DISSERTATION SUBMITTED TO

GOVERNMENT YOGA AND NATUROPATHY MEDICAL

COLLEGE & HOSPITAL.
CHENNAI – 106

MANAGEMENT OF OBESITY

SUBMITTED BY:

R. L. MINU RAJALAKSHMI

REGISTER NO. 821511037

ACADEMIC YEAR: 2015 - 2021

1
 GOVT. YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPITAL,
CHENNAI – 106

DECLARATION

I hereby declare that the dissertation entitled Management of

obesity through yoga and naturopathy treatments submitted for fulfilment of the
requirement for Bachelor of Naturopathy and Yogic Science in Govt. yoga and
Naturopathy Medical College, Chennai-106, is my original work and the
dissertation has not formed the basis for the award of any degree, diploma,
fellowship or other titles. It has not been submitted to any other University or
institution for the award of any degree of diploma.

Place: Signature of the Internee:

Date:

2
 EVOLUTION CERTIFICATE

This is to certify the dissertation entitled Management of Obesity

through Yoga and Naturopathic interventions, submitted by R. L. MINU
RAJALAKSHMI in partial fulfillment of the requirement of Bachelor of
Naturopathy and Yogic Science in Govt .Yoga and Naturopathy Medical College,
Chennai-106, done by her during the period of 2019-2020 under my guidance
supervision and this dissertation or any part of these has not been submitted
elsewhere for any degree.

Place: Signature of the Principal

Date: (Dr. N. MANAVALAN)

3
 ACKNOWLEDGEMENT

I firmly believe that it is only ‘‘Blessing of the God'' that has helped me to fulfill
this Endeavour.

I thank our principal DR. N. MANAVALAN for providing me an opportunity to

do this dissertation.

With gratitude, I would like to thank all faculties for supporting in all aspects to
complete my dissertation successfully.

It's my privilege to express my sincere thanks to all the faculties in the Govt. Yoga
& Naturopathy Medical College for supporting me in all aspects to complete my
dissertation successfully.

Last, but the best my sincere thanks, from the depth of heart goes to my parents,
friends who gave me moral strength and encourage me with affection.

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 S. PAGE
NO: CONTENTS NO.
1. INTRODUCTION 07
2. HISTORY OF OBESITY 07
3. EPIDEMOLOGY 09
4. ETIOLOGY 10
5. CHILDHOOD OBESITY 14
6. SUBTYPES AND GENETIC MARKERS OF
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OBESITY
7. PATHOPHYSIOLOGY 21
8. COMPLICATIONS OF OBESITY 24
9. SYMPTOMS OF OBESITY 34
10. MORBIDITY DUE TO OBESITY 36
11. DIAGNOSIS OF OBESITY 37
12. ALLOPATHIC MANAGEMENT 39
13. YOGA & NATUROPATHIC DIAGNOSIS 41
14. IRIDIAGNOSIS 42
15. SWARA DIAGNOSIS 44
16. PULSE DIGNOSIS 45
17. CHROMO DIAGNOSIS 45
18. FACIAL DIAGNOSIS 46
19. TONGUE DIAGNOSIS 48
20. MANAGEMNT THROUGH YOGA AND
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NATUROPATHY
21. YOGA THERAPY 50
22. HYDRO & CLAY THERAPY 60
23. EXERCISE THERAPY 64
24. MASSAGE THERAPY 67

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25. AROMATHERAPY 69
26. DIET THERAPY 72
27. ACUPUNCTURE 83
28. AURICULOTHERAPY 84
29. CHROMOTHERAPY 87
30. HELIO THERAPY 89
31. AIRTHERAPY 90
32. MAGNETOTHERAPY 91
33. METHODOLOGICAL CASE STUDY 95
34. CASE STUDY QUESTIONNAIRE 98
35. DATA COLLECTION 99
35. STATISTICAL ANALYSIS 101
36. OUTCOME MEASURES 106
37. CONCLUSION 107

OBESITY
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INTRODUCTION :

Obesity is now so common within the world's population that it is beginning to

replace under-nutrition and infectious diseases as the most significant contributor to ill health. In
particular, obesity is associated with diabetes mellitus, coronary heart disease, certain forms of
cancer, and sleep-breathing disorders. Obesity is defined by a body-mass index (weight divided
by square of the height), but this does not take into account the morbidity and mortality
associated with more modest degrees of overweight, nor the detrimental effect of intra-
abdominal fat. The global epidemic of obesity results from a combination of genetic
susceptibility, increased availability of high-energy foods and decreased requirement for physical
activity in modern society. Obesity should no longer be regarded simply as a cosmetic problem
affecting certain individuals, but an epidemic that threatens global well being.

Obesity is a medical condition in which excess body fat has accumulated to the
extent that it may have a negative effect on health. People are generally considered obese when
their body mass index (BMI), a measurement obtained by dividing a person's weight by the
square of the person's height, is over 30 kg/m2, with the range 25–30 kg/m2 defined as
overweight. Obesity increases the likelihood of various diseases and conditions, particularly
cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer,
osteoarthritis and depression.

Overweight and obesity have become mass phenomena with a pronounced

upward trend in prevalence in most countries throughout the world. Obesity presents as one of
the most important public health problem in the United States. As the prevalence of obesity
increases, so does the prevalence of its associated comorbidities. “Overweight” technically refers
to an excess of body weight (including increased muscle), whereas “obesity” refers to an excess
of fat.

HISTORY OF OBESITY :

Obesity, observed in human populations over the ages, has been both
admired and reviled. A sketchy history of obesity starts 30,000 years ago with pocket-sized
figurines of obese women. The most famous of these figurines, dated to about 25,000 B.C., is the
“Venus of Willendorf,” a 10.1-cm statuette of a naked, faceless woman with an elaborate
hairstyle, voluptuous breasts, large curvaceous thighs, a rotund abdomen and an enlarged vulva,
made out of limestone, found in Spain rather than in Austria where the statuette was discovered;
thus, we may assume it traveled for some purpose or other. The statuette is not unique; similar
objects of the same period have been unearthed. Some have theorized that it represented a
fertility symbol, an idolization of beauty or desirability, an object of worship or a totem for good
fortune. Whatever its purpose, we see a representation of obesity admired, probably depicting
women who existed at that time. The relationship of other diseases to obesity is also ancient and

7
can be dated back to Egypt in the 15th century B.C. The Ebers Papyrus mentions treatments for
excess urination, probably secondary to diabetes. Hindu physicians (Charaka, Sushruta and
Vagbhata) noted in the second century B.C. that black ants were attracted to “honey urine.”
Hippocrates stated: “Corpulency is not only a disease, but the harbinger of others. Those who are
constitutionally very fat are more apt to die quickly than those who are thin” (Hippocratic
Corpus). Aristaeus, the Cappadocian, a second-century contemporary of Galen, was the first to
use the term diabetes to describe an affliction of melting down of the flesh and limbs into urine
(Extended Works), portraying the symptoms and signs of this disease in the clearest terms.

After the fall of Rome (circa 500), for the next 1,000 years in the Dark and Middle
Ages of European history, scholarship was for the most part confined to monk archivists.
Whereas artists, writers and musicians in the time of the Italian Renaissance (circa 1,500) rapidly
relearned the secrets of antiquity and made tremendous progress, science and medicine lagged
behind, and the conceptualization that obesity was in essence a malignancy ceased to be
recognized. In certain societies, obesity was often considered a privilege of the upper classes. In
fact, it was obviously considered beautiful, as the Rubenesque obese female nudes demonstrated.
However, obesity was also the subject of parody, for example, in Shakespeare’s characterization
of Sir John Falstaff; as well as freakish, as in sideshow exhibits of fat people. In the 18th century,
John Hunter collected anecdotes and specimens of human anomalies, including the portrait of the
obese Daniel Lambert, today found in the Hunterian Museum at the Royal College of Surgeons,
in London.

The history of obesity includes a variety of tribal customs, such as fattening up

young girls and women to make them more desirable. This custom has been documented in
Afghanistan, Fiji, Jamaica, Kuwait, Mauritania, Nauru, Samoa, South Africa, Tahiti and Tonga.
In this list, South Pacific Island nations predominate. As an example, the custom of ha-apon,
literally “to fatten,” was practiced in Tahiti. It consisted of restricting young women to a special
house for a year with little opportunity to perform the simplest activities. The fattened woman
was subsequently presented to the local chief to be admired as an example of beauty and fertility.

8
It would seem that the adulation of the Venus of Willendorf transcended time; that idol had tiny
or no feet, possibly meant to represent lack of mobility in association with the obesity of the
statuette.

EPIDEMOLOGY OF OBESITY :

Prevalence of obesity across globe :

The prevalence of obesity changed relatively little during the 1960s and 1970s, but
it increased sharply over the ensuing decades—from 13.4% in 1980 to 34.3% in 2008 among
adults and from 5% to 17% among children during the same period.The prevalence of extreme
obesity also increased during 1976–1980 and 2007–2008, and approximately 6% of U.S. adults
now have a BMI of 40 kg/m2 or higher. Obesity is a leading preventable cause of death
worldwide, with increasing rates in adults and children. In 2015, 600 million adults (12%) and
100 million children were obese in 195 countries. Obesity is more common in women than men.
Authorities view it as one of the most serious public health problems of the 21st century. Obesity
is stigmatized in much of the modern world (particularly in the Western world), though it was
seen as a symbol of wealth and fertility at other times in history and still is in some parts of the
world. In 2013, the American Medical Association classified obesity as a disease. Obesity is now
considered to be a global epidemic. In most populations the prevalence of overweight and
obesity has steadily increased over the past 20 years. In 2001, 55% of population was
overweight in the United States. From 1980 to present the number of obese people tripled in
Europe. There are about 4 million additional obese Europeans every year. Thus, across a wide
range of developed and developing countries, studies show increasing prevalence of obesity in
children. Currently, almost one-third of children and adolescents in the United States are either
overweight or obese. Childhood obesity is more common among American Indian, non-Hispanic
blacks, and Mexican Americans than in non-Hispanic whites. Only one small study, examining
children in Scotland, showed a reversal of the trend between 2001 and 2004 [10]. As a general
rule, girls are more prone than boys to develop persistent obesity during adolescence.
Approximately 80% of obese adolescent girls and 30% of obese adolescent males remain obese.

Obesity is a major health problem today that grows into a global epidemic.
According to the World Health Organization report, 1.5 billion adults were overweight, over 500
million of them were obese, and the prevalence of obesity is expected to rise in the years to
come. A similar situation is recorded in Croatia, where there are 25.3% of obese men and 34.1%
of obese women. There are multiple factors that cause obesity. Accelerated lifestyle, fast food,
unhealthy eating habits and sedentary lifestyle are considered as the major risk factors of
overweight and obesity development. Accumulation of fat tissue, especially visceral fat tissue
has been demonstrated to be associated with some chronic changes and diseases of different
organ systems. Some anthropometric measurements, especially body mass index, waist

9
circumference and waist-to-hip ratio, have been used to diagnose obesity and estimate the health
risk. Developing well-structured prevention programs that would encourage people to become
aware of obesity as a disease and that imbalanced dietary habits and physical activity are
important for obesity prevention and health, is a major public health challenge.

Prevalence of obesity in India :

Recent studies have reported that globally, more than 1.9 billion adults are
overweight and 650 million are obese. Approximately 2.8 million deaths are reported as a result
of being overweight or obese. Due to the consumption of energy dense food (i.e. unhealthy food
habits), sedentary life style, lack of health care services and financial support, the developing
countries are facing high risk of obesity and their adverse consequences (i.e. diabetes, ischemic
heart disease, etc). In India, more than 135 million individuals were affected by obesity. The
prevalence of obesity in India varies due to age, gender, geographical environment, socio-
economic status, etc. According to ICMR-INDIAB study 2015, prevalence rate of obesity and
central obesity are varies from 11.8% to 31.3% and 16.9%-36.3% respectively. In India,
abdominal obesity is one of the major risk factors for cardiovascular disease (CVDs). Various
studies have shown that the prevalence of obesity among women were significantly higher as
compared to men. Obesity is one of the main medical and financial burdens for the government.
This problem of obesity can be preventable by spreading public awareness about obesity and its
health consequences. Governmental agencies should promote the benefits of healthy life style,
food habits and physical activity. The aim of this article is to report the prevalence of obesity in
different regions of India and highlight the problem area.

ETIOLOGY OF OBESITY :

Eating more calories than you burn in daily activity and exercise on a long-term basis
can lead to obesity. Over time, these extra calories add up and cause weight gain. But it’s not
always just about calories in and calories out, or having a sedentary lifestyle. While those are
indeed causes of obesity, some causes you can’t control.

Common specific causes of obesity include, genetics, which can affect how your body processes
food into energy and how fat is stored, growing older, which can lead to less muscle mass and a
slower metabolic rate, making it easier to gain weight not sleeping enough, which can lead to
hormonal changes that make you feel hungrier and crave certain high-calorie foods, pregnancy,
as weight gained during pregnancy may be difficult to lose and might eventually lead to obesity

Certain health conditions can also lead to weight gain, which may lead to obesity. These include:
polycystic ovary syndrome (PCOS), a condition that causes an imbalance of female reproductive
hormones Prader-Willi syndrome, a rare condition present at birth that causes excessive hunger
Cushing syndrome, a condition caused by having high cortisol levels (the stress hormone) in

10
your system hypothyroidism (underactive thyroid), a condition in which the thyroid gland
doesn’t produce enough of certain important hormones osteoarthritis (OA) and other conditions
that cause pain that may lead to reduced activity. A complex mix of factors can increase a
person’s risk for obesity. Some people have genes that make it difficult for them to lose weight.

 Genetic factors – Genetic factors play a permissive role and interact with environmental
factors to produce obesity. Studies suggest that heritable factors are responsible for 30 to
50% of the variation in adiposity, but most of the genetic polymorphisms responsible
have not yet been established. Thus, genetic contributions to common obesity likely exist,
but the molecular mechanisms for these factors have yet to be determined. and single-
gene defects, including Prader-Willi syndrome, account for less than 1% of childhood
obesity.
 Environment and community: Your environment at home, at school, and in your
community can all influence how and what you eat, and how active you are. You may be
at a higher risk for obesity if you, live in a neighborhood with limited healthy food
options or with many high-calorie food options, like fast-food restaurants haven’t yet
learned to cook healthy meals, haven’t found a good place to play, walk, or exercise in
your neighborhood.
 Endocrine disease – Endocrine causes of obesity are identified in less than 1% of
children and adolescents with obesity. The disorders include hypothyroidism, cortisol
excess (i.e., the use of corticosteroid medication, Cushing syndrome), growth hormone

11
 deficiency, and acquired hypothalamic lesions (i.e., infection, vascular malformation,
neoplasm, trauma).
 Metabolic programming and maternal nutrition during gestation – There is
increasing evidence that environmental and nutritional influences during critical periods
in development (infancy and early childhood) can have permanent effects on an
individual’s predisposition to obesity and metabolic disease. The precise mediators and
mechanisms for these effects have not been established, but are the subjects of ongoing
investigations.
 Additional maternal endocrine factors – Other markers of the maternal endocrine
milieu, such as younger mother’s age at menarche, are also associated with childhood
obesity, although the mechanisms for that association still are unknown.
 Sleep – Cross-sectional studies suggest an association between shortened sleep duration
and obesity or insulin resistance, after adjustment for a number of potential
environmental confounders [20,21]. The mechanism for the association has not been
established, but may include alterations in serum leptin and ghrelin levels, both of which
have been implicated in the regulation of appetite, or perhaps less sleep creates greater
opportunity to ingest food.
 Psychological and other factor :Depression can sometimes lead to weight gain, as some
people may turn to food for emotional comfort. Certain antidepressants can also increase
the risk of weight gain. Quitting smoking is always a good thing, but quitting may lead to
weight gain too. In some people, it may lead to excessive weight gain. For that reason,
it’s important to focus on diet and exercise while you’re quitting, at least after the initial
withdrawal period.
 Medications, such as steroids or birth control pills, can also raise your risk for weight
gain

Iatrogenic causes include :

 Drugs and hormones

 Hypothalamic surgery.
 Tube feeding.
 Dietary obesity.
 Infant feeding practices.
 Progressive hyperplastic obesity
 Frequency of eating
 High fat diets
 Overeating

Neuroendocrine obesities :

 Hypothalamic obesity.

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  Seasonal affective disorder.
 Cushing's syndrome.
 Polycystic ovary syndrome.
 Hypogonadism.
 Growth hormone deficiency
 Pseudohypoparathyroidism

Social and behavioral factors:

 Socioeconomic status
 Ethnicity
 Psychological factors
 Restrained eaters
 Night eating syndrome
 Binge-eating
 Sedentary lifestyle
 Aging

Genetic (dysmorphic) obesities :

 Autosomal recessive traits

 Autosomal dominant traits.
 X-linked traits.
 Chromosomal abnormalities.

Etiology of obesity includes different factors; the role of genetic factors is minor. The
most important are environmental factors caused by either a sedentary lifestyle or a caloric intake
that is greater than the body’s needs. Increasing trends in glycemic index of foods, sugar-
containing beverages, larger portion sizes for prepared foods, fast food service, and decreasing
structured physical activity have all been considered as causal influences on the rise in obesity.
In particular, a number of well-designed studies have shown associations between intake of
sugar-containing beverages or low physical activity and obesity and/or metabolic abnormalities.
Television viewing and the use of electronic or video games are perhaps the best established
environmental influence on the development of obesity during childhood. There are several
proposed mechanisms for this association : displacement of physical activity, depression of
metabolic rate and poor information on diet quality.

CHILDHOOD OBESITY :

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 Childhood obesity has become one of the more alarming nutritional problems
plaguing the American population, with estimates as high as 25% of all children being obese.
Aside from obesity's associated risks, there are psychosocial and emotional burdens carried by
obese children as well. Clinicians are encountering many of these children in their clinics
everyday for other reasons and yet are failing to address the issue of obesity. The problem is not
so much that physicians are not recognizing it, but rather that they are ignoring it, especially if
the parent or child is unaware that there is a problem.

For a doctor to diagnose a child over 2 years old or a teen with obesity, their BMI has to be in the
95th percentile for people of their same age and biological sex. Percentile range of BMI Class
>5%underweight; 5% to <85%“normal” weight; 85% to <95%; overweight95% or overobesity.

