“Ayurvedic Pharmacotherapy for Pediatric Obesity: A Critical Narrative Review of Molecular Mechanisms, Clinical Evidence, and Safety Considerations”

Pediatric obesity is a multifactorial and persistent health condition that requires management capable of reducing cardiometabolic risk while simultaneously protecting normal nutrition, physical growth, pubertal development, and psychological well-being. This narrative review critically evaluates Ayurvedic pharmacotherapeutic approaches to pediatric obesity by considering their classical therapeutic rationale, proposed molecular mechanisms, available clinical evidence, and safety concerns.According to global estimates, more than 390 million individuals aged 5-18 years were overweight in 2022, including more than 160 million living with obesity. Within the Ayurvedic framework, Sthaulya or Atisthaulya is associated with excessive accumulation of Meda and is linked with dietary excess, insufficient physical activity, disturbed appetite, and constitutional susceptibility. Classical management emphasizes Langhana, Rukshana, Lekhana, DipanaPachana, dietary modification, and physical activity.Among the medicines discussed in relation to obesity, Triphala, Guggulu-based preparations, NavakaGuggulu, and VachaharidradiGanaVati have received attention. However, evidence specifically involving children remains very limited. A systematic review involving 12 randomized controlled studies and 749 participants, predominantly adults, reported potentially beneficial effects of Triphala on selected anthropometric and metabolic parameters, although considerable methodological heterogeneity limits firm conclusions. One randomized controlled study involving 130 adolescents reported an approximate between group BMI difference of -1.4 kg/m² after three months with a proprietary plant-based formulation. A 2025 study comparing Navaka Guggulu and Vachaharidradi GanaVati in children was available as a research protocol rather than as completed efficacy evidence. Experimental studies indicate that some Ayurvedic formulations may influence adipogenesis and several metabolic signalling pathways. Nevertheless, cellular, animal, and computational findings cannot be directly interpreted as evidence of therapeutic effectiveness in children. Safety considerations include gastrointestinal adverse effects, variations in formulation and composition, developmental pharmacokinetic differences, possible herb–drug interactions, contamination, and inadequate adverse-event reporting. Therefore, Ayurvedic medicines should currently be regarded as potential adjuncts to comprehensive family-based lifestyle management rather than replacements for established pediatric obesity care. Their use should involve quality-assured preparations, qualified professional supervision, appropriate monitoring, and systematic pharmacovigilance. Well-designed pediatric clinical trials with adequate sample sizes and long-term assessment of growth, puberty, metabolic health, and adverse events are needed.