Effect of yoga on bio-physiological parameters among overweight and obese adolescents: a case series study

INTRODUCTION

An epidemiological transition involving changes in the economy, nutrition, and physical activity is taking place in many Southeast Asian nations, including India.¹ According to projections from the Organization for Economic Cooperation and Development, nearly one in every six children is overweight or obese. India is the world's third-largest obese nation. In India, obesity is most prevalent among children and teenagers, particularly in urban areas. (WHO 2016).²

According to figures from NFHS 5, India is rising in most states and territories. 33 states and unions reported an increase in the number of overweight children under the age of five. Between NFHS-4 and NFHS-5, the percentage of overweight children increased from 2.1% to 3.4%.³

Obesity is more prevalent in urban regions, according to the latest report from the National Family Health Survey-5. The worst-performing places are Chandigarh, Delhi, and Puducherry, where about half of the population is overweight. The richest people are four times more likely to be overweight than the poorest.

The state of Puducherry has the highest proportion of overweight or obese women (46%), followed by Chandigarh (44%), Delhi (44%), Tamil Nadu (41%), Punjab (39%), Kerala (38%), and the Andaman and Nicobar Islands (38%).⁴ Nearly 80% of obese adolescents will continue to be obese in adulthood. Around 55% of obese children will continue to be obese in adolescence, and more than 70% will be obese after the age of 30.⁵

The COVID-19 lockdown had a profound impact on humanity. Today's situation has several negative impacts on lifestyle and health. The COVID-19 pandemic has also increased the prevalence of obesity worldwide, making the problem of childhood obesity worse. ⁶ Situations that contribute to obesity among children include the absence of playgrounds, parks, motor vehicles, roads that are unsafe for walking and cycling, violence, etc.

A high-calorie, high-fat diet, soft drinks, processed fast food, more restaurants, quick food chains, and bakeries are just a few examples of dietary factors.

Diabetes mellitus, insulin resistance, dyslipidemia, hypertension, atherosclerosis, asthma, sleep apnea, polycystic ovary syndrome, hypothyroidism, and preventing and controlling childhood obesity will require multifaceted, family-centered, and community-based programs. Currently, many weight loss management programs flourish for overweight and obese children, such as physical exercises like walking, jogging, aerobic exercises, yoga, dancing, swimming, special diets, weight loss devices, behavior and lifestyle modification, nutritional education, psychotherapy services, medicine, and bariatric surgery.

Yoga has been practiced as a science in India for thousands of years. It is one of the best means of improving oneself and gaining the full potential of one's body, mind, and soul. Research has shown that practicing yoga improves strength, controls blood pressure, breathing, heart rate, and metabolism, reduces weight, lowers cardiovascular risk factors, etc. The current generation of overweight children could increase the prevalence of obesity in Puducherry over the next 10 years. Therefore, measures should be taken to reduce and avoid obesity in these adolescents.

This study focuses on the impact of yoga on biophysiological parameters, stress, and anxiety in overweight and obese adolescents aged 11 to 13 years.

CASE SERIES

Settings

A school-based case series design was conducted to assess the effect of yoga on bio-physiological parameters among overweight and obese adolescents. 11-13 years at selected schools in Puducherry.

Study design

This project made use of basic design (A-B). An AB design is a two-part or phased design consisting of a baseline measurement of bio-physiological variables (the ‘A’ phase) and a therapy or intervention (the ‘B’ phase). Obese and overweight adolescents in phase B received 24 weeks of yoga practice.

Screening

The census method was used to measure the height and weight of 286 11- to 13-year-old adolescents. The new WHO BMI chart for boys and girls used to figure out overweight and obese.

Cases

The selection criteria includes (1) adolescents of both genders aged 11 to 13 years; (2) BMI is greater than the 87^th percentile in the revised WHO BMI charts for girls and boys; (3) free from chronic illnesses. Exclusion criteria included overweight and obese adolescents who have undergone surgery within the past six months, routinely practice yoga, or are using any weight-management medication.

Participant's recruitment

One school was chosen at random using a simple random sampling procedure. The census method involved screening 147 male and 142 female adolescents for weight and height. The BMI was calculated by dividing weight in kg by height in meters squared and plotted on WHO age- and gender-specific percentile charts of BMI. 113 (or 39.1%) of the teenagers had a normal BMI.

48 (16.6%) of the teenagers were underweight, 84 (29.1%) of adolescents were overweight, and 44 (15.2%) of adolescents were obese. A total of 100 overweight and obese teens were eligible to take part in the study, and 24 were not eligible.

Of the eligible adolescents, only 14 were selected. Five of the fourteen adolescents dropped out of the study. The final nine overweight and obese adolescents were included in this study.

Data collection

Data was collected from March 2022 to August 2022. Informed consent was obtained from the parents, and assent was taken from overweight and obese adolescents of both genders. A total of 14 overweight and obese adolescents who consented to participate in the study were selected using consecutive sampling techniques.