14
 Several conclusions can be drawn on the basis of the research reviewed: Obese children
are more likely to become obese adults than are their thinner peers. Parent weight may interact
with child weight status in the etiology of adult obesity. Obese children with obese parents are
more likely to become obese adults than are obese children with thin parents. The prediction of
adult obesity from childhood obesity improves with the age of the child. As the obese child gets
older, he or she is more likely to become an obese adult. The inclusion of parents in the treatment
process is important for the success of childhood weight control. It may be best to see the parent
and child separately in treatment meetings rather than together. Children with thin parents may
do better in weight control than children of obese parents. Adherence to exercise is likely to be a
problem with obese children, and the choice or design of an exercise program should take these
adherence problems into account. Nutritional adequacy of the child's diet should be evaluated
both in terms of what the child is eating as well as in terms of the prescribed diet. Likewise,
growth of the obese child during dieting should be monitored and should be related to expected
height, which can be based on parent height. In summary, childhood obesity is a problem that
places a child at great risk for becoming an obese adult. However, a growing body of research
has emerged that has identified important risk factors for the development of obesity in children.
Likewise, treatment methods have been developed that produce significant and long-lasting
effects on childhood weight status. Continued development of treatment methods would be of
great potential importance in the prevention and treatment of this prevalent problem.

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SUB TYPES AND GENETIC MARKERS OF OBESITY :

A selective search of two databases (PubMed and the Cochrane Library) between 1998 and 2017
resulted in the selection of the most commonly reported subtypes of obesity and heterogeneity in
adults. The terminology used for searches was as follows: (i) metabolically obese (MO),
metabolically unhealthy obese (MUO), metabolically abnormal obese (MAO); (ii) metabolically
healthy obese (MHO); (iii) metabolically unhealthy normal weight, metabolically abnormal
normal-weight, normal weight obese; (iv) sarcopenic obese (SO); and (v) metabolically healthy
normal-weight. All these terms were cross-checked with the words, genes, epigenetic, genome-
wide association studies (GWAS), biomarkers and receiver operating characteristic (ROC)
analysis.

Heterogeneity in obese individuals :

Among overweight and obese individuals, significant heterogeneity of phenotypes occurs, which
is directly related to the participation of molecules, genes and cells, in addition to environmental,
social and economic factors. For example, central obesity (also known as visceral obesity) is
evident from an apple or android-shaped body, and confers a greater risk of developing
metabolic complications. On the other hand, peripheral obesity, or peripheral fat accumulation in
the gluteofemoral region, gives a pear-shaped body and has a gynecoid phenotype associated
with reduced metabolic risk25. One of the most commonly accepted diagnoses for obesity in a
caucasian population is evidence of a BMI equal to or >30 kg/m26. However, BMIs differ with
ethnicity. A study on Dual-energy X-ray absorptiometry (DEXA) indicates that a BMI of 28
kg/m2 in men, and of 24 kg/m2 in women correlates better with adiposity27. It is generally
acknowledged that BMI indicates general adiposity, and the waist:height ratio (WHtR) indicates
abdominal adiposity28. People with ≥0·5 WHtR are classified as having high abdominal
adiposity29, although it may vary in different populations30. A discrepancy also exists,
particularly in individuals who have higher muscle mass31.

Metabolically healthy obese (MHO) :

MHO group or metabolically normal obese, or metabolically benign obese has been studied
extensively32, and, depending on the method of classification, represents 6-40 per cent of the
obese population. However, these terms are inconsistent with the pathology, leaving no clear
consensus on phenotype. The metabolic spectrum is defined in numerous studies33. The
homeostatic model assessment (HOMA) index is also used in MHO classification to identify an
increased risk of mortality11. In all MHO individuals, insulin levels and insulin resistance
indices for HOMA, quantitative insulin-sensitivity check index (QUICKI), and Mffm/l, high-
sensivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) are similar to a healthy
population15. In addition, higher or lower HOMA, Quicki or Mffm/l results are not specific to
any particular obesity phenotype. However, MHO individuals show increase in other biomarkers,

16
such as, leptin. MHO individuals have a higher risk of developing metabolic syndrome when
compared to healthy individuals of normal weight. Over time, there has been a transition from a
metabolically healthy overweight/obese phenotype to a metabolically abnormal
overweight/obese phenotype. Wang et al found that MHO, in particular, was associated with
subclinical cardiovascular dysfunction, lower global longitudinal systolic strain, dyssynchrony
and early diastolic dysfunction. Chang et al reported that MHO individuals had a higher
prevalence of subclinical coronary atherosclerosis than metabolically healthy normal-weight
individuals; however, later studies suggested that these problems of MHO individuals might be
even higher than in the metabolically unhealthy group.

The inflammatory state is reduced in MHO and may be explained by the fatty acid profile of
myristic, palmitic, stearic, oleic and linoleic acids. MHO is also associated with lower levels of
proinflammatory proteins and higher levels of anti-inflammatory molecules, such as
overexpression of fetuin-A (AHSG), histidine-rich glycoprotein (HRG) and retinol-binding
histidin-rich protein 4 (RBP4), and downregulation of histamine releasing peptide (HRP),
hsCRP, complement factor 4A (C4A), and inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4).
Together, these opposing effects counteract each other creating a pro-/anti-inflammatory profile.
One particular feature of MHO is an abnormality in Bromodomain and extra terminal (BET)
proteins. Wang et al discovered a connection between Brd2 obesity and T2DM. The Brd2
isoform promotes pancreatic β-cell function and proliferation and is one of the protein factors
regulating gene transcription. It binds with acetylated lysines in nucleosomal chromatin and
plays a role in energy metabolism. In MHO, a disruption of the BRD2 gene in the promoter
region results in a reduced level of activity. BRD2 knockdown in mice protects them from
insulin resistance and pancreatic β-cell dysfunction. Inhibition of BET proteins may increase
insulin production and improve pancreatic β-cell function.

Metabolically abnormal obese (MAO) :

A significant number of individuals in this group are overweight and have central obesity with
metabolic syndrome, T2DM, cardiovascular or cerebrovascular disease and are likely to present
diastolic or systolic high blood pressure and increased waist-hip circumference. This group
differs significantly from the metabolic healthy obese subtype in levels of postprandial blood
glucose, high-density lipoprotein cholesterol, triglycerides, insulin and adiponectin. Some of
these are measured on the HOMA-IR despite variations. Certain biomarkers associated with
metabolic syndrome, such as alanine aminotransferase, can increase greatly, but are still within
the normal range of reference. In addition, the International Diabetes Federation (IDF),
American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI)
have published a document on harmonizing the metabolic syndrome. The consensus criteria for a
clinical diagnosis of metabolic syndrome is based on this document.

In the overweight and obese individuals, cardiometabolic risk is one of the main problems for
which waist circumference (WC), and WHtR are used for identification. The other examples of

17
heterogeneity expression are observed in the pro-inflammatory cytokines IL-6, IL-8, monocyte
chemoattractant protein 1 (MCP-1), regulated on activation, normal T cell expressed, and
secreted (RANTES), macrophage inflammatory protein 1 alpha (MIP1α), and plasminogen
activator inhibitor-1 (PAI 1) in visceral adipose tissue (VAT), whereas leptin and interferon
inducible protein 10 are expressed mainly in subcutaneous AT (SAT). VAT is related to
metabolic disorder and to upregulated activation and expression. Leucine rich repeat containing
receptor family pyrin domain containing 3 (NLRP3) gene and IL1b are upregulated in VAT,
which is infiltrated by proinflammatory macrophages in the MUO/MAO subgroup. Marques-
Vidal et al showed increased levels of hsCRP and also tumor necrosis factor-alpha (TNF-α) in a
Swiss population based study which was associated with an increase in WC in men, and BMI in
women.

It has been shown that high carbohydrate comsumption and environmental factors
among others modulate genotype interactions increases risk of obesity. Therefore, epigenetic
mechanisms increase the number of changes in the genome, which may be related to the different
phenotypes of obesity. All gene variants are related to an increased risk of obesity; for example,
the fat mass and obesity associated gene (FTO rs9939609) signicantly predisposes an individual
to diabetes and increased BMI and hip circumference. However, Veerman explained that the
predictive power of this gene was attenuated significantly by its incomplete penetrance,
suggesting that exploring gene expression in medical practice has limited relevance. Subgroups
or subtypes of heterogeneity have also been reported in other studies. A clinical subgroup of
MAO is the hypertriglyceridaemic-waist phenotype (HTGW), which is classified by increased
WC and increased fasting triglyceride levels, and a cluster of factors related to metabolic
syndrome55. An epigenetic mechanism, known as DNA methylation, which is found in the
HTGW phenotype in carnitine palmitoyltransferase 1A (CPT1A) and ATP binding cassette
subfamily G member 1 (ABCG1) genes, may modify gene function through the addition of
methyl to DNA. This process is strongly associated with HTGW in epigenome-wide analysis56.
A number of methylated CpG loci are also associated with obesity. Crujeiras et al57 showed that
DNA methylation levels in obese insulin resistant or insulin sensitive patients could be classified
by the clamp technique. Through genome-wide epigenetic analysis, 982 differentially methylated
CpG sites (DMCpGs) were found in VAT. As proposed by Huang et al58, most of these
DMCpGs could be related to the insulin pathway, and some could be used as markers.
Pietiläinen et al59 studied SAT in monozygotic twins with different body masses and found 17
obesity-associated genes with differentially methylated 22 CpGs regions.

Metabolically obese normal weight (MONW) :

The MONW is also known as metabolically abnormal with no obesity, metabolically abnormal
individuals with no obesity (MANO), normal weight dyslipidaemia, or pre-obesity. As in other
subtypes, MONW has multiple definitions, most of which are inconsistent. Metabolically

18
abnormal individuals with a normal BMI and no visual signs of obesity are also known as pre-
obese individuals. More than 23 per cent BF is evident in men and 30 per cent in women62 and
both may have a visceral fat area (VFA) of ≥100 cm2 with a variable BMI cut off of <23, <25, or
<26 kg/m2. The abnormal accumulation of BF in MONW10, accounts for only a small number
of cases but takes into consideration VFA and BF percentage. These individuals may also
develop prediabetes or borderline dyslipidaemia with upper-normal WC. In studies conducted in
the USA, 24 per cent of adults of normal weight (BMI <25 kg/m2) are considered metabolically
abnormal and are at a high-risk of chronic diseases11 such as T2DM and cardiovascular disease.
These individuals are physically inactive, have a BMI in the range of 20-27 kg/m2 and a fat mass
of 2-10 kg, which is more than healthy controls of the same age.

In MONW, some members of the same family may be hypertensive and have metabolic
syndrome or cardiovascular disease, and a small number may be diabetic, although it is notable
that the risk of developing diabetes mellitus is not dependent on central obesity, it depends on a
number of factors in positive metabolic syndrome. The adipose mass represents an important
source of proinflammatory cytokines in obese individuals, and circulating concentrations of
hsCRP, TNF-α, IL-1 α, IL-1β, IL-6 and IL-8 are elevated. HsCRP in adults is strongly associated
with a number of factors also seen in metabolic syndrome, central obesity and increased
cardiovascular risk; however, it may not be specific to any obesity phenotype. Yaghootkar et al
reported on monogenic forms of insulin resistance in a subtype of MONW with a ‘lipodystrophy-
like’ phenotype linked to 11 genetic variants. It can lead to hypertension, coronary artery disease
and diabetes mellitus.

Sarcopenic obesity:

Sarcopenic obesity, or sarcopenically obese, is defined as a reduction in lean mass and is

associated with predicting factors such as increased age, low socio-economic status, smoking,
decreased physical activity, atherosclerosis and pulmonary disease. These factors are related to
an accumulation of BF and a decrease in skeletal muscle mass and muscle strength. The
prevalence of sarcopenic obesity in adults over 65 yr is higher in countries such as Mexico
(10.2%), South Africa (10.3%) and Spain (11%). For diagnosis, the under quintile of the skeletal
muscle index (muscle skeletal/BMI) is commonly used, along with the measurement for grip
strength (<30 kg for men and <20 kg for women). BF is measured by skinfold thickness,
bioelectrical impedance analysis (BIA), DEXA, or calculation of predictive formulae, among
other criteria12. DEXA not only detects adiposity but also shows osteopenia and osteoporosis.
BIA, is quick, inexpensive and non-invasive and is useful in clinical practice. It measures body
composition and is based on resistance and reactance. Although there is no direct relation
between resistance, reactance and adiposity, a different BIA prediction equation has been found
which gives a positive predictive value for fat-free mass (FFM) in adults, for males and females.

In particular, in sarcopenia studies with BIA, there are three main issues that need to be
considered: (i) lack of standardization in the definition of sarcopenia, (ii) selection of

19
adequate/appropriate equations to calculate FFM or appendicular lean soft tissue, and (iii)
selection of population-specific cut-off points. Sarcopenic obesity can exist in individuals of
different ages, not only in the older adult. Kim et al showed the prevalence of non-sarcopenic
non-obese (53%), sarcopenic non-obese (10%), non-sarcopenic obese (20%) and sarcopenic
obese (15%) individuals. They found an increase in the systolic blood pressure in the sarcopenic
groups. Inflammatory markers, such as hsCRP, increase in males with sarcopenic obesity.
Further, an increase in MCP-1 in serum marks the proinflammatory state. Several loci are
associated with sarcopenic obesity, such as those located in PTPRD, CDK14 and IMMP2L
genes23. Similarly, single nucleotide polymorphism (SNPs), such as the TP53 polymorphism,
predict the risk of sarcopenia, contrasting with other kinds of obesity. An association between
−308 G/A TNF-α polymorphism and sarcopenic obesity was also established.

Adipose tissue, biomarkers and heterogeneity. There are three varieties of adipocytes: brown,
white and beige. In humans, brown adipocytes are found in the neck, interscapular and
supraclavicular areas. White adipocytes are found in subcutaneous and visceral regions, while
beige are found in the supraclavicular region, inguinal canal and near the carotid sheath and the
long muscle of the neck (musculus longus colli). White adipose tissue (WAT) has an intrinsic
heterogeneity with depot-specific differences. Subcutaneous depot expresses higher levels of
TBx15 gene (T-Box transcription factor 15) and adiponectin in visceral WAT than other
markers. Percentages of arachidonic acid and docosahexaenoic acid are higher in subcutaneous
WAT and have an upregulation of 5-lipoxygenase in T2DM in women, in contrast to VAT
(vWAT). Other methods providing quantitative non-invasive biomarkers include magnetic
resonance imaging88, near-infrared-based optical spectroscopy and nuclear magnetic resonance
(NMR), the last two of which have been validated by determining hepatic fat content through a
minimally invasive needle-like probe89. In addition, high-resolution pulsed field gradient
diffusion NMR spectroscopy might delineate WAT and brown AT. The adipocytes produce a
number of cytokines including adiponectin, leptin, interleukin (IL-6), PAI-1, adipsin, TNF-α,
resistin, angiotensinogen, aromatase and CRP91. These are related to obesity, hypertension,
atherosclerosis, diabetes and thrombosis, and some have a strong association with eating
behaviours, chronic inflammation and metabolic disease. Abdominal obesity is associated with
an increase in IL-6, while BMI and WC relate to TNF-α levels. Lim et al found that BMI was a
poor indicator of excess adiposity in the elderly and showed that WC was a better marker. They
also associated MCP-1 with the proinflammatory state, in accordance with studies by Yang et
al22 in which they found an increase in hsCRP in elderly males with sarcopenic obesity.

Accuracy and limitations in terminology and biomarkers:

When considering the main group classifications for, monogenic, polygenic,

multifactorial obesity and mixed cases9, monogenic is proved to be the most useful in
confirming the specific type by molecular methods, and subsequently, implementing strategies
for personalized medicine. In cases linked to multiple genes or polygenic phenotypes, the study
of genetic markers is not beneficial in clinical diagnosis. This takes into consideration that

20
genetic predisposition is not equal to inevitability of disease in wider concept. A wide spectrum
of disease susceptibility may be evident from the genes found in polygenic obesity (for example,
in genes LEPR, MC4R, PCK1, POMC and PPARG), and is also significant in monogenic
obesity. This indicates that highly penetrant rare variants may be related to severe obesity, and
genes with common variants could be related to more common obesity. In addition, FTO, the
gene most strongly associated with obesity, only explains 0.34 per cent of phenotypic variance,
which increases to 1.45 per cent with 32 GWAS. Several of studies claimed that parental BMI,
birth weight, maternal occupation, maternal gestational weight and gestational smoking gave a
better predictive risk of obesity than GWAS. Therefore, genetic studies should be endorsed only
in individuals with early-onset obesity if they have intellectual disabilities or exhibit
developmental delays, or in syndromic types.Without agreed terminology, at present, no research
or clinical diagnoses define the different phenotypes sufficiently. Paradoxically, if the individual
has normal biochemical blood parameters, they are considered healthy. The question, originally
raised by Scully, still remains, as to how to properly distinguish between a real disease and
merely disturbing risk factors, defects or deficits. One other concern of MHO diagnosis is the
doctor´s bias towards, or perception of a patient. Other obesity subgroups related to diet, physical
activity chemical compounds and endocrine disruptors (dichloro-diphenyl-dichloro-ethylene,
bisphenol A, polychlorinated biphenols, phthalates, phytoestrogens, glycyrrhetinic acid and
tricyclic antidepressants among others), have not been taken into consideration, that will very
likely be participating.

PATHOPHYSIOLOGY OF OBESITY :

Much has been learned in the past decade regarding the regulation of obesity as it
relates to the molecular regulation of appetite that affects energy homeostasis, particularly as
positive energy balance upsets lipid and glucose metabolism. Furthermore, obesity appears to
play a central role in the dysregulation of cellular metabolism that accounts for insulin resistance
in diabetes mellitus type 2.

Excess adipocytes secrete numerous cytokines that contribute to vascular

dysfunction in hypertension and dyslipidemia, as manifested by hypercholesterolemia and
triglyceridemia. These conditions eventually contribute to significant atherosclerosis, and when
associated with obesity and/or diabetes and insulin resistance, they constitute the metabolic
syndrome. New knowledge related to fatty liver and its association with inflammation, as well as
visceral adiposity's effect on gastroesophageal reflux, gallstone disease, and cancer of the bowel,
also make the liver and gut vulnerable to comorbidities of obesity. A detailed explanation of the
pathophysiology of obesity, or excess adiposity, and its comorbidities follows.

