Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations

37CHAPTER

Obesity in Ayurveda: Dietary, Lifestyle,
and Herbal Considerations

H. Sharma*,†, H.M. Chandola‡

ÃCenter for Integrative Medicine, The Ohio State University, Columbus, OH, USA
†College of Medicine, The Ohio State University, Columbus, OH, USA
‡Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, India

ABBREVIATIONS

BMI Body mass index
COX Cyclooxygenase
HDL High-density lipoprotein
LDL Low-density lipoprotein

1. INTRODUCTION

The prevalence of obesity is increasing to epidemic proportions globally. The World
Health Organization estimated that in the year 2008 there were more than 1.4 billion
overweight adults worldwide, of which 500 million were obese. In the United States,
the 2009–2010 National Health and Nutrition Examination Survey identified a 35.7%
prevalence of obesity among adults and a 16.9% prevalence of obesity in children and
adolescents aged 2–19 years (Ogden et al., 2012).

Obesity is associated with a multitude of adverse health effects. Central or visceral fat
in obesity pours out free fatty acids and increases insulin resistance. The adipose cells se-
crete multiple hormones, known as ‘adipokines,’ and markers of inflammation. Obesity is
associated with a higher risk of diabetes, hypertriglyceridemia, decreased high-density
lipoprotein (HDL) cholesterol, hypertension, stroke, proteinuria, gallstones, fatty change
in the liver, nonalcoholic steatohepatitis, pancreatitis, venous thrombosis, hypoventila-
tion syndrome, and osteoarthritis (Kumar et al., 2003; Shen et al., 2010). Other condi-
tions for which obesity poses an increased risk include sleep apnea, asthma, stress
incontinence, depression, and several types of cancer (Gaby, 2011).

Obesity has an immense impact globally in terms of human suffering and economic
burden, resulting from the chronic disease and disability associated with obesity. The
conventional treatment for obesity includes decreasing caloric intake and increasing
physical activity, that is, ‘diet and exercise.’ Medications have also been utilized. How-
ever, the long-term success rate of most weight loss programs is very low (Gaby, 2011).

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464 H. Sharma and H.M. Chandola

There is an urgent need for an effective understanding of obesity and its management,
including the use of natural strategies that are affordable and effective. The comprehen-
sive, natural healthcare system known as Ayurveda offers valuable insights and practical
applications in this regard.

2. AYURVEDA

Ayurveda is a comprehensive, holistic healthcare system that originated in the ancient
Vedic times of India. Ayurveda translates as the ‘Science of Life.’ Its primary emphasis
is on prevention of disease and preservation and promotion of health. It also provides
treatment for disease. According to Ayurveda, the human body is composed of five
Mahabhutas, which are basic elements that have the properties of space (Akasha), air
(Vayu), fire (Tejas), water (Jala), and earth (Prithivi). These basic elements combine to
form three psychophysiological principles or Doshas, known as Vata, Pitta, and Kapha.
Vata consists of the lighter elements that have the properties of space and air. Pitta has
the properties of fire and water. Kapha consists of the heavier elements that have the
properties of water and earth. The body is regulated by the three Doshas and the three
qualities of mind, or Gunas, which are known as Sattva, Rajas, and Tamas. Sattva is the
creative influence, Rajas the spur to activity, and Tamas carries the influence of inertia,
which results in stability (Sharma and Clark, 2012).

The Doshas regulate the various functions of the body. Vata regulates functions
associated with movement and communication, such as blood flow, nerve conduction, in-
testinal motility, etc. Pitta regulates functions associated with metabolism, digestion, and
transformation. Kapha regulates the structure and cohesion of the body (Sharma, 2011).
Each person has a certain ratio of Vata, Pitta, and Kapha that is unique to him/her. This
ratio is known as the individual’s Prakriti or psychophysiological constitution.

Ayurveda identifies seven Dhatus in the body, which are fundamental principles that
support the various bodily tissues. These are known as Rasa (plasma), Rakta (blood),
Mamsa (muscle), Meda (fat), Asthi (bone), Majja (bone marrow and nervous system),
and Shukra (sperm or ovum). There are three metabolic waste products known as Malas,
which are Mutra (urine), Purisha (feces), and Sweda (sweat). Energy flow and communi-
cation take place through various channels of organization known as Srotas.

The spectrum of health and disease is dependent on how these various constituents of
the body function together. Optimal health is the result of a state of equilibrium in their
functioning. Disturbance in the equilibrium leads to disease.

3. OBESITY IN AYURVEDA

Obesity is described elaborately in the ancient texts of Ayurveda. The classical Ayurvedic
texts known as Charaka Samhita and Sushruta Samhita describe obesity in detail, including

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 465

its definition, exogenous and hereditary etiological factors, clinical features, pathogenesis,
prognosis, and management. Sthaulya is the term used for obesity in Ayurveda. Extreme
obesity is defined as a condition in which an individual, due to an inordinate increase of
fat and flesh, is disfigured with pendulous buttocks, belly, and breasts, has disturbances in
metabolism, and has increased bulk that is not accompanied by a corresponding increase
in energy (Shastri and Chaturvedi, 2004). Meda Dhatu (adipose tissue) is the site of met-
abolic disturbance in an obese individual. Meda becomes increased due to ingestion of
excessive Sneha (unctuous foods) and Madhura Rasa (sweet substances). Meda is said to
be the main factor that is affected in Sthaulya (obesity) and Prameha (a set of clinical
disorders that includes diabetes). Medoroga (disease of fat metabolism) is a term that
encompasses all the diseases caused by vitiated Meda, including obesity.

