Obesity has reached at pandemic levels and has become a subject of concern as it is directly related to many diseases.

As obesity is directly associated with many diseases, so it needs to be studied properly in all its dimensions so as to prevent it, treat it and also to understand all the underlying factors related.

Diagnostic Measurements and Evaluation Methods for Level of Obesity

To measure fat ratio in our body there are many highly technical ways but clinically feasible and practical are the following 3 ways which are widely used.

1. BMI – Body Mass Index, where the body weight is related with height BMI=Body Mass/ (Body Height)². It is measured as kg/m². BMI of 18.5 to 25kg/m² is considered to be normal, below 18.5kg/m² underweight, 27-30kg/m² overweight, above 30kg/m² Obese. In general a subject having BMI above  27kg/m² and below 18.5 kg/m² is considered to be at health risk.
2. Various Circumferences of body and their relation and ratio with each other, especially waist to hip circumference ratio. Distribution of fat also determines the risk factor as it is observed that central or visceral obesity where fat accumulates in belly around abdominal organs and on trunk is observed to have more health risk compared to diffused subcutaneous fat accumulation.
3. Skin Fold Measurement is also one of the ways to measure fat proportion. This method which gives us better idea about subcutaneous fats. Skinfold measurement when taken along with the other two above mentioned methods gives us a better comparative ratios and evaluation of body fat measurements.

Risk Factors of Obesity

Not only genetics but also environment plays a major role e.g. Its observed that Asian shifting to USA (the obesity capital of world), ratio wise more tend to become obese compared to their counterparts in their country.

Few of the risk factors are mentioned below

• Genetics and familial predesposition
• Enviroment and staple food of the region
• Sedentary lifestyle
• Irregular sleep pattern
• lrregular meal pattern
• Low protein intake
• High carbohydrate and sugar intake
• Certain Metabolic Disorders
• Hypothyroidism
• Diabetes Mellitus
• PCOS polycystic ovarian disease
• Certain Medications
• Certain Psychiatric Eating Disorders
• Bigorexia/muscle dysmorphia
• Body Dismorphic Disorder
• Anorexia Nervosa
• Orthoxia nervosa
• Depression
• Anxiety
• Night Eating Syndrome
• Certain injuries deformities and disabilities that makes patient immobile which causes weight gain.

Pathophysiology of Obesity

To simplyfy the understanding of causation of obesity; which otherwise is too complicated to comprehend with a single article; I have explained it in a broader sense and summarised its essense as follows:

“Obesity is the disease of low energy utilisation compared to intake!”

“When the intake of energy exceeds its utilisation, it then get converted into triglycerides and is stored in adipose tissues causing obesity”

There are many factors that are responsible for obesity but the recent research has come up with an interesting mind boggling study of one of such factor that is the molecule Leptin.

Leptin and Ghrelin with other endocrinal molecules controls Appetite and Satiety centers through hypothalamus. Is a complex Hypothalamo-pitutary-endocrinal axis that is inovolved in the mechanism.

Of all the other various factors, Leptin needs a special reference and attention when it comes to obesity. As Leptin not only controls Apetite but also controls Thermogenesis and other Catabolic processes.

Role of Leptin in Apetite Control

Adipocytes communicate with satiety centers present in hypothalamus by secreting a polypeptide called Leptin. The levels of Leptin are determined by the amount of fat stores in the body. Leptin interacts with the hypothalamus by attaching to Leptin receptors.

When Lateral Hypothalamus(LH) is stimulated it increases appetite and vice a versa.

When Venteromedial Hypothalamus(VMH) is stimulated it creates satiety and vice a versa.

Level of Leptin and its relation with certain appetite controling molecules through Stimulation or inhibition of LH and VMH is as follows:

• Inversely proportional to a powerful appetite stimulators like Neuropeptide Y(NPY) and Agouti Related Peptide(AgRP). Resultant Stimulating LH and Inhibiting VMH
• Directly proportional to powerful appetite inhibitors like Glucagon Like Peptide-1(GLP-1), Pro-opiomelanocortin(POMT) and Cocaine and Amphetamine Regulated Transcript(CART). Resultant Stimulating VMH and inhibiting LH

Role of Leptin in Catabolic Processes.