21
Dysregulation of Lipid and Glucose Metabolism: Lipotoxicity and Insulin Resistance in
Obesity :

The abundance of stored fat is required for survival during nutritionally deprived states such as
starvation. In times of prolonged abundance of food, however, very efficient fat storage results in
the excessive storage of fat, eventually resulting in obesity. It has been hypothesized that the
storage of fatty acid as triacylglycerol within adipocytes protects against fatty acid toxicity;
otherwise, free fatty acids would circulate freely in the vasculature and produce oxidative stress
by disseminating throughout the body. However, the excessive storage that creates obesity
eventually leads to the release of excessive fatty acids from enhanced lipolysis, which is
stimulated by the enhanced sympathetic state existing in obesity.

The release of these excessive free fatty acids then incites lipotoxicity, as lipids
and their metabolites create oxidant stress to the endoplasmic reticulum and mitochondria. This
affects adipose as well as nonadipose tissue, accounting for its pathophysiology in many organs,
such as the liver and pancreas, and in the metabolic syndrome. The free fatty acids released from
excessively stored triacylglycerol deposits also inhibit lipogenesis, preventing adequate clearance
of serum triacylglycerol levels that contribute to hypertriglyceridemia. Release of free fatty acids
by endothelial lipoprotein lipase from increased serum triglycerides within elevated β
lipoproteins causes lipotoxicity that results in insulin-receptor dysfunction.

The consequent insulin-resistant state creates hyperglycemia with compensated hepatic

gluconeogenesis. The latter increases hepatic glucose production, further accentuating the
hyperglycemia caused by insulin resistance. Free fatty acids also decrease utilization of insulin-
stimulated muscle glucose, contributing further to hyperglycemia. Lipotoxicity from excessive
free fatty acids also decreases secretion of pancreatic β-cell insulin, which eventually results in
β-cell exhaustion.

22
The Specific Role of Adipocyte Inflammatory cytokines (Adipocytokines), Including Effects
of Hypertension, Macrophage, and Immune Functions :

Sites and Function of Adipokines:

Adipocytes, consisting of over one billion cells, not only store triacylglycerol in fat depots in
various body sites to provide energy reserves, but in aggregate constitute the largest endocrine
tissue that constantly communicates with other tissues by adipocyte-released secretagogues, such
as the proteohormones lectin, adiponectin, and visfatin. Along with insulin, these
proteohormones help regulate body-fat mass. Other gene groups that contribute to adipocyte
adipokines include cytokines, growth factors, and complement proteins. These include the
inflammatory adipokines tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 that cause
local steatonecrosis, but are also distributed by the vascular system and cause inflammation
elsewhere. The enhanced fat content in muscle becomes so significant in severe obesity that
whole-body magnetic resonance imaging reveals cumulative fat depots in muscle sites similar in
size to that of total visceral adipose tissue. Buttock fat appears to be largely inert with respect to
endocrine function, as this fat is used largely for long-term energy reserves. Visceral fat depots
release inflammatory adipokines, which, along with free fatty acids, provide the
pathophysiologic basis for comorbid conditions associated with obesity such as insulin resistance
and diabetes mellitus type 2. Visceral adipokines are transported by the portal vascular system to
23
the liver, enhancing nonalcoholic steatohepatitis (NASH), and also by the systemic circulation to
other diverse sites. Along with fatty-acid lipotoxicity, visceral adipokines also contribute to the
adipokine inflammatory injury that leads to pancreatic β-cell dysfunction, which, in turn,
decreases insulin synthesis and secretion.

Role of Specific Adipokines :

Dyslipidemia, hypertension, and atherogenesis are comorbid conditions, in addition to insulin

resistance, that are associated with obesity and adversely influenced by the secretion of diverse
inflammatory adipokines, particularly from white adipose tissues (WAT) in visceral fat depots.
Specific adipokines enhance endothelial vasomotor tone by secreting renin, angiotensinogen, and
angiotensin II, which are similar to those within the renal renin-angiotensin system (RAS), but
when secreted from adipocytes, enhance hypertension in obese patients. TNF-α secretion
increases in proportion to increased total body-fat mass and enhances inflammation in fatty livers
and fat depots elsewhere, particularly in pancreas, mesentery, and gut visceral sites.
Inflammatory markers that are increased in obesity commonly contribute to inflammatory
conditions such as NASH and in the bronchial tree of patients with obstructive sleep apnea.
These markers include not only TNF-α and IL-6, but also acute-phase reactants such as C-
reactive protein, α1 acid glycoprotein, and the specific amyloid antigen, particularly in the fatty
liver. The acute-phase reactants are important inflammatory markers that are also upregulated in
the insulin-resistant state associated with diabetes mellitus type 2 and NASH. Adipocytes also
stimulate fat-associated macrophages that also secrete monocyte chemoattractant protein 1
(MCP-1), macrophage migration inhibiting factor (MMIF), and resistin, all of which decrease
insulin sensitivity (ie, enhance insulin resistance). These macrophages contribute to the enhanced
inflammatory state and, as immune stimulators, enhance the mitogenactivated protein kinase
family (C-Jun N-terminal Kinase, inhibitor of nuclear factor kappa beta [NF-KB] Kinase b, and
phosphatidylinositol 3-Kinase), inducing the transcription factor NF-KB that allows
dephosphorylation of the IRS-1 and -2 docking proteins. The latter inhibits the GLUT4
transporter of glucose, resulting in insulin resistance.

The progressive pro-inflammatory state resulting from increased obesity that promotes insulin
resistance also perpetuates atherogenesis throughout its development, from early endothelial
fatty streaks to late-plaque formation, rupture, and thrombosis. Endothelial modulators—such as
vasoactive endothelial growth factor, plasminogen activator inhibitor-1, angiotensinogen, renin,
and angiotensin I- are secreted by white fat cells, in particular by perivascular fat tissues that
contribute to vasomotor dysfunction and cause hypertension and endothelial injury. This process
is followed by the formation of foam cells following the enhanced endothelial uptake of oxidized
low density lipoproteins, free fatty acids, and other lipid metabolites that accumulate as a result
of fatty acid peroxidation—all of which originate from dyslipidemic β-lipoproteins. Both
endothelial and adipose cell lipoprotein lipase activity are also decreased by inflammatory
cytokines such as IL-6, so that by inhibiting lipolysis they increase serum triacylglycerol levels
accentuating hyper-triglyceridemia. Later, as atherosclerosis progresses with macrophage and

24
smooth–muscle cell infiltration, there is additional secretion of other cytokines, such as MCP-1,
MMIF, and endothelin-1, that enhance the evolving inflammatory lesions of atherosclerotic
plaques within the vascular wall. Other adipokine procoagulants include plasminogen activator
inhibitor-1, IL-6, tumor growth factor-β, and TNF-α, which cause thrombosis, particularly from
ruptured atherosclerotic plaques. Progression of atherosclerosis with plaque formation and
remodeling of collagen results from the action of matrix metalloproteinases also secreted by
adipocytes. This activity causes atheroma cap thinning and plaque rupture that precipitates
release of the tissue factor, also promoting intravascular thrombosis. Adipokines also enhance
angiogenesis and promote adipogenesis by neovascularization enhancement of WAT. Immune
and inflammatory mediator effects on the comorbidities of obesity, including atherosclerosis.

COMPLICATIONS OF OBESITY :

Over the last few decades, obesity has become an increasing public health problem worldwide,
and its related conditions differ by region. For example, in China, Russia and South Africa,
obesity is associated with hypertension, angina, diabetes and arthritis, whereas in India, it is
associated with hypertension. Obesity can also lead to a wide variety of other illnesses. Overall,
obesity is defined as the excessive accumulation or abnormal distribution of body fat (BF),
affecting health. It is classified, primarily, by body mass index (BMI, kg/m2), which is a very
limited criterion. Obesity is complicated by other diseases such as type 2 diabetes mellitus
(T2DM), hepatic steatosis, cardiovascular diseases, stroke, dyslipidaemia, hypertension,

25
gallbladder problems, osteoarthritis, sleep apnoea and other breathing problems and certain types
of cancer (endometrial, breast, ovary, prostate, liver, gallbladder, kidney and colon), all of which
can lead to an increased risk of mortality. Cases related to pituitary, thyroid and adrenal gland
diseases are considered an independent pathology but may indicate obesity. Each disease whose
risk is increased by overweight can be classified into one of two pathophysiological categories.
The first category of disabilities arises from the increased mass of fat itself. These include the
stigma of obesity and the behavioral responses it produces, osteoarthritis, and sleep apnea. The
second category is risks that result from the metabolic changes associated with excess fat. These
include diabetes mellitus, gallbladder disease, hypertension, cardiovascular disease, and some
forms of cancer associated with overweight.

26
Characteristics of fat cell :

The fat cell can be viewed as a type of endocrine cell, and adipose tissue as an endocrine organ.
It is the hypertrophy and/or hyperplasia of this organ that is the pathologic lesion in obesity.
After the identification of adipsin or complement D in the fat cell, a number of other secretory
peptides were found. Leptin clearly is the most important and secures the role of the adipocyte as
an endocrine cell and fat as an endocrine organ. From the pathophysiological perspective,
however, the release of free fatty acids may be the most important.

27
Fat distribution is important in the response to the endocrine products of the fat cell. The
accumulation of fat in visceral fat cells is modulated by a number of factors. Androgens and
estrogen produced by the gonads and adrenals as well as peripheral conversion of Δ4-
androstenedione to estrone in fat cells are pivotal in body fat distribution. Male, or android, fat
distribution and female, or gynoid, fat distribution develop during adolescence. The increasing
accumulation of visceral fat in adult life is related to gender, but the effects of cortisol,
decreasing GH, and changing testosterone levels are important in age-related fat accumulation.
Increased visceral fat enhances the degree of insulin resistance associated with obesity and
hyperinsulinemia. Together, hyperinsulinemia and insulin resistance enhance the risk of the
comorbidities described below

Diseases associated with increased fat mass :

1. Psychosocial function. :Overweight is stigmatized ; that is, overweight individuals are

exposed to the consequences of public disapproval of their fatness. This stigma occurs in
education, employment, health care, and elsewhere. One study that used the Medical
Outcomes Study Short-Form Health Survey (SF-36) demonstrated that obese people
presenting for treatment at a weight management center had profound abnormalities in
health-related quality of life. Higher body mass index (BMI) values were associated with
greater adverse effects. Obese women appear to be at greater risk of psychological

28
 dysfunction than obese men; this is potentially due to increased societal pressures on
women to be thin. Intentional weight loss improves the quality of life. Severely obese
patients who lost an average of 43 kg through gastric bypass demonstrated improvements
in all domains of the SF-36 to such an extent that their postweight loss scores were equal
to or better than population norms.
2. Sleep apnea : Alterations in pulmonary function have been described in overweight
subjects, but subjects were free of other potential chronic pulmonary diseases in only a
few studies. When underlying pulmonary disease was absent, only major degrees of
increased body weight significantly affected pulmonary function. The chief effect is a
decrease in residual lung volume associated with increased abdominal pressure on the
diaphragm. Fat distribution, independent of total fat, also influences ventilatory capacity
in men, possibly through the effects of visceral fat level. In contrast to the relatively
benign effects of excess weight on respiratory function, the overweight associated with
sleep apnea can be severe. Overweight subjects with obstructive sleep apnea show a
number of significant differences from overweight subjects without sleep apnea. Sleep
apnea was considerably more common in men than women, and as a group, subjects were
significantly taller than individuals without sleep apnea. People with sleep apnea have an
increased snoring index and increased maximal nocturnal sound intensity. Nocturnal
oxygen saturation also is significantly reduced. One interesting hypothesis is that the
increased neck circumference and fat deposits in the pharyngeal area may lead to the
obstructive sleep apnea of obesity.
3. Diseases of the bones, joints, muscles, connective tissue, and skin : Osteoarthritis is
significantly increased in overweight individuals. The osteoarthritis that develops in the
knees and ankles may be directly related to the trauma associated with the degree of
excess body weight. However, the increased osteoarthritis in other nonweight-bearing
joints suggests that some components of the overweight syndrome alter cartilage and
bone metabolism independently of weight bearing. Increased osteoarthritis accounts for a
significant component of the cost of overweight. Several skin changes are associated with
excess weight. Stretch marks, or striae, are common and reflect the pressures on the skin
from expanding lobular deposits of fat. Acanthosis nigricans with deepening
pigmentation in the folds of the neck, knuckles, and extensor surfaces occurs in many
overweight individuals, but is not associated with increased risk of malignancy.
Hirsutism in women may reflect the altered reproductive status in these individuals

Diseases associated with hypersecretion from enlarged fat cells :

1. Diabetes mellitus, insulin resistance, and the metabolic syndrome : Type 2 diabetes
mellitus is strongly associated with overweight in both genders in all ethnic groups. The
risk of type 2 diabetes mellitus increases with the degree and duration of overweight and
with a more central distribution of body fat. The relationship between increasing BMI
and the risk of diabetes in the Nurses Health Study is shown in Fig. 2. The risk of

29
 diabetes was lowest in individuals with a BMI less than 22 kg/m2. As BMI increased, the
relative risk increased, such that at a BMI of 35 kg/m2, the relative risk increased 40-fold,
or 4000%. A similar strong curvilinear relationship was observed in men in the Health
Professionals Follow-Up Study. The lowest risk in men was associated with a BMI less
than 24 kg/m2, slightly higher than that for the women in the Nurses Health Study. At a
BMI above 35 kg/m2, the age-adjusted relative risk for diabetes in nurses increased to
60.9, or more than 6000% Weight gain also increases the risk of diabetes. Up to 65% of
cases of type 2 diabetes mellitus can be attributed to overweight. Of the 11.7 million
cases of diabetes, overweight may account for two thirds of diabetic deaths. Using the
BMI at age 18 yr, a 20-kg weight gain increased the risk for diabetes 15-fold, whereas a
weight reduction of 20 kg reduced the risk to almost zero. In the Health Professionals
Follow-Up Study, weight gain was also associated with an increasing risk of noninsulin-
dependent diabetes mellitus, whereas a 3-kg weight loss was associated with a reduction
in relative risk. Weight gain appears to precede the onset of diabetes. Among the Pima
Indians, body weight steadily and slowly increased by 30 kg (from 60 to 90 kg) in the
years preceding the diagnosis of diabetes (11). After the diagnosis of diabetes, body
weight slightly decreased. In the Health Professionals Follow-Up Study, relative risk of
developing diabetes increased with weight gain as well as with increased BMI. In long-
term follow-up studies, the duration of overweight and the change in plasma glucose
during an oral glucose tolerance test also were strongly related. When overweight was
present for less than 10 yr, plasma glucose was not increased. With longer durations, of
up to 45 yr, a nearly linear increase in plasma glucose occurred after an oral glucose
tolerance test. The risk of diabetes is increased in hypertensive individuals treated with
diuretics or β-blocking drugs, and this risk is increased in overweight subjects.

In the Swedish Obese Subjects Study, Sjostrom et al. observed that diabetes was present in 13–
16% of obese subjects at baseline. Of those who underwent gastric bypass and subsequently lost
weight, 69% who initially had diabetes went into remission, and only 0.5% of those who did not
have diabetes at baseline developed it during the 2 yr of follow-up. In contrast, in the obese
control group that lost no weight, the cure rate was low (16%), and the incidence of new cases of
diabetes was 7.8%.

Weight loss or moderating weight gain over years reduces the risk of developing diabetes. This is
most clearly shown in the Health Professionals Follow-Up Study, in which relative risk declined
by nearly 50% with a weight loss of 5–11 kg. Type II diabetes was almost nonexistent with a
weight loss of more than 20 kg or a BMI below 20 kg/m2.

30
Both increased insulin secretion and insulin resistance result from obesity. The relationship of
insulin secretion to BMI has already been noted. A greater BMI correlates with greater insulin
secretion. Obesity develops in more than 50% of nonhuman primates as they age. Nearly half of
these obese animals subsequently develop diabetes. The time course for the development of
obesity in nonhuman primates, like that in Pima Indians, is spread over a number of years. After
the animals gain weight, the next demonstrable effects are impaired glucose removal and
increased insulin resistance, as measured by impaired glucose clearance with a euglycemic
hyperinsulinemic clamp. The hyperinsulinemia, in turn, increases hepatic very low density
lipoprotein (VLDL) triglyceride synthesis and secretion, increases plasminogen activator
inhibitor-1 synthesis, increases sympathetic nervous system activity, and increases renal sodium
reabsorption. Insulin resistance is the hallmark of the metabolic (or dysmetabolic) syndrome. A
central feature of this syndrome is increased visceral fat. This increased release of free fatty acids
impairs insulin clearance by the liver and altered peripheral metabolism. The reduced production
of adiponectin by the fat cell is another potential player in the development of insulin resistance.

2. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis : NAFLD

is the term that describes a constellation of liver abnormalities associated with obesity,
including hepatomegaly, elevated liver enzymes, and abnormal liver histology, such as
steatosis, steatohepatitis, fibrosis, and cirrhosis. A retrospective analysis of liver biopsy

31
 specimens obtained from overweight and obese patients with abnormal liver
biochemistries, but without evidence of acquired, autoimmune, or genetic liver disease,
demonstrated a 30% prevalence of septal fibrosis and a 10% prevalence of cirrhosis.
Another study using a cross-sectional analysis of liver biopsies, suggests that in obese
patients, the prevalences of steatosis, steatohepatitis, and cirrhosis are approximately
75%, 20%, and 2%, respectively.
3. Gallbladder disease : Cholelithiasis is the primary hepatobiliary pathology associated
with overweight. The old clinical adage “fat, female, fertile, and forty” describes the
epidemiological factors often associated with the development of gallbladder disease.
This is admirably demonstrated in the Nurses’ Health Study. When the BMI was less
than 24 kg/m2, the incidence of clinically symptomatic gallstones was approximately
250/100,000 person-years of follow-up. Incidence gradually increased with increased
BMI (to 30 kg/m2) and increased very steeply when the BMI exceeded 30 kg/m2. This
confirms published work by many other researchers. Part of the explanation for the
increased risk of gallstones is the increased cholesterol turnover related to total body fat.
Cholesterol production is linearly related to body fat; approximately 20 mg of additional
cholesterol are synthesized for each kilogram of extra body fat. Thus, a 10-kg increase in
body fat leads to the daily synthesis of as much cholesterol as is contained in the yolk of
one egg. The increased cholesterol is, in turn, excreted in the bile. High cholesterol
concentrations relative to bile acids and phospholipids in bile increase the likelihood of
precipitation of cholesterol gallstones in the gallbladder. Other factors, such as nidation
conditions, also determine whether gallstones form. During weight loss, the likelihood of
gallstones increases because the flux of cholesterol is increased through the biliary
system. Diets with moderate levels of fat that trigger gallbladder contraction and thus
empty its cholesterol content may reduce this risk. Similarly, the use of bile acids, such as
ursodeoxycholic acid, may be advisable if the risk of gallstone formation is thought to be
increased. The second gastrointestinal feature altered in obesity is the quantity of fat in
the liver. Increased steatosis is characteristic of the livers of overweight individuals and
may reflect increased VLDL production associated with hyperinsulinemia. The
accumulation of lipid in the liver suggests that the secretion of VLDL in response to
hyperinsulinemia is inadequate to keep up with the high rate of triglyceride turnover.
4. Hypertension : Blood pressure often is increased in overweight individuals. In the
Swedish Obesity Study, hypertension was present at baseline in 44–51% of the subjects.
One estimate suggests that control of overweight would eliminate 48% of the
hypertension in whites and 28% in blacks. For each decline of 1 mm Hg in diastolic
blood pressure, the risk of myocardial infarction decreases an estimated 2–3%.
Overweight and hypertension interact with cardiac function. Hypertension in normal
weight people produces concentric hypertrophy of the heart, with thickening of the
ventricular walls. In overweight individuals, eccentric dilatation occurs. Increased
preload and stroke work are associated with hypertension. The combination of
overweight and hypertension leads to thickening of the ventricular wall and larger heart
32
 volume, and thus to a greater likelihood of cardiac failure. The hypertension of
overweight people appears strongly related to altered sympathetic activity. During insulin
infusion, overweight subjects have a much greater increase in the muscle sympathetic
nerve firing rate than do normal weight subjects, but the altered activity is associated with
a lesser change in the vascular resistance of calf muscles. Hypertension is strongly
associated with type II diabetes, impaired glucose tolerance, hypertriglyceridemia, and
hypercholesterolemia, as noted above in the discussion of the metabolic syndrome.
Hyperinsulinemia in overweight and hypertensive patients suggests insulin resistance and
the metabolic syndrome. An analysis of the factors that predict blood pressure and
changes in peripheral vascular resistance in response to body weight gain showed that a
key determinant of the weight-induced increases in blood pressure was a disproportionate
increase in cardiac output that could not be fully accounted for by the hemodynamic
contribution of new tissue. This hemodynamic change may be attributable to a
disproportionate increase in cardiac output related to an increase in sympathetic
activity.Obesity may also affect the kidney. Glomerulopathy was significantly increased
in pathological specimens compared with other forms of end-stage renal disease.

5. Heart disease : Data from the Nurses’ Health Study indicate that the risk for U.S. women
developing coronary artery disease is increased 3.3-fold with a BMI greater than 29
kg/m2 compared with that in women with a BMI less than 21 kg/m2. A BMI of 27 to less
than 29 kg/m2 increases the relative risk to 1.8. Weight gain also strongly affects this risk
at any initial BMI. That is, at all levels of initial BMI, weight gain was associated with a

33
 graded increase in risk of heart disease. This was particularly evident in the highest
quintile, in which weight gain was more than 20 kg.
6. Dyslipidemia : may be important in the relationship of BMI to increased risk of heart
disease (23). A positive correlation between BMI and triglycerides has been repeatedly
demonstrated. However, the inverse relationship between high density lipoprotein (HDL)
cholesterol and BMI may be even more important, because a low HDL cholesterol carries
a greater relative risk than do elevated triglycerides. Central fat distribution is also
important in lipid abnormalities. Waist circumference alone accounted for as much as or
more of the variance in triglycerides and HDL cholesterol as either waist/hip ratio or
sagittal diameter, two other measures of central fat. A positive correlation for central fat
and triglyceride and the inverse relationship for HDL cholesterol are evident for all
measures.

Increased body weight is associated with a number of cardiovascular abnormalities. Cardiac

weight increases with increasing body weight, suggesting increased cardiac work. Heart weight
as a percentage of body weight, however, is lower than that in a normal weight control group.
The increased cardiac work associated with overweight may produce cardiomyopathy and heart
failure in the absence of diabetes, hypertension, or atherosclerosis. Weight loss decreases heart
weight; this decrease was linearly related to the degree of weight loss in both men and women.
An echocardiographic study of left ventricular midwall function showed that obese individuals
compensated by using cardiac reserve, especially in the presence of hypertension. Interestingly,
heart rate was well within normal limits. Central fat distribution is associated with small, dense
low density lipoproteins (LDL) as opposed to large, fluffy LDL particles. For a similar level of
cholesterol, the risk of coronary heart disease (CHD) is significantly higher in individuals with
small dense LDL than in those with large fluffy LDL. Because each LDL particle has a single
molecule of apolipoprotein B (apo B) protein, the concentration of apo B can be used to estimate
the number of LDL particles. Despres et al. demonstrated that the level of apo B is a strong
predictor of the risk for CHD. Based on a study of French Canadians, these researchers proposed
that estimating apo B, the levels of fasting insulin, the concentration of triglyceride, the
concentration of HDL cholesterol, and waist circumference could help identify individuals at
high risk for the metabolic syndrome and coronary heart disease.

7. Cancer. Certain forms of cancer are significantly increased in overweight individuals.

Males face increased risk for neoplasms of the colon, rectum, and prostate. In women,
cancers of the reproductive system and gallbladder are more common. One explanation
for the increased risk of endometrial cancer in overweight women is the increased
production of estrogens by adipose tissue stromal cells. This increased production is
related to the degree of excess body fat that accounts for a major source of estrogen
production in postmenopausal women. Breast cancer is not only related to total body fat,
but also may have a more important relationship to central body fat. The increased

34
 visceral fat measured by computed tomography shows an important relationship to the
risk of breast cancer.
8. Endocrine changes. A variety of endocrine changes are associated with overweight. The
changes in the reproductive system are among the most important. Irregular menses and
frequent anovular cycles are common, and the rate of fertility may be reduced. Some
reports describe increased risks of toxemia. Hypertension and cesarean section may also
be more frequent. Irregular menses, amenorrhea, and infertility are associated with
obesity. Women with a BMI greater than 30 kg/m2 have abnormalities in secretion of
hypothalamic GnRH, pituitary LH, and FSH, which results in anovulation.

SYMPTOMS OF OBESITY :

The symptoms of obesity go beyond excess body fat. Skin problems, shortness of breath, trouble
sleeping, and more can affect someone with obesity. Some symptoms are even known to increase
a person's risk of developing certain diseases and disorders. In some cases, these may be life-
threatening or even fatal.

Common symptoms of obesity in adults include:

 Excess body fat, particularly around the waist

 Shortness of breath
 Sweating more than usual
 Snoring
 Trouble sleeping
 Skin problems from moisture accumulating in the folds of skin
 Inability to perform simple physical tasks that one could easily perform before weight
gain
 Fatigue, which can range from mild to extreme.
 Pain, especially in the back and joints
 Psychological issues such as negative self-esteem, depression, shame, and social isolation

Morbid Obesity Symptoms :

Morbid obesity is a growing health concern in many developed countries of the world today,
particularly in the United States. When a person is 100 pounds over optimal body weight with a
BMI of 40 or more, they are considered morbidly obese. Morbid obesity is also called extreme
obesity or class III obesity. A person experiencing health conditions related to obesity, such as
high blood pressure or diabetes, with a BMI of 35 or more is also considered morbidly obese.
Morbid obesity can cause a person to struggle with everyday activities such as walking and can

35
make it hard to breathe. It also puts a person at high risk for many other serious health
conditions.

Rare Symptoms :

Early-onset obesity can develop in kids due to rare genetic disorders. These disorders involve
genes that play a role in regulating appetite and energy expenditure. These conditions and their
effects include:

 Pro-opiomelanocortin (POMC) deficiency obesity: Key symptoms include extreme

hunger (hyperphagia) starting during infancy, early-onset obesity, and hormonal
problems.
 Leptin receptor (LEPR) deficiency obesity: Key symptoms include hyperphagia, severe
early-onset obesity, and hypogonadotropic hypogonadism (a condition in which the male
testes or the female ovaries produce little or no sex hormones).
 Bardet-Biedl syndrome (BBS): Key symptoms include early-onset obesity, hyperphagia,
vision impairment, having an extra finger or toe (polydactyly), and kidney problems.

MORBIDITY RATE DUE TO OBESITY :

36
  Breathing disorders (e.g., sleep apnea, chronic obstructive pulmonary disease)
 certain types of cancers (e.g., prostate and bowel cancer in men, breast and uterine cancer
in women)
 coronary artery (heart) disease
 depression
 diabetes
 gallbladder or liver disease
 gastroesophageal reflux disease (GERD)
 high blood pressure
 high cholesterol
 joint disease (e.g., osteoarthritis)
 stroke
 reproductive system disorders, including decreased fertility.

People who are obese may have the symptoms of the medical conditions mentioned above.
High blood pressure, high cholesterol levels, breathing problems, and joint pain (in the knees
or lower back) are common. The more obese a person is, the more likely they are to have
medical problems related to obesity. Aside from the medical complications, obesity is also
linked to psychosocial problems such as low self-esteem, discrimination, difficulty finding
employment, and reduced quality of life.

DIAGNOSIS OF OBESITY :

37
 Body mass index (BMI) is the accepted standard measure of
overweight and obesity for adults and children 2 years of age and older [4,5]. Body mass
index provides a guideline for weight in relation to height, and is equal to the body
weight divided by the height in meters squared. Other measures include weight-for-height
and measures of regional fat distribution (e.g., waist circumference, and waist-to-hip
ratio). Adults with a BMI between 25 and 30 kg/m2 are considered overweight; those
with a BMI ≥30 kg/m2 are considered to be obese. A BMI threshold of ≥40 kg/m2
distinguishes individuals with severe obesity and the highest risks for comorbidities. This
category is sometimes termed “class III obesity” or “extreme obesity”. The term “morbid
obesity” is usually used to identify individuals with severe extreme obesity-related
complications.

An adult’s BMI can be determined using a BMI calculator. Healthcare providers use BMI
ranges to indicate a person's weight status. For adults, a BMI of:

 18.5 to 24.9 is considered normal weight.

 25.0 to 29.9 is considered overweight / moderately obese
 30.0 to 34.9 is considered obesity grade I
 35.0 to 39.9 is considered obesity grade II

38
  40.0 and higher is considered extreme obesity / grade III.

It is important to remember that although BMI is generally a good way to estimate how
much body fat a person has, it does not measure body fat directly and therefore is not
reliable in all cases. For example, a person may have extra weight because he or she is
athletic and has a lot of muscle, and not because he or she has excess body fat

Evaluation of health history: Doctor will ask about your weight history, physical
activities, lifestyle, medication, stress level and routine. The health care professional will
also check with other members of the family if they have a history of obesity.

Waist circumference measurement:

Visceral fat or abdominal fat (fat stored around your waist) imply obesity. Women with a
waist measurement (circumference) of over 35 inches are considered obese while men
with a waist measurement beyond 40 inches fall under “obese”. Numbers on a weighing
scale do not give a fair idea about body fat. Just like weight check, there are ways you
can monitor body fat. Body fat measurement is for everybody; be it those battling the
bulge or those trying to get a measure of overall body composition.

Skin-fold testing using calipers :

Calipers are used at body parts to see how much fat there is in those areas. The body fat
estimate is deduced after the reading is used in number of equations and formulae. It is
one of the most effective methods for measuring body fat.

Hydrostatic weight :

It is one of the oldest methods that used Archimedes’ principle to measure fat on the
body. People, dunked in water, sit atop a scale. Their weight–both dry and submerged–
and amount of water displaced are noted and then a formula is used to calculate the
body's density. It is inconvenient and not the ideal method for fat measurement.

Bioelectrical impedance analysis (BIA) :

It is quite a popular method of measuring body composition. In BIA, an electrical current

is applied to the body and then it is seen how quickly that current is conducted. Electrical
signals give a measure of lean tissue and fat mass.

Digital fat meters :

39
 There are several digital devices that claim to give an estimate of your body fat, lean
tissue, bone and mineral content. Most of these devices are accurate, but expensive.
Every fat measurement method has its drawbacks. It is good to know your true body fat
percentage, but it's usually best to put your energy into exercise and diet than worrying
about all the fat you have or will accumulate.

LIPID PROFILE :

A lipid panel measures the level of specific lipids in the blood. There are two types of
lipids

 Cholesterol
 Triglycerides - they are transported by lipoproteins.

Blood tests: Blood tests for cholesterol, liver function, fasting glucose, a thyroid test and
others provide an insight on your health condition. Heart tests such as an
electrocardiogram may be recommended by doctor.

Standard laboratory studies in the evaluation of obesity should include the following:

 Fasting lipid panel.

 Liver function studies.
 Thyroid function tests.
 Fasting glucose and hemoglobin A1c (HbA1c).

TREATMENT AND PREVENTION :

Changing your lifestyle

Obesity is managed and treated to decrease the health risks caused by obesity and to improve
quality of life. An appropriate weight management program usually combines physical activity,
healthy diet, and change in daily habits. Other programs may also involve psychological
counselling and, in some cases, drug therapy. Losing weight and keeping it off is very
challenging because lifestyle and behavioural changes are required.

What's important is to eat a healthy, balanced diet. Fad and crash diets don't work and can be
dangerous. The body needs a minimum amount of energy from food to function normally. No
daily diet with less than 1000 to 1200 calories should be used without medical supervision.
"Crash diets" are never successful in the long term because once the diet is stopped, the weight
usually comes back. Commercial weight-loss plans and clinics are successful businesses because
they have so many return customers.
40
To lose weight successfully, and to maintain a healthy weight, requires lifelong changes in eating
and exercise habits as well as an understanding of emotional factors that lead to overeating. It
also involves setting and achieving specific and realistic goals. People who are medically obese
should consult a doctor or dietitian for a safe and personalized weight-loss program. Behavioural
therapy or modification can also help. Seeing a therapist or counsellor can help you understand
the emotional and psychological reasons for overeating and can teach you ways to manage your
eating triggers.

Regular physical activity is an important part of weight management. In addition to managing

weight, exercise also improves overall health and can help reduce the risk of diseases such as
certain cancers, heart disease, and osteoporosis. Regular physical activity doesn't mean you have
to join the nearest gym. It can be as simple as climbing the stairs instead of taking the elevator,
walking or cycling to work and leaving the car at home (if at all possible), or going for a walk at
lunchtime with coworkers. What's important is to add exercise to your daily routine, and to work
towards a higher activity level. Choose activities and exercises you enjoy.

Medical intervention

Medications may be part of a weight management program. Medications aren't

"magic cures" leading to permanent weight loss. They're generally used in combination with a
proper diet and exercise program. They are only for people who are classified as obese (i.e.,
those with a BMI over 30), or people with a BMI of 27 and extra heart disease risk factors such
as high cholesterol or diabetes.

Some medications are approved for short-term use only. One example of a weight-
loss medication available in Canada is orlistat*, which blocks the absorption of fat from the
bowel. Liraglutide, a medication used mainly to treat type 2 diabetes, may also be used for
weight loss, as it decreases appetite and food intake. A combination of naltrexone and
bupropion may be used to help with weight loss. Naltrexone is thought to help by suppressing
appetite, while bupropion (traditionally used as an antidepressant) changes the amount of certain
chemicals in the brain which causes a reduction in food intake. Talk to your doctor about
whether medications are an option for you. Surgery is only considered when other weight
management options have not been successful. There are many forms of obesity surgery, but
often surgery reduces the size of the stomach so that only a small amount of food can be eaten
comfortably. Some of the terms used to describe the surgeries used to treat obesity include:

 Gastric bypass surgery refers to a technique in which the stomach is divided into a
small upper pouch and a much larger lower "remnant" pouch and then the small intestine
is rearranged to connect to both.
 laparoscopic band surgery / Sleeve gastrectomy or “sleeve” is performed by removing
approximately 80% of the stomach. The stomach is freed from organs around it, surgical

41
 staplers are used to removes the parts of stomach, making it much smaller in the shape of
banana.
 Roux-en-Y gastric bypass / gastric bypass surgery : the stomach is divided into upper
small top pouch ( about the size of egg), the larger part is bypassed so that it no longer
stores or digests food. The small intestine is also divided and connected to new stomach
pouch to allow food to pass, resulting in a Y shaped structural arrangement.
 Adjustable gastric band (AGB) : AGB is a device made of silicone placed around the
top of stomach to limit the amount of food a person can eat. The device is placed and
secured at the top part of stomach making a small pouch above the device, giving a sense
of fullness depending on the size of the pouch.
 Biliopancreatic Diversion with Duodenal Switch (BPD/DS) : Following creation of the
sleeve-like stomach, the first portion of the small intestine is separated from the stomach.
A part of the small intestine is then brought up and connected to the outlet of the newly
created stomach, so that when the patient eats, the food goes through the sleeve pouch
and into the latter part of the small intestine.
 Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) :
The operation starts the same way as the sleeve gastrectomy, making a smaller tube-
shaped stomach. The first part of the small intestine is divided just after the stomach. A
loop of intestine is measured several feet from its end and is then connected to the
stomach. This is the only intestinal connection performed in this procedure.

YOGA AND NATUROPATHY DIAGNOSIS

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Naturopathy uses a series of principles and beliefs to create individual treatment plans.

These principles and beliefs are:

 Self-healing: Identifying and removing obstacles to recovery, allows for natural healing.
 Underlying symptoms: Rather than stopping symptoms, a naturopathic doctor can
resolve underlying physical or mental issues by treating the body, mind, and spirit.
 Harmless treatment: Treatment plans should not have harmful side effects or control
symptoms negatively.
 Holistic treatment: A naturopathic doctor must recognize individuality to treat all
aspects of a person’s health effectively.
 Education in treatment: Naturopathic doctors teach self-care to help empower people
against ill health.
 Prevention: It is good to remove toxic substances from a lifestyle to prevent problems
from arising.

IRIDOLOGY DIAGNOSIS :

43
 Iridology (also known as iridiagnosis) is one of the non-invasive alternative
medicine technique which uses the changes in iris to help diagnose any condition. It claims that
the patterns, colours, and other characteristics of the iris can be examined to determine
information about persons systemic health. The right iris reflects right side of the body, while left
iris reflects left side of the body. One of the prominent iridology practitioner, Dr. Bernard
Jensen, put it this way: ‘‘Nerve fibers in the iris respond to changes in body tissues by
manifesting a reflex physiology that corresponds to specific tissue.

NERVE RING:

White circles or arcs of circles in the outer part of the iris. They indicate tense, over-
reactive, irritated nervous system. The outer most iris zones represent the lymphatic and
circulatory system and bordering the sclera, the skin.

DARK OUTER RING:

A dark ring at the outer rim (scurf rim) shows the skin is inactive with accumulated
wastes, and needs frequent stimulation, better circulation and improved kidney and lung
activities.

