Deenadayalan Boopalan,1 MD, Venugopal Vijayakumar,2 PhD, Poornima Ravi,3 BNYS, Yogapriya Chidambaram,1 BNYS Akila Anandhan,4 MD, and Maheshkumar Kuppusamy,5 PhD
ABSTRACT
Obesity is defined as abnormal or excessive fat accumulation in the body and is a major risk factor for various non-communicable diseases (NCDs), such as diabetes mellitus, cardiovascular diseases, hypertension, and hyperlipidemia. According to the World Health Organization, more than 1 billion people worldwide are obese—650 million adults, 340 million adolescents, and 39 million children. The often ignored component of obesity is the psychological burden associated with the condition impacting multiple aspects such as low self-esteem, depression, and anxiety. This case report shows the effect of an integrated yoga and naturopathy-based lifestyle in a patient with morbid obesity, with special reference to his psychological status. A 19-year-old male college student diagnosed with obesity underwent integrated yoga and naturopathy management for a period of 20 days. Outcome measures such as anthropometric measurements, positive and negative affects scale (PANAS), depression, anxiety, and stress scale (DASS), and day-to-day activity scale were taken before and after the 20-day intervention period. Results showed improvements in negative affect, depression, and anxiety levels, along with a reduction in body weight. Further studies with adequate sample sizes and experimental study designs are required to validate our findings.
Key Words Depression, anxiety, stress, integrated approach
Obesity is a multifactorial disease, caused by genetic, biological, psychological, cultural, and social factors in addition to many other determinants of health. Lifestyle, family history, and psychological factors play an intertwining role in the pathogenesis of obesity. Globally, there has been a significant increase in the prevalence of obesity in the past 50 years.1 In general, body mass index [BMI (kg/m2)] greater or equal to 30 kg/m2 is considered obesity. Several studies showed that 20% to 60% of persons with obesity, and extreme obesity in particular, suffer from psychological illness.2 The prevalence of obesity continues to rise, severely impacting physical and mental well-being. Current evidence shows that obesity is associated with serious mental disorders, particularly anxiety and depression.3 In spite of remarkable advancements in the pharmacological management of various disease conditions, lifestyle modification still remains a cornerstone in the management of obesity. Yoga and naturopathy are an alternative system of medicine popularized in India that emphasizes salutogenesis,4 which is the intentional focus on health promotion and adopting healthy lifestyle behaviours rather than solely focusing on disease management.5 Naturopathy uses all the five elements of Nature to treat various diseases and also to promote health and well-being. Hydrotherapy, mud therapy, heliotherapy, fasting, and diet therapy are various modalities of treatment in naturopathy. Yoga includes the practice of asana, pranayama, mudra, bandha and meditation for therapeutic purpose.5 In this case report, we aimed to examine the effect of yoga and naturopathy-based lifestyle interventions on physical and psychological well-being in a patient with obesity.
A 19-year-old male college student, diagnosed with morbid obesity (BMI 45 kg/m2) since 2020, visited our hospital for holistic yoga and naturopathy treatment for weight reduction and mental well-being in February 2022. A general physical examination revealed no pallor, icterus, cyanosis, or edema. A systemic examination showed normal functioning of all the systems, and no abnormalities were detected. He did not present with any metabolic disorders (diabetes, thyroid dysfunction) other than obesity. On naturopathy diagnosis, he had mixed encumbrance, and iris diagnosis revealed open and closed lesion in regions in zones 4, 6, and 7 in both eyes. According to yogic tridosha theory, vata is dominant. He also admitted that he often felt disinterested in carrying out day-to-day activities, was upset about his physical appearance and felt guilty for not caring for his health properly. At the onset of his treatment, body weight was 131.5 kilograms, height 1.71 meters with a BMI of 45 kg/m2. After explaining the intervention procedures, written informed consent was obtained.
The intervention involved yoga practices (including surya namaskar, nadi shodhana, and bhramari pranayama) and naturopathy (natural raw diet [Table 1], massage therapy, cold hip bath).
Surya namaskar, or sun salutation, is a component of Hatha yoga consisting of 12 postures (asanas), performed rhythmically, involving major components of the spine, joints, and muscles of the body.6 Nadi shodhana, or alternate nostril breathing, is a slow, rhythmic, alternate nostril breathing technique, consisting of inhaling through one nostril, exhaling through the other nostril and repeating the procedure through the other nostril.7 Bhramari pranayama, or humming bee breathing, is done by closing the ears using the index fingers, and after a full inhalation exhaling, making a soft humming sound.8
The natural raw uncooked diet included raw fruit salad, raw vegetable salad, sprouts, fruit and vegetable juices [656 kcal to 858 kcal] (Table 1).