Leptin receptor stimulation increases

• Energy expenditure
• Physical activity
• Thermogenesis(heat production)

Role of leptin in Energy Expenditure, Physical Activity and Thermogenesis

• Stimulation of leptin receptors in hypothalamus stimulates secretion of Norepinephrine from sympathetic nerve endings in adipose tissue.
• This stimulates β3-adrenergic receptors expressed by fat cells which results into hydrolysis of fatty acids.
• This results into release of energy which is dissipated in the form of heat.

Also there are other catabolic effects of leptin which are mediated through Hypothalamo-Pitutary axis which goes through the channel of endocrinal system by stimulating endocrinal glands.

Deletion or SNP of Leptin producing gene causes leptin deficiency resulting into extreme obesity.

Complications and Diseases Associated with Obesity

Obesity complicates almost all the diseases and precipitates many life threatening chronic diseases.

Few of them which needs special reference are

• Hypertension
• Diabetes Mellitus
• Osteoarthritis
• Gout
• Lumbar spondylodis
• Sciatica
• Meralgia Paraesthetica
• Artherosclerosis
• Hypertriglyceridemia
• Hypercholestrolemia
• Low HDL
• Cardiomegaly
• Congestive Cardiac Failure
• Ischemic Heart Diseases
• Deep Vein Thrombosis
• Pulmonary Embolism
• Fatty Liver
• Cholelithiasis
• Hypoventilation syndrome
• PCOS
• Infertility
• Erectile Dysfunction
• Hypogonadism
• Burried male genitals
• Depression
• Certain Cancers

HOMEOPATHIC MEDICNES AND MANAGEMENT FOR OBESITY

To Lose Weight in obese patient who wants to reduce weight it is necessary to rule out all the pathological factors which may be responsible for obesity and if any found then first the underlying abnormalities needs to be treated first.

Each case preferably needs to be individualised properly as per homoeopathic principles for medicine selection, to yield best results of homoeopathic medicines.

Though , there are some generally used common homoeopathic medicines to lose weight which I have simplified to select by providing basic guidelines which are hard to fail in most of the cases,

1. Phytolacca Berry well proven homoeopathic medicine for weightloss in general.
2. Fucus Vesiculosus compliments well to phytolacca berry and when both given intermittently during weightloss treatment works wonders.
3. Calcarea Carbonica Generalised obesity, for fair, fat and flabby women especially in their forties, mentally and physically sluggish , well suited to women with thyroid disorders.
4. Thuja Occidentalis obesity due to excessive hunger and abnormally high appetite.
5. Ignetia Amara obesity in females due to depressing emotion and PCOS.
6. Thyroidinum obesity due to thyroid disorder
7. Sepia obesity in female do to Polycystic Ovarian Syndrome (PCOS)
8. Iodium obesity due to disorder in thyroid glands
9. Bromium obesity due to disorder in thyroid gland
10.  Nux Vomica for weight gain due to sedentary lifestyle, irregular dietary habbits, irregular routine, lack of sleep, typical central obesity.

Weight Management

• To lose weight a person needs to keep strict control on his diet and need to do exercise on regular basis along with medicines for faster and better results.
• One needs to keep check that he doesnt lose muscle mass in the process
• I recomend to completely stop sugar and jaggery
• Oil and Ghee not more than 1-2 tsp throughout the day
• Increase protien intake as per intensity of workout
• Increase fiber intake in form of salads and fruits that are not too sweet
• 4-5 small meals throughout the day
• Ample of water throughout the day
• 1 hour yoga or brisk walk
• Intense workout under professional guidance for those wants to achieve subnormal so called ripoed and defined body.
• Atleast 7 hours of continious sleep at a stretch is recomended.