RGUHS Nat. J. Pub. Heal. Sci Vol No: 10 Issue No: 2 eISSN: pISSN: 2249-2149
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.
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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
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