Yoga has been known to have stimulatory or inhibitory effects on the metabolic parameters and to be uncomplicated therapy for obesity. Adolescence is more prone to get obese due to lack of physical activity making them more sedentary.

Aim: To identify feasibility of validated Integrated Approach of yoga Therapy module (IAYTM) for Obesity in adolescents.

Method: RCT (Randomized Controlled Trial) was conducted on overweight & obese adolescents. Special yoga training was conducted for yoga group parameters like weight, Body Mass Index (BMI), pulse rate , blood pressure, MAC (Mid Upper Arm Circumferences), Waist Circumference (WC), HC (Hip Circumference), Fasting blood sugar, total cholesterol, High-density lipoproteins, low-density lipoproteins, very low-density lipoprotein & Sr. triglycerides were assessed before and after intervention for both yoga and control groups. Within and between group analyses of the variables were carried out.

Result: The study showed significant reduction in weight, body mass index, very low-density lipoprotein & Sr. triglycerides, circumference & Serum cholesterol in yoga group &percentage of improvement is more in yoga group than that of control group.

Conclusion: Integrated Approach of yoga Therapy module (IAYTM) is effective in management of weight, serum triglyceride & very low - density lipoprotein in adolescent obesity.

Keywords: integrated approach of yoga therapy module, IAYTM, obesity, adolescence, yoga, feasibility

 Obesity is a  metabolic disorder with excessive accumulation of fat cells which leads to adverse impacts on physical as well as psychological functions of theperson.¹ Energy-dense overeating, nutrient-poor foods and a sedentary lifestyle have led to an epidemic of obesity all over the world.² Apart from physical problems there are issues which affect psychological well-being of an individual. Depression is the commonest psychological co-morbidity of obesity. A wide range of treatment options are available for obesity but, balanced nutritional food intake and regular exercise are considered to be the safest and the easiest option.³ The most common reason of obesity is increased high calorie & irregular food intake, insufficient exercise, and hereditary body pattern. ⁴ As per the leading scientist, if not controlled vigorously it may end up in a serious health challenge to the society.⁵ According to WHO, UNICEF & CARE it is one of the most neglected public health problem in recent years.⁶

Adolescence is a transitional stage of physical and psychological human development that occurs between the age of 13 and 19years.⁷ Overweight or obese children may continue this body pattern in adulthood with same or increased levels which may lead to high risk of developing disorders like diabetes, hypertension, cardiovascular diseases and cancers.⁸ It has been observed that obesity in children has dramatically increased over the past two decades.⁹ In the last decade, 43million children were found overweight or obese. 35million of this data were living in developing countries. This data may cross 60 million in coming dead if not managed with systematic & scientific channels. Two systematic reviewpapers^10,11 and one clinical review paper¹² suggest that yoga has beneficial effects on mental and physical health in children and adolescents.

 Yoga has been proved its efficacy in psychosomatic disorders along with scientific evidence in past decade. Few national surveys has reported that more than 10 million Americans are practicing yoga for different health challenges since last 15yearss.^13,14 Diseases due to stress are found to be well managed with Yoga therapy according to many scientific research article.¹⁵ Different schools of yoga have varying proportions of physical, breathing, and mind activities executed through varied practices. Most of these studies found a varied range of positive benefits on obesity. They have a common objective of voluntary mastery over the modifications of the mind.¹⁵

In order to provide yoga for adolescent obesity, we have designed & developed an integrated yoga module for Obesity in adolescents from authentic Yoga texts which were result of group discussion of 16 subject matter experts. The module has been checked for content validity by using Lawshe’s content validity ratio. This study is accepted for publication in another publication. Now before going for a proper randomised trial control in larger population, it needs to be checked for feasibility on pilot basis. This study is designed to provide feasibility of Integrated Yoga Module in overweight & obese Adolescents. It also aims to objectively and rationally uncover the strengths and weaknesses of the module. ¹⁷ It evaluates the project's potential for success.

Two armed perspective RCT (Randomized Controlled Trial) has been conducted for 1month with overweight & obese adolescents of a residential school in Sangamner, pune, and Maharashtra, India who did not had any exposure to Yoga previously. Adolescents having any physical disability, any medical disorder or complication were not included in the study, overweight & obese adolescents (15 male and 8 female) between 11 & 17years of age who consented top anticipate in the study were selected for the study. All the participants were allocated in two groups (Yoga n=14 and control n=9). Signed informed consent was obtained from all participants and their parents or guardians in the prior stage of intervention.

During intervention, Yoga group followed the Integrative Yoga Therapy module for obesity in adolescents which contains body posture, breathing tools, Relaxation and Meditation techniques. All the techniques were conducted under guidance & expert’s observation. Duration of each session of the intervention was 60minutes & sessions were conducted for five days in a week for 1month. The control group were doing regular physical activities. All participants received same type of meal throughout the month. All the participants were assessed for weight, BMI, pulse, blood pressure, mid-arm circumference waist circumference, hip circumference, fasting blood sugar, serum total cholesterol, high-density lipoprotein, low- density lipoprotein, very low- density lipoprotein, serum triglycerides respectively at baseline and after 1-month of the intervention. All the 23 adolescents completed the intervention. There were no adverse effects observed during the study period.

Data analysis

The data analysis was performed with SPSS software 20 th version. In very beginning, the data was analysed for normal distribution. Within groups analysis was analysed with all the variables. Between groups analysis was conducted for the post variables of both the groups.

