Yoga as an Alternative Therapy for Weight Management in Child and Adolescent Obesity: A Systematic Review and Implications for Research

Abstract

Background:
Obesity remains among one of the greatest health care threats facing today's children and adolescents. Yoga has gained increased popularity in the United States and appears as a promising way to assist with weight loss and management in adults. However, research examining yoga programs targeting weight loss for children or adolescents are relatively scarce.

Objective:
The current study provided a systematic review of yoga-based interventions targeting weight loss among overweight or obese children and adolescents.

Methodology:
The authors conducted a systematic review of articles obtained from Alt HealthWatch, CINAHL, SPORTDiscus, PubMed, and Web of Science databases. Inclusion criteria were studies employed yoga as a primary component, targeted overweight or obese children or adolescents, measured body weight or BMI as an outcome, utilized any type of study design, and published in peer-reviewed journals in English language.

Results:
A total of nine studies met the inclusion criteria. Most studies were conducted in the United States (n = 5), and implemented in the school setting (n = 5). Among studies reviewed, three were randomized controlled trials, and two were with the attrition rates approaching 50%. A majority of the interventions were able to facilitate weight loss and relevant behaviors.

Conclusion:
The impact of yoga interventions on child and adolescent obesity was small but meaningful. Some of the limitations include small sample sizes, lack of follow-up assessment after posttest, lack of control groups, lack of utilization of behavioral theories, and lack of intervention targeting disadvantaged populations. Future interventions utilizing randomized controlled trials with large sample sizes are needed to assess the impact of yoga on child and adolescent obesity.

Full text

Dai—Yoga for Weight Management in Child Obesity
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Yoga as an Alternative erapy for Weight
Management in Child and Adolescent Obesity:
A Systematic Review and Implications for Research
Chia-Liang Dai, PhD, CHES; Manoj Sharma, PhD, MBBS, MCHES; Ching-Chen Chen, EdD;
Ezgi Yesilyurt, PhD(c); Samantha Godbey, MA, MLIS
REVIEW ARTICLE
ABSTRACT
Background • Obesity remains among one of the greatest
health care threats facing today’s children and adolescents.
Yoga has gained increased popularity in the United States
and appears as a promising way to assist with weight loss
and management in adults. However, research examining
yoga programs targeting weight loss for children or
adolescents are relatively scarce.
Objective • e current study provided a systematic
review of yoga-based interventions targeting weight loss
among overweight or obese children and adolescents.
Methodology • e authors conducted a systematic
review of articles obtained from Alt HealthWatch,
CINAHL, SPORTDiscus, PubMed, and Web of Science
databases. Inclusion criteria were studies employed yoga
as a primary component, targeted overweight or obese
children or adolescents, measured body weight or BMI as
an outcome, utilized any type of study design, and
published in peer-reviewed journals in English language.
Results • A total of nine studies met the inclusion criteria.
Most studies were conducted in the United States (n
=
5),
and implemented in the school setting (n
=
5). Among
studies reviewed, three were randomized controlled trials,
and two were with the attrition rates approaching 50%. A
majority of the interventions were able to facilitate weight
loss and relevant behaviors.
Conclusion • e impact of yoga interventions on child
and adolescent obesity was small but meaningful. Some of
the limitations include small sample sizes, lack of follow-
up assessment aer posttest, lack of control groups, lack of
utilization of behavioral theories, and lack of intervention
targeting disadvantaged populations. Future interventions
utilizing randomized controlled trials with large sample
sizes are needed to assess the impact of yoga on child and
adolescent obesity. (Altern er Health Med. [E-pub ahead
of print.])
Chia-Liang Dai, PhD, CHES; Department of Teaching and
Learning; University of Nevada Las Vegas. Manoj
Sharma, PhD, MBBS, MCHES; School of Public Health,
Jackson State University. Ching-Chen Chen, EdD;
Department of Counselor Education, School Psychology,
and Human Services, University of Nevada Las Vegas.
Ezgi Yesilyurt, PhD(c); Department of Teaching and
Learning, University of Nevada Las Vegas. Samantha
Godbey, MA, MLIS; University Libraries, University of
Nevada Las Vegas.