Charaka Samhita describes Ashta Nindita – eight types of undesirable constitutions that
are considered the most unhealthy of all. Obesity is one of these conditions. In Ayurveda,
obesity is considered such a hazard to one’s health that Charaka Samhita characterizes an
ideal physician as one who has full knowledge of the etiopathology, symptomatology,
and principles of treatment of obesity (Shastri and Chaturvedi, 2004). Sushruta Samhita
considers obesity to be a causative factor for lowered immunity and malnutrition
(Shastri, 2003). It is identified as a causative factor for several diseases including diabetes.
Dietetics and lifestyle are considered the most important factors in the causation of
obesity as well as its management.

4. ETIOLOGY

Various etiological factors for obesity have been described in the Ayurvedic classic texts.
Charaka Samhita mentions dietetic, lifestyle, psychological, and hereditary components as
causative factors (Shastri and Chaturvedi, 2004). Other factors may involve vitiation of
Meda and Kapha, formation of Ama Anna Rasa (toxic build-up in the physiology)
(Shastri, 2003), and defective intercellular metabolism (Gupta, 1951). The etiological
factors can be classified as follows:

4.1 Bija Svabhava (Hereditary Factors)

According to Charaka Samhita, a defect in Bijabhagavyava (chromosomes and genes) may
lead to defective development of the organ involved. It is also mentioned that Vata is
responsible for partition in Yamala Garbha (twin pregnancy) and development of obesity
in one and asthenic features in the other (Shastri and Chaturvedi, 2004). Overnutrition
during pregnancy, particularly with sweet substances, is mentioned as a predisposing
factor for birth of an obese child (Shastri and Chaturvedi, 2004). This indicates the role
of environmental and hereditary factors in producing obesity.

It is now recognized that the obese phenotype is determined by a group of genes that
determine food intake (energy input) and metabolic rate (energy output). These genetic

466 H. Sharma and H.M. Chandola

factors governing body weight affect physiological activities including adipose-tissue dis-
tribution, resting metabolic rate, changes in energy expenditure in response to overeat-
ing, certain aspects of feeding behavior, food preferences, lipoprotein lipase activity,
maximal insulin-stimulated glyceride synthesis, and the basal rates of lipolysis (Kasper
et al., 2004).

4.2 Environmental Factors
4.2.1 Aharatmaka Nidana (Dietary Factors)
Meda Dhatu (adipose tissue) plays an important role in the pathogenesis of Sthaulya (obe-
sity). The properties of Meda include Guru (heaviness), Shleshma (Kapha Dosha), and
Snigdha (unctuousness). When a diet dominated by these properties is taken in excess,
it causes increased production of Meda, which will ultimately lead to obesity by altering
fat metabolism. Foods with these properties include milk products, yogurt, fatty foods,
coconut, dry fruits, etc. Various disorders, including obesity, can result from the excessive
intake of foods with qualities of unctuousness, sweetness, heaviness, and sliminess, as well
as Abhishyandi (foods with emollient and heavy properties that cause impaired metab-
olism and obstruct the channels of circulation), fresh wine, meat of marshy and aquatic
animals, milk and its products, jaggery (an unrefined form of cane sugar) and flour prep-
arations, etc. (Shastri and Chaturvedi, 2004). Ghrita (ghee – clarified butter), rice, and
foods that are cooling in potency are also considered causative for obesity (Shastri and
Chaturvedi, 2004).

The Ayurvedic texts identify various types of fermented preparations such as Varuni
(alcoholic beverage prepared from rice or dates, along with Ayurvedic herbs) (Shastri and
Chaturvedi, 2004), Sura (cereal-based alcoholic beverage similar to present-day beer),
and Gaudika (prepared with sugar or molasses) (Shastri, 2003) as etiological factors for
Sthaulya (obesity). Ingestion of these preparations aggravates Agni (digestive metabolic
activity) and permits excessive intake of food.

Ayurveda identifies the untimely eating of food as a key dietary factor linked to obe-
sity. Ahara Sevana (guidelines for dietary intake) lays out the general rules to be followed
with regard to consumption of food and water. One of the main topics is Kala (the time
factor). The Ayurvedic texts assert that for human beings there should be only two Anna
Kala (food times) every 24 h. However, due to the drastic transformation in our dietary
patterns, the number of meals per day has increased to three or four, or even more than
that. This adversely affects and impairs the assimilation and absorption of ingested food,
resulting in the formation of Ama (toxin accumulation due to undigested and improperly
metabolized food substances). Adhyashana – eating before the previous meal is fully
digested – can also lead to obesity. It creates Ama accumulation in the body (Mishra,
2002), which Sushruta Samhita identifies as the root cause of obesity (Shastri, 2003).

Drinking water after meals is mentioned as a causative factor for obesity in many of the
Ayurvedic texts (Sharma, 2009; Gupta, 1951; Mishra, 2002). The abdominal muscles

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 467

relax after food and water intake to accommodate the ingested substances and provide
help in digestion. Excessive intake of water after eating a meal can result in prolonged
abdominal muscle relaxation, which in turn can cause loss of muscle tone and lead to
abdominal adiposity. Excessive water intake can also result in improper digestion, since
the hydrochloric acid and digestive enzymes get diluted. This leads to production of
Ama (toxin accumulation due to improperly digested food), which ultimately results
in production of more Kapha, one of the causative factors for obesity.

4.2.1.1 Relationship of Ama to Obesity
Nourishment depends upon the qualities of the food. Liquid and unctuous foods nourish
Rasa Dhatu (the nutrient plasma). However, if this type of food is heavier, it nourishes
Meda Dhatu (fatty tissue). As part of the normal physiological process, the finer part of
each Dhatu nourishes each succeeding Dhatu as an action of Dhatu Agni (metabolic
activity responsible for conversion). If this function of Agni is impaired, the Dhatu
production does not reach its ultimate stage, stopping in between. The intermediary sub-
stance that is formed is known as Ama. When the Agni responsible for production of
Meda Dhatu is hampered, Ama Meda is formed and deposited as excess fat in obese in-
dividuals. This Amavastha (state of indigestion and toxic metabolites) of Meda Dhatu is
present in patients with hypercholesterolemia, high levels of low-density lipoprotein
(LDL), and very-low-density lipoprotein, etc. When Dhatu Agni functions properly,
it results in the generation of Sama Meda Dhatu (proper adipose tissue), which may
manifest as HDL and help the body maintain health.

