Role of Yoga and Meditation in Prevention of Obesity

1
Role of Yoga and Meditation in Prevention of
Obesity

• Dr. Bratati Banerjee
• Professor
• Department of Community Medicine
• Maulana Azad Medical College
• New Delhi, India
• Email bratati1_at_hotmail.com
• Ph 919968604251

2
Introduction

• Non communicable diseases (NCDs) are on the rise
  and have been reported to kill about 38 million
  people annually.
• Along with the already existing communicable
  diseases, increase of non communicable diseases
  is pushing the world to facing a double burden.
• NCDs are associated with various behavioral risk
  factors, which in turn precipitate several
  physiological and metabolic risk factors.
• These risk factors also are intimately related
  and one factor is often associated with one or
  more other factors.
• Obesity is one of the most important metabolic
  risk factors.

3
(No Transcript)
4
Obesity

• Major risk factor of many non communicable
  diseases, the most important of these are
• cardiovascular diseases (mainly heart disease and
  stroke)
• diabetes
• musculoskeletal disorders (especially
  osteoarthritis)
• some cancers (endometrial, breast, and colon).
• Major contributor to mortality and morbidity
• Has more than doubled in the world since 1980.
• In 2014, 39 of adults aged 18 years and more
  were overweight and 13 were obese.
• With increasing BMI, risk of the associated NCDs
  also increases.

5
Behavioral risk factors related to obesity

• Inadequate physical activity
• Unhealthy diet
• Excessive and regular intake of alcohol
• Stress and anxiety through
• release of glucocorticoids and catecholamines
  which alter appetite regulation and metabolism
• increased intake and unhealthy diet
• harmful use of alcohol
• Depression leads to
• decreased physical activity
• increased intake of food
• harmful use of alcohol

6
Inter relationship between risk factors of obesity
Cardiovascular diseases
Inadequate physical activity
Diabetes
Depression
Increased food intake/ unhealthy diet
OBESITY
Musculoskeletal disorders
Stress/ anxiety
Excessive alcohol intake
Cancers
7
Yoga and Meditation

• Originated in India
• The first references of these found in scriptures
  of sixth century BC
• Recently under research and gained popularity all
  over the world
• Many benefits in several lifestyle disorders
• Helps to develop a more positive attitude towards
  life and thus reduce stress
• Most widely used complementary and alternative
  medicine practices
• Recently introduced into mainstream medicine

8
Use of Yoga and Meditation

• Worldwide, yoga is regularly practiced by about
  30 million people
• In America, nearly 14 million (6.1 of the US
  population) reported that yoga had been
  recommended to them by a physician or therapist.
• In 2002 use of relaxation techniques and yoga was
  reported by 14.2 and 5.1 of US adults.
• In the UK, yoga is promoted by the National
  Health Service as a safe and effective approach,
  in health and illness.

9
Use of Yoga and Meditation

• In India, traditional systems of medicine have
  been promoted by the government since long.
• In March 1995, Department of Indian Systems of
  Medicine Homeopathy (ISMH) was created under
  the Ministry of Health Family Welfare,
• In November 2003, it was renamed as Department of
  Ayurveda, Yoga, Unani, Siddha Homeopathy
  (AYUSH)
• In November 2014, Ministry of AYUSH was formed

10
Benefits of Yoga and Meditation

• Bring a holistic way of life
• Lead to a state of complete physical, mental,
  social, and spiritual well-being, as recommended
  by the World Health Organization.
• Cost effective interventions to prevent and
  control risk factors for NCDs including obesity.
• Used for primary and secondary prevention of
  modern epidemic diseases
• Used as nonpharmaceutical measures or complement
  to drug therapy for treatment of these conditions

11
Mechanism of action of yoga and meditation in
primary and secondary prevention of obesity
YOGA
Stimulation of Vagus nerve
Hypersecretion of cholesterol
HPA axis
STRESS
OBESITY
Comfort foods Binge eating
Emotional eating External eating
Alcohol
MEDITATION
12
Yoga

• Yoga - Sanskrit word yuj meaning to unite or to
  yoke.
• A psycho-somatic-spiritual discipline
• Union and harmony between mind, body, and soul
• Ultimate union of our individual consciousness
  with the universal consciousness.
• Improve ones inherent power in a balanced manner
• Attain complete self realization
• Eight traditional forms of yoga have been
  described.
• These are japa yoga, karma yoga, gyana yoga,
  bhakti yoga, raja yoga, swara yoga, kundalini
  yoga, nadi yoga
• Other common forms are kripalu yoga, kriya yoga,
  laya yoga, mantra yoga, vinayasa yoga and many
  more.

13
Meditation

• Meditation - Latin word meditor meaning, to
  reflect, ponder over, consider.
• A mind-body practice with many methods and
  variations
• Silence and stillness of compassionate,
  nonjudgmental present moment awareness
• Main types of meditation include transcendental
  meditation, mindfulness and Sahaja yoga
• Other common types are zen meditation, omkara
  meditation, amrita meditation and many more.