Corresponding author: Chia-Liang Dai, PhD, CHES
E-mail address: chia-liang.dai@unlv.edu
InTRoduCTIon
e prevalence of obesity among U.S. children and
adolescents has almost tripled since 1980, about one in ve
school-aged students are obese, making obesity the largest
health care threat facing today’s children and adolescents.1
Children with obesity are at higher risk of having other
chronic health conditions and diseases.2 Early obesity is also
associated with being obese as an adult.3 Obesity is the most
prevalent nutritional disorder among children and is an
energy imbalance between calories consumed and calories
expended.4 Moderate daily physical activity and healthy
eating are modiable and particularly important for
preventing childhood obesity.5 Weight loss strategies that
incorporate dietary modications and exercise have proven
eective in achieving weight loss, but most of the weight is
regained over time.6
To improve long-term outcomes of weight loss, mind
and body movement approaches, combined with other
traditional weight-loss strategies, have the potential to oer
a holistic approach to sustain wellness.7 Yoga, a form of
lifestyle-based exercise for health and tness, includes low
physical impact postures (asana), breath-work (pranayama),
and meditation (dhyana); emphasizing regular body

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stretching, mind-body awareness, and mindful
concentration. Yoga has experienced enhanced popularity
as a mind-body practice in the United States.8 Lauche and
colleagues’ review study reported that yoga can reduce body
mass index (BMI) in overweight/obese individuals.9 Results
of a study indicated that regular yoga practice was associated
with weight-related health behaviors (e.g., healthy eating,
and moderate-to-vigorous physical activity), which might
facilitate healthy weight management.10 A study that
surveyed 1830 young adults found that participants who
were overweight and practiced yoga regularly showed
decreases in their BMI, whereas those not practicing
regularly had signicant increases in their BMI. Researchers
concluded that regular yoga practices may facilitate weight
gain prevention.11
Researchers implemented yoga interventions in the
school setting suggested that yoga holds the significance
of improving child and adolescent health. These studies
indicated that yoga practice might benefit children by
improving their motor skills, mental ability, social skills12,13
as well as improved general health, attention, and
relaxation skills.14 As the awareness of health benefits of
yoga practice rises, yoga programs have also been designed
into the physical education curriculum in school.15,16,17
According to the National Health Interview Survey, among
children, the use of yoga practice during the past 12
months increased from 2012 to 2017.18 Although use of
complementary and alternative medicine (e.g., mind-body
movement and relaxation techniques) among children and
adolescents is becoming more prevalent, however, the
extent of use of those approaches as treatment options for
specific health conditions in children necessitates further
investigation.19
Yoga appears as a promising way to assist with weight loss
and management in adults. Yoga has also been implemented
for school-aged students and incorporated into the physical
education curriculum. However, research studies examining
yoga-based approaches in preventing or treating obesity
among children or adolescents are relatively scarce in the
empirical literature. us, the purpose of this study was to
review yoga programs published in peer-reviewed literature
targeting weight loss among overweight or obese children or
adolescents. Based on this review, recommendations for future
interventions have been developed.
MeThodS
Literature Search
e current study was designed to provide a systematic
review of evidence-based yoga interventions’ impact on child
and adolescent obesity. A professional librarian developed
customized search strategies for each key database: Alt
HealthWatch (EBSCOHost), CINAHL (EBSCOHost),
SPORTDiscus (EBSCOHost), PubMed, and Web of Science.
e authors performed the search during July 2019 using
combinations of the following keywords: Yoga AND (weight
OR obes* OR overweight OR adiposity OR BMI OR “body
mass index”) AND (child* OR teen* OR adolescen* OR
pediatric). Customized searches are detailed in Appendix 1.
Considering other terms such as meditation, meditative
movement, mind-body practice, and “mindful movement”
that might share similar components as yoga practice, the
authors conducted the search by replacing yoga with each of
those terms in each key database. One additional article was
found that matched the inclusion criteria.29
To identify other potential articles that might not be
indexed in the aforementioned databases, the same keywords
were used for a secondary search on Google Scholar. One
additional article was identied and included.28 e authors
also searched the reference lists of each of the selected
articles. One additional article matched inclusion criteria was
included.27
Additionally, the authors hand-searched for the keywords
on selected peer-reviewed journals publishing yoga related
articles in order to increase the sensitivity of the search
(i.e., International Journal of Yoga erapy, Journal of
Alternative and Complementary Medicine, Journal of
Evidence-Based Integrative Medicine, and Journal of Integrative
Medicine). No additional articles were found that matched
the inclusion criteria.
In the rst stage of the literature search, titles and
abstracts of identied studies were checked for inclusion. In
the second stage, full-text articles were retrieved and checked
for inclusion. Two authors independently assessed the
eligibility of the studies; a third author checked those articles
based on the selection criteria for inclusion. Authors and
titles of studies were used to identify identical articles to
avoid double counting of the same study.
Study Selection
Inclusion criteria were intervention studies that:
(a) used yoga as a primary component of treatment,
(b) targeted overweight or obese (BMI values at or above the
85th percentile for children and teens of the same age and
sex) 20 children or adolescents (World Health Organization’s
denition of a child-a person 19 years or younger was
utilized for this inclusion criteria), (c) measured body weight
or BMI as an outcome, (d) utilized any type of study design,
and (e) published in peer-reviewed journals in English
language with full-text available between January 1968 and
July 2019. Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines (PRISMA)21,22 were applied to
illustrate the selection of these articles for inclusion in this
systematic review (Figure 1).
