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 Table of Contents 
CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 4  |  Page : 1491-1494  

An integrated therapy approach for the management of obesity-associated disorders: A case report


1 Scientific Research Department, Kaivalyadhama, Swami Kuvalayananda Marg, Lonavla, Pune, Maharashtra, India
2 Ayurveda Section, Kaivalyadhama, Swami Kuvalayananda Marg, Lonavla, Pune, Maharashtra, India

Date of Web Publication25-Apr-2019

Correspondence Address:
Mr. Sanjay U Shete
Scientific Research Department, Kaivalyadhama, Swami Kuvalayananda Marg, Lonavla, Pune, Maharashtra - 410 403
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_200_19

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  Abstract 


Obesity (sthoulya), in general, is a significant health problem and is associated with several comorbidities and various discomforts that can cause negative impact on physical, mental, and social well-being of a person. In this case study, an obese patient was suffering from severe multiple joint pains (aam vata) and shortness of breath (shwaas) was unable to climb stairs, and had extreme difficulty in walking. The patient also suffered from stress-related complaints, such as sleep disturbances (anidra) and poor digestion. The treatment was aimed at restoring psycho-physiological and physical health of the patient. Ayurveda panchakarma therapy involves treatments such as snehana (oleation), svedana (sudation), and virechana (purgation), which are the line of treatment for obesity-related disorders. Furthermore, the patient was given special yoga postures to improve flexibility and movement of joints. The integrative therapy of Ayurveda panchakarma and yoga showed significant improvement in functional capacity, quality of life, and musculoskeletal pain.

Keywords: Ayurveda, musculoskeletal pain, obesity, panchakarma, quality of life, shortness of breath, yoga


How to cite this article:
Verma A, Shete SU, Doddoli G. An integrated therapy approach for the management of obesity-associated disorders: A case report. J Family Med Prim Care 2019;8:1491-4

How to cite this URL:
Verma A, Shete SU, Doddoli G. An integrated therapy approach for the management of obesity-associated disorders: A case report. J Family Med Prim Care [serial online] 2019 [cited 2019 May 25];8:1491-4. Available from: http://www.jfmpc.com/text.asp?2019/8/4/1491/257093




  Introduction Top


Obesity is defined as abnormal or excessive fat accumulation in the body that may impair health of an individual. Obesity, in general, is a significant health problem and is associated with several comorbidities and various discomforts that can cause negative impact on physical, mental, and social well-being of a person. Obesity negatively impacts the musculoskeletal system,[1] respiratory system,[2] endocrine system,[3] and digestive system.[4] Thus, obesity can lead to various potentially life threatening diseases and cause shortening of life span of a person. Although symptomatic treatment may be available to give temporary relief but there is no permanent treatment available in the modern medical system.

We present a case of obesity (sthoulya) having aam vata and shwaas (asthma), which was satisfactorily treated with the help of integrated therapy of yoga and Ayurveda. Traditional Ayurvedic therapy involves complex treatment approaches, such as lifestyle and nutritional advice, manual therapies, medication, dietary supplements, detoxification techniques, and yoga.[5]

Case history

A 54-year-old, Indian, nonsmoking, nonalcoholic female consulted in the Ayurveda and Panchakarma section at the Health Care Centre, Kaivalyadhama, Lonavla. On arrival, the patient had complaints of severe multiple joint pains, difficulty in breathing (shwaas), inability to climb stairs, and extreme difficulty in walking due to obesity (sthoulya). The patient also suffered from stress-related complaints, such as sleep disturbances (anidra) and poor digestion due to highly stressful job profile. In fact, irregular food habits and timings led to disturbances in digestive fire (jatharagni). This led to the formation of aam and vata disturbances that manifested into aam vata. The patient had history of hypothyroidism, asthma, and arthritis. Since a long duration, the patient was on hypothyroid medications, B12 supplements, and recently started taking anti-inflammatory medications to relieve the inflammation of joints. The case was subsequently admitted to the Health Care Centre on 04/09/16 for the administration of Ayurveda panchakarma and yoga therapy for 3 weeks.

