Transcript Role of Yoga and Meditation in Prevention of Obesity

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: [email protected]
Ph: +919968604251
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
• 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.
Behavioral risk factors related to obesity
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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
Inter relationship between risk factors of
obesity
Cardiovascular
diseases
Inadequate
physical
activity
Diabetes
Depression
Increased
food intake/
unhealthy
diet
Stress/
anxiety
Excessive
alcohol
intake
OBESITY
Musculoskeletal
disorders
Cancers
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
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.
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 (ISM&H) 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
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
primary and secondary prevention of obesity
YOGA
Stimulation of
Vagus nerve
Hypersecretion of
cholesterol
HPA axis
STRESS
“Comfort foods”
Binge eating
Alcohol
MEDITATION
OBESITY
Emotional eating
External eating
Yoga
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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 one’s 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.
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.
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
Yoga Sutras
• Yoga was systemized by the ancient Indian sage Patanjali
in the Yoga Sutras (300–200 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
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
Integrated yoga…contd
• 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.
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.
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.
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
Materials & Methods…contd
• 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.
Materials & Methods…contd
• 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.
Materials & Methods…contd
Inclusion criteria
Exclusion criteria
 Design - Not RCT
 Language - English
 Intervention
Multiple
 Type - Original article
intervention techniques used
 Design - Intervention
simultaneously
 Participant - Healthy adult
 Participant - controls given
 Intervention some other intervention
Yoga and/or
Meditation
 Outcome - Reduction of
Stress/Anxiety/Depression
Eating disorder
Alcohol use
Obesity
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
Studies included:(N= 15)
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)
RESULTS
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.
Table 1. Effect of yoga and/or meditation on stress/anxiety
Author
Year
Study
design
Number Interventio Outcome
of
n
particip
ants
Result
Significa
nt/ Not
Significa
nt (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
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
Table 2. Effect of yoga and/or meditation on eating behavior
Author
Year
Study
design
Number Interventi Outcome
of
on
participan
ts
Result
Significan
t/
Not
Significan
t (S/NS)
Mitchell
2007
Mclver
2009
RCT
93
Yoga
Eating Disorder No change
-
RCT
90
Yoga
Binge eating
Physical
activity
Reduced
Increased
S
S
Carei
2010
Daubenmier
2011
RCT
53
Yoga
Eating disorder
Reduced
S
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
S
S
Reduced
S
Reduced
S
Reduced
S
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.
Table 3. Effect of yoga and/or meditation on
alcohol intake
Author
Year
Study
design
Number Intervent Outcome Result
of
ion
participa
nts
Significa
nt/ Not
Significa
nt (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
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/trunkleg fat ratio as reported by one researcher.
Table 4. Effect of yoga and/or meditation on overweight/obesity
Author
Year
Study
design
Number Intervent Outcome Result
of
ion
participa
nts
Significa
nt/ Not
Significa
nt (S/NS)
Mclver
2009
RCT
90
Yoga
BMI
Reduced
Waist
Reduced
circumference Reduced
Hip
circumference
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
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
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.
Conclusion…contd
• 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.
Thank
you