4.2.2 Factors related to lifestyle
All habits related to sedentary lifestyle are considered causative factors for obesity. In
Charaka Samhita, these causative factors include abstaining from physical movements
and exercise, excessive sleep, daytime sleep, and beds and seats that are too soft
(Shastri and Chaturvedi, 2004). Coital abstinence is also said to cause weight gain
(Shastri and Chaturvedi, 2004). Vyayama (physical exercise) is emphasized and
prescribed as part of the daily routine. It is prescribed in a balanced quantity and
may differ from individual to individual, depending on their psychophysiological
constitution. Lack of exercise is one of the main causes for aggravation of Kapha
(the Dosha associated with anabolic processes), Agni Vikriti (disturbed digestion and
metabolism), and, ultimately, increase in Meda (adipose tissue). This leads to obesity.
Sleeping too long at night and excessive indulgence in daytime sleep after eating meals
also provoke Kapha and lead to accumulation of Meda. The decline in metabolic rate
during sleep is an important factor for the genesis of excess fat by excessive sleep. More-
over, during sleep energy expenditure is decreased dramatically, which in turn can lead
to obesity.

468 H. Sharma and H.M. Chandola

4.2.3 Psychological factors
Harsha (exhilaration), a relaxed mind, calmness, cheerfulness, and refraining from mental
work (Shastri and Chaturvedi, 2004) are considered causative factors for anabolism in the
body, which may lead to obesity if experienced excessively. Individuals with these char-
acteristics indulge more in worldly pleasures, sedentary habits, overeating, and physical
inactivity, which are well-established causes of obesity.

5. PATHOPHYSIOLOGY

Kapha is the main Dosha involved in the pathogenesis of obesity. According to Charaka
Samhita, obesity is caused by the vitiation of Kapha Dosha and overnutrition (Shastri and
Chaturvedi, 2004). The corpulence or leanness of the body is determined by Rasa Dhatu
(circulating nutrient fluid analogous to plasma). In obesity, there is vitiation of Meda
Dhatu (adipose tissue). Meda and Rasa Dhatu are the main Dushya (refers to disturbed
functioning of the Dhatus) involved in the pathogenesis of obesity. There is excessive
formation of Kapha due to indulgence of the etiological factors (see Section 4). This
causes Jathar Agni (the main ‘digestive fire’) to become Mandagni (‘slow’ Agni, i.e.,
diminished digestive metabolic activity). Thus, proper digestion of food does not occur,
which eventually results in the production of Ama Rasa (toxic substances formed as a
result of partial or incomplete digestion of food). The Ama Rasa circulates throughout
the body along with Kapha Dosha. The Ama Rasa together with Kapha gets localized in
the Medovaha Srotas (channels of adipose tissue), blocking these channels.

This process causes Meda Dhatu Agni Mandya (‘slow’ Agni associated with Meda
Dhatu), which equates with deranged fat metabolism (hypofunctioning of the enzymes
responsible for fat metabolism). Hence, there is increased formation of Vikrit Meda
(altered or abnormal fat). This excessive abnormal fat is deposited mainly in the abdomen,
buttocks, and thighs. Due to excessive fat, the Srotas (channels) are blocked and the fat
accumulates further. Conversion of food results mainly in additional fat tissue; thus,
the other Dhatus (bodily tissues) are not formed properly (Gupta, 1951). This leads to
debility, systemic diseases, and other complications. (See Figure 37.1 for a summary of
the pathogenesis of obesity according to Ayurveda.)

6. CLINICAL MANIFESTATION

In Ayurveda, an obese individual is one who, due to excessive increase of fat, has pen-
dulous buttocks, abdomen, and breasts and suffers from deficient metabolism and energy
(Shastri and Chaturvedi, 2004). Charaka Samhita describes eight undesirable effects char-
acteristic of obese individuals: shortened lifespan, hampered movement, difficulty in sex-
ual intercourse, debility, body odor, excessive sweating, excessive hunger, and excessive
thirst (Shastri and Chaturvedi, 2004). There is an excess of fat, and conversion of food

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 469

Etiological Factors

Hereditary Dietary Lifestyle Psychological

Excess of Shleshma (Kapha Dosha)

Impaired Jathar Agni (hyper and hypo), leading to formation of Ama Rasa

(digestive metabolic activity) (toxic build-up)

Hypofunctioning of Meda Dhatu Agni (metabolic activity of fatty tissue)

Obstruction of channels of adipose tissue
Excess fat accumulation

Obesity

Figure 37.1 Pathogenesis of obesity

results mainly in additional fat tissue, so the production and function of the other Dhatus
(bodily tissues) are inhibited, thus lifespan is shortened. Because of the laxity, softness, and
heaviness of fat tissue, movement is hampered. Obese individuals suffer from fatigue, which
also contributes to hampered movement. Due to disequilibrium in the Dhatus, there is
debility. Body odor is due to the defective nature of the fat, and to excessive sweating
due to the association of Meda (fat tissue) and Kapha Dosha. Due to intensified Agni (di-
gestive metabolic activity) and an abundance of Vayu (the element that governs movement)
in the abdomen, there is excessive hunger and thirst (Shastri and Chaturvedi, 2004).

