RGUHS Nat. J. Pub. Heal. Sci Vol No: 11 Issue No: 1 pISSN: 2249-2194
Dear Authors,
We invite you to watch this comprehensive video guide on the process of submitting your article online. This video will provide you with step-by-step instructions to ensure a smooth and successful submission.
Thank you for your attention and cooperation.
Nandeesh1 , Shivaprasad Shetty2 , Prashanth shetty3
1: Assistant Professor, 2: Dean, 3: Principal,
Sri Dharmasthala Manjunatheshwara College of Naturopathy and yogic Sciences, Ujire
Address for correspondence:
Nandeesh
Email: nsnandeesh@gmail.com
Abstract
Background: Obesity is described as an extra accumulation of adipose tissue. Obesity among adults, overweight among children is the common clinical condition witnessed in day to day practice. Since 1980 there has been amplifying in the share of weight problems amongst adults, obese amongst teenagers and adolescents. Hence, Yoga and Naturopathy which positively have an effect on the pleasant of existence alongside with weight discount are viewed beneficial for sustained weight loss in folks with obesity. This learns about pursuits to verify the impact of Naturopathy interventions coupled with dietary adjustments and Yogic workout routines in weight problems and to display the function of Naturopathy and Yoga in the management of obesity.
Subjects and Methods: Ninety obese subjects with BMI (Body Mass Index) more than 30 kg/m2 and not exceeding 40 kg/m2 belonging to both genders (Males 41 and Females 49) with age groups ranging from 21 to 35 years were randomly allocated into three different groups. Group 1 (Yoga and Naturopathy intervention) Subjects were taken from SDM Yoga and Nature cure Hospital, Dharmasthala, Group 2 (Diet counselling) subjects were taken from SDM Yoga and Naturopathy out Patient Department, Ujire, Group 3 (control group) subjects were students from residential hostel Ujire, Karnataka for the study.The subjects were assessed for BMI,WHR (Waist/hip ratio) and body fat at the baseline and after 10 days of intervention.
Results: Paired sample t-test comparing “Post” with “Pre” values showed a significant decrease in all the parameters within the experimental groups. One way Analysis of variance(ANOVA) showed a significant decrease in BMI in Naturopathy and Yoga intervention group. The Yoga and Naturopathy group has shown significant results with respect to improvement in BMI (p <0.001), Fat% (p <0.001), WHR (P <0.01), Fat mass (p <0.05), Total body water TBW (p <0.001), BMR (Basel Metabolic Rate) (p <0.001). Whereas the Diet intervention group showed significant improvements in BMI (p <0.01), WHR (P <0.5), Fat% (p <0.001), Fat mass (p <0.001), TBW (p <0.01), BMR (p <0.01). The control group did not show any significant changes in any of the parameters. The 10 days of intervention had a minimal significant reduction in the degree of Obesity.
Conclusion: Yoga and Naturopathy, which is a drugless therapy and eating regimen counseling, can be successfully used to decrease the issues in overweight individuals.
Keywords
Downloads
-
1FullTextPDF
Article
INTRODUCTION
Obesity is expected to become the world's biggest health problem. The percentage of adults with obesity has almost become four times more, over the last 3 decades. A Sedentary lifestyle is additionally a fundamental contributor to weight gain.1,2 There is a close relationship between low levels of physical activity and weight gain in both men and women according to National Health and Nutrition Examination Survey (NHANES) and also prolonged television and mobile watching is highly predictive of obesity and diabetes risk in adults and children.3,4 Regular yoga practice was associated with an attenuation of weight gain in middle-aged adults.5 Obesity and its associated comorbidities demand early intervention, but the high and rising prevalence of obesity puts pressure on scarce health-care resources. Data from A Complementary and Alternative Medicine (CAM) intervention study suggests that referral of selected participants by a primary health-care professional to a commercial weight loss program that provides regular weighing, advice about diet and physical activity, motivation, and group support can offer a clinically useful early intervention for weight management in overweight and obese people that can be delivered at large scale.
Since there are no studies on the effect of Yoga and Naturopathy lifestyle intervention on obesity with the control group this study is designed to determine the effect of Yoga and Naturopathy lifestyle intervention on obese individuals and also to compare Yoga & Naturopathy intervention with diet counseling and control group.
AIMS AND OBJECTIVES
Aim: To study the impact of yoga and naturopathy based lifestyle intervention, and diet counseling on obese individuals.