Clinical findings

The patient was obese and had complaints of severe knee pain along with difficulty in breathing, walking, and climbing stairs. The patient had generalized musculoskeletal pain, severely restricted knee movements, and extreme work-related pressures, which led to disturbed sleep. This patient was an established case of hypothyroidism, asthma, and rheumatoid arthritis. Family history of the patient was found to be nonsignificant. The patient had a poor appetite due to reduced digestive fire. There was swelling and tenderness in the prominent joints, such as knee and ankle [Table 1].
Table 1: Timeline of the case

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Assessment

The patient's past biochemical tests were done on 30/08/16, which revealed borderline increase in Thyroid stimulating hormone (TSH) while T3 and T4 were within the normal range. Liver function tests, blood sugar, Antinuclear antibodies (ANA), and HbA1c were normal but RA factor and C-Reactive Protein (CRP) were positive. Accordingly, the treatment was planned to restore psycho-physiological and physical health of the patient. Psychological assessments were conducted at the baseline (04/09/16) and at the end of 3 weeks (24/09/16) of therapy. The patient was administered WHO Quality of Life (QOL)-BREF Questionnaire to assess four domains of quality of life, i.e., physical health, psychological, social relationships, and the environment. The four domain scores denote an individual's perception of quality of life in each particular domain. Orebro Musculoskeletal Pain Questionnaire was also administered to screen the degree of musculoskeletal pain in the patient. Spirometry was conducted to assess pulmonary function of the patient. Furthermore, Jeevan Yantra was used to assess lung function of the patient before and after the therapy of 3 weeks. This instrument was designed by Swami Kuvalayananda, Kaivalyadhama, which enhances the lung function by improving the strength and capacity of the lungs.

Therapeutic focus

The line of treatment was focused on reducing the musculoskeletal pain and improving breathlessness symptoms. As per Ayurveda, the patient was given preparatory treatment followed by main treatment, i.e., medicated purgation therapy. Furthermore, the patient was given loosening exercises, asanas, and pranayama to improve the flexibility and movement of joints, daily in the morning and evening for 3 weeks. The details of therapy have been presented in [Table 2] and [Table 3].
Table 2: Ayurveda panchakarma intervention

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Table 3: Yoga module

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Follow up and outcomes

All the psycho-physiological parameters were reassessed on 24/09/16 and the patient was re-examined by an Ayurveda physician. The results of lung function, quality of life, and overall functional capacity have been presented in [Table 4]. Furthermore, 71.42% improvement in lung function was observed by using the Jeevan Yantra instrument [Table 4].
Table 4: Results of Pulmonary function test, Quality of life, and musculoskeletal pain before and after Ayurveda panchakarma and yoga therapy

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  Discussion Top


The results of this case study showed encouraging findings. There was an improvement in lung function, quality of life, and overall functional capacity after 3 weeks of Ayurveda panchakarma and yoga therapy. In fact, earlier studies indicated that obesity is associated with various functional and psycho-physiological disorders such as hypertension, sleep-disordered breathing/sleep apnea, metabolic syndrome, and musculoskeletal disorders such as osteoarthritis and rheumatoid arthritis.[6]

Ayurveda is an ancient holistic science that mainly deals with the knowledge of life and is practiced as a healthcare system in India. Ayurvedic understanding of this comorbid condition and experiential therapeutic base may offer a great strategy for management and prevention of obesity-related disorders.

Yoga, an ancient Indian science, helps us in improving physical and mental well-being of an individual. According to past research findings, yoga helps us in decreasing obesity and its related disorders along with improving quality of life of an obese individual.[7] As per traditional texts, panchakarma and complementary therapies are recommended in obesity and rheumatoid arthritis.[8] As per the past research studies involving obesity and its related disorders, yoga and Ayurveda panchakarma therapy complement each other and are highly beneficial when given together.

At the time of arrival, patient's joint pain was extremely aggravated due to a recent injury. The patient had difficulty in walking and climbing stairs, along with reduced functional abilities. Hence, the treatment was initiated in accordance to the line of treatment of aam vata and sthoulya as per Ayurveda along with yoga therapy.[9] Yoga therapy has been found to be highly beneficial for obese patients with related disorders, who have limited movements and sometimes can barely walk.[10] The result of this case study revealed significant improvement in functional ability, pulmonary function, musculoskeletal pain, and quality of life after 3 weeks of integrated therapy. Yoga involves passive stretching, which was, perhaps, helpful in loosening stiff joint muscles and reducing inflammation of the joints of the patient.