7. CLASSIFICATION OF OBESITY

The Ayurvedic texts identify generalized classes of obesity. The Charaka Samhita
describes patients as Sthula (obese) and Ati Sthula (extremely obese). Vagbhata, one of
the three prominent authors of the classical Ayurvedic texts (the other two being Charaka
and Sushruta), categorizes obesity as Hina Sthula (mild), Madhya Sthula (moderate), and
Ati Sthula (severe) and describes the dietary and lifestyle-related management for diseases
caused by overnutrition (Gupta, 1951, 1982). An attempt can be made to correlate the
Ayurvedic classification with the current grading of obesity. Hina Sthaulya can be cor-
related with the current classification of ‘overweight’ and can be described as having a
body mass index (BMI) of 25.0–29.9 kg/m2, no complications or secondary diseases, less

470 H. Sharma and H.M. Chandola

than four undesirable effects (see the section ‘Clinical Manifestation’), and chronicity of
less than 1 year. Madhya Sthaulya can be correlated with obesity classes I and II and can be
described as obesity with a BMI of 30.0–34.9 and 35.0–39.9 kg/m2, respectively, the
least complications, no secondary diseases, four to less than eight undesirable effects,
and chronicity of 1–5 years. Ati Sthaulya can be correlated with the classification of
‘extreme obesity’ and can be described as obesity with a BMI of 40.0 kg/m2 or higher,
systemic complications or secondary diseases, all eight undesirable effects, and chronicity
of greater than 5 years.

8. COMPLICATIONS OF OBESITY

The imbalance in the Dhatus that occurs in obesity gives rise to dyspnea, fever, gastric
disorders, anal fissure, diabetes, Urustambha (tenderness and stiffness of the thighs), boils
and abscesses, etc. (Gupta, 1951). Sushruta Samhita also mentions Vata Vikara (neurolog-
ical deficits) as a complication of obesity and asserts that obese individuals will die of one
of the aforementioned disorders/diseases (Shastri, 2003). Charaka Samhita mentions a
number of diseases that are generated as a result of overnutrition: diabetes, diabetic boils,
urticarial patches, itching, anemia, fever, skin diseases, dysuria, anorexia, drowsiness,
impotency, lassitude, heaviness in the body, obstruction in the sense organs and channels
of the body, disorders of consciousness, sleepiness, swelling, etc. (Shastri and Chaturvedi,
2004). Due to malfunctioning of Agni (digestive metabolic activity) and formation of
Ama (accumulation of toxins), complications such as indigestion, diarrhea, hemorrhoids,
other gastrointestinal disorders, etc., can emerge.

9. PROGNOSIS

Most Ayurvedic texts designate Sthaulya (obesity) as Krichhra Sadhya Vyadhi (difficult to
manage) because patients suffer from excessive hunger and thirst and can have lowered
immunity, etc. Secondary diseases cause more difficulties and distress for patients and they
may not be able to tolerate the various types of treatment procedures that are recom-
mended, particularly Samshodhana (purification) therapy, which is the most important
treatment for complete elimination of any disorder.

Vagbhata further clarifies the prognosis of obesity. According to him, Medogata
diseases (related to adipose tissue and fat) are manageable in patients who have relatively
more vitality and strength, less chronicity, and no complications (Gupta, 1982). The best
treatment for obesity is that which can decrease vitiation of Vata Dosha, Agni (digestive
metabolic fire), and Meda (adipose tissue). However, there is no treatment available that
can decrease vitiation of all three simultaneously, because the treatment used to pacify
one aggravates the other. This is why obesity is considered difficult to manage.

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 471

10. MANAGEMENT OF OBESITY

The management of obesity involves a comprehensive strategy that includes avoidance
of etiological factors (see the section ‘Etiology’), dietary recommendations, lifestyle and
behavioral modifications, herbal and herbomineral supplements, and physiological
purification therapies (see Table 37.1).

10.1 Dietary Recommendations

All the classical Ayurvedic texts recommend the administration of Guru–Apatarpana as
dietary therapy for Sthaulya (obesity). Guru refers to foods that have a heavy quality and
take time to digest, and Apatarpana refers to foods that have comparatively less nourishing
effect and catabolic properties (Shastri and Chaturvedi, 2004). Application of Guru–
Apatarpana in Sthaulya acts in many ways: (i) achievement of satiety with less quantity
of food, (ii) longer time for food to digest, (iii) reduced desire for food, and (iv) all
the aforementioned together keep the occurrences of food intake to a minimum. In
addition, the less nourishing quality of the food will not produce further Medo Vridhi
(growth or increase in adipose tissue).

Fasting and skipping meals are absolutely contraindicated in obesity. Both of these
further intensify the appetite and ultimately the body gets the signal to conserve more
food reserves, making the prognosis of obesity poor. Frequent intake of food should
be avoided as well. It is recommended that the individual eat only when he/she feels very
hungry. Precautions are given for liquid intake also. Drinking water just after eating a
meal can be a contributory factor for Sthaulya. Ayurveda therefore advises against this.