A cold hip bath was taken once a day (20 minutes) for 20 days. The hip bathtub was filled with cold water at 10–18°C, enough to cover the hips and reaching up to the umbilical region of the bather.9
Massage therapy included manipulation of tissue in the body for therapeutic purposes. Partial massage was given to the abdomen on alternate days for the period of 20 days.
Psychological well-being outcome measures, such as positive affects, negative affects scale (PANAS),10 were used. The Negative Affect portion of the PANAS evaluates 10 emotions (guilty, hostile, ashamed, afraid, irritable, scared, nervous, upset, distressed, jittery) using a Likert scale ranging from 1 (very slightly or not at all) to 5 (extremely). The depression, anxiety, and stress scale (DASS),11 day-to-day activity scale, and anthropometric measures were used for assessment before and after the 20-day intervention.
After the 20 days of integrated yoga and naturopathy treatments, a reduction in body weight from 131.5 kg to 124 kg, with a corresponding reduction in BMI from 45 kg/m2 to 42.2 kg/m2, in negative affects from 44 to 5, and in depression score from 23 to 11, were observed (Table 2). However, stress level and positive effects were unfavorable because the patient was preparing for exams during the intervention period. It was hard for him to adapt to the natural raw diet initially since he loved eating non-vegetarian food and rarely consumed fruits and vegetables. Moreover, the patient himself admitted that he was gaining interest in building his career and was very proud of the physical transformation he achieved during the 20 days. He also gained confidence in facing society and fellow beings.
TABLE 2 Baseline and post-test assessment of the patient
Yoga is a safe and cost-effective modality to reduce depression and anxiety and improve quality of life. A cold hip bath capable of inducing shivering has been shown to encourage the production of irisin, an adipokine that facilitates white adipose tissue mimicking functions similar to brown adipose tissue and enhances metabolism.12 Naturopathy and yoga have been found to be effective in reducing inflammation, anxiety, and depression.13 A restricted calorie diet has been shown to reduce obesity-induced anxiety among college students.14 Calorie restriction also leads to activation of silent information regulator 1 (SIRT1), which controls the key aspects of lipid and glucose metabolism through interaction with transcription factors.15 SIRT1 regulates many endocrine functions, preventing cells from oxidative stress damage, and promotes DNA stability as well as decreasing various disorders, such as cancer, neurodegenerative disorders, and metabolic abnormalities.16 Obesity and its psychological burdens are related to circadian rhythms, which control energy homeostasis by controlling glucose and lipid rhythms in animals and humans,17 as a misalignment of circadian rhythms has been reported in obesity.18 Integrated yoga and naturopathy treatment are documented as regulating circadian rhythms, known as the biological clock, located in the hypothalamic suprachiasmatic nucleus, functioning as a metabolic, endocrine, and sleep regulator.19 A previous pilot study on naturopathy treatment focused only on naturopathy showed significant changes in anthropometric measures (BMI, weight, waist circumference).20 The current case study is unique in documenting a reduction in body weight, along with a reduction in depression and anxiety, in a patient with obesity through yoga and naturopathy.
Yoga and naturopathy treatments may be effective in a more holistic approach to the management of obesity and a reduction in the psychological burden associated with obesity. However, further studies with a larger sample size and high-quality study design are required to confirm the findings described here.
1Department of Naturopathy, Government Yoga and Naturopathy Medical College and Hospital, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India;
2Department of Yoga, Government Yoga and Naturopathy Medical College and Hospital, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India;
3Government Yoga and Naturopathy Medical College and Hospital, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India;
4Department of Acupuncture and Energy Medicine, Government Yoga and Naturopathy Medical College and Hospital, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India;
5Department of Physiology, Government Yoga and Naturopathy Medical College and Hospital, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India.
We have read and understood the CAND Journal’s policy on conflicts of interest and declare that we have none.
This research did not receive any funding.
1. Bray GA, Kim KK, Wilding JPH, World Obesity F. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18(7):715–23.
Crossref PubMed
2. Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164(2):328–34.
Crossref PubMed
3. Iacovides A, Siamouli M. Comorbid mental and somatic disorders: an epidemiological perspective. Curr Opin Psychiatry. 2008;21(4):417–21.
