Shatkarma: Yogic cleansing practices in the nutritional and metabolic management of sthoulya (obesity): A narrative review

Obesity (Sthoulya) is a persistent metabolic disorder characterized by high adiposity, a defect in energy regulation, and cardiometabolic risk. According to an Indian system of medicine (Ayurveda), it is linked to excess fat accumulation (Medodhatu vriddhi), slowed metabolism (Agnimandya), and structural blockage of transport pathways (Srotorodha). Traditional lifestyle intervention methods tend to exhibit low long-term compliance, underscoring the need to consider additional approaches. Yogic cleansing exercises, also known as Shatkarma, are aimed at gastrointestinal and systemic cleansing and can affect digestion, absorption, and metabolic efficiency. This review aims to provide a narrative synthesis of the nutritional and metabolic management of obesity, integrating classical yogic and Ayurvedic concepts with modern scientific evidence, and employing Shatkarma-based yogic cleansing practices. A narrative review was performed with the use of Google Scholar, PubMed, IndMED, and AYUSH Research Portal databases. It consisted of peer-reviewed articles, classical analyses of Hatha Yoga, and clinical studies of yoga interventions published between 2000 and 2025. There was a focus on mechanistic understanding, nutritional consequences, and anthropometric variations concerning the yogic cleansing practices. It has been proposed that yogic cleansing practices enhance gastrointestinal function (Jatharagni deepana), reduce metabolic byproducts (Ama pachana), and aid in fat regulation. Combined yoga programs with Kapalabhati, Nauli, and Laghu Shankhaprakshalana showed significant changes in body mass index, waist circumference, and lipid parameters, albeit not significantly. Proposed mechanisms include improved gut motility, better autonomic balance, and greater metabolic flexibility. Nonetheless, there are scant Shatkarma-only randomized trials on obesity. Shatkarma-based yogic cleansing shows promise; prakriti-stratified trials are needed for validation.