Foods and drinks that alleviate Vata Dosha and reduce Kapha Dosha and Meda (fat)
are recommended (Shastri and Chaturvedi, 2004). Research has shown that following a
diet according to Ayurvedic psychophysiological constitution favors weight management
(Sharma et al., 2009). Yava (barley, Hordeum vulgare) is considered the best food substance

Table 37.1 Principal Treatments for Obesity

• Nidana Parivarjana (avoidance of etiological factors)
– Dietary
– Lifestyle

• Samshamana (palliative therapies)
– Dietary recommendations
– Herbal and herbomineral supplements

• Samshodhana (physiological purification therapies)
– External
• Fomentation, coarse powder massage, medicated tub bath, warm water shower,
medicated paste application
– Internal
• Emesis, purgation, nasal therapy, medicated enema

472 H. Sharma and H.M. Chandola

to ingest for the treatment of obesity. It can be used in various forms in the diet. Vatya and
Apupa are barley cakes that can be eaten. Including Adhaki Beeja (pigeon peas, red gram,
arhar dal), Patola (Trichosanthes anguina), and Amalaki (Amla, Phyllanthus emblica) in the daily
diet is also advised. Priyangu (Italian millet, Panicum italicum), Shyamaka (Japanese barnyard
millet, Echinochloa frumentacea) (Pandey, 2009), Kodrava (kodo millet), Mudga (green gram,
moong dal), Kulatha (horse gram, Dolichos biflorus) (Pandey, 2009), and Venu (bamboo)
seeds are recommended. Other foods that are beneficial in the management of obesity in-
clude unpolished ‘old’ rice (preferably at least 1 year old), roasted Yavanala (Jawar, great
millet, Sorghum vulgare), Yavak (small barley), leafy vegetables, green bamboo, cucumber,
radish, brinjal (eggplant), pumpkin, ginger, blackberry, betel leaf (Piper betle) (Pandey,
2009), drumstick (Moringa oleifera), black pepper, long pepper (Piper longum), mustard
oil, sesame oil, and warm water.

Madhudaka (pure honey plus water) is the best liquid substance for obese individuals.
Taking Madhudaka early in the morning for an extended period of time is said to be help-
ful. Ayurveda advises against using honey in hot water since it may become toxic to the
physiology. Ushna Anna Manda (hot supernatant watery portion of rice soup) taken in
the early morning on an empty stomach is said to have a similar effect to Madhudaka
(Anonymous, 2000). After meals, honey water and an Arishta (a fermented medicinal
preparation) that alleviates Meda (fat) and Kapha should be taken as a drink (Shastri
and Chaturvedi, 2004).

Utilizing knowledge of the foods and drinks that should not be taken is more vital as
far as the disorder of obesity is concerned, since these are directly involved in the etiology
of obesity. Therefore, obese patients should absolutely avoid new and freshly harvested
grains, alcoholic preparations, and meat and meat soups of domesticated and aquatic
animals. Also to be avoided are sweets, oily/fatty foods, milk, and milk products,
especially yogurt.

10.2 Lifestyle and Behavioral Modifications (Shastri and Chaturvedi, 2004)

As mentioned previously, imbalance between energy intake and utilization is the most
important etiological factor for obesity. Any modifications in lifestyle that can minimize
this inequity will be helpful. Physical exercise is the main recommendation in this regard.
According to Ayurveda the individual should select types of exercise that are suitable to
his/her strength and stamina. Staying up late at night and avoiding daytime sleep are
recommended for reducing weight. Exposure to the heat of the sun is also helpful.
Another significant factor relates to the activity of the mind. An underutilized and
gloomy mind often results in the individual being idle. Staying mentally active is there-
fore an important aspect in weight reduction. Meditation is also recommended for
weight loss. Practicing meditation balances the emotions and counteracts the stress
and tensions of day-to-day life (Shastri and Chaturvedi, 2004).

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 473

The ancient Vedic concept of exercise lies in the philosophy of Yoga, which is con-
sidered part of Ayurveda. Asana is an important part of Yoga that includes various kinds of
Yoga postures that are done along with the maintenance of proper breathing, with the
aim of establishing and maintaining optimal health. Various Asanas are effective in
treating various ailments. For the prevention and management of obesity, some easy pos-
tures that can be done include: Uttanapadasana (Raised Leg Pose), Pavanamuktasana
(Wind Relieving Pose), Bhujangasana (Cobra Pose), Vajrasana (Thunderbolt Pose),
Gomukhasana (Cow-face Pose), Pashchimottanasana (Back Stretch Pose), Tadasana
(Mountain Pose), and Dhanurasana (Bow Pose). These Asanas can be incorporated
into the daily routine and are something more than mere exercise. In addition to their
helpfulness in managing obesity, they maintain flexibility in the body and massage the
internal organs. Pranayama (Yogic breathing exercises) that is recommended includes
Anuloma-Viloma (Alternate Nostril breathing) and Bhastrika (Bellows breathing tech-
nique). Kapalabhati is a breathing technique that cleanses, invigorates, and helps burn
excess adipose tissue. In a study on obese patients, a protocol consisting of several Yogic
procedures was practiced for 21 days. The results showed a very significant decrease in
body weight, BMI, and polyphagia (excessive eating), along with a significant decrease in
weakness, polydipsia (excessive thirst), and features of hypersomnia (excessive sleeping).
The study showed 16.66% marked relief, 66.66% moderate relief, and 16.66% mild relief
of obesity, as evidence of the beneficial effects of specific Yogic practices on obesity (Joshi
et al., 2009).

10.3 Herbal and Herbomineral Supplements

Various herbal supplements are recommended for the management of obesity (see
Table 37.2 for a listing of Sanskrit/Botanical names). These include Guduchi
(Tinospora cordifolia), Devadaru (Cedrus deodara), Mustaka (Cyperus rotundus), Vidanga
(Embelia ribes), Shunthi (Zingiber officinale in the dry form), and honey. Vidanga, Shunthi,
Yava-Kshara (potassium carbonate), and ash powder of black iron mixed with honey and
the powder of barley and Amalaki (Emblica officinalis) is an excellent formulation for obe-
sity. Similarly, Bilvadi Panchamula [a group of five herbs including Bilva (Aegle marmelos)]
mixed with honey, and Shilajatu (Shilajit, Asphaltum punjabianum, a resinous mineral-rich
substance) taken with the juice of Agnimantha (Premna integrifolia) are recommended
(Shastri and Chaturvedi, 2004). Triphala [combination of Haritaki (Terminalia chebula),
Bibhitaki (Terminalia belerica), and Amalaki], Aragvadha (Cassia fistula), Patha
(Cissampelos pareira), Gokshura (Tribulus terrestris), Khadira (Acacia catechu), and
Nimba (Neem, Azadirachta indica) should be given as a decoction. Regular use of this
decoction in the proper dose and frequency will alleviate diseases caused by over-
nutrition. The decoction of Mustaka, Aragvadha, Patha, Triphala, Devadaru, Gokshura,
Khadira, Nimba, Haridra (turmeric, Curcuma longa), Daruharidra (Berberis aristata), and