Crossref PubMed
4. Salwa H, Nair PMK. Raising burden of non-communicable diseases: importance of integrating yoga and naturopathy at primary care level. J Complem Integr Med. 2021;18(2):271–8.
Crossref
5. Maheshkumar K, Venugopal V, Poonguzhali S, Mangaiarkarasi N, Venkateswaran S, Manavalan N. Trends in the use of yoga and naturopathy based lifestyle clinics for the management of non-communicable diseases (NCDs) in Tamilnadu, South India. Clin Epidemiol Global Health. 2020;8(2):647–51.
Crossref
6. Bandyopadhyay A, Halder K, Pathak A, Kumar B, Saha M. Surya namaskar: as an alternative for aerobic fitness. Int J Yoga. 2022;15(2):163.
Crossref PubMed PMC
7. Sharma VK, Trakroo M, Subramaniam V, Rajajeyakumar M, Bhavanani AB, Sahai A. Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students. Int J Yoga. 2013;6(2):104.
Crossref PubMed PMC
8. Maheshkumar K, Dilara K, Ravishankar P, et al. Effect of six months pranayama training on stress-induced salivary cortisol response among adolescents—randomized controlled study. Explore. 2022;18(4):463–6.
Crossref
9. Mooventhan A, Chaudhari S, Venugopal V. Effect of cold hip bath on blood glucose levels in patients with type 2 diabetes mellitus: a pilot study. Diabetes Metab. 2019;46(5):411–2.
Crossref PubMed
10. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063.
Crossref PubMed
11. Oei TPS, Sawang S, Goh YW, Mukhtar F. Using the depression anxiety stress scale 21 (DASS-21) across cultures. Int J Psychol. 2013;48(6):1018–29.
Crossref PubMed
12. Lee P, Linderman JD, Smith S, et al. Irisin and FGF21 are cold-induced endocrine activators of brown fat function in humans. Cell Metab. 2014;19(2):302–9.
Crossref PubMed PMC
13. Jerrin RJ, Theebika S, Panneerselvam P, Manavalan N, Maheshkumar K. Yoga and naturopathy intervention for reducing anxiety and depression of Covid-19 patients—a pilot study. Clin Epidemiol Global Health. 2021;11:100800.
Crossref
14. Wang J, Ran X, Ye J, et al. Obesity-associated anxiety is prevalent among college students and alleviated by calorie restriction. Nutrients. 2022;14(17): 3518.
Crossref PubMed PMC
15. Schug TT, Li X. Sirtuin 1 in lipid metabolism and obesity. Ann Med. 2011;43(3):198–211.
Crossref PubMed PMC
16. Elibol B, Kilic U. High levels of SIRT1 expression as a protective mechanism against disease-related conditions. Front Endocrinol (Lausanne). 2018;9: 614.
Crossref PubMed PMC
17. Li Y, Ma J, Yao K, et al. Circadian rhythms and obesity: timekeeping governs lipid metabolism. J Pineal Res. 2020;69(3):e12682.
Crossref PubMed
18. Noh J. The effect of circadian and sleep disruptions on obesity risk. J Obesity Metabol Syndr. 2018;27(2):78.
Crossref
19. Farhud D, Aryan Z. Circadian Rhythm, Lifestyle and Health: A Narrative Review. Iran J Public Health. 2018 Aug;47(8):1068–1076.
PubMed PMC
20. Kinjal N, Kumar N, Kumar M. A Pilot Study on Impact of Naturopathic Treatment Protocol on Abdominal Obesity Patients. IOSR J Dent Med Sci. 2016;15(12):35–8.
Correspondence to: Dr. Maheshkumar Kuppusamy, BNYS, MSc, Ph.D., Department of Physiology, Govt. Yoga & Naturopathy Medical College & Hospital, Chennai-600106, Tamil Nadu, India. E-mail: doctor.mahesh1985@gmail.com
To cite: Boopalan D, Vijayakumar V, Ravi P, Chidambaram Y, Anandhan A, Kuppusamy M. Effect of yoga and naturopathy treatments on psychological burden in obesity: a single case report. CAND Journal. 2023;30(2):20-22. https:/doi.org/10.54434/candj.122
Received: 10 July 2022; Accepted: 15 May 2023; Published: 29 June 2023
© 2023 Canadian Association of Naturopathic Doctors. For permissions, please contact candj@cand.ca.
CAND Journal | Volume 30, No. 2, June 2023