Yoga Therapy and its effect on obesity

 Yoga Therapy and its effect on obesity

Bridging the Ancient Practice and Modern Science of Healing-Yoga Therapy for Metabolic Health

Summary of Research Articles on Yoga Therapy and its effect on obesity

1, Obesity-related inflammation & cardiovascular disease: efficacy of a yoga-based lifestyle intervention- 

Background- In this review, the association between obesity-related inflammation and CVD, and the role of yoga-based lifestyle intervention in prevention and management of CVD are discussed. Chronic adiposity is associated with metabolic imbalance leading to dyslipidaemia, diabetes, hypertension and cardiovascular diseases (CVD). Adipose tissue acts as an endocrine organ releasing several adipocytokines, and is associated with increased levels of tissue and circulating inflammatory biomolecules causing vascular inflammation and atherogenesis. 

Methods- A reduction in weight may lead to a decrease in inflammation, resulting in CVD risk reduction, and better management of patients with CVD. Lifestyle intervention has been endorsed by several health authorities in prevention and management of chronic diseases. A yoga-based lifestyle intervention appears to be a promising option in reducing the risk for CVD as well as management of patients with CVD as it is simple to follow and cost-effective with high compliance. The efficacy of such lifestyle intervention programmes is multifaceted, and is achieved via reduction in weight, obesity-related inflammation and stress, thereby culminating into risk reduction towards several chronic diseases including CVD. Protocol is 14 weeks of Surya Namaskar. 

Results- Yoga combines a healthy lifestyle with mental peace, and a modification in lifestyle and calming practices are shown to improve clinical profile of patients with various pathologies. Regular practice of pranayama and meditation in healthy volunteers led to an improved cardiovascular metabolic status, and lipid peroxidation even by a short term yoga based lifestyle intervention. Yoga is known to induce relaxation via lowering of cortisol, and increasing the levels of beta-endorphins and resulting in lowered levels of cytokines. A yoga-based lifestyle intervention is efficacious in weight-loss, and it also prevents weight-gain. Yoga also reduces inflammation and increases adiponectin in obese women. Yoga improved adiponectin level, serum lipids, and metabolic syndrome risk factors in obese women. Yoga postures (specifically suryanamaskar) resulted in improved cardiorespiratory fitness. There was a significant reduction in BP following yoga. Yoga-based lifestyle intervention resulted in a decrease in all lipid parameters except HDL. Lifestyle intervention can modulate progression of the vascular inflammation at various steps of pathogenesis, thus counteracting causation/progression of CVD.

Conclusion- Obesity, especially visceral adiposity, upregulates various inflammatory cytokines and other biomolecules. Chronic elevation of these inflammatory mediators leads to cardiovascular morbidity and mortality. Yoga-based lifestyle intervention can effectively prevent and retard the progression of cardiovascular and metabolic disorders. The mechanism of action of such benefit may be attributed to a reduction in weight and stress, networking at mind and body levels, thereby leading to a reduction in inflammation, and causation and progression of the disease.

2. The impact of yoga on components of energy balance in adults with overweight or obesity-

Background- Yoga may reduce body weight in individuals with overweight or obesity, but whether this occurs through decreased energy intake (EI) or increased energy expenditure (EE)/physical activity (PA) is unclear.

Methods- A systematic search of PubMed, Web of Science, Embase, and PsychINFO was conducted from inception until April 26, 2021. Eligible studies included randomized controlled trials or single-arm pre-post studies with any type and duration of yoga intervention in adults with overweight or obesity. Studies with measures related to EI , EE, or PA were eligible. The review initially identified 1,373 articles. Yoga interventions of any duration or frequency and consisting of any combination of asanas, pranayama, or meditation/mindfulness.

