Disease and conditions

Sthaulya (Obesity) is considered the world’s oldest metabolic disorder. It is not a single disease entity but a syndrome with many causes including combination of genetic, nutritional and sociological factors. WHO considers obesity as “Insidious, creeping pandemic which is now engulfing the entire world”. Obesity develops as a result of a complex interaction between a per-son’s genes and the environment characterize by long-term energy imbalance due to excessive caloric consumption, insufficient energy output (sedentary lifestyle, low resting metabolic rate) or both. Diet and life style play a significant role both in development and control of obesity. Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, breathing difficulties during sleep, certain types of cancer, and osteoarthritis. Metabolic syn-drome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes. Having just one of these conditions doesn't mean you have metabolic syndrome. However, any of these conditions increase your risk of serious dis¬ease. If more than one of these conditions occur in combination, your risk is even greater. In modern medicine no exact treatment is available, if present, has adverse effects but in Ayurvedic system of medicine various measures are given. This paper reviews about the metabolic syn¬drome in Ayurveda and management of Sthaulya (obesity).

    Metabolic syndrome is a burgeoning global problem. A global transition in the disease pattern has been observed, where the relative impact of infectious diseases is de¬creasing while chronic diseases like cardi¬ovascular disease (CVD) and diabetes are increasingly dominating the disease pattern. The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with “insulin re¬sistance.” The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syn¬drome.1 Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. It is a risk factor for coronary heart disease, as well as diabetes, fatty liver, and several cancers. The clinical manifesta¬tions of this syndrome may include hyper¬tension, hyperglycemia, hypertriglyceride¬mia, reduced high-density lipoprotein cho-lesterol (HDL-C), and abdominal obesity. Under current guidelines, revised in 2005 by the The US National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following:2
•    Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia)
•    Blood pressure ≥130/85 mm Hg (or receiv¬ing drug therapy for hypertension)
•    Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
•    HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for re¬duced HDL-C)
•    Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women
Medoroga (obesity) has been considered as an abnormality of body characterized by-
a)    Excessive increase of fat and other tis¬sues of body.
b)    Bulky look of body.
c)    Pendulous situation of buttocks, abdo¬men and breast.
d)    Excessive anabolic conditions.
e)    Lack of vitality.
    Commonly abdominal enlargement stated as Sthaulya and the morbid changes occur due to the obstruction of channels of Meda. The physiological concept of Ayur¬veda is based on ahara which further helps in growth and other activities of body. Due to Improper consumption of food and Im¬proper digestion of food due to Agnimandya, Ama-Rasa (Rasa mixed with Ama) is formed which circulates all over body, causing sro¬todusti or blocks the srotas or channels, ac-cumulates the dhatu called Dhatu-vriddhi, srotoavrodha and manifest in form of Medo¬roga, Madhumeha (diabetes), hyper triglyce¬ridemia, hypertension. Obesity (Medoroga) itself is the major cause of hypertension, Madhumeha (diabetes).

Medoroga Nidana5
    Absence of physical activity, sleep¬ing during day, and intake of foods which increase Kapha, make the end product of digestion abnormally sweet which in turn causes increase of Medas (fat). This ob¬structs the nutrient channels of the tissues. Therefore, conditions like hypertension, di¬abetes, and obesity are observed. These make the person incapable of various activi¬ties. Difficulty in breathing even on slight exertion, thirst, delusion, sleep, breathless¬ness exhaustion, excessive hunger, bad smell of the body, poor physical and sexual capacity etc. gradually develop. As the ab¬domen and bones are the chief depots of fat, the abdomen gets enlarged in such persons, buttocks, abdomen and breasts begin to show movement (during activity) due to dis¬proportionate accumulation of fat on those places to his age. The aetiological factors may be classified in following:
1.    Aharajanya hetu (obesity due to dietetic factor): Madhura, Kapha va¬radhak, Sarpi, Dadhi as causative factors of Sthaulata, Guru, Sheet, Snigdha, Navanna, Nava¬madya, Mansa, Ikshu ahara as causa¬tive factor for sthaulyata medoroga.
    Eating too many calories and not get¬ting enough physical activity to burn those calories results in overweight & obesity. Obesity increases the risk of developing several health problems like high blood pressure, insulin resistance, type 2 diabetes, coronary artery disease (heart attacks), cere¬brovascular disease (stroke).
2.    Viharajanya Hetu: Avyayama (Lack of exercise) divaswapana (day time sleep), Avyavaya (lack of sexual intercourse) and sukha shaiya as causative factor for sthulata.
3.    Mansika hetu (Psychological)3 Har¬shana¬titaya (Cheerfulness), Achintata etc.
4.    Garbhopghatkar bhava: Charak has con¬sidered that when mother takes excessive madhura ahara during pregnancy, the prog¬eny will be ‘Sthula’3 It is well known that madhur rasa increases kapha in body which has maximum effect on medodhatu respon¬sible for enhancing sthulata in the body and the infant become sthaulya due to excessive medo-dhatu. Vagbhata has called such preg¬nancy as “Garbhaja vyadhi’ and subdivided in anarasaja type.8  
5.    Bijasvabhava (genetic abnormality): The role of bijasvabhava or genetic abnormality in pathogenesis of medo-roga is stated by Charak.3It can be explained that when par¬ents or grandparents are indulged in mad¬hura, snigdha ahara they may develop bija¬dosa, which gives rise to a constitution that there is tendency for the formation of meda even with normal or subnormal diet. The matri¬bija is responsible for medo dhatu. From abnormal bija the development of medo-dhatu is excessive and child becomes sthaulya.
    In context of body eight type of per¬sons are criticized and discarded (Ninda¬niya) such as over tall, over short, over hairy, less hairy, over black, over fair, over obese, over lean3 Among all over obese has been characterized by eight defects i.e. shortening of life span, restricted movement, difficulty in sexual intercourse, debility foul smell, excess sweating, excess hunger and excess thirst.3 Obesity is caused by over sa¬turation, intake of heavy sweet, cold and fatty diet, indulgence in day sleeping and exhilaration, lack of mental work and ge¬netic defect.
    In obese individuals the life span de¬creases because of laxity, softness and hea¬viness of fat there is restriction in move¬ment. Further, due to non-abundance of se¬men, there is difficulty in sexual intercourse, due to disequilibrium of dhatus there is de¬bility, foul smell is due to defect in fat and excess sweating. Due to association of me¬das with kapha it is of oozing nature having heaviness and intolerance to physical exer¬cise there is excess sweating, because of in¬tensified agni and increase of vayu in sto¬mach there is excessive hunger and thirst3. Due obstruction of passage by fat vayu moves faster and stimulates digestion and absorbed food, hence the person digest food quickly and further desires to have food in excess quantity, and even short delay in con¬suming food may cause severe disorders.