Studies that were non-intervention studies (e.g., cross-
sectional, review, and commentary studies; n
=
95), targeting
adults (n
=
33), repeated studies (n = 39), accepted conference
poster proposals (n
=
4), targeting non overweight or obese
participants (e.g., participants with eating disorders, cerebral
palsy, Duchenne muscular dystrophy; n
=
10), lack of body
weight or BMI assessment (n
=
3), and non-yoga or lower
dosage of yoga intervention studies (n
=
4) were excluded.

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Table 1. Summary of Yoga Programs for Improving Child and Adolescent Obesity (n = 9).
Author(s), country,
year
Sampling frame,
demographics Design, intervention, setting Measures
Time of
assessment Intervention eects
Slawta et al.,23 U.S.,
2008
91 children aged 6-12
(nearly one half
participants exceeded
optimal range of BMI)
Single group pretest-posttest
PRECEDE-PROCEED Model
Triweekly 2-hour physical
activity (including yoga
postures) and nutrition for 12
weeks
School
Body Composition (BMI,
body weight, skinfold
thickness, body fat);
Fitness;
Nutrition Knowledge and
Diet Composition; Lipids
and Lipoproteins
Baseline;
12-week
BMI decreased signicantly at posttest
Benavides &
Caballero,24 U.S., 2009
14 predominantly
Hispanic adolescents
aged 8-15 (mean BMI =
26.4 kg/m2; BMI ≥ 95th
percentile for related age
and gender) at risk for
developing type 2
diabetes
Single group pretest-posttest
Triweekly 75-min Ashtanga yoga
with breath control and
meditation for 12 weeks
Clinic
Body weight, BMI; Lab
parameters (Glucose, total
cholesterol, low density
lipoprotein; high density
lipoprotein; triglycerides;
C-reactive protein);
Psychological measures (Beck
Self-Concept Inventory-
Youth; Beck Anxiety
Inventory-Youth; Beck
Depression Inventory-Youth)
Baseline;
12-week
Of the 14 participants, 11 experienced
weight loss (average weight loss was
2 kg). e mean baseline weight was
61.2 ± 20.2 kg and decreased to
59.2 ± 19.2 kg (p = 0.01), which
correlated with changes in BMI from
26.4 ± 6.6 to 25.6 ± 6.2 kg/m2
Sarvestani et al.,25 Iran,
2009
60 obese female
adolescents aged 11-15
(mean BMI = 29.3 kg/m2;
BMI ≥ 95th percentile
for related age and
gender)
Quasi-experimental
Experiment (n = 30):
Weekly 4-hour session (2-hour
yoga therapy and 2-hour
behavior modication or dietary
instruction) for 16 weeks (lasted
for 6 months)
Control (n = 30):
Attended three sessions of the
same intervention
School
Body weight, BMI, arm
circumferences; Dutch
Eating Behavior
Questionnaire
Baseline;
6-month
ere were statistically signicant
dierences in changes in body weight
(-2.75 kg vs. 0.62 kg), BMI (-1.07 kg/m2
vs. 0.24 kg/m2) in the experimental
group in contrast to control group
Figure 1. Data extraction process
Identication
Records identied through databases searching (n = 194) Databases searched
• Alt HealthWatch (n = 5)
• CINAHL (n = 33)
• SPORTDiscus (n =7)
• PubMed (n = 84)
• Web of Science (n = 65)
ScreeningEligibilityIncluded
Records remaining aer initial screening (n = 23)
Full-text articles assessed for eligibility (n = 6)
Articles included in systematic review (n = 9)
Records excluded
• Non-intervention studies (n = 95)
• Targeting adults (n = 33)
• Repeated studies (n = 39)
• Accepted conference poster proposals (n = 4)
Records excluded
• Targeting non overweight or obese participants (n = 10)
• Lack of body weight or BMI assessment (n = 3)
• Non-yoga or lower dosage of yoga intervention studies (n = 4)
Articles included
• Secondary search of relevant articles (n = 3)

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Seo et al.,26 Korea,
2012
20 obese male
adolescents aged 13-15
(mean BMI = 28.8
kg/m2; BMI ≥ 95th
percentile for related age
and gender)
Randomized
Experiment (n = 10):
Triweekly 50-min Asana yoga
including warm-up (10 min),
yoga postures
(40 min), and relaxation
(10 min) for eight weeks
Control (n = 10):
General health education
regarding type 2 diabetes
prevention, balanced diet
consumption, and physical
activity engagement
School
Body weight, BMI, fat-free
mass, fat mass, body fat,
basal metabolic rate
Baseline;
8-week
Body weight, and BMI signicantly
decreased among experiment group
aer intervention, but not in the control
group
Hainsworth et al.,27
U.S., 2014
16 obese adolescents
aged 11-17 (BMI ≥ 95th
percentile for related age
and gender), and with at
least one medical
comorbidity
Single group pretest-posttest
Semiweekly 60-min Hatha yoga
including warm-up
(5 min), yoga postures
(45-50 min), restoration and
meditation (5-10 min) for eight
weeks (15 sessions in total)
Clinic
Body weight, BMI; Physical
Activity; Physical
Functioning; Feasibility and