Results- Of the 10 included studies, one used indirect calorimeter measures of resting EE, while nine used self-reported measures of EI and PA. Of the seven studies measuring parameters related to EI, only one found greater decreases in EI relative to the control group, although three other investigations reported trends toward improved dietary intake. Of the eight studies measuring PA, two reported greater increases in resting EE or PA in the yoga group relative to the control group. Two reported significant within-group increases in PA from pre-post intervention, and four studies reported a trend for increased PA with no p-values reported.

Conclusion- Limited evidence suggests yoga may reduce EI and increase PA in adults with overweight or obesity. Additional studies that investigate the effects of yoga interventions on energy balance parameters using objective techniques are warranted.

3. Do Mindfulness Interventions Improve Obesity Rates in Children and Adolescents: A Review of the Evidence-

Background- Obesity in children is epidemic and poses a major public health concern. For many reasons identified in the introduction, the solution to treatment is complex and is at least partially dependent on modulation of human eating behavior. In further exploring the human being’s innate ability to control its behavior, this review attempted to evaluate the evidence for multiple different mind-body interventions that have potential utility in improving the health of children and adolescents with obesity. 

Methods- Mind-body interventions were reviewed, ranging from more physically active mindfulness exercises like yoga to physically inactive, while mindfully alert activities such as mindful eating and spirituality. Also included were programs like Mindfulness-Based Stress Reduction courses and Dialectic Behavior Therapy and their modifications for children and adolescents as these programs are increasing in popularity as well as the evidence to support their utility.

Results- In studies done by Kumar et al and the MB-EAT-A programs, the immediate evidence for weight loss is most impressive when activities such as mindful eating and MBSR are combined with nutrition counseling. Regular yoga practice is a true mind-body treatment. Through our review, we have noted that the kinematics of children with obesity are improved as well as positive changes in body composition were seen with regular yoga practice. Mindfulness interventions also show positive changes in laboratory studies. These include decreased insulin resistance with mindful eating and MBSR and normalized lipid profiles in patients participating in yoga.

Conclusion- Mindfulness intervention studies in children show promise. There have been a few studies that have shown positive results regarding stabilizing or decreasing BMI, but they are limited mostly to MBSR, Mindful Eating, and certain kinds of yoga. Other studies have shown more promise treating the psychologic and physiologic comorbidities associated with obesity, such as improvements in kinematics, decreasing rates of anxiety and depression, and improving blood cholesterol and glucose levels. Treating these comorbidities is integral to overall health and wellbeing of children with obesity. For this reason, mindfulness interventions are a reasonable addition to a holistic treatment plan of children with obesity.

4. Yoga, bioenergetics and eating behaviors: A conceptual review-

Background- Yoga is an ancient oriental discipline that emerged from mystical and philosophical concepts. Today it is practiced in the west, partly due to the promotion of its benefits to improve the lifestyle and overall health. As compared to non-Hatha Yoga (HY) practitioners, healthier and better-eating patterns have been observed in those who practice it. Agreement with the brought benefits, HY can be used as a therapeutic method to correct abnormal eating behaviors (AEB), obesity, and some metabolic diseases. However, the energy expenditure during traditional protocols of HY is not high; hence, it is not very effective for reducing or maintaining body weight or to improve cardiovascular conditioning. Even so, several observational studies suggest significant changes in eating behaviors, like a reduction in dietary fat intake and increments in that of fresh vegetables, whole grains and soy-based products, which in turn may reduce the risk for cardiovascular diseases. Given the inconsistency of the results derived from cross-sectional studies, more case–control studies are needed to demonstrate the efficacy of HY as an alternative method in the clinical treatment of disordered eating and metabolic diseases.

Methods- The issues to be addressed in the following sections of this critical review, derived from a systematic search for information on 5 databases (Medline [PubMed], Lilacs [Scielo], Latindex, Science direct, Google Scholar) are recognized in the field of yoga and its health impacts.