Obesity & High blood pressure13: Multiple factors are responsible for increase in blood pressure in obesity. Weight gain is asso¬ciated with decrease in elasticity of blood vessels & increase heart rate. Excess calo¬ries are deposited in body as fat in fatty tis¬sue. This fatty tissue increases demand for oxygen & nutrients, which in turn increases amount of blood circulating in the body. More blood traveling through arteries adds pressure on walls of arteries leading to in¬crease in blood pressure. Obesity increases level of insulin in body. Insulin causes so¬dium & water retention in body, which re¬sults in increase in blood volume & extra pressure on arteries. All of these factors can increase blood pressure.
Obesity & Diabetes: Increased blood sugar level12: Type2 diabetes is a common health problem in diabetes. Insulin controls blood sugar. Insulin is required for the entry of sugar (glucose) into body cells from blood. Excess body fat in obesity makes body resistant to insulin. Because of this in¬sulin resistance, sugar will remain in blood, which will lead to increase in blood sugar or diabetes.  High amount of sugar in blood leads to complications in kidney, eyes, blood vessel, and heart.
Atherosclerosis or fatty deposits in blood vessels15: Cholesterol is carried in the blood as two compounds: Low-density lipoprote¬ins (LDL) and High-density lipoproteins (HDL). HDL is also called the 'good' cho¬lesterol and LDL is also called the 'bad' cholesterol. Obesity is associated with low levels of good (high-density lipoprotein) cholesterol and high levels of bad (LDL) cholesterol. When cholesterol levels are high, some of the cholesterol is deposited on the walls of the blood vessels. Cholesterol deposits reduce the elasticity of blood ves¬sels, narrows blood vessels & decreases blood flow. All these changes lead to athe¬rosclerosis and an increased risk of heart disease & stroke.
Coronary artery disease – angina & heart attack2: Atherosclerosis (fatty deposits in arteries) in coronary arteries (arteries that supply heart) reduces blood supply to heart. Decreased blood flow to heart can cause an¬gina (chest pain) and complete blockage of blood flow to heart can cause heart attack. The World Health Organization says more than 1 billion adults are overweight and 300 million of them are obese, putting them at much higher risk of diabetes, heart prob¬lems, high blood pressure, stroke and some forms of cancer.
Samprapti (Etiopathogenesis) of Sthaulya5
1)    Sanchaya: Because of excessive mad¬hura, snigdha, guru, ahara intake and di¬vasvapna (sleep in day time) avyayama (no exercise or physical activity) etc. and also because of bijasvabhava there is sanchaya of kapha.
2)    Prakopa: The Kapha increases in quan¬tity and quality and is responsible for the formation of the Atimadhura and Atisnigdha ahara rasa.
3)    Prasara: Atimadhura and Atisnigdha ahara-rasa circulates all over body through channels.
4)    Sthanasansrya: The circulating ahara rasa gets collected in the medodhatu be¬cause of kha-vaigunya in medo-vaha-srotas and also medodhatu increases and gets ac¬cumulated in udara etc.
5)    Vyakti: The medodhatu accumulations in body organs make them increase in size and pendulous movements when the person moves. The channels get blocked by the meda causing the ill effects of the Sthaulaya.
6)    Bheda: The manifestation of the upa¬drava or the  complications of obesity such as prameha (diabetes), prameha-pidika (di¬abetic ulcers), bhagandara (fistula) etc. can be considered as the bheda stage of atis¬thaulayata.8,10
Ayurvedic management of Metabolic Syn¬drome:
    Ayurveda has not described as such treatment of metabolic syndrome but there are various pharmacologic and non-pharma¬cologic methods for the prevention and management of obesity. The food and drinks which alleviates vata, reduces kapha and fat should be taken. Use of Guduchi, Musta, Triphla, honey etc14 are recommended for removing obesity or excess fat. Vidanga, Shunthi, yavaksara13 ash powder of black iron mixed with honey, powder of barley and Amalaka is beneficial in the manage¬ment of obesity. Similarly Bilvadi pancha¬mula mixed with honey and use of Shilajatu along with juice of Agnimantha is recom¬mended9. In diet prastika, kangu, shyamaka, yavaka, yava, green gram, kulatha, makus¬tha, patola, amalaki fruits can be used for reducing fat3
    The obese taking regular fatty diet may suffer from various kaphaj disorders. Such individuals should not-sleep in day time. Halimak, headache, cold sensation, heaviness in body parts, body-ache, edema, anorexia, nausea, rhinitis, migraine, itching, drowsiness, cough disorder of throat, de¬rangement of memory and intelligence, fever, incapability of sense organs etc. are the abnormalities that manifests due to ob¬esity and abnormal fat deposition in differ¬ent parts of the body3. Similarly Vagbhata has also listed a number of drugs (yogas) for the management of obesity along with a specific regimen of life and diet to be fol¬lowed by obese person.8
    In brief, a detailed description re¬garding ati-sthulata (obesity/medoroga) is given in classical literature of Ayurveda, which can be correlated with the clinical conditions associated with metabolic syn¬drome.

    Metabolic syndrome is a burgeoning global problem. A global transition in the disease pattern has been observed, where the relative impact of infectious diseases is de¬creasing while chronic diseases like cardi¬ovascular disease (CVD) and diabetes are increasingly dominating the disease pattern. The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with “insulin re¬sistance.” The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syn¬drome.1 Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. It is a risk factor for coronary heart disease, as well as diabetes, fatty liver, and several cancers. The clinical manifesta¬tions of this syndrome may include hyper¬tension, hyperglycemia, hypertriglyceride¬mia, reduced high-density lipoprotein cho-lesterol (HDL-C), and abdominal obesity. Under current guidelines, revised in 2005 by the The US National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following:2
•    Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia)
•    Blood pressure ≥130/85 mm Hg (or receiv¬ing drug therapy for hypertension)
•    Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
•    HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for re¬duced HDL-C)
•    Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women
Medoroga (obesity) has been considered as an abnormality of body characterized by-
a)    Excessive increase of fat and other tis¬sues of body.
b)    Bulky look of body.
c)    Pendulous situation of buttocks, abdo¬men and breast.
d)    Excessive anabolic conditions.
e)    Lack of vitality.
    Commonly abdominal enlargement stated as Sthaulya and the morbid changes occur due to the obstruction of channels of Meda. The physiological concept of Ayur¬veda is based on ahara which further helps in growth and other activities of body. Due to Improper consumption of food and Im¬proper digestion of food due to Agnimandya, Ama-Rasa (Rasa mixed with Ama) is formed which circulates all over body, causing sro¬todusti or blocks the srotas or channels, ac-cumulates the dhatu called Dhatu-vriddhi, srotoavrodha and manifest in form of Medo¬roga, Madhumeha (diabetes), hyper triglyce¬ridemia, hypertension. Obesity (Medoroga) itself is the major cause of hypertension, Madhumeha (diabetes).