acceptability (Holistic
Health Questionnaire;
Pediatric Quality of Life
Inventory); Spielberger
State Anxiety Inventory-
Child
Baseline;
8-week
Weight did not change signicantly
from pretest to posttest
Nanthakumar ,28
Malaysia, 2016
One obese female
adolescent aged 19 (BMI
= 29.1 kg/m2; BMI ≥
95th percentile for
related age and gender)
Qualitative single case study
pretest-posttest
70-min Classical yoga including
awareness practice (5 min), yoga
postures (55 min), breath control
and meditation (10 min) for ten
weeks (14 sessions in total)
School
Body weight, BMI, waist
and hip circumferences;
Physical Strength
Baseline;
10-week
e participant revealed a weight
reduction (i.e., 2 kg) and decrease in
BMI from 29.14 to 28. 30 kg/m2
Shomaker et al.,29 U.S.,
2017
33 obese female
adlescents aged 12-17
(mean BMI = 29.8 kg/
m2; BMI ≥ 95th
percentile for related age
and gender) with family
history of diabetes, and
elevated depressive
symptoms
Randomized
Experiment (n = 17): Weekly 60-
min meditation, yoga “mindful”
movement, mindfulness
awareness practices for six weeks
Control (n = 16): Cognitive
restructuring and behavioral
activation
School
Body weight, BMI; Mindful
Attention Awareness Scale;
Schedule for Aective
Disorders and
Schizophrenia for School-
Age Children; Insulin
Resistance; Acceptability
Baseline;
6-week;
6-month
follow-up
At posttest and six months follow-up,
BMI of participants in both experiment
and control groups remain high
Hainsworth et al.,30
U.S., 2018
10 obese adolescents
aged 11-17 (BMI ≥ 95th
percentile for related age
and gender), and with at
least one medical
comorbidity
Single group pretest-posttest
Semiweekly 60-min Iyengar yoga
including yoga postures and
breath control for eight weeks
(16 total classes)
Clinic
BMI; Gait; Feasibility and
acceptability (Holistic
Health Questionnaire;
Pediatric Quality of Life
Inventory); Pain Intensity;
Physical Activity
Baseline;
8-week
At posttest, participants’ BMI percentile
was
exactly the same
Xiang et al.,31 China,
2019
44 obese adolescents
aged 10-14 (BMI ≥ 95th
percentile for related age
and gender)
Randomized
Experiment (n = 22): 5 hs/day, 6
days/week exercise (including
triweekly 60-90 min yoga with
intensity of 50-75% HRmax) and
dietary intervention for six
weeks
Control (n = 22): Waitlist
Community
(Bootcamp)
BMI; Self-Control (Stroop
Task; Handgrip Task);
Maximal Grip Strength;
Physical Activity; Trait Self-
Control
Baseline;
6-week
BMI was signicantly lower posttest
compared with pretest for the
experiment group; no signicant
decrease in BMI was found in the
control group
Table 1. (continued)

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all included interventions. Additional outcomes assessed
including tness assessment, psychological measures,
physical activity, and eating behaviors. e majority of the
interventions were able to facilitate weight loss and improve
additional outcome behaviors relevant to obesity prevention
in the participants under study. ree interventions evaluated
the program feasibility and acceptability.27,29,30 Table 1
provides descriptive results of the included studies.
Risk of bias of included studies was assessed utilizing
the Cochrane guidelines for systematic reviews.32 Risk of
selection bias was generally high as only two interventions
reported adequate random sequence generation.29,31 Risk of
performance bias was also high as only one intervention
reported blinding of participants and personnel.29 Incomplete
outcome data were adequately addressed in five
interventions.24,26,27,29,30 Risk of selective outcome reporting
had a low risk of bias as all interventions had adequate
reporting. Six interventions were non randomized studies
which may cause selection bias.23,24,25,27,28,30
dISCuSSIon
e purpose of the study was to evaluate yoga-based
intervention targeting weight loss among overweight or
obese children and adolescents. Obesity is an emerging
health concern globally. Yoga, a form of mind-body practice,
is growing in Western society and has been found to be
associated with physical tness and mental well-being.
ough the purpose of yoga is self-realization, it has benecial
eects on physical and psychological health. However, only
nine interventions meeting inclusion criteria were identied
during a 50-year time span. Overall, it was found that yoga-
based interventions might be promising in assisting weight
loss23-28,31 in participants studied in school23,25,26,28,29 and
community settings.24,27,30,31 Future interventions and robust
evaluations utilizing randomized controlled trials are needed
to assess the impact of yoga on child and adolescent obesity.
