Critical analysis of ayurvedic pharmacotherapy in pediatric obesity: Molecular mechanisms, clinical evidence, and safety dynamics- Narrative review

Pediatric obesity is a chronic, relapsing and multifactorial disease in which pharmacotherapy must improve cardiometabolic risk without compromising nutrition, linear growth, puberty or psychological health. This narrative review critically examines Ayurvedic pharmacotherapy for pediatric obesity through traditional rationale, molecular plausibility, clinical evidence and safety surveillance. In 2022, more than 390 million people aged 5-19 years were overweight and over 160 million were living with obesity. Classical Ayurveda describes Sthaulya/Atisthaulya as excessive Meda accumulation associated with over-nourishing food, inadequate activity, disordered appetite and constitutional susceptibility, and proposes Langhana, Rukshana, Lekhana, Dipana-Pachana, dietary regulation and exercise. Triphala, Guggulu-containing formulations, Navaka Guggulu and Vachaharidradi Gana Vati are frequently discussed, but pediatric efficacy data are extremely limited. A Triphala systematic review included 12 randomized studies and 749 participants, predominantly adults; five studies reported reductions in weight-related outcomes, but heterogeneity and risk of bias restrict certainty. One randomized trial in 130 adolescents reported a between-group BMI difference of approximately -1.4 kg/m2 after three months with a proprietary plant formulation, whereas a 2025 pediatric comparison of Navaka Guggulu and Vachaharidradi Gana Vati remained a trial protocol rather than definitive outcome evidence. Mechanistic work suggests anti-adipogenic and multi-target metabolic signalling, but laboratory and computational findings cannot establish pediatric clinical benefit. Safety concerns include gastrointestinal reactions, variable composition, developmental pharmacology, herb-drug interactions, contamination and under-reporting of adverse events. Ayurvedic medicines should therefore remain adjunctive to family-based lifestyle treatment, be restricted to quality-assured products under qualified supervision, and be evaluated in adequately powered pediatric trials with growth, pubertal, metabolic and pharmacovigilance outcomes.