Medoroga Nidana5
    Absence of physical activity, sleep¬ing during day, and intake of foods which increase Kapha, make the end product of digestion abnormally sweet which in turn causes increase of Medas (fat). This ob¬structs the nutrient channels of the tissues. Therefore, conditions like hypertension, di¬abetes, and obesity are observed. These make the person incapable of various activi¬ties. Difficulty in breathing even on slight exertion, thirst, delusion, sleep, breathless¬ness exhaustion, excessive hunger, bad smell of the body, poor physical and sexual capacity etc. gradually develop. As the ab¬domen and bones are the chief depots of fat, the abdomen gets enlarged in such persons, buttocks, abdomen and breasts begin to show movement (during activity) due to dis¬proportionate accumulation of fat on those places to his age. The aetiological factors may be classified in following:
1.    Aharajanya hetu (obesity due to dietetic factor): Madhura, Kapha va¬radhak, Sarpi, Dadhi as causative factors of Sthaulata, Guru, Sheet, Snigdha, Navanna, Nava¬madya, Mansa, Ikshu ahara as causa¬tive factor for sthaulyata medoroga.
    Eating too many calories and not get¬ting enough physical activity to burn those calories results in overweight & obesity. Obesity increases the risk of developing several health problems like high blood pressure, insulin resistance, type 2 diabetes, coronary artery disease (heart attacks), cere¬brovascular disease (stroke).
2.    Viharajanya Hetu: Avyayama (Lack of exercise) divaswapana (day time sleep), Avyavaya (lack of sexual intercourse) and sukha shaiya as causative factor for sthulata.
3.    Mansika hetu (Psychological)3 Har¬shana¬titaya (Cheerfulness), Achintata etc.
4.    Garbhopghatkar bhava: Charak has con¬sidered that when mother takes excessive madhura ahara during pregnancy, the prog¬eny will be ‘Sthula’3 It is well known that madhur rasa increases kapha in body which has maximum effect on medodhatu respon¬sible for enhancing sthulata in the body and the infant become sthaulya due to excessive medo-dhatu. Vagbhata has called such preg¬nancy as “Garbhaja vyadhi’ and subdivided in anarasaja type.8  
5.    Bijasvabhava (genetic abnormality): The role of bijasvabhava or genetic abnormality in pathogenesis of medo-roga is stated by Charak.3It can be explained that when par¬ents or grandparents are indulged in mad¬hura, snigdha ahara they may develop bija¬dosa, which gives rise to a constitution that there is tendency for the formation of meda even with normal or subnormal diet. The matri¬bija is responsible for medo dhatu. From abnormal bija the development of medo-dhatu is excessive and child becomes sthaulya.
    In context of body eight type of per¬sons are criticized and discarded (Ninda¬niya) such as over tall, over short, over hairy, less hairy, over black, over fair, over obese, over lean3 Among all over obese has been characterized by eight defects i.e. shortening of life span, restricted movement, difficulty in sexual intercourse, debility foul smell, excess sweating, excess hunger and excess thirst.3 Obesity is caused by over sa¬turation, intake of heavy sweet, cold and fatty diet, indulgence in day sleeping and exhilaration, lack of mental work and ge¬netic defect.
    In obese individuals the life span de¬creases because of laxity, softness and hea¬viness of fat there is restriction in move¬ment. Further, due to non-abundance of se¬men, there is difficulty in sexual intercourse, due to disequilibrium of dhatus there is de¬bility, foul smell is due to defect in fat and excess sweating. Due to association of me¬das with kapha it is of oozing nature having heaviness and intolerance to physical exer¬cise there is excess sweating, because of in¬tensified agni and increase of vayu in sto¬mach there is excessive hunger and thirst3. Due obstruction of passage by fat vayu moves faster and stimulates digestion and absorbed food, hence the person digest food quickly and further desires to have food in excess quantity, and even short delay in con¬suming food may cause severe disorders.
Obesity & High blood pressure13: Multiple factors are responsible for increase in blood pressure in obesity. Weight gain is asso¬ciated with decrease in elasticity of blood vessels & increase heart rate. Excess calo¬ries are deposited in body as fat in fatty tis¬sue. This fatty tissue increases demand for oxygen & nutrients, which in turn increases amount of blood circulating in the body. More blood traveling through arteries adds pressure on walls of arteries leading to in¬crease in blood pressure. Obesity increases level of insulin in body. Insulin causes so¬dium & water retention in body, which re¬sults in increase in blood volume & extra pressure on arteries. All of these factors can increase blood pressure.
Obesity & Diabetes: Increased blood sugar level12: Type2 diabetes is a common health problem in diabetes. Insulin controls blood sugar. Insulin is required for the entry of sugar (glucose) into body cells from blood. Excess body fat in obesity makes body resistant to insulin. Because of this in¬sulin resistance, sugar will remain in blood, which will lead to increase in blood sugar or diabetes.  High amount of sugar in blood leads to complications in kidney, eyes, blood vessel, and heart.
Atherosclerosis or fatty deposits in blood vessels15: Cholesterol is carried in the blood as two compounds: Low-density lipoprote¬ins (LDL) and High-density lipoproteins (HDL). HDL is also called the 'good' cho¬lesterol and LDL is also called the 'bad' cholesterol. Obesity is associated with low levels of good (high-density lipoprotein) cholesterol and high levels of bad (LDL) cholesterol. When cholesterol levels are high, some of the cholesterol is deposited on the walls of the blood vessels. Cholesterol deposits reduce the elasticity of blood ves¬sels, narrows blood vessels & decreases blood flow. All these changes lead to athe¬rosclerosis and an increased risk of heart disease & stroke.
Coronary artery disease – angina & heart attack2: Atherosclerosis (fatty deposits in arteries) in coronary arteries (arteries that supply heart) reduces blood supply to heart. Decreased blood flow to heart can cause an¬gina (chest pain) and complete blockage of blood flow to heart can cause heart attack. The World Health Organization says more than 1 billion adults are overweight and 300 million of them are obese, putting them at much higher risk of diabetes, heart prob¬lems, high blood pressure, stroke and some forms of cancer.
Samprapti (Etiopathogenesis) of Sthaulya5
1)    Sanchaya: Because of excessive mad¬hura, snigdha, guru, ahara intake and di¬vasvapna (sleep in day time) avyayama (no exercise or physical activity) etc. and also because of bijasvabhava there is sanchaya of kapha.
2)    Prakopa: The Kapha increases in quan¬tity and quality and is responsible for the formation of the Atimadhura and Atisnigdha ahara rasa.
3)    Prasara: Atimadhura and Atisnigdha ahara-rasa circulates all over body through channels.
4)    Sthanasansrya: The circulating ahara rasa gets collected in the medodhatu be¬cause of kha-vaigunya in medo-vaha-srotas and also medodhatu increases and gets ac¬cumulated in udara etc.
5)    Vyakti: The medodhatu accumulations in body organs make them increase in size and pendulous movements when the person moves. The channels get blocked by the meda causing the ill effects of the Sthaulaya.