Five out of nine interventions were implemented in the
school setting. School-based physical activity programs have
been eective in promoting healthy behaviors such as
physical activity and healthy eating that contribute to obesity
prevention.33 Additionally, as obesity disproportionately
ReSulTS
e authors searched and received a total of 194 articles
including Alt HealthWatch (EBSCOHost) (n
=
5), CINAHL
(EBSCOHost) (n
=
33), SPORTDiscus (EBSCOHost) (n
=
7),
PubMed (n
=
84), and Web of Science (n
=
65). Aer screening,
six studies meeting the inclusion criteria were identied.
Additionally, one article was identied by replacing yoga
with other terms (i.e., meditation, meditative movement,
mind-body practice, and “mindful movement”) in each key
database;29 one article was identied via secondary search on
Google Scholar;28 one article was identied by searching the
reference lists of each of the selected article.27 A total of nine
studies met the inclusion criteria (see Figure for data
extraction process).
e following data were extracted: publishing data
(i.e., author, publication year, country where the study was
conducted), characteristics of participants (i.e., number of
participants, gender, age, and mean BMI), study design
(i.e., intervention assignment, duration, intervention
components, and setting), time of assessment, and highlighted
outcomes as presented in Table 1.
e included studies involved 289 participants. Sample
sizes were small, ranging in size from one to 91 adolescents.
Most interventions were conducted in the United
States,23,24,27,29,30 with one in Iran,25 one in Korea,26 one in
Malaysia,28 and one in China.31 Regarding study design
conducted in those interventions, four were single group
pre-and posttest design,23,24,27,30 three were randomized
controlled trials,26,29,31 one was quasi-experimental design,25
and one was qualitative case study design.28 Only one
intervention addressed the use of the PRECEDE-PROCEED
Model as a framework in program development.23 e
interventions implemented were Ashtanga (Classical) yoga,
Hatha yoga, Iyengar yoga, and yoga “mindful” movement.
Five interventions were implemented in school,23,25,26,28,29 the
other four were delivered in community settings (e.g., clinic).
e duration of the intervention ranged from six to 16 weeks.
Only one intervention conducted the follow-up assessment
(i.e., 6-month follow-up) aer posttest.29
Body weight and BMI changes from pretest to posttest
were the only one body composition outcome assessed across
Table 2. Risk of Bias Assessment of Included Studies
Study
Sequence
generation
Allocation
concealment
Blinding of
participants and
personnel
Blinding of
outcome
assessors
Incomplete
outcome
data
Selective
outcome
reporting
Other
sources
of bias
Slawta et al.,23 2008Unclear Unclear Unclear Unclear Unclear Ye s Unclear
Benavides & Caballero,24 2009 Unclear Uncl ea r Unclear Unclear Ye s Ye s Unclear
Sarvestani et al.,25 2009 Unclear Uncl ea r Unclear Unclear Unclear Ye s Unclear
Seo et al.,26 2012 Unclear Uncl ea r Unclear Unclear Ye s Ye s Unclear
Hainsworth et al.,27 2014 Uncl ear Uncl ea r Uncl ear Uncl ear Ye s Ye s Unclear
Nanthakumar,28 2016 Unclear Uncl ea r Unclear Unclear Unclear Ye s Unclear
Shomaker et al.,29 2017 Ye s Ye s Ye s No Ye s Ye s Unclear
Hainsworth et al.,30 2018 Unclear Uncle ar Unc lear Unc lear Ye s Ye s Unclear
Xiang et al.,31 2019 Ye s Unclear Unc le ar Unc le arUnclear Ye s Unclear

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1-4 sessions) out of thirty two who were enrolled in the
intervention.27 Attrition is a threat to the internal validity of
the study and limits the condence in the ecacy of the trial.
Future studies should improve retention and further
investigate participants’ perceived barriers to completing the
intervention. Additionally, only one intervention included
behavior modication in the treatment.25 Future intervention
should utilize behavioral theories to assist with the
sustainment of yoga practice for participants.