The basic demographic data of age and height of the yoga and control group are given in Table 1. The average age of Yoga group was 14.21±1.84 and that of control group was 15.22±1.09. The average height of Yoga group was 1.64±0.09and that of control group was 1.66±0.09. The minimum age in yoga group was 11 years whereas that in control group was 14years and the maximum age in both groups was 17years. The minimum height in yoga group was 1.51 meter and that of control group was 1.54meter. The maximum height in yoga group was 1.85 meter and that of control group was 1.75 meter.

Results of within group analysis of the normally distributed variables of Yoga group are given in Table 2. Weight, blood pressure, mid-arm circumference, waist circumference, fasting blood sugar, high-density lipoprotein,  very low- density lipoprotein, serum triglycerides were normally distributed with Yoga group. There is significant reduction in weight (p=0.000), diastolic blood pressure (p=0.018), fasting blood sugar (p=0.059), very low- density lipoprotein (p=0.001), serum triglycerides (p=0.001) after intervention. There is significant increase in mid-arm circumference (p=0.01). There is non-significant reduction in systolic blood pressure (p=0.08), waist circumference (p=0.45) & high-density lipoprotein (p=0.75).

Results of within group analysis of the not normally distributed variables of Yoga group are given in Table 3. BMI, pulse rate, hip circumference, serum total cholesterol, low- density lipoprotein were not normally distributed in Yoga group. There is significant reduction in BMI (p=0.00), pulse rate (p=0.03), hip circumference (p=0.01), serum total cholesterol (p=0.03). There is non-significant reduction in low- density lipoprotein (p=0.24).

Results of within group analysis of the normally distributed variables of control group are given in Table 4. Weight, BMI, blood pressure, waist circumference, fasting blood sugar, Serum cholesterol, shigh-density lipoprotein, low- density lipoprotein, very low- density lipoprotein , serum triglycerides were normally distributed in control group. There is significant reduction in high-density lipoprotein (p=0.15), serum triglycerides (p=0.009) & very low- density lipoprotein (p=0.009). There is reduction in weight (p=0.634), BMI (p= 0.616), systolic blood pressure (p=0.152), diastolic blood pressure (p=0.055), waist circumference (p=621), fasting blood sugar (p=0.851), serum total cholesterol (p=0.260) & low- density lipoprotein (p=749) but without significance.

Results of within group analysis of the not normally distributed variables of control group are given in Table 5.

Pulse rate, mid arm circumference & hip circumference were not normally distributed in control group. There is significant increase in mid arm circumference (p=0.015). There is reduction in pulse rate (p=0.223), & hip circumference (p=0.916) but without significance. Between group analysis results are given in Table 6.

Percentage of improvement (reduction) of weight & serum cholesterol, waist circumference, hip circumference, serum cholesterol, low- density lipoprotein, high- density lipoprotein is more in yoga group than that of control group. Percentage of improvement (reduction) of serum triglycerides & very low -density lipoprotein were more in control group than that of yoga group.

23 adolescents were intervened by validated IYTM (36practices), and they were assessed pre- and post-intervention for variables out of which weight (P<0.001), Serum triglyceride & triglycerides (P<0.001) & very low- density lipoprotein (P<0.001) showed statistically significant reduction whereas waist circumference (P< 0.45) & high - density lipoprotein (P<0.75) showed statistically non-significant reduction by validated IYTM on obesity in yoga group. This could be due to short duration of study. There was significant reduction in BMI (p=0.001), pulse rate (p=0.038), hip circumference (p=0.011), serum total cholesterol (p=0.035) in non –parametric test. So this result cannot be implicated for the universe.

There is significant increase in mid-arm circumference (p=0.01) with yoga group & (p=0.015) in control group. This could be because that integrated approach of yoga therapy module for obesity practises are having more emphasis on below naval part of body especially focused on hips & thighs. Few practises were there like suryanamaskara, chakarsana & Bhujangasana which was having effect on arm muscles but they were not significant.

Percentage of improvement (reduction) of serum triglycerides & very low -density lipoprotein were more in control group than that of yoga group. The reason of this could be that all subjects were from same hostel & blinding on the intervention was not possible. When yoga group inducted for Yoga intervention, the control group were aware of the yoga programme but practical details were not conveyed to them. This might have also given them some motivation to do regular physical activities because of which improvement was observed with their variables also. All 14 adolescents completed the intervention, there were no adverse effects noticed during the study. However, RCT with larger samples are needed to validate its efficacy as a primary intervention.

This is a unique study on adolescent obesity with control group. It is found that INTEGRATED APPROACH OF YOGA THERAPY MODULE has been proved effective in obesity parameters management. Further both the groups were belonging to similar age limits which leads to reduction of confounding factors. Blind study was difficult as participants of both the groups were studying in same campus. The food plan was same for both the groups. Current study confirms that the one hour INTEGRATED APPROACH OF YOGA THERAPY MODULE is an effective alternative in adolescent obesity. Larger sample study along with psychological parameters is needed to strengthen its efficacy as a primary intervention.

Integrated approach of yoga therapy module having 36practices for adolescent obesity is effective in management of weight, serum triglyceride & very low-density lipoprotein, hip circumference & serum cholesterol. Yoga group has improved better than control group with INTEGRATED APPROACH OF YOGA THERAPY MODULE. This module hasproved efficient in management of adolescent obesity.

We would like to thank Dr. Sanjay Malpani of Dhruv academy, Sangamner where feasibility study was conducted & Mr. Ramkumar Rathi whoprovided finance for the study.

No conflicts of interest.

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