6)    Bheda: The manifestation of the upa¬drava or the  complications of obesity such as prameha (diabetes), prameha-pidika (di¬abetic ulcers), bhagandara (fistula) etc. can be considered as the bheda stage of atis¬thaulayata.8,10
Ayurvedic management of Metabolic Syn¬drome:
    Ayurveda has not described as such treatment of metabolic syndrome but there are various pharmacologic and non-pharma¬cologic methods for the prevention and management of obesity. The food and drinks which alleviates vata, reduces kapha and fat should be taken. Use of Guduchi, Musta, Triphla, honey etc14 are recommended for removing obesity or excess fat. Vidanga, Shunthi, yavaksara13 ash powder of black iron mixed with honey, powder of barley and Amalaka is beneficial in the manage¬ment of obesity. Similarly Bilvadi pancha¬mula mixed with honey and use of Shilajatu along with juice of Agnimantha is recom¬mended9. In diet prastika, kangu, shyamaka, yavaka, yava, green gram, kulatha, makus¬tha, patola, amalaki fruits can be used for reducing fat3
    The obese taking regular fatty diet may suffer from various kaphaj disorders. Such individuals should not-sleep in day time. Halimak, headache, cold sensation, heaviness in body parts, body-ache, edema, anorexia, nausea, rhinitis, migraine, itching, drowsiness, cough disorder of throat, de¬rangement of memory and intelligence, fever, incapability of sense organs etc. are the abnormalities that manifests due to ob¬esity and abnormal fat deposition in differ¬ent parts of the body3. Similarly Vagbhata has also listed a number of drugs (yogas) for the management of obesity along with a specific regimen of life and diet to be fol¬lowed by obese person.8
    In brief, a detailed description re¬garding ati-sthulata (obesity/medoroga) is given in classical literature of Ayurveda, which can be correlated with the clinical conditions associated with metabolic syn¬drome.

    Metabolic syndrome is a burgeoning global problem. A global transition in the disease pattern has been observed, where the relative impact of infectious diseases is de¬creasing while chronic diseases like cardi¬ovascular disease (CVD) and diabetes are increasingly dominating the disease pattern. The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with “insulin re¬sistance.” The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syn¬drome.1 Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. It is a risk factor for coronary heart disease, as well as diabetes, fatty liver, and several cancers. The clinical manifesta¬tions of this syndrome may include hyper¬tension, hyperglycemia, hypertriglyceride¬mia, reduced high-density lipoprotein cho-lesterol (HDL-C), and abdominal obesity. Under current guidelines, revised in 2005 by the The US National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following:2
•    Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia)
•    Blood pressure ≥130/85 mm Hg (or receiv¬ing drug therapy for hypertension)
•    Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
•    HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for re¬duced HDL-C)
•    Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women
Medoroga (obesity) has been considered as an abnormality of body characterized by-
a)    Excessive increase of fat and other tis¬sues of body.
b)    Bulky look of body.
c)    Pendulous situation of buttocks, abdo¬men and breast.
d)    Excessive anabolic conditions.
e)    Lack of vitality.
    Commonly abdominal enlargement stated as Sthaulya and the morbid changes occur due to the obstruction of channels of Meda. The physiological concept of Ayur¬veda is based on ahara which further helps in growth and other activities of body. Due to Improper consumption of food and Im¬proper digestion of food due to Agnimandya, Ama-Rasa (Rasa mixed with Ama) is formed which circulates all over body, causing sro¬todusti or blocks the srotas or channels, ac-cumulates the dhatu called Dhatu-vriddhi, srotoavrodha and manifest in form of Medo¬roga, Madhumeha (diabetes), hyper triglyce¬ridemia, hypertension. Obesity (Medoroga) itself is the major cause of hypertension, Madhumeha (diabetes).

Medoroga Nidana5
    Absence of physical activity, sleep¬ing during day, and intake of foods which increase Kapha, make the end product of digestion abnormally sweet which in turn causes increase of Medas (fat). This ob¬structs the nutrient channels of the tissues. Therefore, conditions like hypertension, di¬abetes, and obesity are observed. These make the person incapable of various activi¬ties. Difficulty in breathing even on slight exertion, thirst, delusion, sleep, breathless¬ness exhaustion, excessive hunger, bad smell of the body, poor physical and sexual capacity etc. gradually develop. As the ab¬domen and bones are the chief depots of fat, the abdomen gets enlarged in such persons, buttocks, abdomen and breasts begin to show movement (during activity) due to dis¬proportionate accumulation of fat on those places to his age. The aetiological factors may be classified in following:
1.    Aharajanya hetu (obesity due to dietetic factor): Madhura, Kapha va¬radhak, Sarpi, Dadhi as causative factors of Sthaulata, Guru, Sheet, Snigdha, Navanna, Nava¬madya, Mansa, Ikshu ahara as causa¬tive factor for sthaulyata medoroga.
    Eating too many calories and not get¬ting enough physical activity to burn those calories results in overweight & obesity. Obesity increases the risk of developing several health problems like high blood pressure, insulin resistance, type 2 diabetes, coronary artery disease (heart attacks), cere¬brovascular disease (stroke).
2.    Viharajanya Hetu: Avyayama (Lack of exercise) divaswapana (day time sleep), Avyavaya (lack of sexual intercourse) and sukha shaiya as causative factor for sthulata.
3.    Mansika hetu (Psychological)3 Har¬shana¬titaya (Cheerfulness), Achintata etc.
4.    Garbhopghatkar bhava: Charak has con¬sidered that when mother takes excessive madhura ahara during pregnancy, the prog¬eny will be ‘Sthula’3 It is well known that madhur rasa increases kapha in body which has maximum effect on medodhatu respon¬sible for enhancing sthulata in the body and the infant become sthaulya due to excessive medo-dhatu. Vagbhata has called such preg¬nancy as “Garbhaja vyadhi’ and subdivided in anarasaja type.8  
5.    Bijasvabhava (genetic abnormality): The role of bijasvabhava or genetic abnormality in pathogenesis of medo-roga is stated by Charak.3It can be explained that when par¬ents or grandparents are indulged in mad¬hura, snigdha ahara they may develop bija¬dosa, which gives rise to a constitution that there is tendency for the formation of meda even with normal or subnormal diet. The matri¬bija is responsible for medo dhatu. From abnormal bija the development of medo-dhatu is excessive and child becomes sthaulya.
    In context of body eight type of per¬sons are criticized and discarded (Ninda¬niya) such as over tall, over short, over hairy, less hairy, over black, over fair, over obese, over lean3 Among all over obese has been characterized by eight defects i.e. shortening of life span, restricted movement, difficulty in sexual intercourse, debility foul smell, excess sweating, excess hunger and excess thirst.3 Obesity is caused by over sa¬turation, intake of heavy sweet, cold and fatty diet, indulgence in day sleeping and exhilaration, lack of mental work and ge¬netic defect.