474 H. Sharma and H.M. Chandola

Table 37.2 Herbs Used in the Management of Obesity

Sanskrit name Botanical name

Agnimantha Premna integrifolia
Amalaki Emblica officinalis
Apamarga Achyranthes aspera
Aragvadha Cassia fistula
Ativisha Aconitum heterophyllum
Bibhitaki Terminalia belerica
Bilva Aegle marmelos
Brahati Solanum indicum
Chitraka Plumbago zeylanica
Daruharidra Berberis aristata
Devadaru Cedrus deodara
Dhanyaka Coriandrum sativum
Eranda (Castor oil plant) Ricinus communis
Gokshura Tribulus terrestris
Guduchi Tinospora cordifolia
Guggulu Commiphora mukul
Haridra (Turmeric) Curcuma longa
Haritaki Terminalia chebula
Hingu (Asafoetida) Ferula foetida
Jeeraka Cuminum cyminum
Kanchanar Bauhinia variegata
Kantakari Solanum xanthocarpum
Katuka Picrorhiza kurroa
Kebuka Costus speciosus
Khadira Acacia catechu
Kutaja Holarrhena antidysenterica
Lasuna (Garlic) Allium sativum
Maricha (Black pepper) Piper nigrum
Mustaka Cyperus rotundus
Nimba (Neem) Azadirachta indica
Nirgundi Vitex negundo
Patha Cissampelos pareira
Patola Trichosanthes anguina
Pippali (Long pepper) Piper longum
Salaparni Desmodium gangeticum
Shigru Moringa oleifera
Shilajatu (Shilajit) Asphaltum punjabianum
Shunthi (Ginger in the dry form) Zingiber officinale
Udumbara Ficus racemosa
Vacha Acorus calamus
Varahi Kanda Dioscorea bulbifera
Varuna Crataeva nurvala
Vasa Adhatoda vasica
Vidanga Embelia ribes
Yavani Trachyspermum copticum

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 475

bark of Kutaja (Holarrhena antidysenterica), taken in the morning according to one’s
Dosha predominance, also alleviates diseases caused by overnutrition (Shastri and
Chaturvedi, 2004).

Charaka Samhita describes an herbal mixture that stimulates the digestive power,
alleviates diseases caused by overnutrition, and develops the memory and intellect. This
mixture contains Trikatu [combination of Shunthi, Maricha (black pepper, Piper nigrum),
and Pippali (long pepper, Piper longum)], Vidanga, seeds of Shigru (Moringa oleifera),
Triphala, Katuka (Picrorhiza kurroa), Brahati (Solanum indicum), Kantakari (Solanum
xanthocarpum), Haridra, Daruharidra, Patha, Ativisha (Aconitum heterophyllum), Salaparni
(Desmodium gangeticum), Hingu (Hing, Asafoetida, Ferula foetida), roots of Kebuka (Costus
speciosus), Yavani (Trachyspermum copticum), Dhanyaka (Coriandrum sativum), Chitraka
(Plumbago zeylanica), Sauvarchala (black salt), and Jeeraka (Cuminum cyminum). These
herbs are powdered and added to oil, ghee, and honey, each in quantity equal to the pow-
der. All this is mixed with 16 times the quantity of roasted grain flour and a drink is then
prepared. This is helpful for alleviating diseases caused by overnutrition, diabetes, flatu-
lence, skin disease, hemorrhoids, jaundice, splenomegaly, anemia, edema, dysuria, an-
orexia, heart disease, phthisis, cough, dyspnea, helminthiasis, Grahani (inflammatory
bowel disease and irritable bowel syndrome), leucoderma, and obesity (Shastri and
Chaturvedi, 2004). Vagbhata recommends taking Triphala, Guduchi, Haritaki, or Musta,
daily with honey (Gupta, 1951).

In a preliminary study, 5 gm of Apamarga (Achyranthes aspera) seed powder adminis-
tered twice a day for 45 days showed very significant results on parameters such as fasting
blood sugar, total lipids, body weight, BMI, abdominal circumference, chest circumfer-
ence, and hip circumference, and significant results for serum cholesterol. Vidanga pow-
der administered in a similar manner showed very significant results on many of the same
parameters. A study on albino rats revealed significant hypolipidemic effects of Apamarga
and Vidanga. Both these herbs produced food intake reduction without enhancing the
fecal output, suggesting the possibility of adaptive thermogenesis. Apamarga also reduced
the body weight (Sawant and Sharma, 1997).

Udumbara (Ficus racemosa) bark powder administered at a dose of 10 gm three times
a day for 3 months (n ¼ 50) showed very significant results for reduction of body weight
and BMI, with a significant reduction of fasting blood sugar, serum cholesterol,
and total lipids. There was also very significant reduction of the circumferences of
neck, chest, arm, forearm, abdomen, hip, mid-thigh, and mid-calf. Similar results
were observed for various skinfolds such as suprascapular, infrascapular, triceps, biceps,
abdomen, suprailiac, mid-thigh, and mid-calf (Pandya and Singh, 1999). Varahi
Kanda (Dioscorea bulbifera) (Shetty and Babu, 2005) in the same dose and duration
(n ¼ 25) showed very significant reduction of body weight, BMI, skinfolds measure-
ment, and circumference of the previously mentioned body areas, with significant
lowering of fasting blood sugar, serum cholesterol, and total lipids (Pandya and
Singh, 1999).