Results- Given the growing popularity of Hatha Yoga, it can be considered as an alternative to increase the level of physical activity. However, it is recommended to increase the intensity and duration and to include alternative exercises like Surya Namaskar to ensure a maximal TEE and cardiovascular fitness. For instance, the practice of asanas could be an optimal method for preserving the physical function in older people if exercise series are adapted to muscle and joint performance as demonstrated in the Yoga Empowers Senior Study. Lastly, the Surya Namaskar could be a better alternative for cardiovascular health, but this should be practiced with caution, especially in people with low fitness levels.

Conclusion- Contemporary HY (asanas + pranayamas + dhyana), seen holistically, is effective for certain health problems such as hypertension, ED, stress, among others. However, due to their low intensity and low EE, they are not recommended for weight loss or improving cardiovascular conditioning. There are alternative exercises like Surya Namaskar, which can be included in its everyday practice, thereby improving health benefits. Also, the practice of Yoga is associated to healthy EBs such a higher consumption of fresh vegetables, dairy products, whole-grains and functional foods (e.g. soy-based products), which could help in ED, but more case–control studies are needed to recommend it as a clinical approach in eating disorders.

5. Heated hatha yoga to target cortisol reactivity to stress and affective eating in women at risk for obesity-related illnesses: A randomized controlled trial-

Background: Cortisol reactivity to stress is associated with affective eating, an important behavioral risk factor for obesity and related metabolic diseases. Yoga practice is related to decreases in stress and cortisol levels, thus emerging as a potential targeted complementary intervention for affective eating. This randomized controlled trial examined the efficacy of a heated, hatha yoga intervention for reducing cortisol reactivity to stress and affective eating.

Method: Females (N = 52; ages 25-46 years; 75% White) at risk for obesity and related illnesses were randomly assigned to 8 weeks of Bikram Yoga practice or to waitlist control. Cortisol reactivity to a laboratory stress induction was measured at Weeks 0 (pretreatment) and 9 (posttreatment). Self-reported binge eating frequency and coping motives for eating were assessed at Weeks 0, 3, 6, and 9.

Results: Among participants with elevated cortisol reactivity at pretreatment ("high reactors"), those randomized to the yoga condition evidenced greater pre- to post treatment reductions in cortisol reactivity, but there were no significant condition differences for the "low reactors". Yoga participants reported greater decreases in binge eating frequency and eating to cope with negative effects.

Conclusions: This study provides preliminary support for the efficacy of heated hatha yoga for treating physiological stress reactivity and affective eating among women at risk for obesity-related illnesses. 

6. Transcriptional modulation of inflammation, and aging in Indian obese adults following a 12-week yoga-based lifestyle intervention: A randomized controlled trial-

Background: Obesity is one of the major global problems in today's world, both in children, and the adult age group. Current evidence suggests obesity alters the expression of various genes related to oxidative stress, inflammation, and aging. In recent times complementary therapy like yoga-based lifestyle intervention (YBLI) is used as an adjunct therapy to modern medicine. This study examines the efficacy of 12 weeks of yoga-based lifestyle intervention with standard care (SC) on the expression of genes related to oxidative stress, inflammation, and aging in obese adults.

Method: This was a two-arm parallel randomized control trial implemented at Integral Health Clinic (IHC), an outpatient facility that regularly conducted YBLI programs for the prevention of lifestyle diseases like obesity and diabetes in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi. Blood samples at baseline and weeks 2,4, and 12 were collected from 72 adults (male n = 21; female n = 51) of age 20-45 years with a body-mass index (BMI) of 25-35 kg/m2 who were randomized to receive either a 12-week SC (n = 36) or YBLI (n = 36). SC included recommendations for the management of obesity as per Indian guidelines including a low-calorie individualized diet and physical activity. Asana (physical postures), pranayama (breathing exercises), and meditation were all part of the YBLI. Primary outcomes were relative fold change in the expression of genes associated with oxidative stress [Nuclear factor-kappa B (NF-Kappa B)], inflammation [Tumor necrosis factor-α (TNFα), interleukin-6 (IL-6)], and aging [human telomerase reverse transcriptase (TERT)] in peripheral blood mononuclear cells between the two groups at week-12.