Objective of the study: To evaluate the effect of Yoga and Naturopathy lifestyle intervention in obese individuals, only diet modification and compare with a wait list control group in obese individuals with respect to
a. Body mass Index(BMI)
b. Hip/waist ratio (WHR)
a. Body composition with variables of WHR, Fat%, Fat Mass, TBW%, BMR & Degree of obesity.
MATERIALS AND METHODS
Source of Subjects: Study participants were recruited Group 1 from Sri Dharmasthala Manjunatheswara Yoga and Nature Cure hospital Shantivana, Dharmasthla, Group 2 SDM Yoga and Naturopathy out Patient Department, Ujire and Group 3 Students from residential hostel ujire, Karnataka.
Inclusion Criteria:
The following inclusion criteria were adopted for recruiting the subjects:
• Well established Diagnosis of obesity based on National Health and Nutrition Examination Survey (NHANES).
• Young adults between the age group of 21 – 35 years who are moderate to severe obese (≥30 BMI ≤40)
• Those who were given written consent form and willingness to participate in the study.
Exclusion Criteria
• Subjects were excluded if severely obese (BMI ≥ 40) and those unable to perform yoga and physical activity.
• Obesity associated with systemic complications, epilepsy, any psychological conditions and with any other co-morbid medical conditions.
• Individuals on weight loss medications.
• Significant behavioral problems.
Signed informed consent: Subjects were explained in detail about the procedures involved in assessments as well as intervention. A signed informed consent was taken from each subject. The project was approved by the Institutional Ethics Committee.
Setting for assessment & intervention: The whole set up for the pre-assessment of variables, intervention and post assessment was carried out at Research laboratory at SDM Naturopathy and Yoga Hospital.
Design: Three Arm Study. Subjects were stratified based on BMI and simple random allocation in three groups as per the source of the subject i.e., Yoga and Naturopathy (Group 1), Diet modification by counseling (Group 2) and wait list (Group 3) using a random number table. The assessments were done on Day 1 (baseline) and Day10 (post intervention).
Assessments: The subjects are recorded for the following assessments as per the standard operating procedures before and after the intervention.
Body Mass Index (BMI): BMI is calculated by weight in kilograms divided by height in meters squared (BMI = kg/m2) by using standard tape and standard weighing machine ESSAE, EEROKA LTD.
Waist-Hip ratio (WHR): For measuring waist circumference subjects were asked to wear light clothing and to stand upright with feet 25 to 30 cm apart, and weight evenly distributed. A measuring tape was used for measuring, which was fitted around the abdominal girth without compressing soft tissue. Waist circumference was measured in a horizontal plane mid- way between the inferior costal margin and the iliac crest. Hip circumference was measured around the pelvis at the point of maximal protrusion of the buttocks.42
Body composition: Body composition was measured by using Tanita TBF-410 Pro body composition analyser, which records fat percentage, fat mass, basal metabolic rate, total body water percentage and Degree of obesity.43
Intervention:
Group 1 (Yoga and Naturopathy: n= 30): Subjects admitted in the hospital as inpatients were given 90 minutes of therapeutic obesity yoga daily morning followed by 90 minutes of naturopathy treatments and total 5000 calorie restricted diet given for 10 days.
Group 2 (Diet counseling: n= 30): Patients attending S.D.M Yoga and Nature cure Outpatient department, Ujire were given Diet counseling and advised with fiber rich diet chart of 2000 calories per day to follow for 10 days.
Group 3 (Wait list: n= 30): No interventions were given during the study period and informed to do their regular activities and food. They were given an option to voluntarily choose any of the study interventions as per their willing after the study period.
Data analysis
Statistical analysis was done using SPSS (Version20.0) package. P values less than 0.05 were accepted as indicating significant differences. One way ANOVA was used to look at the difference between 3 groups.
RESULTS
The present study was conducted to evaluate the effectiveness of Yoga and Naturopathy life style intervention where three groups’ data was collected and analysed by using One way ANOVA test. The Yoga and Naturopathy group have shown significant results with respect to improvement in BMI (p <0.001), Fat% (p <0.001), WHR (P <0.01), Fat mass (p <0.05), TBW (p <0.001), Basel Metabolic Rate BMR (p <0.001). In the Diet intervention group showed significant improvements in BMI (p <0.01), WHR (P <0.5), Fat% (p <0.001), Fat mass (p <0.001), TBW (p <0.01), BMR (p <0.01). The wait list control group did not show any significant changes in any of the parameters. The 10 days of intervention had minimal significant reduction in the degree of Obesity.