476 H. Sharma and H.M. Chandola

Guggulu (Commiphora mukul), the gum resin of the plant, is one of the components
of various Ayurvedic formulations used to treat inflammation, obesity, and lipid disor-
ders. Several compounds isolated from Guggulu, including bioactive terpenoids and
guggulusteroids, were assayed for lipid peroxidation and cyclooxygenase (COX)
enzyme inhibitory activities. Lipid peroxidation was inhibited by as much as 79%
compared to controls. The COX-2 enzyme was inhibited by as much as 83%
(Francis et al., 2004). Additional research showed that Guggulu and its component,
guggulsterone, significantly inhibit oxidative modification of LDL (Wang et al.,
2004). These inhibitory activities of Guggulu may be associated with its health-
promoting effects.

In rabbits with experimentally induced hypercholesterolemia, crude Guggulu
significantly reduced serum cholesterol after 4 weeks of administration. Guggulu oleo-
resin lowered serum cholesterol in hypercholesterolemic rabbits and also reduced body
weight of the fat-fed rabbits. The alcoholic extract of Guggulu and two pure fractions
showed a hypocholesterolemic effect, with decreases of 69% and 54.3% for the steroid
and terpenoid fractions, respectively, and 59.2% for the alcoholic extract. A Guggulu
fraction reduced cholesterol levels in monkeys on a high-cholesterol diet and was com-
parable to treatment with Atromid-S (clofibrate). Fractions of gum Guggulu decreased
cholesterol levels in hypercholesterolemic chicks. Guggulipid, a fraction of Guggulu
(oleoresin) that contains sterones, has significant hypolipidemic activity. In human
studies, it reduced cholesterol levels by causing mobilization of cholesterol from the
tissues and a significant increase in excretion from the body, as evidenced by resolution
of xanthomatosis, a condition in which yellowish, cholesterol-laden material is depos-
ited in tendons or other parts of the body (Foundation for Revitalization of Local
Health Traditions, 2005).

Pure honey (used alone or in combination with other treatments) and Shilajatu are
effective against Meda (fat tissue). Rasanjana, a solidified decoction of Daruharidra, is
very beneficial in the management of Medoroga (diseases of fat tissue) (Shastri, 2002).
The roots of Guduchi have shown hypolipidemic effects in alloxan diabetic rats
(Foundation for Revitalization of Local Health Traditions, 2005). An aqueous extract
administered at a dose of 2.5 and 5 g kgÀ1 for 6 weeks reduced serum and tissue cho-
lesterol. The leaf of Haritaki showed hypolipidemic effects in rats, and in rabbits fed a
cholesterol diet, and induced partial inhibition of rabbit atheroma (Foundation for
Revitalization of Local Health Traditions, 2005). The fruit pericarp of Haritaki
showed cardiotonic activity in frog hearts, increasing the force of contraction and
cardiac output without altering the heart rate (Reddy et al., 1990). Haritaki extract
pretreatment reduced myocardial damage caused by isoproterenol in rats. Lipid per-
oxide formation was ameliorated, and activities of the myocardial marker enzymes
were retained (Suchalatha and Shyamala Devi, 2004). Mitochondrial damage was
attenuated and near normal function of the mitochondria was retained (Suchalatha

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 477

et al., 2007). In a study on cholesterol-induced atherosclerosis in rabbits, Haritaki, Bib-
hitaki, and Amalaki all significantly reduced cholesterolemia, aortic sudanophilia, and
cholesterol content of the aorta and liver, compared with the control group (Thakur
et al., 1988). Pippali and the aqueous extract of Nimba leaf have hypolipidemic effects
in rats (Foundation for Revitalization of Local Health Traditions, 2005). In choles-
terol-fed rabbits, Lasuna (garlic, Allium sativum) significantly reduced total, free,
and ester cholesterol levels and phospholipids, resulting in a lower degree of athero-
sclerosis (Foundation for Revitalization of Local Health Traditions, 2005).

Extracts of Vacha (Acorus calamus) as well as saponins isolated from the extract showed
significant hypolipidemic activity in rats (Parab and Mengi, 2002). The effects of Vacha
and purified Guggulu were investigated in a clinical study on ischemic heart disease
(n ¼ 45). At the end of 3 months, there was reduced body weight, improvement in
the echocardiogram, decreased serum cholesterol and LDL, and increased serum HDL
in the group that received Vacha and the group that received Guggulu, compared with
the control group.

Medohara Vati is an herbomineral compound that contains Parada (processed mercury;
the mercury is processed extensively according to strict guidelines in the ancient Ayurvedic
texts, to render it nontoxic while maintaining its healing properties), Abhraka (processed
mica), iron, Chitraka, Guduchi, Mustaka, Vidanga, Nirgundi (Vitex negundo), Aragvadha,
Kanchanar (Bauhinia variegata), Varuna (Crataeva nurvala), Shigru, Katuka, Shilajatu, Gug-
gulu, and Triphala. A clinical study showed that taking Medohara Vati for 3 months
(n ¼ 21) yielded very significant decreases in all the parameters of obesity tested: serum cho-
lesterol, total lipids, fasting blood sugar, body weight, BMI, circumference of various body
areas, and measurement of various skinfolds. There was no associated toxicity with the use
of this herbomineral formulation (Pandya and Singh, 1999). Panchatikta Guggulu is a
polyherbal preparation containing five Tikta Rasa-dominant (bitter) herbs [Guduchi,
Nimba, Vasa (Adhatoda vasica), Kantakari, and Patola (Trichosanthes anguina)] and Guggulu.
A clinical study on this preparation showed that after 45 days there were very significant
decreases in fasting blood sugar, serum cholesterol, body weight, BMI, body circumfer-
ence, and various skinfold measurements, along with a significant decrease in total lipids.
Similar results were seen in a clinical trial on Panchatikta Ghana Vati, a pill that contains the
same five herbs, without Guggulu (Savjavani and Baghel, 2001). Agnimanthadi com-
pound is a preparation that contains Agnimantha, Mustaka, Eranda (Castor oil plant, Rici-
nus communis), and Godhan/Gomootra Ark (refined cow’s urine – the numerous
therapeutic effects of this substance include weight loss). The Agnimanthadi compound
has shown significant beneficial results in obesity (Goyal et al., 2005).

