbows and
dorsal inter-phalangeal spaces.
Mechanical complication of obesity

48. Pulmonary diseases
• Obesity hypoventilation syndrome
(Pickwickian syndrome) may also develop.
• Hypersomnolence:- Develops both at night
and during the day. It is often associated with
apneic pauses during sleep (sleep apnea),
polycythemia and right-sided heart failure
(corpulmonale).

49. Cancer
• Obesity in males is associated with higher
mortality from cancer, such as cancer of
the prostate, colon, esophagus, rectum,
pancreas and liver.
• Obesity in females is associated with
higher mortality from cancer of the
breasts, endometrium, thyroid,
gallbladder, bile ducts, cervix and ovaries.

51. Gastrointestinal Disorder
• Gastro-esophageal reflux disease
• Gallstones:- Higher incidence of gallstones,
especially cholesterol gallstones.
• Fatty Liver (Steatosis) and Non Alcoholic
steatohepatitis (NAFLD):-Nonalcoholic
streatohepatitis can progress to hepatic cirrhosis
and rarely to hepatocelluar carcinoma.

52. Childhood Obesity

54. Management
1. Obesity is a serious medical condition requiring long-
term management.
2. Management needs to be flexible and intergrate
different therapeutic approaches according to
individual patient needs including.
• Lifestyle Modification
• Pharmaco Therapy
• Surgery

55. Lifestyle Modification

56. Diet
• Food Selection
• Portion size control
• Avoidance of snackling
regular meals to
encourage satiety
• Regular support from
the dietician at a
weight loss group may
be helpful.

57. • Low carbohydrate, High Protein diets appear to be more effective in
lowering BMI.
• Improving coronary heart disease risk factors, including an
increase in HDL cholesterol and a decrease in triglyceride levels.

58. Exercise
• With use, muscles consume energy derived from both fat and
glycogen. Due to the large size of leg muscles, walking,
running and cycling are the most effective means of exercise to
reduced body fat.
• Exercise affects macronutrient balance. During moderate
exercise, equivalent to a brisk walk, there is a shift to greater
use of fat as a fuel.
• To maintain health the American Heart Association
recommends a minimum of 30 minutes of moderate exercise
at least 5 days a week.

60. Pharmaco Therapy
• Anti-Obesity medication or weight loss drugs are all
pharmacological agents that reduce or control weight.
• These drugs alter one of the fundamental processes of the human
body, weight regulation, by altering either appetite, or absorption
of calories.
• ORLISTAT is the only drug currently licensed for long- term use.
Mode of Action
• Orlistat inhibits pancreatic and gastric lipases and thereby
decreases the hydrolysis fat absorption by approximately 30%
• The drug is not absorbed.

61. Surgery
• Bariatric surgery to reduce the size of the stomach is by far
the most effective long-term treatment for obesity.
• Bariatric surgery should be offered to those a BMI of 40
kg/m2 or over and Also to those with a BMI of 35-40 kg/m2
who also have obesity related complications, such as DM.
• Bariatric surgery should be contemplated in motivated
patients who have very high risks of complications of
obesity, in whom extensive dietary and drug therapy has
been inadequately effective.
• This reduces the overall mortality by approx 40%

62. Management of Childhood Obesity

64. Introduction
• In Ayurveda AtiSthaulya or Morbid Obesity is described under
one of the eight despicable(Asthaunindita purusha)
conditions.
• Atisthaulyata is described under the caption of santarpan-
janya-vyadhi (disease due to over nurishment).
• It is also said that Sthaulya(Obesity) management is relatively
very difficult than the management of Karsya(lenness).
Definition -
A person in whom there is excessive accumulation of Meda
(fat/adipose tissue) and Mamsa(flesh muscle tissue) leading to
flabbiness of hips,abdomen, and breast has been categorized as
Atisthulya.

65. Etiological Factors(Nidaan)
• The etiological factors for atiSthaulya is
described in ayurvedic classics. They can be
categorised as –
1. Dietetic causes
2.Lifestyle
3.Psychological
4.Genetic(Beejadoshath)

66. • Dietetic causes :-
 Ati-sampoornam(over intake) of Guru(heavy digest)
 Sleshmal-aahara-sevinah (which cause kaphavriddhi)
 Madhura-anna-rasa-pradan(food predominated by sweet taste)
 Seeta(cooling)
 Snigdha(Unctuous)
Consumption of this diet tend to accumulate calories in the body thus conversion into fat.
• Lifestyle:-
 Avyayama(Not doing physical exercise)
 Avyavaya (abstinence from sexual intercourse)
 Diva swapna (day sleep)
All the lifestyle factors are calorie conservations causing fat accumulation.
• Psychological :-
 Harsha-nitya (uninterrupted cheerfulness)
 Achinta (lack of mental excercise )
These psychological factors facilitate elated mood and lacks serious thinking thus
conserve The energy.
• Beeja-dosha :- Beejaswabhavath (genetic). The advancements in the research of
obestiy due importance to genetic factors for the development of obesity.

67. Etiopathogenesis(Samprapti)
Obstruction of passage by Medas
Movement of Vata is specially confined to Kostha
Stimulation of digestive power and absorption of food
Patient digest food quickly and becomes a voracious
eater
Atisthaulyata

68. Complications(Updrava)
• Adoption of above type food and lifestyle result in excessive nourishment of Medas
while other bodily elements(Dhatus) are deprived of nourishment.
• Dis-proportionately increased Medas accountable for several serious consequences
as reported is charak samhita
 Aayu Kshaya (Decreased Life Span)
 Krichr-avyavayata (Difficulty in sexual act)
 Douragandhya (Bad Odour)
 Dourbalya (Decrease of strength)
 Kshut Pipasadhikya(Excessive Hunger and Thirst)
 Swedavadha (Excess perspiration)
 Javoparodha (Decrease in enthusiasm and activity)
In the event of disproportionate increase in fat, disease of very serious
types are caused by vaishamyata of vata and agni which may lead to
instantaneous death.

69. Management
• Avoidance of cause is prime mode of treatment in
Ayurveda.
• Drugs which are having Guru guna and Apatarpana in
action should be administered to treat Sthaulya.
• Administration of Drugs which possess Vata, Shleshma
and Medonashaka properties are ideal for Samshamana
therapy.
• Medicated compositions consisting of Triphala, Sonth,
Kshara, Vayavidang, Loha-Bhasma, Shilajatu are to be
used.
• Vyayama and Tikshna, Ruksha, Ushna, Basti should be
prescribed in the management of Sthaulyata.

70. CONCLUSIONS
• Obesity, although it has reached the scale of the
world epidemic, is no longer just a health issue. In
addition to the consequences as obvious as the
development of biochemical and physiological
disorders of the body and shortening the life
expectancy, it is also an economic and social
problem, which has to be managed not only by
well developed countries, but also those
developing and with low income.