44
 In obesity, the iris may show a thin, slimy ring on the outer rim of the sclera known as
“cholesterol ring”, when there is increased serum cholesterol levels. If hypertension is also
present, then a small half-lunar shaped ring is present known as “sodium ring”.

FACIAL DIAGNOSIS :

Facial diagnosis is the ability to determine the physical status of a person from
external appearances. Through this it is easy to elicit the amount and location of matter in the
body, foreign to its normal condition. This in turn reflects the ideology of naturopathy “the
common cause of all disease is the presence of foreign substances in the body”. These foreign
matter is termed as ENCUMBRANCE. The four types of encumbrances are:

 Front encumbrance
 Back encumbrance
 Side encumbrance (right OR left)
 Whole body encumbrance

In case of OBESITY, whole body encumbrance is predominant.

SWARA DIAGNOSIS :

Swara yoga is a science which is realization of cosmic consciousness through control and
manipulation of breath. In case of obesity LEFT nostril breathing is prominent. According to
Swara yoga by Swami Mukthibhodanandha, when the left nostril is dominant, the mind wanders.
The person, becomes restless or anxious, feels difficulty in doing day-to-day activities, gets
lethargic or lazy in functioning, mentally drained and depressed. They tend to over-think and
over-analyse, has very low self-esteem, gets defensive for even the smallest of issues, feels
judged by others, and criticize themselves a lot.

45
PULSE DIAGNOSIS :

How to diagnose using pulse?

Pulse diagnosis is based on another microsystem with internal organs

represented on the wrists. The main sites for pulse assessment are the radial arteries in the left
and right wrists, where it overlays the styloid process of the radius, between the wrist crease and
extending proximal, approximately 5 cm in length (or 1.9 cun, where the forearm is 12 cun). In
traditional Chinese medicine, the pulse is divided into three positions on each wrist. The first
pulse closest to the wrist is the cun (inch, 寸) position, the second guan (gate, 關), and the third
pulse position furthest away from the wrist is the chi (foot, 尺). He will first use only light
pressure against the patient's wrist, then increase it. The light pressure allows the doctor to check
one specific organ, the increased pressure another one. Every organ's status can be monitored by
the quality of the pulse.

Pulse diagnosis in Obesity :

From TCM’s perspective, excess fats are mostly due to ‘dampness’ and ‘phlegm’ in the
body. Our spleen is in charge of the transportation and transformation of food and our bodily
fluids. Over time, due to inactivity and excessive intake of sweet, fried and greasy food, the
spleen becomes less efficient in the movement and transport of fluids and food. Hence,
‘dampness’ and ‘phlegm’ accumulates and turn into fatty tissues.

In obesity, there is predominance of pittha, and few predominance of vatha among all age
groups in tridoshas.

46
In OBESITY, pulse diagnosis shows :

 YIN – Kidney energy deficient.

 YANG - urinary bladder energy deficient.
 Liver – congested.
 Spleen – dampened. F

Wd

Wa

CHROMODIAGNOSIS :

Chromodiagnosis is done by allowing the patient to sit in a comfortable position,

make them concentrate on the breathing and abdominal movements, and slowly asking the
patient to visualize one colour at a time, following your instruction, and note the change in
physical and mental nature of the patient or how they respond to each colour you propose.

In obesity, RED color is deficient.

FACIAL DIAGNOSIS :

47
 Facial diagnosis is one of the most important applications in facial analysis. It can be
traced back thousands of years when traditional medicine practitioners applied their knowledge
to diagnose the health status of an individual.

 SKIN: it is oily and moist in patient adjoined with uterine disorders, pigmented
and dry in old, male patients, and in patients with hypothyroidism.
 URINE: Straw colored in genetically obese patients, little to dark yellowish in
patients with hypertension
 NAIL: pale in PCOS patients, half-luna is mostly absent in any obese patients.
 STOOLS: brownish yellow, cylindrical in shape under normal conditions but
hard in nature on constipated individuals.
 EYES: Dull, sunken and slightly protruded in hypothyroid patients.
 HAIR: Lustreless, brittle, split ends assosciated with thinning of hair in PCOS
patients and baldness in hypertensive males.
 SCLERA: Pale, lusterless in most obese patients, however may appear reddish
in hypertensive patients and a tint of faint yellow in diabetic or dyslipidemic
patients.
 TONGUE: whitish coated in most obese patients, assosciated with reddish tips
in hypertensive patients, yellowish coating in diabetic patients.
 LIPS : Dark, brownish, chapped and dry in all obese patients
 HANDS: No deformity.
 EAR: slightly reddish.
 MOUTH: Foul smell present in all obese patients.
 NOSE: Nasal bridge more prominent in some hypertensive patients.
 FOOT: Pedal oedema present in hypertensive patients.
 TEETH: Evenly arranged
 FACE: Puffiness present, acne in chin region & around the nose in patients
with PCOS. Veins prominent on temples for hypertensive patients, acne present
in cheek region when patients are constipated.

TONGUE DIAGNOSIS :

48
 The tongue provides important clues reflecting the conditions of the internal organs.
Like other diagnostic methods, tongue diagnosis is based on the “outer reflects the inner”
principle of Chinese medicine, which is that external structures often reflect the conditions of the
internal structures and can give us important indications of internal disharmony. A normal,
healthy tongue is pale red or pink with a thin white coating. The tongue should have spirit, but it
should not tremble or quiver. It should have a shape which is not too swollen or flabby, with no
cracks, and be slightly moist. However, in obesity :

 Slightly red on both sides of tongue.

 Yellowish coated present on stomach region.
 Cracks present.
 Tip of the tongue is red.

NATUROPATHY AND YOGIC MANAGEMENT FOR OBESITY

49
 Naturopathic philosophies conclude three major principles as root cause of any diseases :

1. Lowered vitality
2. Abnormal composition of blood and lymph.
3. Accumulation of morbid matter.

AIMS FOR TREATING OBESITY :

Obesity is one of the leading causes of higher mortality across the world. However, it
can be treated by making various lifestyle changes, dietary changes and promoting healthy
physical activities. The aims for treating obesity include :

Find the root cause of disease and treat.

Life style modification
Healthy diet management
Regulate the metabolism and bodily functions.
Enhance good quality of life.

METHOD OF TREATMENT IN NATUROPATHY INCLUDES :

 Yoga therapy
 Hydrotherapy
 Exercise therapy
 Diet therapy
 Magnetotherapy
 Chromotherapy
 Massage therapy
 Aroma therapy
 Acupuncture
 Auriculotherapy.

YOGA THERAPY

50
Yoga therapies includes the practice of asans, pranayamas, shat-kriyas and meditation in treating
various diseases of life.

Effect of suryanamaskar on obesity :

The dynamic movements in each step of Suryanamaskar make the body contract
and expand its muscles alternatively and tone up the joints. This makes the stagnant blood at
the inactive muscles and joints to be redirected back to the kidneys and lungs for purification.
Regular practice of Suryanamaskar ensures proper and efficient functioning of not only the
muscles and joints of the body but also stimulates the internal organs. Especially the stomach
and other abdominal organs as it involves alternative stretching and compression at the
abdominal area. Suryanamaskar also improves peristalsis of the intestines, stimulates blood
circulation throughout the body, massages, and tones up kidneys so that wastes are efficiently
eliminated from the body at ease, and helps the body to eliminate toxins through increased
perspiration. Toxin elimination is an important process to maintain healthy skin and thus
helps prevent skin diseases. Suryanamaskar enhances the gaseous exchange at alveoli and
thus improves the rate of respiration. The immune system protects the body against the
disease-causing agents by the production of antibodies and other mechanisms.
Suryanamaskar increases the efficiency of the immune system.

Suryanamaskar increases the mobility of almost all the joints of the body evident from
kinematics studies using three-dimensional motion capture in ten healthy Yoga practitioners.
Different poses of Suryanamaskar are reported to produce specific muscle activation patterns
depending on the practitioner's skill levels. Improvement in physical fitness of school
children with Suryanamaskar practice was evaluated using cardiovascular parameters and
pulmonary function. Improvement in muscle strength, involvement of isometric contraction,
and chest expansion during different postures of Suryanamaskar have been reported. The
effects of Suryanamaskar performed at different speeds revealed that fast pace
Suryanamaskar is more similar to aerobic exercise and owing to increased muscle endurance
and power. Whereas effects of slow pace practice led to a decline in cardiovascular
parameters to normal levels similar to Yoga training.

Body mass index (BMI) is an important index for body muscle mass. BMI exceeds the
normal levels in obese individuals. The minimum energy production needed for the
maintenance of cellular metabolism when the body is in the basal condition is called Basal
metabolic rate (BMR). Surya namaskar is suggested as an ideal exercise to attain optimum
physical fitness in college students. A significant increase in muscle strength & endurance
and a significant decrease in body fat and BMI was reported. Effect on BMR of healthy Yoga
practitioners through a combination of stretching, supine, prone, and sitting postures in which
includes Padahasthasana (step 3) and Bhujangasana (step 7) of BSY Suryanamaskar were
evaluated. This study revealed a significant decrease in BMR owing to the reduced arousal as
a result of the long-term practice of Yoga. Healthy life demands proper maintenance of BMI

51
and BMR in every human being. This could be achieved just by practicing Surya namaskar
regularly.

Cardio-respiratory illness is considered a common disorder in day-to-day life. Every human

being strives hard in their way to protect their heart and its function by walking, physical
exercise, Yoga practice, going to the gymnasium, etc. Reports are evaluating
cardiorespiratory responses during Suryanamaskar practice in Yoga practitioners. Coronary
artery disease patients were evaluated for various parameters pre and post-Yoga practice with
a set of asanas including Bhujangasana (step 7) and Hastha uthanasana (step 2). This study
reported a significant decrease or alteration in various associated physiological parameters
namely heart rate, body fat, cholesterol, triglycerides, and LDL levels emphasizing the
importance of these Asanas in such patients. Suryanamaskar is recommended as a practice to
improve cardio-respiratory efficiency both for healthy individuals and cardiac patients.

The practice of a panel of 5 Asanas including Bhujangasana (step 7) showed no

significant difference in the systolic time intervals measured in 5 healthy regular Yoga
practitioners. This report emphasized that the changes produced in cardiac function during
the practice are within the normal functional limit of the heart. Further, Suryanamaskar is
suggested as an activity of optimal stress on the cardiorespiratory system. Total energy
consumption of 13.91 kcal with an average of 3.79 kcal/min for one complete round of
Suryanamaskar was observed in male volunteers from the Indian Army. Oxygen
consumption was reported to be the highest while in Bhujangasana. Another study in a 60 kg
individual reported the expenditure of 230 kcals of energy/30 min practice session with four
rounds of Suryanamaskar. It is inferred that Age, weight, pace, and deep breathing impacts
the energy expenditure which tends to vary for each scenario.

Effects on endocrine functions :

Suryanamaskar is often considered as a bridge between Sukshma Vyayama
(Loosening Exercises) and the practice of other advanced Asanas and Pranayamas. It helps to
relieve any kind of mental disturbance. Imbalance in mental health is often associated with or
leads to an imbalance in hormones and thus it manifests as a disease or syndrome e.g.
Diabetes, Thyroid dysfunction, and so on. Endocrine glands are toned and massaged by
regular practice of this excellent group of Asanas. Suryanamaskar stimulates the brain
centers and the associated nerve fibers running throughout the body. It is emphasized that in
addition to the benefits that these group of Asanas bestows to each physiological system in
the body, it also provides a balance between the circulatory, respiratory and endocrine
systems with one another and thus helps in the prevention of diseases and so on.

52
 During the performance of any Asanas, it is commonly recommended to concentrate
on a particular point or the breath for the fact that Yoga is defined as the union of body, mind
& breath. These points are the psychic centers and are referred to as ‘Chakras’. Endocrine
glands and the major nervous plexuses are often associated with the Chakras at the physical
level. The Chakra means a ‘whirlpool’ or a ‘vortex’. Chakra lies dormant and inactive in
most people and by yogic practices the flow of energy through the Chakra can be stimulated
and they can be activated. Each Chakra is connected to the ‘nadis’ which are the network of
psychic channels. Most important Chakras are seven in number and located along the energy
channel ‘Sushumna’ which flows through the center of the spinal cord. The Chakras are
depicted as lotus flowers with a distinct number of petals and characteristic colours.

JOINT EXERCISES :

 These exercises help with, loosening the joints and help relieve any congestion,
promotes the circulation in these areas.
 These exercises also help with removing stagnant, waste lymphatic fluids and flush
out the toxins.
 These exercises act as an preparatory poses and help one feel fresh.

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SAKTHIBANDASANA SERIES :

 This series helps in alternatively compress and stretch the abdominal organs and
muscles of that region. Helps with constipation and removes unnecessary fat deposits.
 This series also helps with toning the nerves and organs of the pelvis and abdomen. It
is very useful in regulating the menstrual cycle.
 It also helps in relieving tension among shoulder and neck region, relieves any
congestion or tension of back.

TADASANA :

 This pose helps with activating the sympathetic nervous system and help regulate
metabolic functions.
 This helps stretch the vertebrae and help remove the congestion in spinal nerves.

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PADAHASTHASANA :

 It helps with burning the abdominal fat and fat in thigh regions by increasing the
circulation and expelling the waste products.
 Helps massage the abdominal organs and regulate their functions.

PASCHIMOTTANASANA & JANUSIRASASNA :

 Stretches the hamstring muscles, increase the flexibility of hip joints.

 Burns fat in the abdominal and thigh regions.

USHTRASANA :

 Regulates the functions of thyroid gland and helps regulating hormonal dysfunction.

55
  Stretches the spinal nerves, and back muscles, burning unwanted fat cells.

UTTANPADASANA :

 Strengthens the lower back region, increases the circulation in upper thigh region nd
helps burn fat.
 Also increases splanchic circulation, removes any unwanted exudates and help
maintain a good gut health.

SARVANGASANA :

 Massages the thyroid gland and helps in regulating its function.

 Provides good physical and mental balance.

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PAWANMUKTHASANA :

 It helps with burning fat in the thighs, buttock and abdominal region
 Strengthens the back muscles and tones muscles of arms and legs.

SETUBANDHASANA :

 Tones the buttock muscles, shoulders and arms.

 Strengthens the lumbar muscles.

NAUKASANA :

 Massages the abdominal organs, stimulates the digestive system and promotes
expulsion of wastes.
 Aids in weight loss.

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KRIYAS :

HOW SHAT-KRIYAS WORK ?

Drainage of waste and toxins

Vaman Dhauti, Vastra dhauti, Basti and Shankhaprakshalana, are associated with the excretion
of the waste from the digestive system. They are also associated with cleaning of all body
systems. During yogic cleansing toxins are drained towards the digestive track to get flushed out
of the body. In Neti the mucus secretion is increased. Along with the usual secretion, some
toxins are also excreted through secretion. Practice of all three type of Kapalbhati causes excess
removal of carbon dioxide from the frontal lobe of brain. Action of vagus nerve-increased
secretions and mobility. Vagal activation is one of the important mechanisms of cleaning
process. Vagus nerve is tenth cranial nerve which connects Brain to the Respiratory track, Heart,
Digestive track and glands in abdomen. In Vaman Dhauti, Vastra Dhauti and
Shankhaprakshalan, due to activation of vagus nerve, the effect can be seen on all three systems.
After vaman dhauti, vagal stimulation increases the movements of large intestine, thus helps to
wash out the stool from the large intestine, it increases secretions of digestive glands because of
that the digestion is improved and vagus nerve restores the resting rhythm of the heart. Pressure
mechanism Kapalbati, Agnisar, Nauli, produces pressure inside the abdomen. This pressure on
abdominal muscles produces massage on the internal organs. The massage improves the micro
circulation which nourishes internal organ and also drains waste or toxins towards blood from
the interstitial spaces. Even in Vaman Dhauti the pressure mechanism is created.

Improves the blood supply to nervous system :

Blood supply towards nervous system is more when the digestive track is significantly empty.
Cleansing processes help to empty the digestive track. Kapalbhati practices are good for

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activating the frontal lobe. Practice of Kapalbhati causes excess removal of carbon dioxide and
builds up oxygen in the peripheral tissue of the brain, more supply of oxygen causes optimum
metabolism in the forebrain.. Shatkriyas like shankhaprakshalana, basti, etc. wash out large
intestine completely, thus avoid the bad effect of toxins on the brain.

Nauli :

The meaning of Nauli is abdominal massaging. Thus, practice involves isolating the rectus
abdominis muscles. When we isolate this muscle at the right side is called Dakshina Nauli, at the
left is Vama, and at the center is called Madhyama. This particular practice strengthens the
secretions of gastric juice including endocrine and exocrine functions of the pancreas. Nauli
helps in improving the blood supply to the peripheral part of the stomach as it increases the
negative pressure within abdominal cavity.

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PRANAYAMA :

HOW PRANAYAMA HELPS IN OBESITY AND ITS CO-MORBIDITIES :

 High blood pressure, or hypertension, is when your blood pressure reaches

an unhealthy level. It increases the risk for some potentially serious health conditions like
heart disease and stroke. Stress is a major risk factor for high blood pressure. Nadi
Shodana Pranyama, Anuloma – viloma pranayama can help minimize this risk by
promoting relaxation.
 Bhramari pranayama helps in regulating the thyroid dysfunction and can be useful in
regulating endocrine functions.

KAPALBATHI : Kapalbhati pranayama helps to tone up the abdominal muscles, tones and
massages the abdominal organs, promotes faster digestion of foods and expulsion of waste. It is
also helpful in reducing abdominal fat, burns any unnecessary adipocytes lying surrounding the
abdominal organs.

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 HYDROTHERAPY AND CLAY THERAPY

BENEFITS WITH WATER THERAPY:

With water therapy, you can prevent and cure some of the diseases. If you drink water
sufficiently, then it will help in enhancing your glow skin and keep you physically fit. Water
therapy is used to regulating the temperature of your body.

ENEMA :

The injection of liquid into the rectum through the anus for cleansing and stimulating
evacuation of the bowels for therapeutic purposes.

 Neutral enema (92- 98 F)

 Neem + turmeric water enema (Neutral 92 – 95 F)

PHYSIOLOGICAL EFFECTS:

 It removes chronic toxins from the large intestine.

 It relaxes and tones the pelvic and perineum muscles thereby relaxing the uterine
muscles and its ligament, and also soothens the sacral plexus and facilitates its
physiological functions such as regulation of menstrual cycle.
 It helps in alleviating digestive disturbances.