    In obese individuals the life span de¬creases because of laxity, softness and hea¬viness of fat there is restriction in move¬ment. Further, due to non-abundance of se¬men, there is difficulty in sexual intercourse, due to disequilibrium of dhatus there is de¬bility, foul smell is due to defect in fat and excess sweating. Due to association of me¬das with kapha it is of oozing nature having heaviness and intolerance to physical exer¬cise there is excess sweating, because of in¬tensified agni and increase of vayu in sto¬mach there is excessive hunger and thirst3. Due obstruction of passage by fat vayu moves faster and stimulates digestion and absorbed food, hence the person digest food quickly and further desires to have food in excess quantity, and even short delay in con¬suming food may cause severe disorders.
Obesity & High blood pressure13: Multiple factors are responsible for increase in blood pressure in obesity. Weight gain is asso¬ciated with decrease in elasticity of blood vessels & increase heart rate. Excess calo¬ries are deposited in body as fat in fatty tis¬sue. This fatty tissue increases demand for oxygen & nutrients, which in turn increases amount of blood circulating in the body. More blood traveling through arteries adds pressure on walls of arteries leading to in¬crease in blood pressure. Obesity increases level of insulin in body. Insulin causes so¬dium & water retention in body, which re¬sults in increase in blood volume & extra pressure on arteries. All of these factors can increase blood pressure.
Obesity & Diabetes: Increased blood sugar level12: Type2 diabetes is a common health problem in diabetes. Insulin controls blood sugar. Insulin is required for the entry of sugar (glucose) into body cells from blood. Excess body fat in obesity makes body resistant to insulin. Because of this in¬sulin resistance, sugar will remain in blood, which will lead to increase in blood sugar or diabetes.  High amount of sugar in blood leads to complications in kidney, eyes, blood vessel, and heart.
Atherosclerosis or fatty deposits in blood vessels15: Cholesterol is carried in the blood as two compounds: Low-density lipoprote¬ins (LDL) and High-density lipoproteins (HDL). HDL is also called the 'good' cho¬lesterol and LDL is also called the 'bad' cholesterol. Obesity is associated with low levels of good (high-density lipoprotein) cholesterol and high levels of bad (LDL) cholesterol. When cholesterol levels are high, some of the cholesterol is deposited on the walls of the blood vessels. Cholesterol deposits reduce the elasticity of blood ves¬sels, narrows blood vessels & decreases blood flow. All these changes lead to athe¬rosclerosis and an increased risk of heart disease & stroke.
Coronary artery disease – angina & heart attack2: Atherosclerosis (fatty deposits in arteries) in coronary arteries (arteries that supply heart) reduces blood supply to heart. Decreased blood flow to heart can cause an¬gina (chest pain) and complete blockage of blood flow to heart can cause heart attack. The World Health Organization says more than 1 billion adults are overweight and 300 million of them are obese, putting them at much higher risk of diabetes, heart prob¬lems, high blood pressure, stroke and some forms of cancer.
Samprapti (Etiopathogenesis) of Sthaulya5
1)    Sanchaya: Because of excessive mad¬hura, snigdha, guru, ahara intake and di¬vasvapna (sleep in day time) avyayama (no exercise or physical activity) etc. and also because of bijasvabhava there is sanchaya of kapha.
2)    Prakopa: The Kapha increases in quan¬tity and quality and is responsible for the formation of the Atimadhura and Atisnigdha ahara rasa.
3)    Prasara: Atimadhura and Atisnigdha ahara-rasa circulates all over body through channels.
4)    Sthanasansrya: The circulating ahara rasa gets collected in the medodhatu be¬cause of kha-vaigunya in medo-vaha-srotas and also medodhatu increases and gets ac¬cumulated in udara etc.
5)    Vyakti: The medodhatu accumulations in body organs make them increase in size and pendulous movements when the person moves. The channels get blocked by the meda causing the ill effects of the Sthaulaya.
6)    Bheda: The manifestation of the upa¬drava or the  complications of obesity such as prameha (diabetes), prameha-pidika (di¬abetic ulcers), bhagandara (fistula) etc. can be considered as the bheda stage of atis¬thaulayata.8,10
Ayurvedic management of Metabolic Syn¬drome:
    Ayurveda has not described as such treatment of metabolic syndrome but there are various pharmacologic and non-pharma¬cologic methods for the prevention and management of obesity. The food and drinks which alleviates vata, reduces kapha and fat should be taken. Use of Guduchi, Musta, Triphla, honey etc14 are recommended for removing obesity or excess fat. Vidanga, Shunthi, yavaksara13 ash powder of black iron mixed with honey, powder of barley and Amalaka is beneficial in the manage¬ment of obesity. Similarly Bilvadi pancha¬mula mixed with honey and use of Shilajatu along with juice of Agnimantha is recom¬mended9. In diet prastika, kangu, shyamaka, yavaka, yava, green gram, kulatha, makus¬tha, patola, amalaki fruits can be used for reducing fat3
    The obese taking regular fatty diet may suffer from various kaphaj disorders. Such individuals should not-sleep in day time. Halimak, headache, cold sensation, heaviness in body parts, body-ache, edema, anorexia, nausea, rhinitis, migraine, itching, drowsiness, cough disorder of throat, de¬rangement of memory and intelligence, fever, incapability of sense organs etc. are the abnormalities that manifests due to ob¬esity and abnormal fat deposition in differ¬ent parts of the body3. Similarly Vagbhata has also listed a number of drugs (yogas) for the management of obesity along with a specific regimen of life and diet to be fol¬lowed by obese person.8
    In brief, a detailed description re¬garding ati-sthulata (obesity/medoroga) is given in classical literature of Ayurveda, which can be correlated with the clinical conditions associated with metabolic syn¬drome.

    Metabolic syndrome is a burgeoning global problem. A global transition in the disease pattern has been observed, where the relative impact of infectious diseases is de¬creasing while chronic diseases like cardi¬ovascular disease (CVD) and diabetes are increasingly dominating the disease pattern. The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with “insulin re¬sistance.” The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syn¬drome.1 Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. It is a risk factor for coronary heart disease, as well as diabetes, fatty liver, and several cancers. The clinical manifesta¬tions of this syndrome may include hyper¬tension, hyperglycemia, hypertriglyceride¬mia, reduced high-density lipoprotein cho-lesterol (HDL-C), and abdominal obesity. Under current guidelines, revised in 2005 by the The US National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following:2
•    Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia)
•    Blood pressure ≥130/85 mm Hg (or receiv¬ing drug therapy for hypertension)
•    Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
•    HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for re¬duced HDL-C)
•    Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women
Medoroga (obesity) has been considered as an abnormality of body characterized by-
a)    Excessive increase of fat and other tis¬sues of body.
b)    Bulky look of body.
c)    Pendulous situation of buttocks, abdo¬men and breast.
d)    Excessive anabolic conditions.
e)    Lack of vitality.