DISCUSSION
The present study is conducted to compare the effect of Yoga and Naturopathy based interventions on obese individuals and to compare the effect with the Diet counseling group and Wait list control group. There was significant decrease in BMI, WHR, Fat%, Fat mass, TBW and BMR in Yoga and Naturopathy Group and Diet counseling group. The wait list control group did not show any significant changes. These facts are supported by the various earlier studies.44
One of the interventions in the present study for naturopathy and yoga group was fasting. During fasting it is known that there is increased stimulation of adipose tissue b-adrenergic receptors is which increases lipolysis during fasting. The increase in b-adrenergic- mediated lipolysis during fasting is caused, in part, by an increase in adrenal medullary secretion of epinephrine.45
For diet counseling group where the subjects are advised to have restricted calorie diet with more fiber predominantly with lemon honey juice and more of fruit juices. Low calorie diet induces increased oxidation of lipids.46 which may be the major cause in reduced body weight and changes in BMI which was found in our study.
Physical inactivity is the major contributor for obesity. With this view, for the naturopathy and yoga group we have given dynamic yogic exercises. The physiological effects of yoga training that have been previously reported include the inhibition of body weight gain. When exercise is included in a weight-loss program, there is usually an improvement in body composition due to a gain in lean body weight because of an increase in muscle mass and a concomitant decrease in body fat.47 A studies done by Marie – Adeline Marques and his colleague showed mechanical massage produced noticeable changes in the expression of number of genes involved in pathways related to metabolism and enhancement of both lipolytic responsiveness of Gluteofemoral Adipose Tissue (GAT) and Adipose tissue Blood Flow (ATBF).48 A study by S. N Murthy using Naturopathy and Yoga intervention in obese individual for a period of 21 days had shown reduction body weight, BMI.49
No interventions were given to the waitlist group during the study period. They were given an option to voluntarily choose any of the study interventions if willing after the study period in that we equally divided 30 subjects for yoga and naturopathy intervention 15 subjects and 15 subjects for diet counseling.
The merits found in this study were there were no dropouts during the study and simple randomization was used.
Most of the studies done previously were open label studies, so current study has used well designed three arm study, which is one of the merits of the study.20, 26, 46-49
Limitations
• Follow up is not done after the study.
• This study shows short duration only for 10 days.
• Though we wanted to assess polypeptides and other obesity parameters like lipid profile and cholesterol. Due to funding restrictions we could not access these parameters.
• We have not analysed waitlist group after taking either of the two treatments, which is one of the limitations of the study.
CONCLUSION
The present study showed that Yoga, Naturopathy and diet counseling has beneficial results in reducing weight, BMI, WHR, Fat%, Fat Mass, TBW, BMR in obese individuals. Hence Yoga and Naturopathy life style intervention can be efficiently implemented in obese individuals to reduce BMI, WHR and Body composition and thereby overcome obesity induced risk factors for diabetes, hypertension and hyperlipidemia. The system of naturopathy involves food which acts as a medicine and hydrotherapy, manipulative therapy are major treatment procedure, so the diet counseling group also shown improvement in comparison to waitlist group. In contrast the yoga and naturopathy life style intervention is proved beneficial for obesity Individuals.
Data collection
Data was collected prospectively at baseline and at end point for all the three groups
Table 2: Summary of Results
Paired sample t test comparing “Post” with “Pre” values * p<0.05; ** p<0.01; *** p <0.001, One way ANOVA between the groups @@@ p<0.001
BMI= Body Mass Index, WHR = Waist Hip Ratio, TBW = Total Body Water & BMR = Body Mass Index
Conflict of Interest: Declared
References
1. Mehio Sibai A, Nasreddine L, Mokdad AH, Adra N, Tabet M, Hwalla N. Nutrition transition and cardiovascular disease risk factors in Middle East and North Africa countries: reviewing the evidence. Ann Nutr Metab. 2010;57(3-4):193– 203.
2. Smith DE, Lewis CE, Caveny JL, Perkins LL, Burke GL, Bild DE. Longitudinal changes in adiposity associated with pregnancy. The CARDIA Study. Coronary Artery Risk Development in Young Adults Study. JAMA. 1994;271(22):1747–1751.
3. Williamson DF, Madans J, Anda RF, Kleinman JC, Kahn HS, Byers T. Recreational physical activity and ten-year weight change in a US national cohort. Int J Obes Relat Metab Disord. 1993;17(5):279–286\
4. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003;289(14):1785–1791.
5. Baer RA, Smith GT, Allen KB. Assessment of mindfulness by self-reports. The Kentucky Inventory of Mindfulness Skills Assessment 2004; 11:191–206.