Results: There were no significant changes in fold change of TERT, IL-6, and NF-kappa B between the groups at week 12. The relative fold change of TERT was significantly greater in the YBLI group (p = <0.0001) vs the SC group at 2 weeks. The relative fold change of TNF α was significantly lower at week 12 in YBLI though the change was not continuous and reliable. Within both groups, TERT expression was significantly increased at week 2 though the change was greater in the YBLI group (p < 0.0001). TNF α gene expression was significantly lower at weeks 2 and 4, compared to baseline level, in the SC group but it increased at week 12.

Conclusions: The results are suggestive of a positive impact of YBLI and SC on the fold change of aging-related TERT gene in obesity, though the benefit was not evident till week 12. To better understand the positive effects of YBLI on oxidative stress, inflammation, and aging-related gene expression in obesity, larger studies are recommended.

7. Suryanamaskar: An equivalent approach towards management of physical fitness in obese females-

Background: In India, obesity is highly prevalent in women as compared to men. As the obesity epidemic spreads, there are growing concerns about efficient obesity management. Aim is to compare between circuit training (CT), treadmill (TM) walking and suryanamaskar (SN) training in weight management and physical fitness enhancement in obese females.

Method: Comparative controlled study conducted in a community setting. Materials and methods: 119 females of age between 20 and 40 years of body mass index (BMI) between 25.1 and 34.9 kg/m(2). 87 participants completed the study. Group 1: CT; group 2: TM walking; group 3: Modified SN; group 4: Control. Outcome measures: Body composition, cardio-respiratory and muscle endurance, flexibility. Statistical analysis: Within-group data was analyzed with the paired t-test. P =0.05. Analysis between the groups was done using a one way ANOVA test. Analysis between the groups was done using ANCOVA test controlling for baseline differences only for those variables that have significant differences at baseline. For those which do not have significant differences at baseline, RMANOVA was done at the end of 8 weeks.

Results: Reducation in mean body weight in CT group (2.2%), TM (1.7%) and SN (1.6%), (P < 0.05), BMI in all the three groups (P < 0.01), total body fat % in the CT (5%) and SN (3.7%), (P < 0.01), metabolic age with CT (2%) and TM (2%), (P = 0.001). Improvement in muscle mass in CT (4%, P = 0.009), VO2max in CT group by 17.2%, SN (14%), TM group (8%) (P < 0.05). Upper limb Muscle endurance in CT (51.3%), SN group (51.24%) and in TM group (40%), (P = 0.05), in lower limb TM (21.2%) and SN (24.5%) (P = 0.05), flexibility in SN (12.4%, P = 0.0001).

Conclusions: All three methods were effective in weight and physical fitness management. CT and SN were more effective in improving cardio-respiratory fitness and upper limb muscle endurance while only SN was effective in improving body flexibility.

8. A comparative controlled trial comparing the effects of yoga and walking for overweight and obese adults-

Background: Walking and yoga have been independently evaluated for weight control; however, there are very few studies comparing the 2 with randomization.

Methods: The present study compared the effects of 90 minutes/day for 15 days of supervised yoga or supervised walking on: related biochemistry, anthropometric variables, body composition,  postural stability, and bilateral hand grip strength in overweight and obese persons. Also measured were Anthropometric measurements Body weight, BMI, waist circumference, hip circumference,waist-hip ratio, and  mid-arm circumference were assessed using standard methods. Body composition, Postural stability and Hand grip strength were also measured. Sixty-eight participants, of whom 5 were overweight (BMI ≥25 kg/m2) and 63 were obese (BMI ≥30 kg/m2; group mean age ±S.D., 36.4±11.2 years; 35 females), were randomized as 2 groups - a yoga group and a walking group - given the same diet. The participants of the yoga group practiced yoga for 45 minutes twice a day between (i) 05:00 hours and 05: 45 hours and (ii) 17:00 hours and 17:45 hours, for 15 days. Two sessions of yoga were selected as being fairly feasible to carry out at home. An instructor, who had been studying yoga for 5 years leading to a university degree, with a total of 17 years of study including practice, supervised the participants throughout the yoga session. Each 45-minute yoga session included breathing techniques for 33 minutes. The remaining time was spent in specific yoga postures. Participants repeated postures as many times as was possible within the time. The details of the yoga intervention are given in Table 2.