    Commonly abdominal enlargement stated as Sthaulya and the morbid changes occur due to the obstruction of channels of Meda. The physiological concept of Ayur¬veda is based on ahara which further helps in growth and other activities of body. Due to Improper consumption of food and Im¬proper digestion of food due to Agnimandya, Ama-Rasa (Rasa mixed with Ama) is formed which circulates all over body, causing sro¬todusti or blocks the srotas or channels, ac-cumulates the dhatu called Dhatu-vriddhi, srotoavrodha and manifest in form of Medo¬roga, Madhumeha (diabetes), hyper triglyce¬ridemia, hypertension. Obesity (Medoroga) itself is the major cause of hypertension, Madhumeha (diabetes).

Medoroga Nidana5
    Absence of physical activity, sleep¬ing during day, and intake of foods which increase Kapha, make the end product of digestion abnormally sweet which in turn causes increase of Medas (fat). This ob¬structs the nutrient channels of the tissues. Therefore, conditions like hypertension, di¬abetes, and obesity are observed. These make the person incapable of various activi¬ties. Difficulty in breathing even on slight exertion, thirst, delusion, sleep, breathless¬ness exhaustion, excessive hunger, bad smell of the body, poor physical and sexual capacity etc. gradually develop. As the ab¬domen and bones are the chief depots of fat, the abdomen gets enlarged in such persons, buttocks, abdomen and breasts begin to show movement (during activity) due to dis¬proportionate accumulation of fat on those places to his age. The aetiological factors may be classified in following:
1.    Aharajanya hetu (obesity due to dietetic factor): Madhura, Kapha va¬radhak, Sarpi, Dadhi as causative factors of Sthaulata, Guru, Sheet, Snigdha, Navanna, Nava¬madya, Mansa, Ikshu ahara as causa¬tive factor for sthaulyata medoroga.
    Eating too many calories and not get¬ting enough physical activity to burn those calories results in overweight & obesity. Obesity increases the risk of developing several health problems like high blood pressure, insulin resistance, type 2 diabetes, coronary artery disease (heart attacks), cere¬brovascular disease (stroke).
2.    Viharajanya Hetu: Avyayama (Lack of exercise) divaswapana (day time sleep), Avyavaya (lack of sexual intercourse) and sukha shaiya as causative factor for sthulata.
3.    Mansika hetu (Psychological)3 Har¬shana¬titaya (Cheerfulness), Achintata etc.
4.    Garbhopghatkar bhava: Charak has con¬sidered that when mother takes excessive madhura ahara during pregnancy, the prog¬eny will be ‘Sthula’3 It is well known that madhur rasa increases kapha in body which has maximum effect on medodhatu respon¬sible for enhancing sthulata in the body and the infant become sthaulya due to excessive medo-dhatu. Vagbhata has called such preg¬nancy as “Garbhaja vyadhi’ and subdivided in anarasaja type.8  
5.    Bijasvabhava (genetic abnormality): The role of bijasvabhava or genetic abnormality in pathogenesis of medo-roga is stated by Charak.3It can be explained that when par¬ents or grandparents are indulged in mad¬hura, snigdha ahara they may develop bija¬dosa, which gives rise to a constitution that there is tendency for the formation of meda even with normal or subnormal diet. The matri¬bija is responsible for medo dhatu. From abnormal bija the development of medo-dhatu is excessive and child becomes sthaulya.
    In context of body eight type of per¬sons are criticized and discarded (Ninda¬niya) such as over tall, over short, over hairy, less hairy, over black, over fair, over obese, over lean3 Among all over obese has been characterized by eight defects i.e. shortening of life span, restricted movement, difficulty in sexual intercourse, debility foul smell, excess sweating, excess hunger and excess thirst.3 Obesity is caused by over sa¬turation, intake of heavy sweet, cold and fatty diet, indulgence in day sleeping and exhilaration, lack of mental work and ge¬netic defect.
    In obese individuals the life span de¬creases because of laxity, softness and hea¬viness of fat there is restriction in move¬ment. Further, due to non-abundance of se¬men, there is difficulty in sexual intercourse, due to disequilibrium of dhatus there is de¬bility, foul smell is due to defect in fat and excess sweating. Due to association of me¬das with kapha it is of oozing nature having heaviness and intolerance to physical exer¬cise there is excess sweating, because of in¬tensified agni and increase of vayu in sto¬mach there is excessive hunger and thirst3. Due obstruction of passage by fat vayu moves faster and stimulates digestion and absorbed food, hence the person digest food quickly and further desires to have food in excess quantity, and even short delay in con¬suming food may cause severe disorders.
Obesity & High blood pressure13: Multiple factors are responsible for increase in blood pressure in obesity. Weight gain is asso¬ciated with decrease in elasticity of blood vessels & increase heart rate. Excess calo¬ries are deposited in body as fat in fatty tis¬sue. This fatty tissue increases demand for oxygen & nutrients, which in turn increases amount of blood circulating in the body. More blood traveling through arteries adds pressure on walls of arteries leading to in¬crease in blood pressure. Obesity increases level of insulin in body. Insulin causes so¬dium & water retention in body, which re¬sults in increase in blood volume & extra pressure on arteries. All of these factors can increase blood pressure.
Obesity & Diabetes: Increased blood sugar level12: Type2 diabetes is a common health problem in diabetes. Insulin controls blood sugar. Insulin is required for the entry of sugar (glucose) into body cells from blood. Excess body fat in obesity makes body resistant to insulin. Because of this in¬sulin resistance, sugar will remain in blood, which will lead to increase in blood sugar or diabetes.  High amount of sugar in blood leads to complications in kidney, eyes, blood vessel, and heart.
Atherosclerosis or fatty deposits in blood vessels15: Cholesterol is carried in the blood as two compounds: Low-density lipoprote¬ins (LDL) and High-density lipoproteins (HDL). HDL is also called the 'good' cho¬lesterol and LDL is also called the 'bad' cholesterol. Obesity is associated with low levels of good (high-density lipoprotein) cholesterol and high levels of bad (LDL) cholesterol. When cholesterol levels are high, some of the cholesterol is deposited on the walls of the blood vessels. Cholesterol deposits reduce the elasticity of blood ves¬sels, narrows blood vessels & decreases blood flow. All these changes lead to athe¬rosclerosis and an increased risk of heart disease & stroke.
Coronary artery disease – angina & heart attack2: Atherosclerosis (fatty deposits in arteries) in coronary arteries (arteries that supply heart) reduces blood supply to heart. Decreased blood flow to heart can cause an¬gina (chest pain) and complete blockage of blood flow to heart can cause heart attack. The World Health Organization says more than 1 billion adults are overweight and 300 million of them are obese, putting them at much higher risk of diabetes, heart prob¬lems, high blood pressure, stroke and some forms of cancer.
Samprapti (Etiopathogenesis) of Sthaulya5
1)    Sanchaya: Because of excessive mad¬hura, snigdha, guru, ahara intake and di¬vasvapna (sleep in day time) avyayama (no exercise or physical activity) etc. and also because of bijasvabhava there is sanchaya of kapha.
