Obesity in Pregnancy - Yoga proposal for a pregnancy health and wellness model - c. Doret June 2019
In 2017-18 two thirds (67.0%) of Australian adults were regarded as overweight or obese (ABS Stats). Studies show that obesity increases the risk of cardiovascular disease, hypertension and diabetes. In pregnancy obesity is associated with an increased risk of delayed labour onset, slow labour progress, gestational diabetes and pre-eclampsia (1). Obese women have higher rates of medical interventions and higher rates of caesarean section (Dr Sheehan P., Prof Parkington H. The Royal Women’s Pregnancy Research Centre). Elevated BMI contributes to weak contractions and this has been found to lead to caesarean delivery in many obese women. (2)
In addition to an inadequate diet, the most important contributing factor to overweight and obesity is a sedentary lifestyle, hence regular physical activity is recommended as the most important treatment option (3).
Yoga can help in the management of obesity using postures (asanas), breathing techniques (pranayama), deep relaxation (Yoga Nidra) and Meditation4. Many studies show the effectiveness of weight loss and weight control with yoga (5).
The Multidimensional Benefits of Yoga
Yoga is an ancient practice originating from India. It is 5000 years old and was introduced to the western world in the 19th century. Yoga is purifying, cleansing, strengthening, relaxing and calming. It is a complete system, which works on all levels, physical, mental and spiritual. (6) The word yoga is derived from the Sanskrit root "YUJ" which means union. It is the process of unification of individual consciousness and universal consciousness.
Yoga integrates the mind, body and spirit through the combined practices of movements or postures, breathing techniques, relaxation and meditation. Yoga has unlimited potential when it comes to health and wellbeing.
It is said that all yoga is remedial because it seeks to remedy state of imbalance and can therapeutically assist people with a wide range of conditions.
The main goal of yoga is to influence the state of mind and restore balance. For instance in Yoga Therapy an essential element is the letting go of unhealthy attachments and self-destructive behaviour. Yogic practices increase mind-body connection by emphasising awareness, which aids in changing behavioural patterns, as well as promoting a relaxed state of mind, which increases control and clear perception. (7)
Sympathetic over activity can be reduced by the practice of meditation, relaxation and breathing techniques (8) hence increasing mind/body calmness and increase self control.
On a physical level yoga:
Improves flexibility, posture and balance
Builds muscular strength
Releases tension
Nourishes joints and tissues
Increases energy
On a physiological level yoga:
Promotes lymphatic circulation and hormonal secretions (6, 8) boosts the metabolism (9, 10)
Strengthens the immune system (8)
Increases/improves oxygenation
Stimulates the function of internal organs
Improves the respiratory (10), cardio and digestive systems (8, 11)
Regulates blood pressure (8-10, 12)
On a psychological & emotional level yoga:
Improves sleep (13)
Promotes calmness and centeredness
Lowers stress levels (8,13)
Stimulates and changes emotional attitudes (6)
Increases awareness
Restores emotional balance
Develop body consciousness (14)
Yoga and Obesity
Regaining our awareness through the yogic practices is the key to health. (15)
The advantage of using yoga to combat obesity is that its combined practices (postures, breathing, relaxation and meditation) work on the mind and the body. The practice of yoga postures contributes to weight control/weight loss by improving metabolism and other body functions, and the other practices work by decreasing stress and increasing mindfulness, which assist in reducing emotional eating.
Studies show that yoga is safe and effective in weight control/weight loss and in reducing BMI as well as supporting behavioural changes, enhancing mindfulness and body awareness. It is suggested that mindfulness increases self-regulatory capacity, which may play a role in weight loss.
Studies indicate that 3 to 6 month yoga intervention showed reduction in weight and waistline, reduced BMI, reduction in fasting blood glucose, decrease in total cholesterol, improved conditions such as hypertension and diabetes in women with abdominal obesity. Mental and physical wellbeing and improved self-esteem has also been recorded. (3-5, 8, 10, 12, 13, 16, 17)
Yoga in Pregnancy
Yoga is a wonderful and gentle way of keeping the body fit and healthy during pregnancy and preparing for childbirth. A mind/body practice, yoga has an energizing and relaxing effect on both the mind and the body. Its practice during pregnancy will maintain health and ensure wellbeing.