Results: All differences were pre-post changes within each group. Both groups showed a significant; repeated measures ANOVA, post-hoc analyses) decrease in: BMI, waist circumference, hip circumference, lean mass, body water, and total cholesterol. The yoga group increased serum leptin and decreased LDL cholesterol. Practicing yoga resulted in a reduction in BMI, glycemic control, malondialdehyde and increase in glutathione, and vitamin C in persons with type 2 diabetes mellitus. A short-term, intensive yoga program caused a decrease in serum leptin levels, along with favorable changes in the body mass index, waist-hip circumference, total cholesterol, better postural stability, and increased hand grip strength. Yoga also improved the BMI, anthropometric measurements, body composition, and relevant biochemical measurements in persons with obesity.

Conclusions: Both yoga and walking improved anthropometric variables and serum lipid profile in overweight and obese persons. Yoga increased serum leptin levels, increased right hand grip strength, obese participants were able to remain posturally stable or balanced for a longer time after yoga, an increase in balance following yoga facilitated mobility in obese persons, and compliance with physical activity programs. In the yoga study, the decrease in lean mass was 6.3%. The yoga intervention resulted in a significant decrease in the waist circumference and in the hip circumference but no change in the waist/hip ratio, decrease in total cholesterol, LDL cholesterol, and triglycerides.

9. Effect of a Short-Term Yoga-Based Lifestyle Intervention on Health-Related Quality of Life in Overweight and Obese Subjects-

Background: To study the effect of a short-term yoga-based lifestyle intervention on health-related quality of life (HRQOL) in overweight and obese persons. Nonrandomized, single-arm interventional study conducted from August 2012 to March 2015 at Integral Health Clinic, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

Methods: Participants: Overweight (body-mass index [BMI], 23-24.9 kg/m(2)) and obese (BMI, ≥25 kg/m(2)) persons (n = 279) aged 20-60 years. Pretested yoga-based lifestyle intervention, including asanas (postures), pranayama (breathing exercises), relaxation techniques, lectures, group support, nutrition awareness program, and individualized advice. Primary outcome measure was HRQOL, measured by using a short version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Secondary outcome measures were anthropometric variables, systolic and diastolic blood pressure, pulse rate, lipid profile, and fasting glucose. A subgroup analysis according to sex was also performed.

Results: The overall quality of life and health improved after short-term yoga-based lifestyle intervention in overweight and obese persons. Physical, psychological and environmental domain scores significantly increased from baseline to day 10, and efficacy was noted in both male and female subgroups. After 10 days of intervention, the following also decreased significantly: body weight, BMI, total body fat, waist and hip circumference, waist-to-hip ratio, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein, triglycerides, and fasting glucose.

Conclusion: A short-term yoga-based lifestyle intervention had a positive effect on HRQOL in overweight and obese persons while decreasing body weight, BMI, total body fat, waist and hip circumference, waist-to-hip ratio, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein, triglycerides, and fasting glucose

10. Quality of Life in Yoga Experienced and Yoga Naïve Asian Indian Adults with Obesity-

Background: Obesity adversely affects quality of life which then acts as a barrier to weight loss and weight loss maintenance. Hence, those interventions which positively influence the quality of life along with weight reduction are considered useful for sustained weight loss in persons with obesity. An earlier study showed better quality of life in obese adults who had experience of yoga compared to yoga naïve obese adults. However, the main limitation of the study was the small sample size (n=20 in each group).: The present study aimed to determine whether with larger sample sizes the quality of life would differ in yoga experienced compared to yoga naïve adults with obesity.