Although examining the psychosocial outcomes is not
the purpose of the study, ndings from ve included
interventions24,27,28,29,30 reported improved mental health
indicators (e.g., anxiety, depression, self-image, stress, etc.).
ese ndings are consistent with a systematic review that
concluded that yoga practice may be an ecacious approach
for managing stress.38 Yoga practice is associated with
heightened mindfulness and improved mood which might
help reduce food intake.39
Limitations of the Interventions
Some limitations of yoga interventions for child and
adolescent obesity were discovered. Majority of the studies
utilized a small sample size, which limited the power of
statistical analysis. Some of the studies were randomized
controlled trials; other research designs were used
(e.g., single group pretest-posttest, quasi-experimental, case
study). Only one intervention was implemented for ethnic
minority groups, it limited the variety of literature
documenting the eect of yoga on weight loss. Some of the
included studies reported that participants’ BMI remain the
same aer the intervention, hence longer or more intensive
interventions may be needed to achieve substantial changes
in body weight or BMI. Or other outcome measures should
also be considered when examining the eectiveness of the
interventions. Finally, only one intervention utilized behavior
change theory to assist with the development and
implementation of yoga program in the included studies.
Limitations of is Review
ere were some limitations of this review. e search
was limited to the following databases: Alt HealthWatch
(EBSCOHost), CINAHL (EBSCOHost), SPORTDiscus
(EBSCOHost), PubMed, and Web of Science so that some
articles might not have been identied. is review aimed to
examine the impact of yoga on child and adolescent obesity,
only interventions targeting individuals age 19 or younger
with BMI values at or above the 85th percentile for related
age and gender were included; intervention targeting
overweight or obese college students aged older than 19 were
excluded. Intervention studies utilized yoga as merely part of
the treatment with lower dosage (e.g., 1-hour practice in
total) were excluded, in which confounding occurs as
outcomes may be inuenced by other primary physical
activity components (e.g., walking, rock climbing, strength
training) instead of yoga practice. e literature search was
limited to articles published in the English language; articles
burdens children residing in low-income areas and ethnic
minority populations, only one intervention reviewed was
delivered to Hispanic children with 14 participants completed
the program.24 is nding is consistent with results from the
2017 National Health Interview Survey,18 which presented
that the use of yoga among Hispanic and non-Hispanic black
children was lower than among non-Hispanic white children.
Future school-based interventions should be designed and
implemented for culturally minority populations as those
who are at risk of being obese.
It is worth noting that three interventions reviewed were
conducted for adolescent female,25,28,29 two interventions
found reduced body weight and BMI among participants
under study.25,28 Studies presented that several perceived
barriers such as body-image, gender norms,34 concern about
safety,35 teacher attitudes and support, and type of activities36
might inhibit adolescent female from engaging in physical
activity. Besides, ndings of a national survey reported that
adolescent girls were more likely to have practiced yoga
compared with adolescent boys.18 To facilitate adolescent
female to involve in 60 minutes of moderate-to-vigorous
physical activity daily and receive health benets of regular
exercise, future studies implementing yoga programs for
adolescent girls are still needed.
Among interventions reviewed, in three of those, yoga
was oered along with dietary intervention as primary
components of treatment;23,25,31 in which participants who
completed the program showed signicantly decreased
anthropometric indices (i.e., body weight, BMI) and
improved obesity prevention behaviors (e.g., self-control,
emotional eating, diet composition and knowledge). ese
ndings provided evidence that combining with other weight
loss strategies (e.g., behavior modication, or dietary
instruction), yoga practice might be a benecial adjuvant to
weight management programs for overweight or obese
children and adolescents.
In some interventions reviewed participants’ BMI
remain high at posttest assessment.29,30 Factors that may have
inuenced the lack of changes in BMI or body weight in
these studies including: First, these programs focused on
using yoga physical movement and breath control as a
means, however, the evidence showed that nutrition plays an
important role to create change in weight management;6
second, these programs provided short duration of
intervention, ranged from six to eight weeks. Weight loss
takes time. Yoga is an integrative approach exercise to
improve one’s physical tness (e.g., exibility, strength),
attention, and relaxation, and emphasize healthy lifestyle.37
erefore, utilizing yoga intervention for weight management,
it is imperative that longer or more intensive interventions
are oered to increase the opportunity to make behavioral or
nutritional changes in weight management.
For two of the interventions, the attrition rates were
approaching 50% (i.e., 47% and 44% each) with fourteen
completed the study out of the thirty participants,24 and with
fourteen (twelve did not attend any session and four attended

Dai—Yoga for Weight Management in Child Obesity
ALTERNATIVE THERAPIES, [E-Pub AHEAd of PRINT]
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
10. Watts AW, Rydell SA, Eisenberg ME, Laska MN, Neumark-Sztainer D. Yoga’s
potential for promoting healthy eating and physical activity behaviors among
young adults: a mixed-methods study. Int J Behav Nutr Phys Act. 2018;15(1):42.
11. Neumark-Sztainer D, MacLehose RF, Watts AW, Eisenberg ME, Laska MN,
Larson N. How is the practice of yoga related to weight status? Population-based
ndings from Project EAT- IV. J Phys Act Health. 2017;14(12):905-12.