10.4 Panchakarma (Purification Therapies)

Charaka Samhita describes various types of Langhana (‘reducing’ therapies) for diseases
caused by overnutrition. These include techniques of physiological purification (emesis,

478 H. Sharma and H.M. Chandola

purgation, and medicated enema), resisting the urge to eat and drink, exposure to strong
wind, exposure to heat from the sun, digestive measures, and physical exercise (Shastri
and Chaturvedi, 2004). Vagbhata recommends Samshodhana (biopurification by evacua-
tory techniques) for patients with Ati Sthaulya (extreme obesity) who have a high level of
vitality and strength, and a dominance of Kapha and Pitta. Dipana-Pachana (formulations
that regulate the digestive fire/Agni and eliminate or subside Ama) are recommended for
patients with Madhya Sthaulya (moderate obesity), with moderate Kapha and Pitta.
Resisting the urge to eat and drink is recommended for patients with Hina Sthaulya (mild
obesity), with a low level of vitality and strength, and low Kapha and Pitta (Gupta, 1951).

The purification techniques known as Swedana Karma (fomentation therapies) pos-
sess anti-Vata and anti-Kapha actions. Sweda (sweat) has a close association with Meda
(fat); sweat is a Mala (metabolic waste) of Meda. Thus, fomentation therapy that induces
sweating may help in the expulsion of the metabolic waste of Meda. Results of a study
conducted on obese individuals (n ¼ 29) who received Bashpa Swedana (steam therapies)
for 6 weeks, with an interval of 1 week in between, showed significant reductions in
body weight and BMI, with symptomatic improvement and reductions in circumfer-
ences of the mid arm, abdomen, and hip (Goyal et al., 2005).

11. CONCLUSION

Obesity is discussed in detail in the ancient Ayurvedic texts. Considered a disease related
to improper diet and lifestyle, including overnutrition and sedentary habits, this clinical
condition is said to produce a number of other disease conditions, including diabetes.
According to Ayurveda, the pathophysiology of obesity is complex. Treatment recom-
mendations are comprehensive, with the main emphasis on dietary and lifestyle rec-
ommendations. The administration of single or compound herbal formulations is
beneficial. Physiological purification therapies are also recommended. Ayurveda’s in-
sights into obesity and its recommendations for treatment offer a comprehensive, natural
approach that can be used in conjunction with regular medical care to help eradicate this
widespread epidemic.

ACKNOWLEDGMENTS

The authors are very thankful to Dr. Kamayani Shukla, MD (Ayu), Institute for Post Graduate Teaching and
Research in Ayurveda, Gujarat Ayurved University, Jamnagar, for her significant contributions in the for-
mation of this chapter. They are also thankful to Dr. Shyam Prasad and Dr. Anju P. Ramachandran, PhD
scholars, Department of Kayachikitsa, Institute for Post Graduate Teaching and Research in Ayurveda,
Gujarat Ayurved University, Jamnagar, for speeding up the completion of this task. They are also grateful
to Ellen Kauffman for her assistance in the preparation of the chapter.

Obesity in Ayurveda: Dietary, Lifestyle, and Herbal Considerations 479

GLOSSARY

Agni The digestive metabolic activity.
Ama Toxin accumulation in the physiology due to undigested and improperly metabolized food

substances, mixed with metabolic waste products from the physiology.
Ayurveda A comprehensive, holistic healthcare system that originated in the ancient Vedic times of India.

Ayurveda translates as the ‘Science of Life.’ Its primary emphasis is on prevention of disease and
preservation and promotion of health. It also provides treatment for disease.
Dhatus Fundamental principles that support the various bodily tissues. These are known as Rasa (plasma), Rakta
(blood), Mamsa (muscle), Meda (fat), Asthi (bone), Majja (bone marrow), and Shukra (sperm or ovum).
Doshas Three psychophysiological principles, known as Vata, Pitta, and Kapha, that regulate the various
functions of the body.
Kapha The psychophysiological principle that regulates the structure and cohesion of the body.
Meda Fat: adipose tissue. Meda is one of the Dhatus.
Pitta The psychophysiological principle that regulates functions associated with metabolism, digestion, and
transformation.
Sthaulya The Sanskrit term used for ‘obesity’ in Ayurveda. (‘Sthula’ is the Sanskrit term for ‘obese.’)
Vata The psychophysiological principle that regulates functions associated with movement and
communication, such as blood flow, nerve conduction, intestinal motility, etc.

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FURTHER READING

Mishra, L.C., 2004. Scientific Basis for Ayurvedic Therapies. CRC Press, Boca Raton.
Sharma, H., Clark, C., 2012. Ayurvedic Healing. Singing Dragon, London.

RELEVANT WEBSITES

http://www.ccras.nic.in – Central Council for Research in Ayurveda and Siddha. Research activities;
Clinical research; Obesity and lipid disorders (accessed on 11 June 2012).

http://www.who.int – World Health Organization. Obesity and overweight. Fact Sheet No. 311, dated
May 2012 (accessed on 10 June 2012).