Monitoring Obese Patients in the Age of Insta

The first time I asked a patient to climb on the weighing scale in my clinic, the look he gave me could have melted mercury. “Doctor, can we just skip that part?” he said, half-hopeful. He was 32, weighed well over 130 kilos, and carried the burdens of adipose tissue and social judgment. Since then, I’ve seen a thousand versions of that expression—defensive humour, shame masked in sarcasm, resistance wrapped in politeness.

 In my three decades of practice, I’ve seen obesity go from rare to routine. It now walks into my clinic daily, dressed in a suit, a saree, or athleisure wear. Sometimes it has a confident smile, a tired sigh. But rarely does it come alone. It brings along hypertension, diabetes, joint pain, infertility, sleep apnea, depression, and worst of all—denial.

Monitoring obese patients clinically is like measuring a waterfall with a measuring cup. Their conditions shift, hide, fluctuate, and resist. In this digital age, when most patients trust Instagram reels more than ancient Rasayanas, our job has become part-physician, part-therapist, and part-stand-up comedian.

“Doctor, my weight hasn’t changed, but I feel lighter,” said a cheerful 42-year-old after two weeks of following an Insta diet that promised miracles via cucumbers and chanting. Her blood reports, however, said otherwise. She had lost electrolytes, not fat. She was dizzy, dehydrated, and borderline hypokalemic.

Another time, a well-meaning person, 68, came beaming after his grandson had “cured” him with intermittent fasting based on a YouTube guru. He had fainted in the temple queue after 20 hours without food. “But doctor, he said autophagy would happen,” he protested. “Autophagy?” I replied. “Sir, at your age, ‘auto’ anything is risky without supervision!”

Monitoring obese patients is not just about weight. It’s about their fluid balance, lipid profile, liver function, mental health, blood pressure patterns, HbA1c trajectory, sleep cycle, and movement metrics. Every reading tells a story. But the story they tell me often differs from the one the reports whisper.

In Ayurveda, we speak of Medo dhatu dushti—the vitiation of the fat tissue. It’s not just about excess. It’s about dysfunction. Obesity is not always born from indulgence; sometimes it is a result of imbalance, chronic stress, suppressed grief, or metabolic trauma. A desk-bound IT worker, binging on sugar to stay awake during US calls, is not sinning; he is surviving. But his Agni—his digestive fire—is flickering. His Vata is displaced, his Kapha aggravated, and Medas—the fat tissue—accumulates as a buffering blanket.

One of my patients, Preeti (name changed), 27, walked into my clinic weighing 106 kilos. “I’ve been fat since puberty,” she said. “And I’m tired of being told to eat less.” She had PCOD, hair loss, acne, and an exhausted liver. Her thyroid was lazy, and her mind was more so. She needed not just lekhana herbs like Triphala, Guggulu, or therapies like Virechana or Udvartana but validation, understanding, and a pace that respected her biology. Over 18 months, she lost 24 kilos. But more importantly, she regained her periods, confidence, and mornings.

One of the challenges in clinical monitoring is honesty—both from the patient and the doctor. “I only eat two meals daily, doctor,” said Ramamurthy, 40. His wife rolled her eyes behind him. The two meals were biryani and sweets. In between, he “only” had tea with four spoons of sugar, biscuits, fried snacks, and “prasad.”

Weight loss is not linear, and neither is monitoring. A 500g gain doesn’t mean failure, and a 2kg drop doesn’t mean success. We must monitor inch loss, mood shifts, bowel patterns, Prakriti changes, and lipid behaviour. In Ayurveda, it’s about samyak pariksha, a holistic examination. Clues include tongue coating, pulse patterns, sleep quality, and appetite rhythm.

Then there is the cultural comedy of it all. In India, fat still means prosperous. Auntyjis proudly tell me their grandson is “healthy” while patting his oversized cheeks. “Doctor, he just has baby fat,” they insist. The boy is 17, with a borderline fatty liver and breathlessness after one flight of stairs.

Add to that the festive sabotage. When a patient is on track, Diwali arrives like a sugar tsunami. “Doctor, just one laddoo,” they say. That laddoo becomes ten. It is followed by New Year, Pongal, Holi, Eid, Raksha Bandhan, and birthday parties. Each occasion is wrapped in ghee, sugar, and love.

Even weighing them poses a logistical issue. Our clinic scale has been repaired twice. Once, a 155kg gentleman stood on it, and it sighed like a collapsing harmonium. Since then, we have used “kindly step gently on the scale.”

Yet, not everything is bleak. Monitoring offers beautiful moments, too. A patient who could barely sit cross-legged in his first yoga session now does Ardha Matsyendrasana with ease. A bride who wept at her dress trials is now glowing with grace. A man who feared public speaking now gives wellness talks.

Technology, too, has helped. Smartwatches now tell me what patients forget. “Doctor, I walked 10,000 steps yesterday!” Me: “But your watch says 3,200.” Patient: “Maybe I walked in dreams?”

Obesity is chronic, relapsing, and multifactorial. Gut microbiome, endocrine disruptors, circadian mismatch, and stress hormones all play a role. But Ayurveda said it long ago. We spoke of ahara, vihara, and aachara—food, lifestyle, behaviour. We treated the gut as sacred and the mind as the master of metabolism.

My tips for clinicians monitoring obese patients?

• Never reduce a patient to their weight. See their context, not just circumference.
• Build rapport before you build regimens. Humour heals more than harshness.
• Use langhana (lightening therapies) but offer emotional brimhana (nourishment).
• Teach slow eating, early dinners, and the sacredness of routine (dinacharya).
• Keep checklists—weight, waist, vitals, lipids, mood, sleep.
• Celebrate the non-scale victories—lesser knee pain, improved sleep, lighter periods.

For patients, I say monitor yourself with compassion. Not every mirror shows truth, and not every Instagram post offers wisdom. Walk a little, laugh, chew slowly, and sleep deeply.

One patient once said, “Doctor, I don’t want to be skinny. I want to bend down and tie my shoelaces without holding my breath.” That, my friends, is clinical progress.

Obesity monitoring is not about numbers. It’s about stories—stories of resilience, relapses, and rediscovery. It’s a weighty responsibility—pun intended—but a deeply rewarding.

 I remind myself that my role is not to chase kilos but to kindle Agni. Not to scold, but to support. Not to fix, but to facilitate balance. That’s the Ayurvedic way. Gentle, wise, and enduring.

 Maybe the next time a patient steps on the scale, they won’t look scared. They’ll smile. Because they’ll know they’re not being judged. They’re being understood.