6. Arthur Guyton, John Hall. Textbook of Medical Physiology. Elsevier Inc; 2006.
7. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303:242–9.
8. Mohamed-Ali V, Pinkney JH, Coppack SW: Adipose tissue as an endocrine and paracrine organ. Int J Obes Relat Metab Disord 1998; 22:1145-1158.
9. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness Assessment 2006; 13:27–45.
10. Fauci, Braunwald, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 17th Edition, McGraw Hill Medical Publishing Division.
11. Senn JJ, Klover PJ, Nowak IA, Mooney RA: Interleukin-6 induces cellular insulin resistance in hepatocytes. Diabetes 2002; 51:3391-3399.
12. Tsigos C, Papanicolaou DA, Kyrou I, et al: Dose-dependent effects of recombinant human interleukin-6 on glucose regulation. J Clin Endocrinol Metab 1997; 82:4167-4170.
13. Kahn BB, Flier JS: Obesity and insulin resistance. J Clin Invest 2000; 106:473-481.
14. Wajchenberg BL: Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev 2000; 21:697-738.
15. Mavoa HM, McCabe M. Sociocultural factors relating to Tongans’ and Indigenous Fijians’ patterns of eating, physical activity and body size. Asia Pac J Clin Nutr. 2008;17(3):375–384
16. Friedman JM: Obesity in the new millenium. Nature 2000; 404:632-634.
17. Lee Y, Wang MY, Wang ZW, et al: Liporegulation in diet-induced obesity. The antisteatotic role of hyperleptinemia. J Biol Chem 2001; 276:5629- 5635.
18. Considine RV, Sinha MK, Heiman ML, et al: Serum immunoreactive leptin concentrations in normal weight and obese humans. N Engl J Med 1996; 334:292-295.
19. Kolaczynsky JW, Ohammesian JP, Considine RV, et al: Response of leptin to short-term and prolonged overfeeding in humans. J Clin Endocrinol Metab 1996; 81:4162-4165.
20. Flier JS: Clinical review 94: What's in a name? In search of leptin's physiologic role. J Clin Endocrinol Metab 1998; 83:1407-1413.
21. Steppan CM, Bailey ST, Bhat S, et al: The hormone resistin links obesity to diabetes. Nature 2001; 409:307-312.
22. Weyer C, Funahashi T, Tanaka S, et al: Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J Clin Endocrinol Metab 2001; 86:1930-1935.
23. Yang WS, Lee WJ, Funahashi T, et al: Weight reduction increases plasma levels of an adipose-derived anti-inflammatory protein, adiponectin. J Clin Endocrinol Metab 2001; 86:3815-3819.
24. Yu JG, Javorschi S, Hevener AL, et al: The effect of thiazolidinediones on plasma adiponectin levels in normal, obese, and type 2 diabetic subjects. Diabetes 2002; 51:2968-2974.
25. Collins C. Yoga: intuition, preventive medicine, and treatment. J Obstet Gynecol Neonatal Nurs. 1998;27:563–568.
26. Supriya joshi (deole), Yogesh s. Deole, g.h. vyas, s. c. dash. Management of Overweight and Obesity through specific Yogic procedures. AYU-VOL. 30, NO. 4. 2009 October-December, pp. 425-435 .
27. S. Dhananjai, Sadashiv, Sunita Tiwari, Kumar Rajjan, M.P.S. Negi. Effect of Yoga practice in the management of risk factors associated with obesity: A pilot study. Indian Streams Research Journal. October 2011. Vol - I , ISSUE – IX.
28. Okonta, Nkechi Rose MSN, RN. Does Yoga Therapy Reduce Blood Pressure in Patients With Hypertension?: An Integrative Review. Holistic Nursing Practice. May/June 2012 - Volume 26 - Issue 3 - p 137–141.
29. DING Xi-zhou. The Effect and Research of Yoga Asana to Slimming Body. Journal of Henan Normal University(Natural Science). April/ June 2006 - Volume 21 - Issue 2 - p 108–113.
30. Guarracino, Joanna Lazos MS; Savino, Susan MS; Edelstein, Sari PhD, RD. Yoga Participation is Beneficial to Obesity Prevention, Hypertension Control, and Positive Quality of Life. Topics in Clinical Nutrition. April/June 2006 - Volume 21 - Issue 2 - p 108–113
31. Mary Koithan, PhD, RN-C, CNS-BC and Elizabeth Sutherland, ND. Naturopathic Treatment of Obesity. J Nurse Pract. 2009 October; 5(9): 693–694.