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  It helps to fight against infections and controls the production of excessive amount of
discharge.

COLON HYDROTHERAPY

Colonic hydrotherapy is a holistic health treatment meant to clean out your colon and an effort to
lose weight.

Function

Colonic hydrotherapy, also known a colonic, is a procedure that involves allowing a slow flow of
water into the rectum. The process does not use any drugs or chemicals; only warm, filtered
water is used. After a small tube is inserted into your rectum, you lie on a medical table. The
water will induce contractions in the colon and through the contractions , matter inside the colon
will be expelled from the body. It is a clean and sanitary process. The fecal matter gets washed
away into a tube and into a sanitary storage area. While you receive the treatment, the therapist
might be present to monitor the water flow or massage the abdomen, allowing more matter to
dislodge from the colon.

COLD HIP BATH :

 Tones the abdominal and pelvic organs, helps regulate the menstrual related issues.
 Aids in weight loss

STEAM BATH :

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  Hot, warm air causes fast burning of fat cells, alongside profuse sweating helps with
expulsion of any metabolic wastes.
 Increases body metabolism, thus help with utilization of stagnant fat cells around
abdominal organs.
 Increases circulation, which inturn helps with faster and healthier functioning of body,
proper drainage of lymphatic wastes.
 Deep cleanses the skin
 Helps eliminate toxins
 Boosts your immune system

FULL WET SHEET PACK

PHYSIOLOGICAL EFFCETS:

 Causes shivering in the initial stage, which results in increased metabolism and burning
of fat cells, generating heat.
 The sweating or the final stage of the pack is used as a spoliative and eliminative
process, and can be useful in burning excess fats, eliminating toxins and reducing body
weight.
 Helps eliminate toxins

MUD BATH :

First the mud is prepared by soaking it in water. The mud is then applied to the full body either
in sitting or lying down position. Mud is kept for 45 to 60 minutes and ideally be exposed to sun
light, at least intermittently. Remember that the head should always be covered when exposing
the body to sunlight. Afterwards, the person should be thoroughly washed with cold to luke
warm water. Dry the person quickly and transfer to a warm bed. A mud bath helps in increasing

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the blood circulation and energizing the skin tissues. It thus helps in cleansing and improving the
skin condition generally. Regular mud baths may be considered as natural beauty treatment
procedure as it also helps in improving skin complexion and reducing spots and patches, possibly
the result of some skin disorder like chickenpox or small pox. Mud baths are useful in many skin
diseases such as Psoriasis, Urticaria, leucoderma, Leprosy and other skin allergic conditions.

PHYSIOLOGICAL EFFECTS :

 Helps in detoxification of the body and fluxes out toxins .

 Aids in digestion.
 Mud bath increases the efficiency of the body's various functions, especially those related
to digestion.
 Complete digestion of food prevents increase in fat storage

MUD PACK TO ABDOMEN AND EYES

Effective in decreasing intestinal heat and stimulates peristalsis and helps relieve constipation.

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PHYSIOTHERAPY / EXERCISE THERAPY FOR OBESITY :

HOW IT WORKS :

Exercise is planned and structured movement within a period of time to maintain and improve
physical fitness and health

How exercise can increase Resting Metabolic Rate and decrease body weight?

 The addition of a high intensity, high volume resistance training program to a Very Low
Calorie Diet can attenuate the loss of Lean Body Mass and increase Resting Metabolic
Rate with a significant weight loss.
 Combining aerobic exercise and Very Low Calorie Diet resulted in a significant decrease
in body weight.

What exercises are effective to burn body fats and calories?

A variety of exercises are recommended to lose body weight. A Combination of aerobic type of
exercise and resistance training is advisable.

 Traditional cardiovascular (aerobic exercise) and weight loss programs for adults often
include activities such as walking, running, cycling, and swimming. Adults can achieve
improvements in cardio-respiratory status and BMI through participation in an Interactive
Video Dance Game (IVDG) exercise program which is effective and more enjoyable.
 Concurrent resistance and endurance training have beneficial effects on energy
expenditure and weight loss. Whereas single-mode training, such as endurance or
resistance training, has been shown extensively to increase aerobic capacity and muscular
strength, respectively.
 Aerobic exercise is a physical activity which will make you sweat. When your heart starts
beating faster and you start breathing harder, the by-product of these two is sweat. Doing
aerobics exercise not only helps your cardiovascular health but also helps deliver oxygen
to your body more efficiently. Since aerobic exercises use large muscle groups, they
consequently leads to weight loss. Aerobic means how efficiently your body uses oxygen

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 to meet its energy demand during high activity levels, for example, when you’re
exercising. Aerobic exercise helps you to lose weight due to how easy they are to follow.
Other than that, aerobic exercises also ensure fast and steady results as they get your
heartbeat high. Aerobic exercises are easy to follow, quickest in application and not all of
them require equipment.

 Walking is a great exercise for beginners, as it can be done anywhere, doesn’t require
equipment, and puts minimal stress on your joints. Try to incorporate more walks into
your day-to-day activities. Pebble walking and eight shaped walking is also useful
 Jogging or running : these are great exercises to help you lose weight. Although they
seem similar, the key difference is that a jogging pace is generally between 4–6 mph
(6.4–9.7 km/h), while a running pace is faster than 6 mph (9.7 km/h). If you find jogging
or running outdoors to be hard on your joints, try running on softer surfaces like grass.
Also, many treadmills have built-in cushioning, which may be easier on your joints.
 Cycling : it is great for people of all fitness levels, from beginners to athletes. Plus, it’s a
non-weight-bearing and low-impact exercise, so it won’t place much stress on your
joints. Not only is cycling great for weight loss, but studies have found that people who
cycle regularly have better overall fitness, increased insulin sensitivity, and a lower risk
of heart disease, cancer, and death, compared with those who don’t cycle regularly.
 Weight training : Weight training is a popular choice for people looking to lose weight.
It can help you build strength and promote muscle growth, which can raise your resting
metabolic rate (RMR), or how many calories your body burns at rest. In addition,
numerous studies have shown that your body continues to burn calories many hours after
a weight-training workout, compared with aerobic exercise.

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 Swimming : advantage of swimming is its low-impact nature, meaning that it’s easier on
your joints. This makes it a great option for people who have injuries or joint pain.
 Strength Training : It's a misconception that doing weights bulks you up, it in fact also
helps you slim down and revs up your metabolism permanently. Another option is circuit
training, which involves moving quickly from one exercise to the next, and burns 30%
more calories than a typical weight workout. It blasts fat and sculpts muscle, burning up
to 10 calories a minute.
 Pilates : Pilates is a great beginner-friendly exercise that may help you lose weight.
Although Pilates may not burn as many calories as aerobic exercises like running, many
people find it enjoyable, which makes it easier to stick to over time. An 8-week study in
37 middle-aged women found that performing Pilates exercises for 90 minutes 3 times
per week significantly reduced waist, stomach, and hip circumference, compared with a
control group that did no exercise over the same period.
 Interval training, more commonly known as high-intensity interval training (HIIT), is a
broad term that refers to short bursts of intense exercise that alternate with recovery
periods. Typically, a HIIT workout lasts 10–30 minutes and can burn a lot of calories.
Your body's fat-burning potential shoots up and the pounds melt away. High-intensity
exercise increases the release of growth hormones, which mobilize fat to be used as fuel.
 Zumba: A derivative of dancing, Zumba is more specialised. With effective exercises
specifically made for certain body parts, Zumba is great for weight loss. Zumba is a feel-
good way to improve your fitness and an effective way of incorporating exercise into
your daily routine. Zumba is all about loosening up and burning calories. No wonder, it
has been found to help relieve stress, increase energy and improve strength. It
incorporates vigourous exercise and high intensity movement which helps sculpt the
body.
 Incorporating Exercise Into Your Lifestyle : The total amount of exercise you engage
in during a day matters more than whether or not you do it in a single session. That’s why
small changes in your daily routine can make a big difference in your waistline. Healthy
lifestyle habits to consider include: walking or riding your bike to work or while running
errands, taking the stairs instead of the elevator, parking farther away from destinations
and walking the remaining distance.

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 MASSAGE FOR OBESITY :

HOW MASSAGE WORKS :

 INCREASES BLOOD CIRCULATION :

An increased blood flow carries more oxygen and nutrients to body organs and
removes all the toxic metabolites from the body through the kidney as urine. In this way, the
increased removal of waste products prevents their accumulation in the body, thus decreasing the
chance of weight gain.

 IMPROVES MUSCLE TONE :

It manipulates your tissues. It improves muscle tone mainly by improving oxygen supply
to oxygen through increased blood flow. It also helps tight muscles to loosen, thus decreasing the
soreness of muscles.

 FASTENS METABOLISM :

A slow metabolism burns only a few calories, which means more fat gets stored in
your body resulting in weight gain. On the other hand, increased metabolism means increased
energy consumption by your body, helping you burn some extra calories. Massage improves
blood circulation. Increased blood flow results in an increased exchange of materials (nutrients)
and oxygens between blood cells and body tissues, thus increasing metabolism. It allows muscles
to burn more calories.

 IMPROVES DIGESTION :

Massage over the abdomen increases blood circulation to the stomach, which releases
acid that promotes the breakdown of food. Massage also stimulates peristalsis, which pushes the
food downward in the body towards the intestine

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SWEDISH MASSAGE FOR OBESITY

Swedish massage uses long kneading strokes or tapping on the top layer of muscle.
Your massage therapist may focus on particular areas of concern. You can also expect to have a
full body massage.

Swedish massage may loosen up your tight muscles. It stimulates your nerve
endings and improves blood flow. It also improves your lymph drainage. All these mechanisms
collectively enhance your weight loss.

1. AROMATHERAPY MASSAGE:

An aromatherapy massage is a special type of weight loss massage that cuts down desire to
binge eat. Special aromatic oils made from the extracts of flowers, fruits, leaves, barks, and seeds
are used.

Researchers found one hour of aromatherapy massage with grapefruit oil, cypress, and other oils
for six weeks helped reduce abdominal fat and waist circumference.

People who use this massage have often said that they sleep better and have reduced muscle
pain. Aromatherapy massage may also help reduce stress and depression. This, in turn, can
reduce the desire to binge eat or eat nothing at all (leads to slow metabolism and weight gain).

2. LYMPHATIC MASSAGE FOR WEIGHT LOSS

Weight gain and obesity can lead to lymphedema. This further amplifies inflammation and
weight gain. Lymphatic massage helps in lymphatic drainage, flushing out extra fluid from the
waist, wrist, ankles, and legs. It reduces puffiness.

A study found that lymphatic drainage massage or manual massage could help reduce thigh and
belly fat. People who play sports use this massage often to heal injuries . must eliminate

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unhealthy food from your diet. Get a licensed lymphatic massage therapist to get the massage
done on a regular basis.

AROMATHERAPY

Essential oils are known for their ability to affect your mood and can either calm
you down or energize you. This can help with the psychological hang-ups many people
experience during their weight loss journeys, including emotional eating, junk food cravings,
fatigue and decrease in motivation`

Lemon Oil:

Research shows that breathing in the scent of lemon essential oil improves the neurological
activity that promotes the breakdown of body fat. Lemon oil actually has both stimulating and
calming properties, and it promotes a positive mood ,which can be extremely helpful when you
are working to reach your weight-loss goals. It also enhances the body's detoxification
capabilities and supports healthy digestion – an all-important factor when you're trying to lose
weight.

Grapefruit:

Grapefruit essential oil helps to activate enzymes in the body that work to break down body fat.
Grapefruit benefits weight loss because it contains compounds like D-limonene, which helps to
support your metabolism and cleanse your lymphatic glands so they can carry nutrients between

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the tissues and the bloodstream. Studies also show that using grapefruit oil affects autonomic
nerves, which regulate important body functions like heart rate and digestion, and reduce
appetite and body weight.

Ginger:

One of the most important benefits of ginger essential oil is its ability to support digestion
and the absorption of nutrients. By improving the absorption of the vitamins and minerals that
consuming, ginger oil is supporting the body's cellular energy and, in effect, promoting weight
loss. A key compound in ginger oil, called gingerol, also effectively reduces inflammation in the
body and possesses antioxidant activity. which helps keep active and burning more calories.

Pepper mint:

Peppermint is a natural energizer that reduces fatigue and improves focus, so you can keep
your eyes on your weight-loss goal. It also reduces hunger cravings and can help to feel full
faster.

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Cinnamon:

Cinnamon oil helps to balance blood sugar levels, thereby aiding weight loss and reducing sugar
cravings. When your blood sugar levels are unstable, you may find yourself overeating and
gaining weight. Plus, when energy levels are low, it's difficult to exercise and burn calories.

METHOD OF APPLICATION :

In treating obesity, essential oils is used in the form of

 Candles or incense sticks, containing essence of essential oils are burnt in office or work
places, in houses, which gives them a sense of calmness.
 Humidifier : by using humidifier, the essential oils can be directly inhaled by the patient.
 Direct application on skin : by mixing essential oil with a carrier oil, one can directly
apply it on the skin.
 Aromatic massages : usual massage therapy is given along with using essential oils,
which gives the benefit of both.
 In baths : aromatic oils, along with Epsom salts can be used while taking baths, which not
only calms the mind, but also reduces the release of stress hormone “ cortisol”, thus
relieving stress.

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FASTING AND DIET THERAPY :

Physiology of fasting in obesity :

It has been suggested that humans, like other species, have evolved special biochemical
pathways to subsist for long periods without food during periods of food scarcity (climate,
injury, illness). 16 While fasting, the body primarily uses fat stores from adipose tissue for
energy while recycling nonessential tissue for maintenance of pivotal systems. This streamlining
utilizes nonessential protein sources, including digestive and glycolytic enzymes, muscle
contractile fibers, and other connective tissue. Research has determined that an average 70-kg
man has the fat stores to maintain basic caloric requirements for 2 to 3 months of fasting.
However, as this threshold approaches, the body can no longer effectively or efficiently mobilize
fat stores for fuel, and significant protein catabolism again becomes necessary for energy
production.

During feeding, the conversion of fatty acids to acetyl coenzyme-A (CoA) is regulated by
the availability of L-glycerol 3-phosphate (derived from glucose through the glycolytic
pathway). As the concentration of acetyl CoA rises, it is resynthesized into triglycerides, with L-
glycerol 3-phosphate serving as the accepter to which three acyl CoA groups are attached
(through esterification). Conversely, during fasting, there is inadequate glucose to provide the
needed glycerol for triglyceride synthesis, resulting in acetyl CoA levels in excess of the
oxidative capacity of the Krebs cycle. The excess is then shunted into the synthesis of ketone
bodies. Research using respiratory quotient and urinary nitrogen studies has repeatedly shown
that triglycerides are the major fuel during fasting. Inadequate blood glucose in fasting prompts
hydrolysis (lipolysis) of triglycerides within adipocytes, allowing fatty acids and glycerol to
leave the cell. The fatty acids are transported in a physical complex with albumin to the liver and
muscle.

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Type of fasting:

For obesity patients it is best to undergo the following types of fasting:

 Intermittent fasting
 Juice fasting

INTERMITTENT FASTING :

Intermittent energy restriction encompasses dietary approaches including intermittent fasting,

alternate day fasting, and fasting for two days per week. Intermittent fasting (IF), also known as
alternate day fasting (ADF), periodic fasting or intermittent energy restriction (IER) is a
relatively new dietary approach to weight management that involves interspersing normal daily
caloric intake with a short period of severe calorie restriction/fasting. In terms of the possible
underlying biological benefits of intermittent fasting, there is some evidence, predominantly
from animal studies, to demonstrate beneficial effects on weight loss and cardio-metabolic risk
factors. Whilst the underpinning mechanistic evidence is limited, there is some evidence to
suggest that the benefits may be explained mechanistically through fat utilization and nutritional
stress.

How intermittent fasting works in weight loss :

Alternate-day fasting involves alternating fasting days, during which no calories are consumed,
and feeding days, during which foods and beverages are consumed ad libitum. In 2007, Varady
& Hellerstein reviewed alternate-day fasting studies in rodents and concluded that this fasting
regimen was as effective as simple caloric restriction in reducing obesity-associated body weight
and fasting insulin and glucose concentrations. Alternate-day fasting in rodent models of obesity
has also been shown to reduce total plasma cholesterol and triglyceride (TG) concentrations,
reduce liver steatosis and inflammatory gene expression, and have beneficial effects on cancer
risk factors, such as cell proliferation.

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Insulin sensitivity, circadian rhythm and fasting at night :

Circadian rhythms have an impact on metabolism across the day in humans, and these effects are
malleable by behavioral intervention. Insulin sensitivity decreases throughout the day and into
the night . This is, in part, due to the circadian rhythm of insulin secretion and the insulin-
impeding action of growth hormone, the pulsatile concentrations of which increase at night.
Postprandial insulin and glucose responses to meals increase across the day and into the night.
Thus, meals consumed at night are associated with greater postprandial glucose and insulin
exposure than content-matched meals consumed during the day, leading to increased HbA1c
levels and risk of type 2 diabetes over time

Fasting regimens that exclude or dramatically reduce energy intake in the evening and exclude
energy intake during the nighttime synchronize food ingestion with the times of optimal
postprandial hormonal response. As circadian rhythm synchronizers, it is hypothesized that
fasting and time-restricted feeding regimens that actively impose a diurnal rhythm of food intake
aligned with the 24-hour light–dark cycle lead to improved oscillations in circadian clock gene
expression, the reprogramming of molecular mechanisms of energy metabolism, and improved
body weight regulation. Interested readers are encouraged to read more about these molecular
outcomes in detailed reviews on the mechanisms underlying circadian biology.

Healthy gut microbiota :

Many functions of the gastrointestinal tract exhibit robust circadian, or sleep–wake, rhythms. For
example, gastric emptying and blood flow are greater during the daytime than at night and, as
described above, metabolic responses to a glucose load are slower in the evening than in the
morning. Therefore, it is plausible that a chronically disturbed circadian profile may affect
gastrointestinal function and impair metabolism and health. The gut microbiome impacts
metabolic health; its diversity is regulated by diet; and it has a circadian rhythm that is entrained

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by food signals. Rodent studies show that the gut microbiome is highly dynamic, exhibiting daily
cyclical fluctuations in compositional diversity.