14
Pranayama

• Another traditional method followed is Pranayama
• The word pranayama is derived from two Sanskrit
  words, namely, prana, which means vital force or
  life energy, ayama means to prolong
• It is basically a combination of several forms of
  breathing exercises

15
Yoga Sutras

• Yoga was systemized by the ancient Indian sage
  Patanjali in the Yoga Sutras (300200 B.C.)
• Patanjali defined the purpose of yoga as
  knowledge of the true Self and outlined eight
  steps for direct experience of Self.
• The eight steps or limbs of yoga are as follows
• Yama Codes of restraint, abstinences,
  self-regulations
• Niyama Observances, practices, self-training
• Asana Meditation posture
• Pranayama Expansion, regulation, control of
  breath
• Pratyahara Withdrawal of the senses, bringing
  inward
• Dharana Concentration
• Dhyana Meditation
• Samadhi Deep absorption, meditation in its
  higher state, the state of perfect concentration

16
Integrated yoga

• It combines physical postures (asanas), breathing
  exercises (pranayamas), and meditation or
  relaxation exercise, along with spiritual
  teaching.
• Concept of yoga by Patanjali, which includes
  physical postures, breathing exercises and
  meditation.
• Also known as hatha yoga, which includes asana,
  mudra, pranayama, and is very commonly practised
  all over the world.
• Qigong, a Chinese technique, integrates physical
  postures, breathing techniques and focused
  intention
• Integrated form is more beneficial for physical,
  psychological and spiritual well-being

17
Integrated yogacontd

• Health effects of Hatha Yoga
• reduction of stress, overall improvement of
  physical fitness and reduction of some risk
  factors for cardiovascular diseases.
• prevention of cardiac arrhythmias, hypertension,
  insomnia, cardiopulmonary disorders, depression
  and anxiety, epilepsy, cancer, menopause symptoms
  and chronic back pain.
• Mindfulness, subjective well-being, healthy body
  mass index, fruit and vegetable consumption,
  vegetarian status and vigor.

18
Effects of yoga and meditation

• A form of mind-body medicine, most importantly in
  its integrated form, that can
• address the physical, psychological, and
  spiritual aspects, and
• assist with behavioral change, weight loss, and
  maintenance,
• thus playing an important role in primary and
  secondary prevention of obesity.

19
Aim and Objectives

• Aim of the present review is to throw light upon
  the role of yoga and meditation in prevention and
  control of obesity, through
• regulation of release of stress hormones
• reduction of harmful behavioral risk factors
• development of healthy lifestyle.
• The objectives of the review are
• To study the role of yoga and meditation in the
  prevention of obesity,
• with particular attention to some of the factors
  that are directly or indirectly related to
  obesity, like
• stress
• eating behaviour
• alcohol intake.

20
Materials Methods

• Study design Narrative review
• Key words - A combination of key words for
• intervention related term yoga/meditation AND
• outcome related term obesity/ anthropometry/
  stress/ anxiety/ depression/ eating disorder/
  binge eating disorder/ eating behavior/ alcohol
  use/ alcohol dependence AND
• study design related term intervention/
  experimental/ trial

21
Materials Methodscontd

• Search strategy
• Most commonly used scientific search engines were
  searched for identification of studies.
• Title screened based on pre-specified inclusion
  criteria.
• Abstracts and full texts of potentially eligible
  articles were identified.
• Review articles were read to extract cross
  references.
• Articles that fitted into the exclusion criteria
  were excluded from the review.

22
Materials Methodscontd

• Without a control group comparison cannot be
  made.
• In the absence of randomization of subjects into
  intervention and control groups results can be
  biased.
• Presence of multiple interventions done
  simultaneously makes the effect of any particular
  intervention difficult to assess.
• If control subjects are given some other
  intervention the ultimate effect size of the
  interventions under study may be reduced.
• Hence such research work was not considered in
  the present review.
• However, continuation of treatment as usual for
  controls was considered.

23
Materials Methodscontd

• Inclusion criteria

• Exclusion criteria

• Language - English
• Type - Original article
• Design - Intervention
• Participant - Healthy adult
• Intervention -
• Yoga and/or
• Meditation
• Outcome - Reduction of
• Stress/Anxiety/Depression
• Eating disorder
• Alcohol use
• Obesity

• Design - Not RCT
• Intervention - Multiple intervention techniques
  used simultaneously
• Participant - controls given some other
  intervention

24

• Potentially relevant articles identified, based
  on Inclusion Criteria-
• (N 38)
•  
• Language - English
• Type - Original article
• Design - Intervention
• Participant - Healthy adult
• Intervention - Yoga and/or Meditation
• Outcome - Reduction of
• Stress/Anxiety/Depression
• Eating disorder
• Alcohol use
• Obesity

Articles removed on the basis of Exclusion
Criteria- Study design - not Randomized
Controlled Trial (n 12) Intervention -
multiple techniques used simultaneously
(n 8) Participants - controls given some other
intervention (n 3)
Studies included-   (N 15)
25

• RESULTS

26
Table 1

• Yoga and meditation are techniques that bring
  about relaxation of mind and body and hence
  reduce stress.
• Both these techniques have been reported to
  reduce stress and anxiety in subjects of the
  intervention group significantly more than that
  in the control group, by several authors.

