Role of Yoga and Meditation in Prevention of Obesity Dr. Bratati Banerjee Professor Department of Community Medicine Maulana Azad Medical College New Delhi, India Ph: 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. 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 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 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 STRESSOBESITY Hypersecretion of cholesterol Comfort foods Binge eating Alcohol Emotional eating External eating Stimulation of Vagus nerve HPA axis Mechanism of action of yoga and meditation in primary and 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 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. 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 (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 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 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. 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 & 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. 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. Materials & Methodscontd Inclusion 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 - 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 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) 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) 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 particip ants Interventio n OutcomeResultSignifica nt/ Not Significa nt (S/NS) Puryear 1976 RCT159MeditationAnxietyReducedS Dillbeck 1977 RCT33MeditationAnxietyReducedS Javnabhakt 2009 RCT65YogaAnxietyReducedS Carei 2010 RCT53YogaAnxiety Depression Reduced NS Garland 2010 RCT53MeditationStressReducedS Daubenmier 2011 RCT47MeditationCortisol awakening response ReducedS vandana 2011 RCT150MeditationAdrenaline Cortisol 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 of participan ts Interventi on OutcomeResultSignifican t/ Not Significan t (S/NS) Mitchell 2007 RCT93YogaEating DisorderNo change- Mclver 2009 RCT90YogaBinge eating Physical activity Reduced Increased SSSS Carei 2010 RCT53YogaEating disorderReduced S Daubenmier 2011 RCT47MeditationEmotional eating External eating Reduced SSSS Alberts 2012 RCT26MeditationFood cravings Dichotomous thinking Body image concern Emotional eating External eating Reduced SSSSS SSSSS 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 of participa nts Intervent ion OutcomeResultSignifica nt/ Not Significa nt (S/NS) Bowen 2009 RCT168MeditationAlcohol use Craving Reduced SSSS Garland 2010 RCT53MeditationAlcohol cues Alcohol attentional bias Reduced SSSS Witkiewitz 2010 RCT168MeditationCraving Alcohol use Reduced SSSS Reddy 2014 RCT38YogaAUDIT score Symptoms Symptom management Reduced Improved NS S Hallgren 2014 RCT18YogaAlcohol consumption ReducedNS 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 participa nts Intervent ion OutcomeResultSignifica nt/ Not Significa nt (S/NS) Mclver 2009 RCT90YogaBMI Waist circumference Hip circumference Reduced SSSSSS Daubenmier 2011 RCT47Meditation Abdominal fat/trunk-leg fat ratio Overall weight No difference ---- Jeong-Ah 2012 RCT16YogaBody weight Percentage of body fat Lean body mass Body mass index Waist circumference Visceral fat area Reduced SSSSSSSSSSSS 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. 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. Thank you