12. Khalsa S, Bethany B. Yoga in school settings: A research review. Ann NY Acad Sci.
2016;13731(1):45-55
13. Accardo AL. Yoga as a school-wide positive behavior support. Child Educ.
2017;93(2):109-113.
14. O’Neil ME. Ideishi RI, Benedetto M, Ideishi SK, Fragala-Pinkham M. A yoga
program for preschool children in Head Start and early intervention: A feasibility
study. J Yoga Phys er. 2016;6(2).
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JOPERD 2014;85(2):19-23.
16. Galan V, Iryna S, Zoriy Y, Briskin Y, Pityn M. Designing an eective approach to
sport for the integration in higher education institutions (the eects of yoga
practice). J Phys Educ Sport. 2017;17(1):509-518.
17. Noggle JJ, Steiner NS, Minami T, Khalsa S. Benets of yoga for psychosocial well-
being in a US high school curriculum: A preliminary randomized controlled trial.
J Dev Behav Pediatr. 2012;33(3):93-201.
18. Black LI, Barnes PM, Clarke TC, Stussman BJ, Nahin RL. Use of yoga, meditation,
and chiropractors among U.S. children aged 4-17 years. NCHS Data Brief, no 324.
Hyattsville, MD: National Center for Health Statistics. 2018.
19. Ndetan H, Evans MW, Williams RD, Woolsey C, Swartz JH. Use of movement
therapies and relaxation techniques and management of health conditions among
children. Altern er Health Med. 2014;20(4):44-50.
20. Centers for Disease Control and Prevention. Dening childhood obesity.
Retrieved from https://www.cdc.gov/obesity/childhood/dening.html. Updated
July 3, 2018. Accessed July 22, 2019.
21. Moher D, Liberati A, Tetzla J, Altman DG, e PRISMA Group. Preferred
reporting items for systematic reviews and meta-analyses: e PRISMA statement.
Int J Surg. 2010;8(5):336-341.
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children: A pilot program of Be a Fit Kid. Health Promot Pract. 2008;9(3):305-312.
24. Benavides S, Caballero J. Ashtanga yoga for children and adolescents for weight
management and psychological well being: An uncontrolled open pilot study.
Complement er Clin Pract. 2009;15(2):110-4.
25. Sarvestani RS, Jamalfard MH, Kargar M, Kaveh MH, Tabatabaee HR. Eect of
dietary behaviour modication on anthropometric indices and eating behaviour
in obese adolescent girls. J Adv Nurs. 2009;65(8):1670-5.
26. Seo DY, Lee S, Figueroa A, et al. Yoga training improves metabolic parameters in
obese boys. Korean J Physiol Pharmacol. 2012;16(3):175-80.
27. Hainsworth KR, Salamon KS, Stolzman SC, et al. Hatha Yoga for pediatric obesity:
a pilot study. J Yoga Phys er. 2014;4(4):172-9.
28. Nanthakumar C. Intervention of classical yoga in pediatric obesity: A case study.
J Nurs Health Sci. 2016;5(1):34-43.
29. Shomaker LB, Bruggink S, Pivarunas B, et al. Pilot randomized controlled trial of
a mindfulness-based group intervention in adolescent girls at risk for type 2
diabetes with depressive symptoms. Complement er Med. 2017;32:66-74.
30. Hainsworth KR, Liu XC, Simpson PM, et al. A pilot study of Iyengar yoga for
pediatric obesity: Eects on gait and emotional functioning. Children (Basel).
2018;5(7):92.
31. Xiang MQ, Liao JW, Huang JH, et al. Eect of a combined exercise and dietary
intervention on self-control in obese adolescents. Front. Psychol. 2019;10:1385.
32. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions
Version 5.1.0 [updated March 2011]. e Cochrane Collaboration, 2011. Available
from www.handbook.cochrane.org.
33. Kriemler S, Meyer U, Martin E, van Sluijs EM, Andersen LB, Martin BW. Eect of
school-based interventions on physical activity and tness in children and
adolescents: A review of reviews and systematic update. Br J Sports Med.
2011;45(11):923-30.
34. Satija A, Khandpur N, Satija S. Physical activity among adolescents in India: A
qualitative study of barriers and enablers. Health Educ Behav. 2018;45(6):926-934
35. Dwyer JJ, Allison KR, Goldenberg ER, Fein AJ, Yoshida KK, Boutilier MA.
Adolescent girls’ perceived barriers to participation in physical activity.
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linguistically diverse and low income backgrounds in school sport: A pilot
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37. Woodard C. Exploring the therapeutic eects of yoga and its ability to increase
quality of life. Int J Yoga. 2011;4(2):49-54.
38. Sharma M. Yoga as an alternative and complementary approach for stress
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2014;19(1):59-67.