2)    Prakopa: The Kapha increases in quan¬tity and quality and is responsible for the formation of the Atimadhura and Atisnigdha ahara rasa.
3)    Prasara: Atimadhura and Atisnigdha ahara-rasa circulates all over body through channels.
4)    Sthanasansrya: The circulating ahara rasa gets collected in the medodhatu be¬cause of kha-vaigunya in medo-vaha-srotas and also medodhatu increases and gets ac¬cumulated in udara etc.
5)    Vyakti: The medodhatu accumulations in body organs make them increase in size and pendulous movements when the person moves. The channels get blocked by the meda causing the ill effects of the Sthaulaya.
6)    Bheda: The manifestation of the upa¬drava or the  complications of obesity such as prameha (diabetes), prameha-pidika (di¬abetic ulcers), bhagandara (fistula) etc. can be considered as the bheda stage of atis¬thaulayata.8,10
Ayurvedic management of Metabolic Syn¬drome:
    Ayurveda has not described as such treatment of metabolic syndrome but there are various pharmacologic and non-pharma¬cologic methods for the prevention and management of obesity. The food and drinks which alleviates vata, reduces kapha and fat should be taken. Use of Guduchi, Musta, Triphla, honey etc14 are recommended for removing obesity or excess fat. Vidanga, Shunthi, yavaksara13 ash powder of black iron mixed with honey, powder of barley and Amalaka is beneficial in the manage¬ment of obesity. Similarly Bilvadi pancha¬mula mixed with honey and use of Shilajatu along with juice of Agnimantha is recom¬mended9. In diet prastika, kangu, shyamaka, yavaka, yava, green gram, kulatha, makus¬tha, patola, amalaki fruits can be used for reducing fat3
    The obese taking regular fatty diet may suffer from various kaphaj disorders. Such individuals should not-sleep in day time. Halimak, headache, cold sensation, heaviness in body parts, body-ache, edema, anorexia, nausea, rhinitis, migraine, itching, drowsiness, cough disorder of throat, de¬rangement of memory and intelligence, fever, incapability of sense organs etc. are the abnormalities that manifests due to ob¬esity and abnormal fat deposition in differ¬ent parts of the body3. Similarly Vagbhata has also listed a number of drugs (yogas) for the management of obesity along with a specific regimen of life and diet to be fol¬lowed by obese person.8
    In brief, a detailed description re¬garding ati-sthulata (obesity/medoroga) is given in classical literature of Ayurveda, which can be correlated with the clinical conditions associated with metabolic syn¬drome.

    Metabolic syndrome is a burgeoning global problem. A global transition in the disease pattern has been observed, where the relative impact of infectious diseases is de¬creasing while chronic diseases like cardi¬ovascular disease (CVD) and diabetes are increasingly dominating the disease pattern. The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with “insulin re¬sistance.” The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syn¬drome.1 Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying abnormal adipose deposition and function. It is a risk factor for coronary heart disease, as well as diabetes, fatty liver, and several cancers. The clinical manifesta¬tions of this syndrome may include hyper¬tension, hyperglycemia, hypertriglyceride¬mia, reduced high-density lipoprotein cho-lesterol (HDL-C), and abdominal obesity. Under current guidelines, revised in 2005 by the The US National Cholesterol Education Program Adult Treatment Panel III (2001) requires at least three of the following:2
•    Fasting glucose ≥100 mg/dL (or receiving drug therapy for hyperglycemia)
•    Blood pressure ≥130/85 mm Hg (or receiv¬ing drug therapy for hypertension)
•    Triglycerides ≥150 mg/dL (or receiving drug therapy for hypertriglyceridemia)
•    HDL-C < 40 mg/dL in men or < 50 mg/dL in women (or receiving drug therapy for re¬duced HDL-C)
•    Waist circumference ≥102 cm (40 in) in men or ≥88 cm (35 in) in women; if Asian, ≥90 cm (35 in) in men or ≥80 cm (32 in) in women
Medoroga (obesity) has been considered as an abnormality of body characterized by-
a)    Excessive increase of fat and other tis¬sues of body.
b)    Bulky look of body.
c)    Pendulous situation of buttocks, abdo¬men and breast.
d)    Excessive anabolic conditions.
e)    Lack of vitality.
    Commonly abdominal enlargement stated as Sthaulya and the morbid changes occur due to the obstruction of channels of Meda. The physiological concept of Ayur¬veda is based on ahara which further helps in growth and other activities of body. Due to Improper consumption of food and Im¬proper digestion of food due to Agnimandya, Ama-Rasa (Rasa mixed with Ama) is formed which circulates all over body, causing sro¬todusti or blocks the srotas or channels, ac-cumulates the dhatu called Dhatu-vriddhi, srotoavrodha and manifest in form of Medo¬roga, Madhumeha (diabetes), hyper triglyce¬ridemia, hypertension. Obesity (Medoroga) itself is the major cause of hypertension, Madhumeha (diabetes).

Medoroga Nidana5
    Absence of physical activity, sleep¬ing during day, and intake of foods which increase Kapha, make the end product of digestion abnormally sweet which in turn causes increase of Medas (fat). This ob¬structs the nutrient channels of the tissues. Therefore, conditions like hypertension, di¬abetes, and obesity are observed. These make the person incapable of various activi¬ties. Difficulty in breathing even on slight exertion, thirst, delusion, sleep, breathless¬ness exhaustion, excessive hunger, bad smell of the body, poor physical and sexual capacity etc. gradually develop. As the ab¬domen and bones are the chief depots of fat, the abdomen gets enlarged in such persons, buttocks, abdomen and breasts begin to show movement (during activity) due to dis¬proportionate accumulation of fat on those places to his age. The aetiological factors may be classified in following:
1.    Aharajanya hetu (obesity due to dietetic factor): Madhura, Kapha va¬radhak, Sarpi, Dadhi as causative factors of Sthaulata, Guru, Sheet, Snigdha, Navanna, Nava¬madya, Mansa, Ikshu ahara as causa¬tive factor for sthaulyata medoroga.
    Eating too many calories and not get¬ting enough physical activity to burn those calories results in overweight & obesity. Obesity increases the risk of developing several health problems like high blood pressure, insulin resistance, type 2 diabetes, coronary artery disease (heart attacks), cere¬brovascular disease (stroke).
2.    Viharajanya Hetu: Avyayama (Lack of exercise) divaswapana (day time sleep), Avyavaya (lack of sexual intercourse) and sukha shaiya as causative factor for sthulata.
