ETIOLOGICAL AND PREVENTIVE PERSPECTIVES OF STHAULYA (OBESITY): AN INTEGRATIVE AYURVEDIC AND BIOMEDICAL NARRATIVE REVIEW
DOI:
https://doi.org/10.5281/zenodo.21942841Keywords:
Sthaulya; obesity; Nidana Parivarjana; Meda; Ayurveda; preventionAbstract
Background: Sthaulya is an Ayurvedic clinical construct characterised by excessive Meda and Mamsa, impaired functional capacity and disturbed metabolic regulation. It overlaps with, but is not identical to, modern obesity. Objective: To critically synthesize Ayurvedic etiological and preventive concepts of Sthaulya with contemporary evidence on obesity. Methods: A focused narrative review of major Ayurvedic compendia and selected authoritative reports, guidelines, systematic reviews and landmark biomedical studies was undertaken. Evidence was organised around causation, pathophysiology, assessment and prevention; proposed cross-system correspondences were treated as conceptual rather than proven biological equivalences. Results: Ayurvedic descriptions emphasise excessive or inappropriate nourishment (Santarpana), heavy, unctuous and sweet foods, overeating, insufficient exercise, inappropriate daytime sleep, psychological and hereditary susceptibility, followed by Kapha-Meda increase, impaired Agni and Srotorodha. Biomedical evidence identifies interacting genetic, neuroendocrine, behavioural, environmental and adipose-tissue mechanisms. The strongest convergence concerns modifiable determinants: food quality and quantity, physical inactivity, sedentary time, sleep disruption, stress and an obesogenic environment. Nidana Parivarjana provides a useful organising principle for personalised and population-level prevention when combined with validated cardiometabolic assessment and non-stigmatising care. Conclusion: An integrative approach may enrich prevention by combining Ayurveda’s attention to routine, food qualities and individual context with biomedical risk stratification and evidence-based intervention. Literal translation of Ayurvedic constructs into biomedical mechanisms should be avoided, and better-designed interdisciplinary research is required.
Downloads
References
World Health Organization. Obesity and overweight. Geneva: World Health Organization; 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed August 12, 2026.
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403:1027-1050.
World Health Organization. One in eight people are now living with obesity. Geneva: World Health Organization; 2024. Available from: https://www.who.int/news/item/01-03-2024-one-in-eight-people-are-now-living-with-obesity. Accessed August 12, 2026.
Bray GA, Kim KK, Wilding JPH; World Obesity Federation. Obesity: a chronic relapsing progressive disease process. Obes Rev. 2017;18(7):715-723.
Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804-814.
GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13-27.
Ahirwar R, Mondal PR. Prevalence of obesity in India: a systematic review. Diabetes Metab Syndr. 2019;13(1):318-321.
International Institute for Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-5), 2019-21: India. Mumbai: IIPS; 2021.
Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians. J Assoc Physicians India. 2009;57:163-170.
Agnivesha. Charaka Samhita, revised by Charaka and Dridhabala, with Ayurveda-Dipika commentary of Chakrapanidatta. Acharya YT, editor. Varanasi: Chaukhambha Surbharati Prakashan; 2016. Sutra Sthana 21.
Agnivesha. Charaka Samhita, revised by Charaka and Dridhabala, with Ayurveda-Dipika commentary of Chakrapanidatta. Acharya YT, editor. Varanasi: Chaukhambha Surbharati Prakashan; 2016. Sutra Sthana 23.
Sushruta. Sushruta Samhita with Nibandhasangraha commentary of Dalhana. Acharya YT, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2017. Sutra Sthana 15.
Vagbhata. Ashtanga Hridaya with Sarvangasundara commentary of Arunadatta and Ayurvedarasayana of Hemadri. Paradakara HS, editor. Varanasi: Chaukhambha Surbharati Prakashan; 2016. Sutra Sthana 14.
Bhavamishra. Bhavaprakasha with Vidyotini Hindi commentary. Mishra BS, editor. Varanasi: Chaukhambha Sanskrit Bhawan; 2018. Madhyama Khanda, Medorogadhikara.
Haslam DW, James WPT. Obesity. Lancet. 2005;366(9492):1197-1209.
Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635-643.
Hall KD, Heymsfield SB, Kemnitz JW, et al. Energy balance and its components: implications for body weight regulation. Am J Clin Nutr. 2012;95(4):989-994.
Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89(6):2548-2556.
Rosen ED, Spiegelman BM. Adipocytes as regulators of energy balance and glucose homeostasis. Nature. 2006;444(7121):847-853.
Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860-867.
Reaven GM. Banting lecture 1988: role of insulin resistance in human disease. Diabetes. 1988;37(12):1595-1607.
Friedman JM, Halaas JL. Leptin and the regulation of body weight in mammals. Nature. 1998;395(6704):763-770.
Loos RJF, Yeo GSH. The genetics of obesity: from discovery to biology. Nat Rev Genet. 2022;23(2):120-133.
Maes HH, Neale MC, Eaves LJ. Genetic and environmental factors in relative body weight and human adiposity. Behav Genet. 1997;27(4):325-351.
Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936-941.
Malik VS, Popkin BM, Bray GA, et al. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121(11):1356-1364.
Bray GA, Popkin BM. Dietary fat intake does affect obesity! Am J Clin Nutr. 1998;68(6):1157-1173.
Mattson MP, Allison DB, Fontana L, et al. Meal frequency and timing in health and disease. Proc Natl Acad Sci U S A. 2014;111(47):16647-16653.
Owen N, Healy GN, Matthews CE, et al. Too much sitting: the population-health science of sedentary behavior. Exerc Sport Sci Rev. 2010;38(3):105-113.
Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143-1211.
St-Onge MP, Grandner MA, Brown D, et al. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health. Circulation. 2016;134(18):e367-e386.
Kyrou I, Tsigos C. Stress mechanisms and metabolic complications. Horm Metab Res. 2007;39(6):430-438.
Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220-229.
Macht M. How emotions affect eating: a five-way model. Appetite. 2008;50(1):1-11.
Després JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301-1313.
Kaur J. A comprehensive review on metabolic syndrome. Cardiol Res Pract. 2014;2014:943162.
Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation. 2014;129(25 Suppl 2):S102-S138.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
Warburton DER, Bredin SSD. Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol. 2017;32(5):541-556.
Jayedi A, Soltani S, Emadi A, et al. Aerobic exercise and weight loss in adults: a systematic review and dose-response meta-analysis. JAMA Netw Open. 2024;7(12):e2452185.
Lopez P, Taaffe DR, Galvão DA, et al. Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: a systematic review and meta-analysis. Obes Rev. 2022;23(5):e13428.
Lauche R, Langhorst J, Lee MS, et al. A systematic review and meta-analysis on the effects of yoga on weight-related outcomes. Prev Med. 2016;87:213-232.
Asiah ASS, Ismail S, Sulaiman N, et al. Effect of yoga on anthropometry, quality of life, and lipid profile in patients with obesity and central obesity: a systematic review and meta-analysis. Complement Ther Med. 2023;74:102948.
Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med. 2010;16(1):3-12.
Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: a meta-analysis. Psychoneuroendocrinology. 2017;86:152-168.
Slavin JL. Dietary fiber and body weight. Nutrition. 2005;21(3):411-418.
Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet. 2019;393(10173):791-846.
Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875-E891.
Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485-497.
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020.