Studies show that yoga is a safe and effective intervention during pregnancy and can be safely used with depression, women at high-risk and for lumbo-pelvic pain. It was also found that the practice of prenatal yoga is more effective than walking or standard prenatal exercises and that the benefits of prenatal yoga were observed not only during pregnancy but also during labour and after delivery.
Studies show that women who did yoga had lower incidences of pain and stress, preeclampsia (PE), pregnancy induced hypertension (PIH), fewer small gestational age (SGA) and greater psychological well being (reduced anxiety, stress, etc.) (13)
The goal of prenatal yoga; Targeting health and wellbeing
The aim of yoga in pregnancy is to help strengthen the body so that it can better carry the load of pregnancy and to condition it in preparation for childbirth, to increase positive attitude, eliminate anxiety and raise confidence, increase energy, improve sleep, strengthen uterine and pelvic muscles, improve blood circulation in the pelvic region, as well as to avoid, remedy and manage various pregnancy conditions such as heart burn, varicosity, sciatica, back tension and constipation. Also of importance is its ability to increase awareness of correct posture and proper body alignment to protect joint and prevent postural aches (11, 14, 18)
Prenatal yoga for obesity class format
The practice is alignment focused and emphasises mind-body connection.
The aim of the postures is to counteract bad posture, to create space for the uterus and internal organs, to remove muscular tension, lengthen the spine, open the chest and hips, to improve blood circulation in the pelvic region, to strengthen uterine and pelvic muscles ( 11, 14). Also, to increase mind-body connection by consciously working through the postures.
The aim of breathing and relaxation is to improve breath capacity and improve oxygenation, to promote mental and physical relaxation, to increase energy (12), to increase mental focus, centeredness and calmness.
From studies and my own experience of 19 years teaching prenatal yoga I would recommend an ongoing yoga program with once or twice weekly group sessions of 1 hour length plus additional short daily home practice.
Ongoing prenatal yoga throughout pregnancy (14, 15)
The aim of the program is to help regain body awareness, to increase mindfulness and psychological well-being and to instilcalmness in order to reduce binge eating, to control food intake and promote behavioural changes, the by-product of which will be a reduction of weight and BMI as well as enjoying the many health benefits stated above in Yoga in Pregnancy and Yoga and Obesity (improved hypertension, diabetes, reduced PE, PIH, SGA and improved labour outcome).
1sttrimester: breathing practice, relaxation practice, and joint release exercise
2nd& 3rd trimesters: add poses to 1st trimester practice.
Class setting
In order to provide individual attention and maximise the experience of students, hence increase the benefits for each participant, I would recommend that the size of classes be kept to a maximum of 10 participants.
Minimum equipment required is a standard yoga mat. Walls and chairs can be used for support in postures. For seated/reclined and side lying poses, yoga blankets and bolsters are useful.
Program Format
Walls, chairs, yoga props can be used to reduce joint loads, maintain correct postural alignment and stability in the postures.
The session starts with a passive posture to allow the students to come to themselves, bring breath/body awareness and state of being, to settle their minds and relax their bodies. If bolsters are available, they will facilitate chest opening and increase body/breath awareness, help release the shoulders, back and neck and gently open/stretch the groins and inner thighs. The quiet state and mental focus acquired in the passive posture is then carried throughout the practice.
Some seated postures come next to set the theme for the standing poses, focusing on lengthening, creating space and body/breath awareness. Continuing to observe the effects of a posture while being performed, to listen to the body and its responses allow the student to self adjust and correct, this in turn increases self awareness and confidence.
Standing postures are more demanding and require increased focus. They can be performed with aid (chairs or walls) for support. Standing postures include forward and lateral bends. They stretch and contract muscles, they strengthen and release muscular tension. Correct alignment and body/breath awareness are emphasised.
Seated poses aim at releasing/opening/strengthening the groins, hips and back. They can be performed with support such as a chair, blanket or bolster.