Methods: There were 596 Asian Indian obese adults (age range 20 to 59 years; group mean age ± SD; 43.9 ± 9.9 years): of whom (i) 298 were yoga experienced (154 females; group mean age ± SD; 44.0 ± 9.8 years) with a minimum of 1 month of experience in yoga practice and (ii) 298 were yoga naïve (154 females; group mean age ± SD; 43.8 ± 10.0 years). All the participants were assessed for quality of life using the Moorehead-Ardelt quality of life questionnaire II. Data were drawn from a larger nationwide trial which assessed the effects of yoga compared to nutritional advice on obesity over a one-year follow-up period (CTRI/2018/05/014077).

Results: There were higher participant-reported outcomes for four out of six aspects of quality of life in the yoga experienced compared to the yoga naïve (p < 0.008, based on t values of the least squares linear regression analyses,. These were enjoyment in physical activities, ability to work, self-esteem, and social satisfaction. Higher levels of psychological well-being in the questionnaire can be considered to be partially based on higher levels of self-esteem in yoga experienced persons compared to those who are yoga naïve. Practicing gives specific emphasis to body awareness and responsiveness to self-objectification]. When body awareness and responsiveness to how the body is viewed increases, there is a greater sense of body satisfaction and lesser chances of self-objectification. These factors could have contributed to the better self-esteem in yoga experienced obese persons. Improved self-esteem could in turn influence interaction with other persons. Yoga practice creates more interpersonal interactions. These factors also increase mental well-being associated with yoga practice which could explain the higher levels of social satisfaction in the yoga experienced compared to the yoga naïve participants. 

Conclusion: Obese adults with yoga experience appear to have better quality of life in specific aspects, compared to yoga naïve persons with a comparable degree of obesity.

Summary- 

Yoga interventions, encompassing various practices like asanas, pranayama, meditation, and mindfulness, have demonstrated significant benefits for cardiovascular health, metabolic status, and lipid peroxidation. They lower cortisol levels, increase beta-endorphin levels, and reduce cytokine levels. Additionally, a yoga-based lifestyle intervention aids in weight loss and prevents weight gain. It reduces inflammation, improves adiponectin levels, serum lipids, and factors related to metabolic syndrome.

Yoga enhances cardiorespiratory fitness, reduces blood pressure, and positively impacts lipid parameters, excluding HDL. It also moderates the progression of vascular inflammation, potentially mitigating the development or advancement of cardiovascular disease. While yoga may decrease energy expenditure, it promotes physical activity and improves kinematics, reducing rates of anxiety and depression. Moreover, it effectively addresses health issues such as hypertension, erectile dysfunction, and stress.

Surya Namaskar is recommended for maximizing total energy expenditure and cardiovascular fitness, aiding in weight loss and managing physical fitness. Certain practices like CT and SN are particularly effective in improving cardiorespiratory fitness, while heated hatha yoga shows promise in managing physiological stress reactivity and affective eating in women at risk of obesity-related illnesses.

Asanas, pranayama, and meditation have a positive impact on the fold change of the aging-related TERT gene in obesity. They also lead to improvements in body mass, decreased BMI, waist and hip circumference, and reductions in total cholesterol. Yoga interventions increase serum leptin and decrease LDL cholesterol levels.

For individuals with type 2 diabetes mellitus, practicing yoga results in reduced BMI, improved glycemic control, decreased malondialdehyde, and increased levels of glutathione and vitamin C. Short-term yoga-based lifestyle interventions have favorable effects on various health markers including total body fat, waist and hip circumference, waist-to-hip ratio, blood pressure, lipid profile, and fasting glucose levels.

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