Pre-tests were done on bio-physiological parameters among overweight and obese adolescents. Performed yoga three times a week for 45 min from 3.15 to 4 pm for 24 weeks under the investigators' supervision. The first and second post-tests on bio-physiological parameters were conducted between 12 and 24 weeks after yoga practice, respectively.

Outcome measure

The outcomes of the study were measured by the investigator at baseline, 12 weeks, and 24 weeks after yoga practice. The socio-demographic profile of adolescents and their families was assessed using a self-structured questionnaire, which consisted of 16 items. Weight was measured using an Omron (India) weighing machine to the nearest 100 grams with light clothing. Height was measured to the nearest 0.1 cm using the standard stadiometer with an erect posture. Waist circumference was measured to the nearest 0.1 cm by using an inch of tape approximately at the level of the midpoint between the lower margin of the last palpable rib and the top of the iliac crest with the arms at the sides, feet positioned close together, and weight evenly distributed across the feet in the standing position.

The measurement was taken at the end of normal expiration, and the tape is snug but does not compress the skin. Hip circumference was measured to the nearest 0.1 cm by wrapping measuring tape around the widest part of the buttocks while subjects were tightly clothed, arms at the sides. The skin fold thickness was measured using the Harpenden Skin Fold Caliper on the right side of the body, and a minimum of two measurements were taken on each side. Triceps skin fold thickness was measured vertically, halfway between the acromion (bony point of the shoulder) and olecranon processes (the bony part of the elbow), with arms held freely to the side of the body. Sub-capular skin fold thickness was measured diagonally by locating 1 to 2 cm below the inferior angle of the scapula at the bottom of the shoulder.

Blood pressure was measured by Omron mx3 automated blood pressure monitoring at the level of the arm, 2 inches above the antecubital fossa on the left upper arm in the supine position, twice, at intervals of 10 minutes, and the average blood pressure was calculated. The body composition was assessed using the BodyStat QuadScan 4000 with 8-12 hours of fasting.

Two electrodes were fixed to the hand and the leg, respectively. The anthropometric values, age, and activity level of the child were entered into the instrument. The instrument was calibrated before the test. The test was run, and the results were transferred to the laptop.

FFM, fat percentage, total fat mass, cellular hydration status (total body water, extracellular fluid, and intracellular fluid), and basal body metabolism were estimated.

Description of the intervention

Under the supervision of the researchers, the adolescents practiced yoga three times a week for 45 minutes between 3.15 pm and 4 pm for 24 weeks. The yoga schedule is displayed in the table below.

Data analysis

Data entry was done with Microsoft Excel, and data analysis was done with SPSS version 25 software for social sciences. Descriptive statistics such as frequency, percentage distribution, mean, and standard deviation were used. Inferential statistics such as one-way repeated measures, ANOVA F-test, the paired t-test, and Karl Pearson's correlation coefficient were done.

Demographic characteristics of overweight and obese adolescents, 55.6% of participants are overweight and 44.4% are obese. (44.4%) the age of 12 years, and 66.7% of participants were firstborn children. 77.8% had one brother or sister; all were studying in an english medium, and most (55.6%) were in grade 8. The Table 3 showed that 44.4% of the family had four family members, 100% of them were non-vegetarians, 100% of them lived in urban areas, and 44.4% of the family had an income of Rs. 15,160 to Rs. 20,209 per month. With regard to the father's education and occupation, 88.9% of the fathers studied in high school, and 66.7% of the fathers were on daily wages.

In terms of the mother's education and occupation, 44.4% of the mothers studied were in high school, with 55.6% being housewives. 100% of adolescents have a family history of obesity. The Table 4 shows 77.8% of the mother and 77.8% of the fathers did not have obesity-related health problems. The Table 5 shows that the pre-test and post-test mean difference in terms of weight was 4.0 kg, the BMI was 1.7, the waist circumference was 4.6 cm, the hip circumference was 6.2 cm, the triceps skin fold thickness was 4.9 mm, and the subcapsular skin fold thickness was 5.7 mm, which was statistically significant at p<0.001 after yoga intervention. According to the table, there was a statistically significant difference between the pre-test and post-test mean difference in pulse reduction: 8.8, systolic blood pressure was 11.0, and diastolic pressure was 6.9, which was statistically significant at p<0.001 following yoga intervention. The findings reflect significant differences between pre-test and post-test. The mean reduction after yoga practice in terms of fat (%) was 3.4, water (%) was 2.4, ECW (%) was 1.1, ICW (%) was 2.0, and body fat mass index (BFMI) was 1.7. There were no statistically significant differences observed in the control group. The results showed that there is a strong link between the thickness of the skin fold on the triceps versus the systolic blood pressure, and BMI versus weight. All other variables did not correlate.

Note: ***S-Very highly significant at p≤0.001, NS- not significant.

Note: **S- Highly significant at <0.01; ***S- very highly significant at p≤0.001.

Note: NS=Non significant at p>0.05 level; **S-highly significant at p<0.01; ***S- very highly significant at p≤0.001.

