Introduction

Obesity is one of the most prevalent metabolic disorders globally and is recognized as a major risk factor for numerous non-communicable diseases, including type 2 diabetes mellitus, cardiovascular diseases, dyslipidemia, and certain cancers. In 2022, approximately 2.5 billion adults were overweight, of whom nearly 890 million were obese—reflecting a doubling of adult obesity since 1990.^[1] The World Obesity Federation projects that obesity among adults will more than double from 524 million in 2010 to 1.13 billion by 2030, an increase of over 115%.^[2] Alarmingly, recent projections suggest that by 2050, more than half of all adults and nearly a third of children globally will be overweight or obese.^[3] In India, this trend mirrors the global crisis. Nearly 24% of women and 22.9% of men are now overweight or obese, with predictions estimating a rise in adult obesity from 8% in 2023 to over 11% by 2035.^[4] One recent study projects that by 2050, nearly one-third of India’s population - around 218 million men and 231 million women—will fall into the obese category.^[5] Additionally, one in five Indian households now has all adult members overweight or obese.^[6] Leptin, a hormone produced by adipocytes, plays a vital role in regulating appetite and energy metabolism. However, in many obese individuals, despite elevated leptin levels, the body exhibits resistance to its effects, leading to persistent hunger, fat accumulation, and insulin resistance.^[7] This dysfunction is a hallmark of metabolic syndrome, which includes central obesity, hypertriglyceridemia, low HDL, high blood pressure, and impaired glucose tolerance.^[8] In Ayurveda, obesity is described under the condition Medoroga, which is caused by the vitiation of Kapha Dosha and Medovaha Srotas Dushti. The deranged Agni (digestive fire), improper transformation of Rasa Dhatu into Meda Dhatu, and accumulation of Ama (toxins) result in excessive fat accumulation and blockage of Srotas.^[9] Medovaha Srotas refers to the physiological pathways that govern fat tissue metabolism, and its dysfunction leads to systemic imbalance correlating with modern understanding of metabolic disease.^[10] By integrating Ayurvedic diagnostic tools such as Dashavidha Pariksha, Agni Pariksha, and Srotodushti Lakshana with modern metabolic markers like serum leptin, lipid profile, fasting insulin, and HOMA-IR, a deeper, personalized understanding of obesity can be achieved.^[11]

Patient Selection Criteria

Inclusion Criteria

1. Age between 25–45 years
2. BMI ≥ 30 kg/m²
3. Clinical features of obesity & metabolic syndrome
4. Willingness to participate and provide consent

Exclusion Criteria

1. Patients with secondary obesity due to endocrine disorders
2. Pregnant or lactating women
3. Known cases of psychiatric illness or genetic syndromes

Ayurvedic Examination Parameters

• Dashavidha Pariksha: Assessment of Prakriti, Vikriti, Sara, Samhanana, Satva, Satmya, Ahara Shakti, Vyayama Shakti, Vaya, and Desha
• Srotodushti Lakshana (Medovaha Srotas): Symptoms such as Staimitya (heaviness), Snigdhata, Atisweda, Kshudra Shwasa, and Atikshudha were observed and documented
• Agni Bala: Assessed as Mandagni, Tikshnagni, Vishamagni, or Samagni
• Vyayama Shakti and Nidra quality were evaluated
• Presence of Ama was noted through clinical sig-ns like Malasanga, Mukhavairasya, & Jadhyatha

Modern Clinical Evaluation

• Anthropometric Measurements:

• Height, weight, BMI
• Waist circumference (WC), Hip circumference (HC), and Waist-Hip Ratio (WHR)

• Clinical Parameters:

• Blood Pressure
• Heart Rate

• Laboratory Investigations:

• Fasting Blood Sugar (FBS)
• Fasting Serum Insulin

• Serum Leptin
• Lipid Profile (Total Cholesterol, HDL, LDL, Triglycerides)
• HOMA-IR (Homeostatic Model Assessment for Insulin Resistance)

• Waist Circumference: 98 cm
• Hip Circumference: 112 cm
• Waist-Hip Ratio:875

Vital Signs

• Blood Pressure: 138/90 mmHg
• Pulse Rate: 82/min
• Respiratory Rate: 20/min

Laboratory Investigations

• Fasting Blood Sugar: 106 mg/dL
• Serum Triglycerides: 184 mg/dL
• HDL-C: 38 mg/dL
• Fasting Insulin:5 µIU/mL
• Serum Leptin:2 ng/mL (elevated)
• HOMA-IR: 64 (indicative of insulin resistance)

Ayurvedic Examination

• Prakriti: Kapha-Pittaja
• Agni Bala: Mandagni
• Vyayama Shakti: Alpa
• Satva: Madhyama
• Sara: Mamsa-Sara Alpa
• Medovaha Srotodushti Lakshanas Present:

• Sthairya, Snigdhata, Atisweda, Kshudra Shwasa, Anga Gaurava
• Clinical signs of Ama: Mukhavairasya, Jadhyatha, Malasanga

Diagnosis

Modern Diagnosis: Obesity (Class II) with Metabolic Syndrome and Leptin Resistance.

Ayurvedic Diagnosis: Sthoulya with Medovaha Srotas Dushti due to Kapha-Medo Dushti, Mandagni, and Ama.

Observations

The patient presented with clinical obesity (BMI – 36.2 kg/m²), central adiposity (waist circumference – 98 cm), and fulfilled the diagnostic criteria for metabolic syndrome as per the IDF guidelines. Biochemical investigations revealed:

• Elevated fasting insulin (21.5 µIU/mL)
• Increased serum leptin (38.2 ng/mL)

Conclusion

This case study illustrates the diagnostic and conceptual relevance of Medovaha Srotas Dushti in the pathogenesis of obesity, particularly when viewed alongside modern parameters such as leptin resistance and metabolic syndrome. The clinical picture of the patient - marked by obesity, central adiposity, insulin resistance, dyslipidemia, and elevated serum leptin - aligns closely with the Ayurvedic features of Sthoulya, Agnimandya, Ama Nirmiti, and Kapha-Medo Dushti. The Ayurvedic perspective of Medoroga emphasizes the importance of Agni, Ahara, and Vihara in the genesis of metabolic imbalance. Srotodushti in the Medovaha Srotas impairs lipid metabolism and disrupts Dhatu Poshana, much like how leptin resistance disturbs energy regulation in modern physiology. This case reinforces the concept that obesity is not merely an accumulation of fat but a systemic disorder involving digestive fire, tissue metabolism, and subtle channels of transport (Srotas). By establishing a correlation between classical Ayurvedic parameters and modern biomarkers, the study underscores the importance of a holistic, multidimensional diagnostic approach in lifestyle disorders like obesity. The findings also support the relevance of personalized Ayurvedic assessment in identifying underlying imbalances and potential therapeutic targets. Such integrative case assessments can pave the way for novel interventions where Ayurvedic diagnosis guides individualized treatment, even as modern tools monitor progress objectively. This not only validates ancient knowledge systems but also enhances their applicability in managing global health challenges like obesity and metabolic syndrome.

References