Furthermore, the quality of life of the patient was also found to be improved. There was no worsening of any symptoms until 24/09/16. Past yoga research studies have also shown decreased psychosomatic disorders,[11] reduced musculoskeletal discomfort,[12] and improved quality of life along with better pulmonary functions in patients suffering from obesity-related disorders. Also, Ayurvedic treatments for obesity [13] and rheumatic disorders [14] have shown promising results in the past research studies.[15] Therefore, the patient was given Ayurvedic treatment, i.e. panchakarma and yoga therapy, which was found to be beneficial in improving overall physical and psychological well-being of the patient. In the view of encouraging outcome obtained so far, the treatment can be administered for a longer duration and in larger number of patients suffering from obesity to substantiate the findings of this case study.

Patient consent

Informed written consent has been obtained from the patient for publishing this case study.

Acknowledgments

The authors are grateful to Swami Maheshananda, Director of Research, Kaivalyadhama, Shri O. P. Tiwari, Secretary, Kaivalyadhama, and S. M. Y. M. Samiti and Shri Subodh Tiwari, CEO, Kaivalyadhama for giving constant encouragement to complete research activities. Authors are thankful to yoga teachers of Kaivalyadhama for providing dedicated yoga sessions, and last but not the least, Ayurveda therapists who administered panchakarma therapy to the patient are thanked earnestly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zdziarski LA, Wasser JG, Vincent HK. Chronic pain management in the obese patient: A focused review of key challenges and potential exercise solutions. J Pain Res 2015;8:63-77.  Back to cited text no. 1
    
2.
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Halsted CH. Obesity: Effects on the liver and gastrointestinal system. Curr Opin Clin Nutr Metab Care 1999;2:425-9.  Back to cited text no. 4
    
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6.
Kokkoris P, Pi-Sunyer FX. Obesity and endocrine disease. Endocrinol Metab Clin North Am 2003;32:895-914.  Back to cited text no. 6
    
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Joshi S, Deole YS, Vyas GH, Dash SC. Management of overweight and obesity through specific yogic procedures. AYU 2009;30:425-35.  Back to cited text no. 7
    
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Raut AA, Gundeti MS. Obesity and osteoarthritis comorbidity: Insights from Ayurveda. J Obes Metab Res 2014;1:89-94.  Back to cited text no. 8
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9.
Sharma MR, Mehta CS, Shukla DJ, Patel KB, Patel MV, Gupta SN. Multimodal Ayurvedic management for Sandhigatavata (Osteoarthritis of knee joints). AYU 2013;34:49-55.  Back to cited text no. 9
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Moonaz SH, Bingham CO, Wissow L, Bartlett SJ. Yoga in sedentary adults with arthritis: Effects of a randomized controlled pragmatic trial. J Rheumatol 2015;42:1194-202.  Back to cited text no. 10
    
11.
Garg S, Ramya CS, Shankar V, Kutty K. Efficacy of short-term yoga therapy program on quality of life in patients with psychosomatic ailments. Indian J Psychiatry 2015;57:78-80.  Back to cited text no. 11
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12.
Telles S, Dash M, Naveen KV. Effect of yoga on musculoskeletal discomfort and motor functions in professional computer users. Work 2009;33:297-306.  Back to cited text no. 12
    
13.
Paranjpe P, Patki P, Patwardhan B. Ayurvedic treatment of obesity: A randomised double-blind, placebo-controlled clinical trial. J Ethnopharmacol 1990;29:1-11.  Back to cited text no. 13
    
14.
Singh SK, Rajoria K. Ayurvedic approach for management of ankylosing spondylitis: A case report. J Ayurveda Integr Med 2016;7:53-6.  Back to cited text no. 14
    
15.
Jindal N, Shamkuwar MK, Kaur J, Berry S. Efficacy of ayurvedic treatment using panchakarma combined with balance exercises for disability and balance in progressive supranuclear palsy. Anc Sci Life 2012;32:54-8.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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