32. S.N.Murthy: N.S.N.Rao: Babina Nandakumar: Avinash Kadam: Management of obesity through naturopathy and yoga interventions. Indian Journal of Ancient Medicine and Yoga. April-June 2010; Volume 3 Number 2.
33. Patricia A. Sharpe, Heidi M. Blanck, Joel E. Williams, Barbara E. Ainsworth, Joan M. Conway. Use of Complementary And Alternative Medicine for Weight Control in The United States. The Journal of Alternative and Complementary Medicine. March 2007, 13(2): 217-222.
34. Oláh M, Koncz Á, Fehér J, Kálmánczhey J, Oláh C, Nagy G, Bender T. The effect of balneotherapy on antioxidant, inflammatory, and metabolic indices in patients with cardiovascular risk factors (hypertension and obesity)--a randomised, controlled, follow-up study. Contemp Clin Trials. 2011 Nov;32(6):793- 801.
35. Sadatoshi Biro, Akinori Masuda, Takashi Kihara and Chuwa Tei. Clinical Implications of Thermal Therapy in Lifestyle-Related Diseases. Rsmjournals. 2003, 228:1245-1249.
36. Monica C Klempel, Cynthia M Kroeger,1Surabhi Bhutani, John F Trepanowski, and Krista A Varady. Intermittent fasting combined with calorie restriction is effective for weight loss and cardio-protection in obese women. 2012 November.
37. Eshghinia S, Mohammadzadeh F. The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women. 2013 Jan 9;12(1):4.
38. Mangge H, Summers K, Almer G, Prassl R, Weghuber D, Schnedl W, Fuchs D. Antioxidant food supplements and obesity-related inflammation. Curr Med Chem. 2013 Mar 15.
39. Liu X, Zhang G, Ye X, Li H, Chen X, Tang L, Feng Y, Shai I, Stampfer MJ, Hu FB, Lin X. Effects of a low-carbohydrate diet on weight loss and cardiometabolic profile in Chinese women: a randomised controlled feeding trial. Br J Nutr. 2013 Mar 25:1-10.
40. Douglass JM, Rasgon IM, Fleiss PM, Schmidt RD, Peters SN, et al. Effects of a raw food diet on hypertension and obesity. South Med J 1985. 78: 841-844.
41. Varady KA, Hellerstein MK. Alternate-day fasting and chronic disease prevention: a review of human and animal trials. Am J Clin Nutr 2007. 86: 7-13
42. Seidell JC et al. Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. American Journal of Clinical Nutrition. 2001; 74:315–321.
43. Melodie K. Moorehead, PhD; Elisabeth Ardelt-Gattinger , PhD ; Hans Lechner ,PhD; Horacio E. Oria, MD, F ACS. The Validation of the Moorehead-Ardelt Quality of Life Questionnaire II. Obesity Surgery. 13; 684-692.
44. Vijay Tundwala, R.P. Gupta, *Surendra Kumar, V.B. Singh, Sandeep BR, Prabhu Dayal, Parul Prakash. A study on effect of yoga and various asanas on obesity, hypertension and dyslipidemia. International Journal of Basic and Applied Medical Sciences ISSN: 2277-2103. 2012 January-April. Vol. 2 (1). pp.93-98.
45. Bessard T, Schutz Y, Jequier E: Energy expenditure and postprandial thermogenesis in obese women before and after weight loss. Am] Clin Nutr. 1983; 38:680-693.
46. Dae Yun Seo, SungRyul Lee, Arturo Figuero, Hyoung Kyu Kim, Yeong Ho Baek, Yi Sub Kwak4 et al. Yoga Training Improves Metabolic Parameters in Obese Boys. Korean J Physiol Pharmacol. June, 2012; Vol 16: 175－180.
47. Oscai LB, Holloszy JO. Effects of weight changes produced by exercise, food restriction or overeating on body composition. J Clin Invest 1969; 48: 2124–2128.
48. Marie-Adeline Marquesa, Marion Combesa, Balbine Roussel, Laurence Vidal-Dupont, Claire Thalamas, Max Lafontana, Nathalie Viguerie. Impact of a Mechanical Massage on Gene Expression Profile and Lipid Mobilization in Female Gluteofemoral Adipose Tissue. Obes Facts 2011;4:121–129.
49. Unick JL, Beavers D, Bond DS, Clark JM, Jakicic JM, Kitabchi AE, Knowler WC, Wadden TA, Wagenknecht LE, Wing RR. The long-term effectiveness of a lifestyle intervention in severely obese individuals. Am J Med. 2013 Mar;126(3):236-42.