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of overweight and obesity. Am J Lifestyle Med. 2014;8(1):33-41.
published in other languages were excluded. Conference
abstracts with missing information on the intervention
description or outcomes were also excluded. Finally, ndings
reported were limited on studies measured body weight or
BMI as an outcome. BMI may not be the most accurate
indicator to determine the eect of weight on health, however,
this is the only body composition outcome assessed across all
of those included interventions. ere are limitations
inherent to the systematic review methods utilized in the
study, thus the interpretation of the ndings need to be
carefully considered.
ConCluSIonS
e study aimed at evaluating the impact of yoga-based
interventions targeting overweight or obese children and
adolescents. Yoga-based interventions appear to be a
promising approach for weight loss and management among
overweight or obese children and adolescents. e eects
were small but meaningful, further research is needed to
investigate how yoga practice could treat and prevent the
growing issue of child and adolescent obesity. More research
should be conducted on studies of yoga on weight loss among
groups such as various ethnicity, socioeconomic status,
geographical location, and younger children. It is necessary
that the researchers and practitioners continue to examine
the impact of yoga intervention, a life-long mind-body
approach, on children and adolescents who are overweight or
obese. In school, yoga-based exercise could also be
incorporated into curricula that may be benecial to obesity
prevention among children and adolescents.
AuThoRS’ dISCloSuRe STATeMenT
e authors of the article do not receive any research funding to conduct this research.
FundIng
e authors of the article do not receive any research funding to conduct this research.
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Dai—Yoga for Weight Management in Child Obesity ALTERNATIVE THERAPIES, [E-Pub AHEAd of PRINT]
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PubMed
Search Conducted: 7/23/19
(“yoga”[All Fields]) AND (weight[Title/Abstract] OR
obes*[Title/Abstract] OR overweight[Title/Abstract] OR
adiposity[Title/Abstract] OR BMI[Title/Abstract] OR “body
mass index”[Title/Abstract] OR “body weight”[MeSH] OR
“Body Weight Changes”[MeSH] OR “Weight Reduction
Programs”[MeSH] OR “weight loss”[MeSH] OR
“Overweight”[MeSH] OR “Obesity”[MeSH] OR “Pediatric
Obesity”[MeSH]) AND (child*[Title/Abstract] OR
adolescen*[Title/Abstract] OR teen*[Title/Abstract] OR
youth [Title/Abstract] OR pediatric[Title/Abstract] OR
Child[MeSH] OR Adolescent[MeSH] OR Pediatrics[MeSH])
Results: 84
Web of Science Core Collection
Date Range for Index: 1900-present
Search Conducted: 7/23/19
ALL FIELDS: (yoga AND (weight OR obes* OR overweight
OR adiposity OR BMI OR “body mass index”) AND (child*
OR adolescen* OR teen* OR youth OR pediatric))
Results: 65
AppendIx
Alt HealthWatch
Date Range for Database: 1990-present
Search Conducted: 7/19/19
yoga AND (TI(weight OR obes* OR overweight OR adiposity
OR BMI OR “body mass index”) OR AB(weight OR obes*
OR overweight OR adiposity OR BMI OR “body mass
index”) OR DE(“weight loss” or “body weight” or “obesity”))
AND ((TI(child* OR adolescen* OR teen* OR youth OR
pediatric) OR AB(child* OR adolescen* OR teen* OR youth
OR pediatric) OR DE (“children” or “adolescence” or
“teenagers” or “youth”))
Results: 14
Limited to Peer-Reviewed, Academic Journals: 5
CINAHL
Date Range for Database: 1937-present
Search Conducted: 7/19/19
yoga AND (TI(weight OR obes* OR overweight OR adiposity
OR BMI OR “body mass index”) OR AB(weight OR obes*
OR overweight OR adiposity OR BMI OR “body mass
index”) OR MH(“Body Weight Changes” OR “Weight
Reduction Programs” OR “Weight Control” OR “Obesity”
OR “Pediatric Obesity”)) AND ((TI(child* OR adolescen*
OR teen* OR youth OR pediatric) OR AB(child* OR
adolescen* OR teen* OR youth OR pediatric) OR MH(“Child”
OR “Adolescence”))
Results: 59
Limited to Academic Articles: 33
SPORTDiscus
Date Range for Database: 1975-present
Search Conducted: 7/19/19
yoga AND (TI(weight OR obes* OR overweight OR adiposity
OR BMI OR “body mass index”) OR AB(weight OR obes*
OR overweight OR adiposity OR BMI OR “body mass
index”) OR DE(“weight loss” or “body weight” or “obesity”
or “overweight children” or “overweight teenagers”)) AND
(TI(child* OR adolescen* OR teen* OR youth OR pediatric)
OR AB(child* OR adolescen* OR teen* OR youth OR
pediatric) OR DE(“children” or “teenagers” or “youth” or
“pediatrics”))
Results: 28
Limited to Academic Journals: 7