Annexe
Photos in the annexe (not shown) were taking at the Hills Yoga studio between 2005 and 2016 from experienced Hills Yoga students who had become pregnant with their first or second child and attended PowerBirth®. At the time of the photo shoot students where in their late second and last trimester.
Corinne Doret
Mobile 0490 022 719
Reference
1) Carlson N.S et al. Parturition dysfunction in obesity: time to target the pathobiology. Reproductive Biology and Endocrinolog 2015
2) Parkington H.C et al. Diminished hERGK+ channel activity facilitates strong
human labour contractions but is dysregulatedin obese women. 2014 Monash University
3) Lauche Romy, Langhorst Jost, Lee Myeong Soo, Dobos Gustav, Cramer Holger. A Systematic review and meta-analysis on the effects of yoga on weight related outcomes, Preventive Medicine, 2016
4) Yunus Emre Uzun and Keyifle Yasam. The effects of yoga on weight management. 21st European Nutrition and Dietetics Conference 2018. J NutrFoodSci, Volume 8 DOI: 10.4172/2155-9600-C3-059
5) Ross A., Brooks A., Touchton-Leonard K. and Wallen G. A Different Weight Loss Experience: A qualitative study exploring the behavioral, physical, and psychosocial changes associated with yoga that promote weight loss. 2016 www.ncbi.nlm.nih.gov/pmc/articles/
6) Iyengar BKS. BKS IyengarYoga - The Path to Holistic Health. Dorking Kindersley Book 2001, ISBN 07511321672
7) Kraftsow Gary. Yoga for Wellness, Penguin Arkana 1999, ISBN 01401.95696
8) Dr Annapoorna K. & Dr Vasantalaxmi. K.Kasurba Medical College and Hospital, Manipal. Effects of Yoga Therapy on Obesity and Quality of Life In Women: A Longitudinal study. International Journal of Yoga and Allied Sciences (ISSN: 2278 – 5159) Vol: 2, Issue: 1. 2015
9) Dhananjai S, Sadashiv, Tiwari Sunita, Dutt Krishna and Kumar Rajjan. Reducing psychological distress and obesity through Yoga practice – International Journal of Yoga. 2013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573546/
10) TundwalaVijay, R.P. Gupta, Kumar Surendra, Singh V.B., BR Sandeep, Dayal Prabhu, Prakash Parul. A study on effect of yoga and various asanas on obesity, hypertension and dyslipidemia. International Journal of Basic and Applied Medical Sciences, 2012 Vol. 2. ISSN: 2277-2103
11) Iyengar G.S. Yoga a Gem for Women, Timeless Books 1990 ISBN 0-931454-20-4
12) Kristal AR et al. Yoga practice is associated with attenuated weight gain in healthy, middle-aged men and women. 2005 https://www.ncbi.nlm.nih.gov/pubmed
13) Jiang Qinxian, Wu Zhengguo, Zhou Li, Dunlop Jenae, Chen Peijie. Effects of Yoga Intervention During Pregnancy: A Review for current status. Thieme Medical Publishers, 2014
14) Iyengar Geeta S., Keller Rita and Khattab Kerstin. Iyengar Yoga for Motherhood. Sterling, 2010 ISBN 9781402726897
15) Swami Karmananda Saraswati, Yogic Management of Common Diseases, 1984 ISBN 0949551112
16) Cramer Holger, Meral Shushila Thoms, Anheye rDennis Lauche Romy, Dobos Gustav. Yoga in Women With Abdominal Obesity - a Randomized Controlled Trial. 2016 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098025/
17) Gluck M.E, Geliebter A, Lorence M. Cortisal stress response is positively correlated wit central obesity in obese women with binge eating disorder before and after cognitive behavioural treatment. The New York Academy of Sciences 2009
17a) Harvard Health Publishing, Harvard Medical School. Stress and overeating, 2011.
17b) RazzoliM. et al. Stress, overeating and obesity, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403578/
17c) Yau Y.H.C and Potenza M.N. Stress and Eating Behaviors, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214609/
18) Elizabeth Noble. Essential Exercises for the Childbearing Year. John Murray 1982 ISBN 0719537509