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Obesity and metabolic syndrome are among the most pressing non-communicable disease burdens worldwide, and their prevalence is rising rapidly in South Asia. Ayurveda describes Sthaulya as a disorder of excess Meda (adipose tissue) and Kapha with obstruction of the body channels (Srotorodha), and it names Sthaulya among the eight undesirable body constitutions. This article reviews the classical concept of Sthaulya, its modern correlates in obesity and metabolic syndrome, the Panchakarma procedures traditionally prescribed (Udvartana, Vamana, Virechana, Lekhana Basti and related therapies), plausible biological mechanisms, and the current state of evidence. Available clinical data are encouraging but limited by small samples, heterogeneity and weak blinding. Panchakarma is best positioned as a supervised component of a wider programme of diet, physical activity and medical care rather than as a stand-alone cure.