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Background: Sthaulya (obesity) is described in Ayurveda as a Kapha-predominant disorder closely associated with Prameha. Panchakarma procedures, particularly Vamana, Virechana and Lekhana Basti, are used in its management. Objective: To review the classical concepts and recent mechanistic and clinical studies of Panchakarma in obesity and related metabolic dysfunction. Methods: Narrative review based on a PubMed search and classical texts. Findings: In 19 patients with obesity, Virechana was associated with reduced colonisation of facultative aerobic bacteria and correction of gut dysbiosis. In six participants with a BMI above 30 kg/m2, urinary exosome proteomics showed changes in eight obesity-related hub proteins after Lekhana Basti. In 29 healthy volunteers, escalating oral ghee in the preparatory phase was followed by weight and abdominal circumference reduction without adverse change in total cholesterol, HDL or LDL. A seasonal Vamana study listed obesity and dyslipidaemia among Kapha-origin conditions for which preventive Vamana is advocated. Conclusion: Early mechanistic studies are of interest, but all are small and uncontrolled. Controlled trials with body composition and metabolic endpoints are required.