27
Table 1. Effect of yoga and/or meditation on
stress/anxiety
Author Year Study design Number of participants Intervention Outcome Result Significant/ Not Significant (S/NS)
Puryear 1976 RCT 159 Meditation Anxiety Reduced S
Dillbeck 1977 RCT 33 Meditation Anxiety Reduced S
Javnabhakt 2009 RCT 65 Yoga Anxiety Reduced S
Carei 2010 RCT 53 Yoga Anxiety Depression Reduced Reduced NS NS
Garland 2010 RCT 53 Meditation Stress Reduced S
Daubenmier 2011 RCT 47 Meditation Cortisol awakening response Reduced S
vandana 2011 RCT 150 Meditation Adrenaline Cortisol Reduced Reduced S
28
Table 2

• Researchers have reported improvement in eating
  behavior following intervention with yoga and
  meditation.
• They have also shown significant reduction of
  eating disorder and Binge Eating Disorder.
• Physical activity also increases with yoga

29
Table 2. Effect of yoga and/or meditation on
eating behavior
Author Year Study design Number of participants Intervention Outcome Result Significant/ Not Significant (S/NS)
Mitchell 2007 RCT 93 Yoga Eating Disorder No change -
Mclver 2009 RCT 90 Yoga Binge eating Physical activity Reduced Increased S S
Carei 2010 RCT 53 Yoga Eating disorder Reduced S
Daubenmier 2011 RCT 47 Meditation Emotional eating External eating Reduced Reduced S S
Alberts 2012 RCT 26 Meditation Food cravings Dichotomous thinking Body image concern Emotional eating External eating Reduced Reduced Reduced Reduced Reduced S S S S S
30
Table 3

• Following courses of yoga and meditation
  reduction in alcohol use, craving for alcohol and
  dependence on alcohol was reported.
• There was improvement in symptoms and AUDIT
  scores too.
• However, in many of the studies the differences
  were not statistically significant.

31
Table 3. Effect of yoga and/or meditation on
alcohol intake
Author Year Study design Number of participants Intervention Outcome Result Significant/ Not Significant (S/NS)
Bowen 2009 RCT 168 Meditation Alcohol use Craving Reduced Reduced S S
Garland 2010 RCT 53 Meditation Alcohol cues Alcohol attentional bias Reduced Reduced S S
Witkiewitz 2010 RCT 168 Meditation Craving Alcohol use Reduced Reduced S S
Reddy 2014 RCT 38 Yoga AUDIT score Symptoms Symptom management Reduced Reduced Improved NS NS S
Hallgren 2014 RCT 18 Yoga Alcohol consumption Reduced NS
32
Table 4

• Statistically significant reduction was observed
  in body weight, percentage of body fat, lean body
  mass, body mass index, waist circumference and
  visceral fat area, by several authors.
• However, there was no difference between the two
  groups in overall weight and abdominal
  fat/trunk-leg fat ratio as reported by one
  researcher.

33
Table 4. Effect of yoga and/or meditation on
overweight/obesity
Author Year Study design Number of participants Intervention Outcome Result Significant/ Not Significant (S/NS)
Mclver 2009 RCT 90 Yoga BMI Waist circumference Hip circumference Reduced Reduced Reduced S S S
Daubenmier 2011 RCT 47 Meditation Abdominal fat/trunk-leg fat ratio Overall weight No difference No difference - -
Jeong-Ah 2012 RCT 16 Yoga Body weight Percentage of body fat Lean body mass Body mass index Waist circumference Visceral fat area Reduced Reduced Reduced Reduced Reduced Reduced S S S S S S
34
Limitations

• Systematic Review and Meta-analysis could not be
  done due several methodological deficiencies as
  follows
• inconsistency in the study methodologies
• small sample size
• lack of complete information
• inadequate description of methods
• failure to adjust for lifestyle characteristics
• large variation in the nature, duration,
  intensity, and delivery methods of the
  interventions used

35
Conclusion

• Though a lot of research has been undertaken to
  assess the role of yoga and meditation in various
  parts of the world, no conclusive evidence can be
  drawn.
• Most of the studies have several limitations that
  compromise the validity.
• More randomized controlled trials with large
  sample size are required to be conducted in
  various settings, to confirm these findings.

36
Conclusioncontd

• Existing knowledge does point to the benefits
  of yoga and meditation as these are
• cost-effective techniques without side effects
• feasible to be implemented and sustained by the
  community
• Hence focus may be given on mainstreaming
  yoga/meditation for primary and secondary
  prevention of obesity, which in addition will
  provide double benefit by helping to control the
  risk factors as well as the major non
  communicable diseases.

37

• Thank
• you