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==== Consequences of obesity (verse 5-8) ====

==== Consequences of obesity (verse 5-8) ====

Serious diseases (''daruna vikara'') are the outcome of excessive obesity due obstruction of body channels by the ''medas''. This indicates ancient wisdom of Ayurveda acharyas, which is comparable to the impact of obesity on health perspectives of biomedical science . We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span (ayukshaya) is stated to be an important consequence of obesity in Ayurveda. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis.   Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management.

Serious diseases (''daruna vikara'') are the outcome of excessive obesity due obstruction of body channels by the ''medas''. This indicates ancient wisdom of [https://en.wikipedia.org/wiki/Ayurveda Ayurveda] ''acharyas'', which is comparable to the impact of obesity on health perspectives of biomedical science. We have yet to understand what they had foreseen in reference to fat accumulation around the kidneys. Decreased life span (''ayukshaya'') is stated to be an important consequence of obesity in [https://en.wikipedia.org/wiki/Ayurveda Ayurveda]. According to contemporary science, metabolic and psychological pathologies are often present together and are associated with dysregulation of the hypothalamic-pituitary-adrenal axis. Affect disorders are also reported among obese binge eaters. The National Institute of Health, USA has issued an alert labeling obesity a "Killer disease" due to its health-related consequences such as coronary disease, diabetes mellitus, hypertension, hyperlipidemia, kidney disorders, gallbladder disorders, cancer of colon, pancreas, breast, uterus, kidney and gallbladder, osteoarthritis, menstrual irregularities in females, cryptogenic cirrhosis of the liver and hepatocellular carcinoma, insulin resistance, and physiological hyperinsulinemia. Some of the social consequences of obesity could include divorces, due in part to reduce sexual activities between partners. Besides there, transitional physiological phases such as weight gain during adolescence in boys and girls, post-natal weight gain in women, and peri-post menopausal obesity are frequently noted in clinical settings that warrant special care and management.

==== Etiology, features, and consequences of atikrisha (emaciation) ====

==== Etiology, features, and consequences of ''atikrisha'' (emaciation) ====

The etiological factors for atikrisha may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in atikrisha. In the pathogenesis of krishata, Vayu plays an important role. Most of the etiological factors observed in the case of krisha and atikrisha provoke vata vitiation. Thus, vitiated vata may be considered the most important factor in the pathogenesis of krisha. In sthaulya there is excessive formation and under-utilization (due to sedentary habit) of the rasa dhatu. On the other hand, in krishata there is less formation of rasa due to diseases or due to undernourishment. Further, Charaka and Suśruta both have categorized krishata as a rasa pradoshaja vyadhi (C.Su.28:10, Su.Su.15:37,24:8). In this way, rasa dhatu dushti mainly in the form of kshaya is found in extremely lean or emaciated people. The other dhatu involved in the pathogenesis of obesity as well as atikrisha is Meda since it is mentioned that medokshaya (or the deficiency of meda) cause krisanga (A.H.Su.11:18).   

The etiological factors for ''atikrisha'' may be divided into two groups - excessive expenditure of calories and fewer intakes of calories. Either of these conditions leads to under-nutrition which ultimately results in atikrisha. In the pathogenesis of ''krishata'', ''vayu'' plays an important role. Most of the etiological factors observed in the case of ''krisha'' and ''atikrisha'' provoke ''vata'' vitiation. Thus, vitiated ''vata'' may be considered the most important factor in the pathogenesis of ''krisha''. In ''sthaulya'' there is excessive formation and under-utilization (due to sedentary habit) of the ''rasa dhatu''. On the other hand, in ''krishata'' there is less formation of ''rasa'' due to diseases or due to undernourishment. Further, Charaka and Suśruta both have categorized ''krishata'' as a ''rasa pradoshaja vyadhi'' (C.Su.28:10, Su.Su.15:37,24:8). In this way, ''rasa dhatu dushti'' mainly in the form of ''kshaya'' is found in extremely lean or emaciated people. The other ''dhatu'' involved in the pathogenesis of obesity as well as ''atikrisha'' is ''meda'' since it is mentioned that ''medokshaya'' (or the deficiency of ''meda'') cause ''krisanga'' (A.H.Su.11:18).   

In biomedical terms, emaciation is the outcome of loss of the fatty contents or loss of adipose tissue component of subcutaneous fat, which is lying beneath the outer covering of the body. It is also known as extreme weight loss, leanness, or thinness.   In general term, it is also known as wasting, which is caused by hampered nutritional requirement at the tissue level and excessive starvation. Wasting or leanness is an important symptom of improper nourishment, which is commonly seen in various clinical conditions such as poverty, a variety of gastrointestinal disorders, various eating disorders, prolonged fever, malignant diseases, endocrine disorders, chronic infections, autoimmune disorders as well as parasitic infections. The malnourished person faced a lot of problems related to cardiovascular, integumentary and urogenital systems. Disturbances in blood circulation, serum electrolyte, and serum protein are commonly observed in emaciated person. Such type individuals are more to suffer from infections due to deranged immune power and swelling in general.   

In biomedical terms, emaciation is the outcome of loss of the fatty contents or loss of adipose tissue component of subcutaneous fat, which is lying beneath the outer covering of the body. It is also known as extreme weight loss, leanness, or thinness. In general term, it is also known as wasting, which is caused by hampered nutritional requirement at the tissue level and excessive starvation. Wasting or leanness is an important symptom of improper nourishment, which is commonly seen in various clinical conditions such as poverty, a variety of gastrointestinal disorders, various eating disorders, prolonged fever, malignant diseases, endocrine disorders, chronic infections, autoimmune disorders as well as parasitic infections. The malnourished person faced a lot of problems related to cardiovascular, integumentary and urogenital systems. Disturbances in blood circulation, serum electrolyte, and serum protein are commonly observed in emaciated person. Such type individuals are more to suffer from infections due to deranged immune power and swelling in general.   

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness (C.Su. 23/3-34). The patients of atikrisha and sthaulya perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because sthula (or the obese) suffers more in comparison to atikrisha (the emaciated) (Su.Su. 15:42). Further, it is mentioned that atikṛisha is a grave disease, but is considered better than atisthula from treatment aspect because there is no treatment for sthaulya. For proper treatment of sthulya the drugs must have Medohara, Agnihara and Vatahara action at the same time, which is neither possible from karshaṇa nor brimhana. Recent evidence also suggests that Charaka had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity.   

Obesity and leanness can manifest themselves in very severe and excessive forms than discussed here and those cases could make the management of such disorders - and any disease it could lead to – very challenging. While the principles of treatment remain unchanged, the therapeutic measures should be suitably intensified to counter the numerous disorders that arise because of excessive obesity and leanness (C.Su. 23/3-34). The patients of ''atikrisha'' and ''sthaulya'' perpetually suffer from diseases but the standpoint of treatment, the former is significantly more manageable because ''sthula'' (or the obese) suffers more in comparison to ''atikrisha'' (the emaciated) (Su.Su. 15:42). Further, it is mentioned that ''atikṛisha'' is a grave disease, but is considered better than ''atisthula'' from treatment aspect because there is no treatment for ''sthaulya''. For proper treatment of ''sthulya'' the drugs must have ''medohara, agnihara'' and ''vatahara'' action at the same time, which is neither possible from ''karshaṇa'' nor ''brimhana''. Recent evidence also suggests that Charaka had associated extreme weight-loss/undernourishment with high rates of morbidity and mortality, although to a lesser extent than obesity.   

    

    

==== Management of the Morbidly Obese (20-28) ====

==== Management of the Morbidly Obese (20-28) ====