Role of Yoga and Meditation in

Prevention of Obesity

• 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.

INTRODUCTION

• 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.

OBESITY

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

Inter relationship between risk factors of obesity

Inadequate physical activity

Increased food intake/ unhealthy

diet

Excessive alcohol intake

Depression

Stress/ anxiety

OBESITY

Cardiovascular diseases

Diabetes

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

YOGA

MEDITATION

STRESS OBESITY

Hypersecretion of cholesterol

“Comfort foods”Binge eating

AlcoholEmotional eatingExternal eating

Stimulation of Vagus nerve

HPA axis

Mechanism of action of yoga and meditation in primary & secondary prevention of obesity

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 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…contdInclusion 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

Exclusion criteria➢Design - Not RCT➢ Intervention - Multiple

intervention techniques used simultaneously

➢Participant - controls given some other intervention

Potentially relevant articles identified, based on Inclusion Criteria:-(N= 38) Language - EnglishType - Original articleDesign - InterventionParticipant - Healthy adultIntervention - Yoga and/or MeditationOutcome - 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 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 AnxietyDepression

ReducedReduced

NSNS

Garland 2010

RCT 53 Meditation Stress Reduced S

Daubenmier 2011

RCT 47 Meditation Cortisol awakening response

Reduced S

vandana2011

RCT 150 Meditation Adrenaline Cortisol

ReducedReduced

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 of participants

Intervention

Outcome Result Significant/ Not Significant (S/NS)

Mitchell 2007

RCT 93 Yoga Eating Disorder No change -

Mclver2009

RCT 90 Yoga Binge eatingPhysical activity

Reduced Increased

SS

Carei 2010

RCT 53 Yoga Eating disorder Reduced

S

Daubenmier 2011

RCT 47 Meditation Emotional eating External eating

ReducedReduced

SS

Alberts2012

RCT 26 Meditation Food cravingsDichotomous thinkingBody image concernEmotional eating External eating

Reduced Reduced

Reduced

Reduced

Reduced

SS

S

S

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 intakeAuthor Year

Study design

Number of participants

Intervention

Outcome Result Significant/ Not Significant (S/NS)

Bowen 2009

RCT 168 Meditation Alcohol useCraving

Reduced Reduced

SS

Garland 2010

RCT 53 Meditation Alcohol cuesAlcohol attentional bias

ReducedReduced

SS

Witkiewitz 2010

RCT 168 Meditation Craving Alcohol use

ReducedReduced

SS

Reddy 2014

RCT 38 Yoga AUDIT scoreSymptoms Symptom management

Reduced ReducedImproved

NSNSS

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/trunk-leg fat ratio as reported by one researcher.

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)

Mclver2009

RCT 90 Yoga BMIWaist circumferenceHip circumference

Reduced ReducedReduced

SSS

Daubenmier 2011

RCT 47 Meditation

Abdominal fat/trunk-leg fat ratioOverall weight

No differenceNo difference

--

Jeong-Ah 2012

RCT 16 Yoga Body weightPercentage of body fatLean body massBody mass indexWaist circumference Visceral fat area

ReducedReducedReducedReducedReducedReduced

SSSSSS

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.

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