Note: **Correlation is significant at p<0.01 level (2-tailed); *-correlation is significant at p<0.05 level (2-tailed).

DISCUSSION

Obesity is becoming more prevalent worldwide and is a major risk factor for cardiovascular and metabolic disorders. Particularly worrying is the fact that obese children and adolescents can become obese adults. The increase of people migrating from rural to urban, urbanization, increasing per capita income, available food options, increasing availability of non-vegetarian and fast food, low quantity micronutrients, technical advancements in lifestyle, such as motorized vehicles, sedentary school activities, inadequate outdoor or recreational space, sedentary behaviors such as television viewing, internet gazing, etc., all contribute to obesity.

When the average income grows, activities associated with obesity, such as watching television, purchasing fast meals, and eating highly processed fast food, become more prevalent. Yet access to health care, education, nutritious foods, and leisure activities that promote weight maintenance remains inadequate.

Chronic non-communicable diseases are more likely to develop in people who are obese. Alternative therapies are crucial for preventing obesity and promoting good health in overweight youth. The purpose of the study was to assess the effect of yoga on biophysiological parameters in overweight and obese adolescents.

The major weakness of the design is that there is no randomization for the selection of study participants, the sample size is too small to generalize the results, and the family is not involved in the treatment plan. To achieve the desired weight loss, not only the client but also the entire family must modify their behavior. While establishing a treatment plan, it is crucial to determine whether a family is willing to undertake dietary and physical activity modifications that may be worth the work required to implement them. Participation in sports has several benefits for children and adolescents, including physical, physiological, and social development. Many studies demonstrated that children and adolescents who engaged in greater physical activity had a lower chance of developing cardiovascular diseases such as metabolic syndrome. So Government and the policy maker can give importance to physical activities.

Our study findings showed that there was a significant mean reduction in weight of 4.0, a BMI of 1.7, a waist circumference of 4.6, a hip circumference of 6.2, a triceps skin fold thickness of 4.9, and a subcapsular skin fold thickness of 5.7. This was consistent with previous studies. Vandana Jain reported similar outcomes after 18 weeks of yoga intervention. The median (IQR) reduction in BMI was similar between the standard and yoga arms, at 1.4 (3.1, 0.5) kg/m² and 1.2 (2.3, 0.6) kg/m2, respectively, while it rises by 0.3 (0.3, 0.1) kg/m² in the control arm.⁸ Another study was done by Kumar et al and Patel et al to see the effect of 6 weeks of yoga practice and diet control on weight, BMI, skin fold thickness, and cholesterol levels among obese women aged 25-30 years. The findings showed a significant decrease in body weight, BMI, skin fold thickness, and total cholesterol after 6 weeks of yoga practices with diet control in the experimental group compared to the control group. The experimental group's pre- and post-test mean BMI was 32.39 and 30.2, respectively; its mean weight was between 96 and 94.28; and its mean skin fold thickness was between 54.04 and 51.36, respectively.² After participating in yoga, our research showed that there was a significant difference in mean pulse, systolic, and diastolic blood pressure. Vandana Jain also reported that the mean systolic blood pressure decreased in the yoga arm from 118 to 114 mmHg (p=0.019).⁸ Banerjee et al discovered that practicing yoga for one hour every day for three months results in statistically significant reductions in BMI, systolic and diastolic blood pressure, and hemoglobin percentage. Though PR, WBC, and platelets showed improvement in values after yoga practice, it was statistically non-significant. ¹⁰

Our results showed a mean reduction in fat (%), water (%), ECW (%), ICW (%), and body fat mass index (BFMI), and there were no significant changes in basal metabolic rate or fat-free mass index. Our findings also show that there is a significant positive correlation between the post-test triceps skin fold thickness and SBP.

Marisa Poomiphak Na Nongkhai evaluated the efficacy of continuous yoga on body composition in 40 overweight adolescents. The results of the study showed that the yoga intervention group had a much lower mean BMI and BFM. In the yoga group, muscle mass continued to rise by 0.515 a week, which was statistically significant.¹¹

Our results were also comparable to the study done by Mueller et al and Gadham et al.^12,13 The effects of yoga on obesity, hypertension, and lipid profiles were assessed. Fifty male subjects in the age range of 35-55 years were randomly selected. BP, BMI, and lipid profiles were estimated before and after 3 months of yoga. The results showed a statistically significant decrease in systolic blood pressure, diastolic blood pressure, and BMI after 3 months of yoga training. Also, we observed a decrease in total cholesterol, VLDL, and triglycerides and an increase in HDL cholesterol, which is not statistically significant.

CONCLUSION

Yoga is easy to do, doesn't cost much money, and can help to get in shape. Yoga lowers stress and anxiety, improves health and metabolic parameters, and is a simple cure for obesity. The study concluded that yoga is an effective way to manage obesity and develop healthy citizen's in future teenage children. This study focuses on emphasizing Indian traditional knowledge for holistic improvement and inculcating self-reliant citizens.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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