3.    Mansika hetu (Psychological)3 Har¬shana¬titaya (Cheerfulness), Achintata etc.
4.    Garbhopghatkar bhava: Charak has con¬sidered that when mother takes excessive madhura ahara during pregnancy, the prog¬eny will be ‘Sthula’3 It is well known that madhur rasa increases kapha in body which has maximum effect on medodhatu respon¬sible for enhancing sthulata in the body and the infant become sthaulya due to excessive medo-dhatu. Vagbhata has called such preg¬nancy as “Garbhaja vyadhi’ and subdivided in anarasaja type.8  
5.    Bijasvabhava (genetic abnormality): The role of bijasvabhava or genetic abnormality in pathogenesis of medo-roga is stated by Charak.3It can be explained that when par¬ents or grandparents are indulged in mad¬hura, snigdha ahara they may develop bija¬dosa, which gives rise to a constitution that there is tendency for the formation of meda even with normal or subnormal diet. The matri¬bija is responsible for medo dhatu. From abnormal bija the development of medo-dhatu is excessive and child becomes sthaulya.
    In context of body eight type of per¬sons are criticized and discarded (Ninda¬niya) such as over tall, over short, over hairy, less hairy, over black, over fair, over obese, over lean3 Among all over obese has been characterized by eight defects i.e. shortening of life span, restricted movement, difficulty in sexual intercourse, debility foul smell, excess sweating, excess hunger and excess thirst.3 Obesity is caused by over sa¬turation, intake of heavy sweet, cold and fatty diet, indulgence in day sleeping and exhilaration, lack of mental work and ge¬netic defect.
    In obese individuals the life span de¬creases because of laxity, softness and hea¬viness of fat there is restriction in move¬ment. Further, due to non-abundance of se¬men, there is difficulty in sexual intercourse, due to disequilibrium of dhatus there is de¬bility, foul smell is due to defect in fat and excess sweating. Due to association of me¬das with kapha it is of oozing nature having heaviness and intolerance to physical exer¬cise there is excess sweating, because of in¬tensified agni and increase of vayu in sto¬mach there is excessive hunger and thirst3. Due obstruction of passage by fat vayu moves faster and stimulates digestion and absorbed food, hence the person digest food quickly and further desires to have food in excess quantity, and even short delay in con¬suming food may cause severe disorders.
Obesity & High blood pressure13: Multiple factors are responsible for increase in blood pressure in obesity. Weight gain is asso¬ciated with decrease in elasticity of blood vessels & increase heart rate. Excess calo¬ries are deposited in body as fat in fatty tis¬sue. This fatty tissue increases demand for oxygen & nutrients, which in turn increases amount of blood circulating in the body. More blood traveling through arteries adds pressure on walls of arteries leading to in¬crease in blood pressure. Obesity increases level of insulin in body. Insulin causes so¬dium & water retention in body, which re¬sults in increase in blood volume & extra pressure on arteries. All of these factors can increase blood pressure.
Obesity & Diabetes: Increased blood sugar level12: Type2 diabetes is a common health problem in diabetes. Insulin controls blood sugar. Insulin is required for the entry of sugar (glucose) into body cells from blood. Excess body fat in obesity makes body resistant to insulin. Because of this in¬sulin resistance, sugar will remain in blood, which will lead to increase in blood sugar or diabetes.  High amount of sugar in blood leads to complications in kidney, eyes, blood vessel, and heart.
Atherosclerosis or fatty deposits in blood vessels15: Cholesterol is carried in the blood as two compounds: Low-density lipoprote¬ins (LDL) and High-density lipoproteins (HDL). HDL is also called the 'good' cho¬lesterol and LDL is also called the 'bad' cholesterol. Obesity is associated with low levels of good (high-density lipoprotein) cholesterol and high levels of bad (LDL) cholesterol. When cholesterol levels are high, some of the cholesterol is deposited on the walls of the blood vessels. Cholesterol deposits reduce the elasticity of blood ves¬sels, narrows blood vessels & decreases blood flow. All these changes lead to athe¬rosclerosis and an increased risk of heart disease & stroke.
Coronary artery disease – angina & heart attack2: Atherosclerosis (fatty deposits in arteries) in coronary arteries (arteries that supply heart) reduces blood supply to heart. Decreased blood flow to heart can cause an¬gina (chest pain) and complete blockage of blood flow to heart can cause heart attack. The World Health Organization says more than 1 billion adults are overweight and 300 million of them are obese, putting them at much higher risk of diabetes, heart prob¬lems, high blood pressure, stroke and some forms of cancer.
Samprapti (Etiopathogenesis) of Sthaulya5
1)    Sanchaya: Because of excessive mad¬hura, snigdha, guru, ahara intake and di¬vasvapna (sleep in day time) avyayama (no exercise or physical activity) etc. and also because of bijasvabhava there is sanchaya of kapha.
2)    Prakopa: The Kapha increases in quan¬tity and quality and is responsible for the formation of the Atimadhura and Atisnigdha ahara rasa.
3)    Prasara: Atimadhura and Atisnigdha ahara-rasa circulates all over body through channels.
4)    Sthanasansrya: The circulating ahara rasa gets collected in the medodhatu be¬cause of kha-vaigunya in medo-vaha-srotas and also medodhatu increases and gets ac¬cumulated in udara etc.
5)    Vyakti: The medodhatu accumulations in body organs make them increase in size and pendulous movements when the person moves. The channels get blocked by the meda causing the ill effects of the Sthaulaya.
6)    Bheda: The manifestation of the upa¬drava or the  complications of obesity such as prameha (diabetes), prameha-pidika (di¬abetic ulcers), bhagandara (fistula) etc. can be considered as the bheda stage of atis¬thaulayata.8,10
Ayurvedic management of Metabolic Syn¬drome:
    Ayurveda has not described as such treatment of metabolic syndrome but there are various pharmacologic and non-pharma¬cologic methods for the prevention and management of obesity. The food and drinks which alleviates vata, reduces kapha and fat should be taken. Use of Guduchi, Musta, Triphla, honey etc14 are recommended for removing obesity or excess fat. Vidanga, Shunthi, yavaksara13 ash powder of black iron mixed with honey, powder of barley and Amalaka is beneficial in the manage¬ment of obesity. Similarly Bilvadi pancha¬mula mixed with honey and use of Shilajatu along with juice of Agnimantha is recom¬mended9. In diet prastika, kangu, shyamaka, yavaka, yava, green gram, kulatha, makus¬tha, patola, amalaki fruits can be used for reducing fat3
    The obese taking regular fatty diet may suffer from various kaphaj disorders. Such individuals should not-sleep in day time. Halimak, headache, cold sensation, heaviness in body parts, body-ache, edema, anorexia, nausea, rhinitis, migraine, itching, drowsiness, cough disorder of throat, de¬rangement of memory and intelligence, fever, incapability of sense organs etc. are the abnormalities that manifests due to ob¬esity and abnormal fat deposition in differ¬ent parts of the body3. Similarly Vagbhata has also listed a number of drugs (yogas) for the management of obesity along with a specific regimen of life and diet to be fol¬lowed by obese person.8
    In brief, a detailed description re¬garding ati-sthulata (obesity/medoroga) is given in classical literature of Ayurveda, which can be correlated with the clinical conditions associated with metabolic syn¬drome.