Intermittent fasting may directly influence the gut microbiota, which is the
complex, diverse, and vast microbial community that resides in the intestinal tract. Studies
suggest that changes in the composition and metabolic function of the gut microbiota in obese
individuals may enable an obese microbiota to harvest more energy from the diet than a lean
microbiota and, thereby, influence net energy absorption, expenditure, and storage. Diet-induced
obesity dampens cyclical microbiota fluctuations. Time-restricted feeding in mice, in which food
is available only during the nocturnal active phase, partially restores these cyclical fluctuations.
Thus, cyclical changes in the gut microbiome resulting from diurnal feeding and fasting rhythms
contribute to the diversity of gut microflora and represent a mechanism by which the gut
microbiome affects host metabolism. An extended fasting period (i.e., gut rest) could also lead to
reduced gut permeability and, as a result, to blunted postprandial endotoxemia and to blunted
systemic inflammation, which are typically elevated in obesity. Recently, investigators from the
Salk Institute for Biological Studies reported that a brain–gut pathway activated in the brain
during fasting acts to promote energy balance by enhancing gut epithelial integrity.Fasting
regimens appear to have positive impacts on the gut microbiota.

Modifiable Lifestyle Behaviors : Fasting regimens have the potential to impact modifiable
health behaviors. A study in 8 overweight young adults found that increasing the nightly fasting
duration to ≥14 hours resulted in statistically significant decreases in energy intake and weight,
as well as improvements in self-reported sleep satisfaction, satiety at bedtime, and energy levels.

Sleep : Numerous observational studies have reported that nighttime eating is associated with
reduced sleep duration and poor sleep quality, which can lead to insulin resistance and increased
risks of obesity, diabetes, cardiovascular disease, and cancer Specifically, eating meals at
abnormal circadian times (i.e., late at night) is hypothesized to lead to circadian
desynchronization and subsequent disruption of normal sleep patterns. Chowdhury et al. found
no effect of regularly skipping the breakfast meal (i.e., prolonging the nighttime fast) on waking
time, sleep time, or sleep duration compared with controls. To our knowledge, no other studies
have directly examined associations between intermittent fasting and sleep in free-living adults.

The potential effects of prolonged nightly fasting on energy intake, sleep, physical activity, and
circadian activity rhythm may act in concert to reduce the risks of cardiometabolic disease and
cancer.

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Juice fasting:

It is a type of fasting by taking only juices of either fruits or vegetables at regular intervals.

Juices like Oranges or Sweet lime, pineapple, papaya, carrot, tomato, wheatgrass, etc.

Effects of fasting:

 Fruits rich in soluble dietary fibres are mostly chosen. These fibres help with the
expulsion of metabolic waste, increases the utilization of excess fats, promote helthy gut
lining.
 The dietary fibres combine with fat cells to form a insoluble “michelle” like structure
which is not readily absorbed by the gut, but easily expelled out by the intestine.
 Since it is in a diluted form, the minerals and other nutrients in the fruit can be easily
absorbed by the body and readily utilized.
 As there is no stress on the gut to digest heavy foods or as such, this lag period helps in
toning the abdominal organs, promotes faster expulsion of metabolic wastes, and rests the
gut in a sense.
 Regulates menstrual cycle.
 Reduces the LDL cholesterol.
 Increases the HDL cholesterol.
 Regulates BP.

DIET :

There's no single rule that applies to everyone, but to lose weight at a safe and
sustainable rate of 0.5 to 1kg a week, most people are advised to reduce their energy intake by
600 calories a day. For most men, this will mean consuming no more than 1,900 calories a day,
and for most women, no more than 1,400 calories a day. The best way to achieve this is to swap
unhealthy and high-energy food choices – such as fast food, processed food and sugary drinks
(including alcohol) – for healthier choices.

A healthy diet should consist of: plenty of fruit and vegetables, plenty of potatoes,
bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties) some
milk and dairy foods some meat, fish, eggs, beans and other non-dairy sources of protein just
small amounts of food and drinks that are high in fat and sugar. Try to avoid foods containing
high levels of salt because they can raise your blood pressure, which can be dangerous for people
who are already obese. Read some tips for a lower-salt diet. You'll also need to check calorie
information for each type of food and drink you consume to make sure you don't go over your
daily limit. Some restaurants, cafés and fast food outlets provide calorie information per portion,
although providing this information isn't compulsory.

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 Diet programmes and fad diets : Avoid fad diets that recommend unsafe practices, such
as fasting (going without food for long periods of time) or cutting out entire food groups.
These types of diets do not work, can make you feel ill, and are not sustainable because
they do not teach you long-term healthy eating habits. This is not to say that all
commercial diet programmes are unsafe. Many are based on sound medical and scientific
principles and can work well for some people. A responsible diet programme should
educate you about issues such as portion size, making behavioural changes and healthy
eating not be overly restrictive in terms of the type of foods you can eat be based on
achieving gradual, sustainable weight loss rather than short-term rapid weight loss, which
is unlikely to last.
 Very low calorie diets : A very low calorie diet (VLCD) is where you consume less than
800 calories a day. These diets can lead to rapid weight loss, but they are not a suitable or
safe method for everyone, and they are not routinely recommended for managing obesity.
VLCDs are usually only recommended if you have an obesity-related complication that
would benefit from rapid weight loss. VLCDs should not usually be followed for longer
than 12 weeks at a time, and they should only be used under the supervision.

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MONO DIET :

Also known as the monotrophic diet, the mono diet is an eating pattern that involves eating just
one food item or food group for several days or weeks at a time. Here are some examples of food
groups that can fit into a mono diet:

1. Fruits
2. Vegetables
3. Legumes.

Almost any food can be included on the mono diet. Few of the most common examples of foods
included on the mono diet:

1. Almonds
2. Apples
3. Milk
4. Bananas
5. Pears
6. Watermelon
7. Grapefruit

For most people, eating just one food per day will likely lead to decreased intake and weight
loss. However, whether you’ll lose weight on the mono diet depends on which foods you’re
consuming and how much of them. For example, if you’re only eating low calorie foods like
vegetables, you’re likely to consume fewer calories — or even too few calories — throughout
the day, which may lead to weight loss. Conversely, if you’re eating large amounts of high
calorie foods like chocolate, you may gain weight on the diet

Cons of Mono diet

The disadvantage of the mono diet is that you can't get enough nutrition from just one
food! There is no food that provides everything your body requires, so you will be sacrificing
some nutrients. It may have an effect on energy levels, muscle mass and other factors. You'll also
consume too much of certain nutrients, which could have negative consequences. Excess sugar,
for example, can increase your risk of developing type 2 diabetes.

The mono diet is not recommended as a long-term solution, according to most

experts. It's not sustainable, and it could lead to other compensatory behaviours such as binge
eating. At best, it's a temporary fix to jump-start your weight-loss plan until you find something
more suitable. Though you may lose weight on this diet, you'll almost certainly suffer from
malnourishment and muscle loss, and that muscle loss will translate into a slower metabolism,

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NUTRIENTS FOR WEIGHT LOSS :

80
MODEL DIET PLAN JUICE FASTING (250 ml) :

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MODEL DIET PLAN :
TIMING COOKED FOODS
EARLY MORNING Drink 400 ml of warm water / warm lemon juice + honey – 200ml.
5:30 AM – 6:30 AM Fenugreek soaked water 100 ml/ ashgourd juice 200ml/ buttermilk +
cumin seeds powder - 200 ml.
BREAKFAST Ragi idly – 2, ridge gourd chutney -
7:30 AM – 8:30 AM 50 gms/ sprouted green gram dosa –
2/Millet pongal (any one) – 250gms/
brown rice flakes upma / foxtail millet tomato-200gms fruit salad –
kichchadi – 200gms with chutney
50gms.
MID MORNING Green tea/tulsi tea 50 ml
10:30 AM – 11 AM
LUNCH Brown rice / millet rice (any one)
12:30 PM –1:30 PM +boiled Vegetables (ashgourd,
bottlegourd, radish, bittergourd)
200gms. (Carrot, beans, beetroot,
radish, cabbage, (anyone poriyal).
-50 gms + horse gram rasam
50 ml + buttermilk 200ml
EVENING Betel leaves/hibiscus/barely+ black
4:00 PM – 5:00 PM beans soup-50ml.
Ginger/cardamom tea-50m
DINNER Bajra roti 2pieces+boiled
7:00 PM – 8:00 PM vegetables-100gms.(beans, carrot,
Beetroot, onion, tomato)
RAW FOODS
Vegetable salad-cucumber,
bottle gourd, chow-chow,
carrot, beetroot, onion,
banana, guava, orange, grapes,
watermelon 200gm+ sprouted
green gram - 50 gms
Watermelon/musk
melon/pine apple /
orange/lemon juice.-200ml
Spicy green gram sprouts-
(onion, tomato, carrot, pepper
powder) 50 gms+ fruit salad-
(guava, orange, banana, grapes,
pomegranate, watermelon)
250gms
Orange/apple/bottle gourd juice-
200mL
Vegetable salad-Carrot +
cucumber + beetroot +
onion -200gms.Fruits -
watermelon/musk melon,
orange, banana, grapes, apple
200gms. Sprouted green gram,
50 gms.

HERBAL HOME REMEDIES :

 Make a mixture of 1 teaspoon of honey and lemon juice in a glass of warm water, mix
well and have this mixture daily in the morning.
 Green tea is an effective remedy for weight loss. Add 2-3 cups of green tea everyday to
your daily routine to combat obesity.
 Mint leaves are another useful remedy that aid in losing weight. Prepare a peppermint tea
and consume twice a day daily. You can also chew some raw mint leaves during your
meals.

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 Drink at least 8-10 glasses of warm water daily to make sure that your body is getting
enough water. Drinking warm water will help shed those extra flabs in your body by
burning extra calories several times a day, hence it can help you lose weight.
 Vegetables such as tomatoes, carrots and dark green leafy vegetables are low-calorie
foods that are good for your health. Therefore, include some vegetables salad and fruits in
your daily diet to keep you full and satisfied throughout the day.
 Fenugreek in rich in soluble fibres, trigonelline present in fenugreek may help combat
type 2 diabetes and aids in weight loss. Hence, try drinking fenugreek soaked water on
empty somach.
 Cinnamon and honey infused tea: Cinnamon (Dalchini) is a regularly used spice in many
Indian dishes, both sweet and savoury. However, you may not be aware of the fact that
cinnamon aids in reducing weight. The spice comes with internal properties that curb the
sugar cravings and also helps regulate the insulin level in the blood. To prepare the honey
and cinnamon tea, warm up a glass of water. Add two cinnamon sticks and a teaspoon of
honey into the lukewarm water. Mix well and strain the mixture. Drink the cinnamon and
honey-infused water on an empty stomach each morning. This will work wonders in case
of your weight loss at home.
 Hibiscus contains phenolic compounds (nonessential dietary components appearing in
vegetable foods that help reducing weight), flavonoids (a diverse group of plant
chemicals that help maintain a healthy weight), and anthocyanins (blue, red or purple
pigment compounds that fight obesity). Drinking hibiscus tea will help in regulating the
metabolism of lipids and is also useful in eliminating fat from your body. Hibiscus tea is
very effective in reducing the size of fat cells and balancing your weight. Take two
teaspoons of dry hibiscus leaves and add them to one liter of water. Boil them for nearly
10 to 15 minutes and strain them. Drink at least 2 cups every day which will help you in
losing weight.
 Cumin Seeds. It helps in burning fat faster and is useful in increasing the speed of
metabolism. You can lose belly fat by consuming cumin seeds or cumin water daily for
about 20 to 30 days. Beneficial for people who suffer from constipation, it helps in
enhancing the activity of the digestive enzyme present in your gut. Drink cumin water
daily empty stomach once in the morning

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 ACUPUNCTURE AND ACUPRESSURE FOR OBESITY :

ACUPRESSURE :
Acupressure functions on the basic principle of applying targeted external
physical pressure on a few, easy to access body parts. This ancient healing practice also claims
to aid weight loss by boosting metabolism. Acupressure points to boost our metabolism and lose
weight:

1.Upper lip
Apply gentle pressure on the space between upper lip and nose (philtrum). Make sure
to apply moderate pressure right in the centre of the philtrum. This pressure point is known as the
shuigou spot. Also massage this spot in a circular motion for 2-3 minutes every day to stimulate
metabolism.
2. Inner elbow
Bend arm slightly to locate this point on the inner elbow. This pressure point is located an inch
below from the crease of our elbow joint, towards your inner elbow. Press this point daily for 2-
3 minutes with using the thumb. It helps in stimulating the intestinal function
3. Ear point
To locate this point, simply place the finger where the jaw starts from. Move to the jaw up and
down and put the finger on the pressure point with the most movement. Press this point with the
forefinger for 1-2 minutes daily. Pressing this point which is located just beneath your earlobe
helps in controlling appetite
4. Thumb point
Locate the pressure point on the bottom part of the thumb and apply pressure. It will stimulate
the thyroid gland and increase the metabolism. Apply pressure on the point for around two
minutes daily.

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 ACUPUNCTURE :
Traditional Chinese medicine explains that health is the result of a harmonious
balance of the complementary extremes of “yin” and “yang” of the life force known as “qi,”
pronounced “chi.” Illness is said to be the consequence of an imbalance of the forces.Qi is said to
flow through meridians, or pathways, in the human body. These meridiens and energy flows are
accessible through 350 acupuncture points in the body.Inserting needles into these points with
appropriate combinations is said to bring the energy flow back into proper balance.
There is no scientific proof that the meridians or acupuncture points exist, and it is hard to prove
that they either do or do not, but numerous studies suggest that acupuncture works for some
conditions.
Some experts have used neuroscience to explain acupuncture. Acupuncture points are seen as
places where nerves, muscles, and connective tissue can be stimulated. The stimulation increases
blood flow, while at the same time triggering the activity of the body’s natural painkillers.It is
difficult to set up investigations using proper scientific controls, because of the invasive nature of
acupuncture. In a clinical study, a control group would have to undergo sham treatment, or a
placebo, for results to be compared with those of genuine acupuncture.Some studies have
concluded that acupuncture offers similar benefits to a patient as a placebo, but others have
indicated that there are some real benefits.
Acupuncture for weight loss :
Advocates of acupuncture for weight loss believe that acupuncture can stimulate the body’s
energy flow (chi) to impact factors that can reverse obesity such as:
 increasing metabolism
 reducing appetite
 lowering stress
 affecting the part of the brain that feels hunger
Weight gain, according to traditional Chinese medicine, is caused by body imbalance. That
imbalance, according to ancient teachings, can be caused by a malfunctioning:
liver
spleen
kidney
thyroid gland
endocrine system
So, for weight loss, acupuncture treatments commonly target these areas of the body. Points
for obesity
 k-16
 ren-6
 ren-4
 ren-3
 st-30
 Zigong

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Reiki and pranic healing :

Reiki and pranic healing is also effective for obesity. This involves healing without touching or
any other invasive procedures. In this, the pranic healer is supposed to sensitize their hands,
observe the aura of the patient and then correct his/her aura.

Auriculotherapy for weight loss :

1. auricular shenmen, located in the triangular fossa at the bifurcating point between the
superior and inferior antihelix crus at the lateral 1/3 of the triangular fossa.
2. The spleen point has two major auricular locations; one is located on the middle of the
back side of the ear. The other location is at the lateral and superior aspect of the cavum
concha. The cavum concha point is more commonly applied in clinical settings. The
spleen auricular point is traditionally used for strengthening the spleen and harmonizing
the stomach. It helps to produce ying-blood and benefits the muscles. Common

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 indications treated with the spleen auricular point are uterine bleeding, abdominal
distention, diarrhea and other digestive dysfunctions.
3. The stomach auricular acupuncture point is located at the end of the cruz of the helix in
the cavum concha. It is the area formed by the end of the crus of the helix and the border
of the lower antehelix cruz.

4. The endocrine point used in the 5 acupuncture point combination is located in the
cavum concha in the intertragic notch. The endocrine point is classically applied for
removing liver qi stagnation, regulating the menses, invigorating the blood, expelling
wind and benefitting the lower jiao. Indications for use of this auricular point include skin
disorders, impotence, irregular menstruation and endocrine system dysfunction.
5. The hunger auricular acupuncture point is located on the lower part of the tragus in the
direction of the transitional fold near the facial skin. The hunger point can be used to up-
regulate or down-regulate sensations of hunger. It is used for issues of anorexia, bulimia
and digestive disturbances

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 CHROMOTHERAPY

Colours are certain wavelengths of electro-magnetic energy seen through our eyes. The colour
we see is the part of the visible spectrum that is reflected back by a certain object. when all
colours join the result is white light. Therefore working with White Light brings about
completeness, oneness, union of all complementary parts.

Colour for obesity & its effects:

Blue colour :
According to colour therapy for weight loss, the colour blue suppresses appetite. If you want to
lose weight fast, try to change your current refrigerator light with an economical blue light. It is a
known fact that of all the colours in the spectrum, blue colour therapy is a strong appetite
suppressant. Blue is definitely one of the best colours for weight loss.
Yellow colour therapy is used for weight loss and to boost the performance of sluggish organs
Red color :
The other perfect colour therapy for weight loss is red. It is also said that red increases
metabolism. Everyday try to visualise the colour red for nearly ten minutes to get better results. It
is better to do this twice a day. You can also invest in clear glasses that come in red tint since it
helps to suppress your appetite
 Drinking of Yellow Solarized water
 Intake of Orange and yellow Food – orange, papaya, carrot, muskmelon, pumpkin, etc.
Green Food – broccoli, cabbage, avocado, peas, bitter gourd, etc.
 Wearing of Orange & Green dress.
 Breathing or Visualization on blue colour
 Red solarised oil massage to abdomen and thighs.
 Yellow (Manipura chakra) meditation
 Yellow colour glass exposure to abdomen.

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89
 HELIOTHERAPY

ATAPSNANA / PLANTAIN LEAF BATH :

The treatment aids in facilitating the movement of green rays present in the sun,
directly into the body. These rays are found to serve as a good antiseptic agent and have excellent
healing properties. This process is regarded as one of the detoxification processes which involves
profuse sweating. The treatment involves in covering the affected by plantain leaves or banana
leaves. These banana leaves convert the harmful ultraviolet sun rays into healthy rays. It could be
due to the presence of polyphenol, Epigallocatechin Gallate (EGCG – a very beneficial ingredient
in the skin rejuvenation treatment) in its leaf.

The plantain leaf bath causes lot of perspiration, which helps with elimination of unwanted
toxins out of the body. The heat generated within the body, increases the basal metabolic rate,
utilizing excess fat cells, thus reducing weight.

ABHYANGSNANA :

 Increased circulation to nerve endings

 Toning of muscles and the whole physiology
 Calming the nerves
 Improved elimination of impurities from the body

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AIR BATH :
Air bath has soothing and tonic effect upon the millions of nerve endings all over the
surface of the body. It has good results in cases of nervousness, neurasthenia, rheumatism, skin,
mental and various other chronic disorders. Breathing technique also plays a vital role in
improving effectiveness of Air therapy. Deep breaths help in intake of more oxygen which
refreshes the body and improves its resistance. It is important that one inhales through nose as
small hairs present in nose purify air before it enters the body. While taking air therapy one must
be careful as to not walk around in a polluted area. A walk on a busy and polluted road will not
be as effective as walk in a green garden/park.

COLD AIR BATH :

One can take an cold air bath daily for 20 minutes or longer if possible. It is more advantageous
when combined with friction and exercises. In this process, one should walk daily after
removing the clothes or wearing light clothes at a lonely clean place where adequate fresh air is
available. Another alternate method is in a constructed room without roof and surrounded by
shutter like walls so as to allow free passage of air but prevent any view of the interior. Cold air
increase the systemic circulation, and invigorates the abdominal organs. Cold air bath stimulates
the sympathetic nervous system, increasing the basal metabolic rate. This causes the utilization
of unwanted fat cells and aids in weight loss. However, cold air bath is contra-indicated in
patients with any cardiac compromise or breathing difficulty.

HOT AIR BATH :

The procedure to take hot air bath is similar to that of cold air bath, where the hot air is made to
come in contact with skin in a closed environment. The hot air increases the peripheral
circulation and aids in removing stagnant metabolic wastes through perspiration. The heat
produced in this bath, increases resting metabolic rate, promotes proper elimination through
sweating and increases the burning of fat cells. However , it is contra-indicated in people with
hypertension, skin burns, psoriasis, open wounds.

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 MAGNETOTHERAPY

Magneto therapy is a clinical system in which human ailments are treated and cured through the
application of magnets to the body of the patients. It is the simplest, cheapest and entirely
painless system of treatment with almost no side or after effects. The only tool used is the
magneto therapy is applied directly to the body parts by the therapeutic magnets available in
different powers or as general treatment to the body. Also magnetic belts are available for
different parts.

HOW MAGNETS HELPS WITH OBESITY :

1. VASCULAR EFFECT :
It has been observed that the magnets facilitate the capillary neoformation, the
appearance of pericytes in capillaries and opens the precapillary sphincters which all
results in vasodilation in a local level due to arterial circulation improvement.

2. AUTONOMOU NERVOUS SYSTEM :

Magnetic application increases the chemical mediators like catecholamine,
adrenaline, nor adrenaline or as acetylcholine. It also causes increase in the nerve

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 impulses and stimulates sympathetic nervous system, which results in increased digestive
and eliminative function.

3. BOOSTS METBOLISM :
Local application of magnets causes the increased peripheral circulation, which
results in uptake of fat cells around the applied region, increases the resting metabolic
rate, aiding in weight loss. In instance like magnetic abdominal belt, there is increased
sphlancic circulation resulting in utilization of stagnant fat cells in and around the soft
tissues and burning them to produce energy, and sucking of lymphatic waste to the
surface, which is then expelled by our body thus resulting in reducing abdominal fat and
reducing BMI.

The magnet of the belt causes your stomach muscles to relax and contract. This
process stimulation takes place during different abdominal exercises. You should wear the belt
properly so that both the ends of the belt meet the belly button.

MAGNETISED WATER : The magnetized hexagonal water has been known to be effective in
the prevention and treatment of diseases such as diabetes and cancer by promoting metabolism in
the body and improving bio activation. Researches presented the possibility that magnetized
water can prevent aging and fatigue by increasing the cell membrane permeability.

On plasma glucose level :Experimental studies showed that when magnetized water is
administered to experimental animals to induce type 1 diabetes, pancreatic β-cells become
destructed and insulin secretion is decreased, which then causes abnormal metabolism and
increased blood glucose level. However, after 4 weeks of magnetized water supplementation, the
blood glucose level decreased.

On circulation and metabolism : Ma et al. [19] observed physiological effects that magnetized
water increased glutamate decarboxylase activity by about 30%. It was interpreted as the
interaction among the magnetized water molecules becoming reduced, while the interaction
between enzymes and magnetized water was promoted in the weak magnetic field established by
magnetized water, finally affecting the structure of enzymes. Electrolytes in the water have
higher degree of ionization, and magnetic treatment on such water changes chemical and
physical characteristics of water by converting the kinetic energy of ions into electrical energy,
and thus electrolyte ions become activated to the state that can bind others easily. Such activated
electrolytes are quickly absorbed in the body and promote biological activation of tissues and
cells, and activate enzyme actions in the metabolism. The study on the effect of drinking
electrolyzed reduced water, which had a higher pH and effective in ROS scavenging capacity,
showed that the intake of electrolyzed reduced water protected β-cell damages and improved
blood glucose status in db/db diabetic rats.

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Magnetized water, after being absorbed in the body, is transported to the heart through the portal
vein and circulated in the body, and a part of kinetic energy of the blood is converted to electrical
energy to generate new electricity in the blood by which unionized electrolytes can be ionized.
Such ions, when acting on the autonomic nerves, can improve blood circulation and thus
improve the treatment effect on several diseases related to blood circulation

OZONE THERAPY
What is ozone therapy ?

Ozone is a form of oxygen. ozone therapy use gas or liquid forms of ozone to treat medical
conditions and as a topical disinfectant. Ozone gas is a form of oxygen. This colorless gas is
made up of three oxygen atoms. In the upper atmosphere, a layer of ozone gas protects the earth
from the sun’s UV radiation

How to Lose Weight with Ozone Therapy?

Weight loss with ozone methods is based on the following principles:

Accelerating metabolism,
Regulation of blood sugar,
Disposal of edema,
Providing regional thinning by burning fat and renewing cells.

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METHODS OF OZONE APPLICATION :

For example, the application of major ozone accelerates metabolism. In the application of major
ozone, a certain amount of blood taken from the person is mixed with ozone in a special
environment and the ozonated blood is returned to the body. In this way, blood sugar is regulated
while accelerating metabolism. Regulation of blood sugar is just as important as accelerating
metabolism. This is because excessive carbohydrate and sugar consumption is reduced. Insulin
resistance is broken and sugar is burned.

Another ozone method used in slimming is the ozone sauna process. Ozone is entered into a one-
person cabin in the sauna. The body sweats and pores open with hot and steam. Then ozone gas
is given to the body from inside the cabin. Thus, both edema is thrown and skin is renewed.

Another method of slimming is ozone injection. This method, also called ozone lipolysis,
provides regional thinning. Ozone is injected with mesotherapy needles in the areas to be
examined. It is especially effective in areas that are very difficult to weaken, such as belly and
basin. Ozone is made easier to burn fat. Exercise and plenty of water consumption is useful in
conjunction with the application. This application provides the breakdown of fats, while also
helping to regenerate tissues by regenerating cells.

Ozone is a complementary therapy. It is essential that people who want to lose weight go to
calorie restriction and exercise to burn excess weight.

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 METHODOLOGICAL CASE STUDY

EFFICACY OF YOGA AND NATUROPATHY IN OBESITY

AIM:

To prove the efficacy of naturopathy and yoga treatment in the management of obesity patients.

 To reduce weight
 To treat the sign and symptoms.
 To improve quality of life of patients with obesity by early intervention and proper
management .

OBJECTIVES:-

The goal of study was to estimate the effects of Naturopathy and Yogic management on obesity
patients with the age limits between 20-60 yrs.

DESIGN :-

Single case study

No. of subjects - 50

Group – patients with obesity

Subject has learnt life style modification, naturopathy treatments and yoga intervention in the

hospital for minimum of 1 month & practiced for 3 months at home, after 3 months
postassessment follow ups were taken.

Materials & methods :-

Source of data: The subjects will be recruited from outpatient & inpatient facility of GOVT

YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPITAL.

Selection criteria

Inclusion criteria:

 Patients having BMI 25 and above

 Patients from the age group of 20 to 60 were selected
 Both genders

Exclusion criteria:

 With CNS dysfunction

96
  With psychological issues
 Cardiac rehabilitation following bypass surgery
 Female subjects during their menstrual cycle
 During pregnancy

STUDY DESIGN :
SELLECTON OF PATIENTS (1MONTH)

CONFIRMING THE PATIENTS ARE UNDER INCLUSION

CRITERIA (1 MONTH)

ASKING COMPLAINTS OF PATIENTS

USING QUESTIONNAIRE (1 MONTH)

YOGA AND NATUROPATHY INTERVENTIONS GIVEN (1 MONTH )

TREATMENT FOLLOWED (3 MONTHS)

FOLLOW UP (3 MONTHS) & DATA ANALYSIS (2 MONTHS)

RESULTS (1 MONTH )

Material required :

 Yoga mat, chakra charts

 Foot bath tub, steam bath, mud pack, hip bath tub, wet sheet pack
 Colour bottles, colour glass, garments & magnets
 Acupuncture needles
 Massage table, aroma oil

Treatment:

The following Yoga and Naturopathy treatments were given to the patients for the period of 1
month based on the expert physician advice.

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Yogic intervention

 Asana, pranayama, mudra, Bandha

 Kriyas
 Meditation & yoga nidra

Naturopathic intervention

 Hydrotherapy & Mud therapy

 Diet therapy
 Massage & Aroma therapy
 Chromo & magneto therapy
 Acupuncture, acupressure, reflexology
 Exercise therapy

Outcome measurement:

The following parameters were assessed before and after 1 month of Yoga and
Naturopathy Treatments.

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GOVT.YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPITAL

OBESITY QUESTIONNARIE

NAME: OP.NO
AGE : SEX : MALE / FEMALE

1) Do you have breathlessness while walking? Yes/No

2) Do you have extra fat around waist? Yes/No
3) Do you have fat deposition on abdomen? Yes/No
4) Do you have dark pigmentation (Acanthosis) around your neck? Yes/No
5) Do you have joint pain? Yes/No
6) Do you have frequent bowel movement? Yes/No
7) Do you feel asleep on day time? Yes/No
8) Do you have excessive sweating? Yes/No
9) Do you have breakfast every day? Yes/No
10) Quality of life? Good/Poor

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 DATA COLLECTION

S.NO NAME / AGE/SEX Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10

B A B A B A B A B A B A B A B A B A B A
1 SURENDAR /42 Y/M N N Y N Y N N N N N N N Y N Y N N N P G
2 KUMAR/ 32 Y/ M Y Y Y N Y Y Y N N N N N N N Y N Y Y P P
3 KUMARAN /39Y/M Y N Y Y Y N N N Y Y N N N N Y N Y Y P G
4 SATHYA/26 Y/M Y N N N N N Y Y Y N Y Y N N Y N Y Y P P
5 SANGEETHA/43Y/F N N Y N Y N N N Y Y N N Y N N N Y Y P G
6 KAMAL Y N Y N Y N N N N N N N Y Y N N Y Y P G
ADITHYA/17Y/M
7 MOHAN RAJ/ 27 Y/M Y Y Y Y Y Y N N Y N N N N N Y N N N P P
8 FATHIMA/ 27 Y/ F N N Y N Y N N N N N N N Y N N N Y Y P G
9 VENKATESAN /49 Y/M N N Y N Y N N N Y N N N Y N N N Y Y P G
10 NARMADA/27 Y/F N N Y N Y N Y N N N Y N Y N N N Y Y P G
11 SATISH/ 29 Y/M Y N Y N Y Y N N Y Y N N N N Y N N Y P G
12 AMRUTHAVALLI/26 Y/F N N Y N Y N Y N N N Y N Y N N N N Y P G
13 MANGALAM /41 Y/F Y N Y N Y N N N Y Y N N N Y Y Y Y Y P P
14 SAHAYAM/ 49 Y/ M N N Y N Y N Y N N N Y N Y Y N N Y Y P G
15 BALU /41 Y /M N N Y N Y N Y N Y Y Y N Y N N N Y Y P G
16 SHANMUGAM/43Y/M N N Y N Y N Y N N N N N Y N N N N Y P G
17 SANTOSH KUMAR/31 N N Y N Y N N N Y N N N N N Y N N Y P G
Y/M
18 ATHITHI/ 25 Y /F Y Y Y N Y N N N Y N N N N N Y N N Y P G
19 AARTHI / 32 Y/F N N Y Y Y N Y Y Y N N N Y N Y N N Y P P
20 LANISH JAFRIN /30Y/M N N Y N Y N N N N N Y N N N Y N N Y P G
21 SHEEBA /24 Y/ F Y N Y Y Y Y N N N N N N Y N Y N N Y P P
22 HALIL MOHAMMED 54 N N Y N Y N Y N Y N N Y Y N N N N Y P P
Y/M
23 VINITHA /29 Y/F N N Y N Y N N N N N Y N Y N N N N Y P G
24 MANICKAM /41 Y/M N N Y N Y N N N Y N N N Y N Y N N Y P G
25 GEETHA /49 Y/F Y Y Y Y Y Y N N Y N Y N Y N Y N N Y P P
26 MALA /48 Y/F Y N Y N Y N N N Y Y N N N N Y N Y Y P P
27 RAGAVENDHRAN 43 N N Y N Y N Y N N N N N Y N N N N Y P G
Y/M

100
28 KAVITHA /39 Y/F N N Y N Y N N N N N Y N N N Y Y N Y P G
29 DEEPA/51 Y /F N N Y N Y N N N N N Y N N N Y N N Y P G
30 SARAVANAN/ 32Y/M Y N Y Y Y Y N N N N N N Y N Y N N Y P P
31 RAJESHWARI/ 25 Y/F N N Y N Y N Y N Y N N Y Y N N N N Y P P
32 AMUDHA/ 49 Y/F N N Y N Y N N N N N Y N Y N N N N Y P G
33 SENTHAMIL/ 42 Y/ F N N Y N Y N N N Y N N N Y N Y N N Y P G
34 SUGANTHI / 38 Y/F Y N N N N N Y Y Y N Y Y N N Y N Y Y P P
35 DHARANI/ 27 Y/F N N Y N Y N N N Y Y N N Y N N N Y Y P G
36 RAJALAKSHMI/33 Y/F Y N Y N Y N N N N N N N Y Y N N Y Y P G
37 SUBHASHINI/45 Y/F Y Y Y Y Y Y N N Y N N N N N Y N N N P P
38 SAMUEL/27 Y/M N N Y N Y N N N N N N N Y N N N Y Y P G
39 DIWAKAR/ 42 Y/M Y N Y N N Y Y N N Y N N Y N Y N N Y P P
40 JEYA/39 Y/F N N N N Y N Y N N Y N N N N Y N Y Y P P
41 MALATHI/ 48 Y/F N N Y N N N Y N N Y N N Y N N N N Y P G
42 RAVEENA/26 Y/F Y Y Y N Y Y N N N Y N N N N Y Y N Y P G
43 INDHUMATHI/25 Y/F N N Y Y N N Y N Y Y Y N N N Y N N Y P G
44 ARPUTHAM/ 31Y/ F N N N N N N Y Y N Y N N Y N Y N N Y P P
45 ADHITHYA / 26Y/M N N Y N N N N N N Y N Y Y N N N N Y P P
46 CHARULATHA/50 Y/M N N N N N N Y N N Y N N Y N N N N Y P G
47 ADHISAYAM/54 Y/M Y N Y N N Y Y N N N N N Y N Y N N Y P G
48 NANDHINI/ 25 Y/F N N N N Y N Y N N Y N Y N N Y N Y Y P P
49 SAVITHA/21 Y/F N N Y N N N Y N Y N N N Y N Y N N Y P G
50 SANGEETHA/30Y/F Y Y Y N Y Y N N Y N N Y Y N N N N Y P G

STATISTICAL ANALYSIS :

101
1. Breathlessness while walking :

70%
60%
50%
40% YES
30% NO
20%
10% NO
0%
BT YES
AT

2. Fat around waist :

80%
70%
60%
50%
YES
40% NO
30%
20%
NO
10%
0%

BT YES
AT

3. Abdominal fat :

102
 90%
80%
70%
60%
50% YES
40% NO
30%
20%
NO
10%
0%
BT YES
AT

4. Pigmentation around neck :

70%

60%

50%

40%
YES
30% NO

20%

10% NO

0%
BT YES
AT

5. Pain on joints :

103
 80%
70%
60%
50%
YES
40%
NO
30%
20%
10% NO
0%
BT YES
AT

6. Frequent bowel movements :

70%
60%
50%
40% YES
30% NO

20%
10% NO
0%
BT YES
AT

7. Sleep during daytime :

104
 70%
60%
50%
40%
YES
30% NO

20%
10% NO
0%
BT YES
AT

8. Excessive sweating :

80%
70%
60%
50%
40% YES
NO
30%
20%
10% NO

0%
BT YES
AT

9. Breakfast everyday :

105
 80%
70%
60%
50%
40% YES
NO
30%
20%
10% NO
0%
BT YES
AT

10. Quality of life :

90%
80%
70%
60%
50%
POOR
40% GOOD
30%
20%
10% GOOD
0%
BT POOR
AT

106
 GOVT. YOGA & NATUROPATHY MEDICAL COLLEGE & HOSPITAL
CHENNAI – 106.

OUTCOME MEASUREMENTS

S.
NO : SYMPTOMS % OF POST THERAPY

1. Do you have breathlessness

39.4 %

2. Do you have fat around waist

54.2%

3. Do you have fat depositions on the

abdomen 59.5%

4. Do you have dark pigmentation

(acanthosis ) around your neck 32.1%

5. Do you have joint pain

23.4%

6. Do you have frequent bowel movements

60.1%

7. Do you feel asleep on day time

56%

8. Do you have excessive sweating

49.5%

9. Do you have breakfast everyday

71%

10. Quality of life

73%

107
RESULTS :
By analyzing the patient with obesity for past 1-3 months data were collected which
includes signs and symptoms along with treatment given to the patient. The outcome are
breathlessness reduced 39.4%,frequent bowel movement reduced 60.1%,excessive sweating
reduced 49.5%,quality of life 73%.

CONCLUSION:
Obesity specially refers to an excessive amount of body fat. Obesity may
lead to severe health risks, like type 2 diabetes mellitus, heart disease, high blood
pressure, high blood cholesterol, osteoarthritis, reproductive problems in women,
including menstrual irregularities, infertility, PCOD etc. yogic management can
effectively manage obesity and provide weight loss through the burning of
excessive fat, harmonizing the hormones and regulates the bodily function in
unique. Naturopathic diet and therapies also help to accelerate the weight loss
process for obese patients. Hence Yoga & Naturopathy are effective in managing
and reducing body weight.

108