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      A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning

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          Abstract

          Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11–17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.

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          2000 CDC Growth Charts for the United States: methods and development.

          Robert J. Kuczmarski, Cynthia Ogden, Shumei S. Guo … (2002)
          This report provides detailed information on how the 2000 Centers for Disease Control and Prevention (CDC) growth charts for the United States were developed, expanding upon the report that accompanied the initial release of the charts in 2000. The growth charts were developed with data from five national health examination surveys and limited supplemental data. Smoothed percentile curves were developed in two stages. In the first stage, selected empirical percentiles were smoothed with a variety of parametric and nonparametric procedures. In the second stage, parameters were created to obtain the final curves, additional percentiles and z-scores. The revised charts were evaluated using statistical and graphical measures. The 1977 National Center for Health Statistics (NCHS) growth charts were revised for infants (birth to 36 months) and older children (2 to 20 years). New body mass index-for-age (BMI-for-age) charts were created. Use of national data improved the transition from the infant charts to those for older children. The evaluation of the charts found no large or systematic differences between the smoothed percentiles and the empirical data. The 2000 CDC growth charts were developed with improved data and statistical procedures. Health care providers now have an instrument for growth screening that better represents the racial-ethnic diversity and combination of breast- and formula-feeding in the United States. It is recommended that these charts replace the 1977 NCHS charts when assessing the size and growth patterns of infants, children, and adolescents.
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            Health-related quality of life of severely obese children and adolescents.

            Jeffrey B. Schwimmer, Tasha Burwinkle, James Varni (2003)
            One in 7 US children and adolescents is obese, yet little is known about their health-related quality of life (QOL). To examine the health-related QOL of obese children and adolescents compared with children and adolescents who are healthy or those diagnosed as having cancer. Cross-sectional study of 106 children and adolescents (57 males) between the ages of 5 and 18 years (mean [SD], 12.1 [3] years), who had been referred to an academic children's hospital for evaluation of obesity between January and June 2002. Children and adolescents had a mean (SD) body mass index (BMI) of 34.7 (9.3) and BMI z score of 2.6 (0.5). Child self-report and parent proxy report using a pediatric QOL inventory generic core scale (range, 0-100). The inventory was administered by an interviewer for children aged 5 through 7 years. Scores were compared with previously published scores for healthy children and adolescents and children and adolescents diagnosed as having cancer. Compared with healthy children and adolescents, obese children and adolescents reported significantly (P<.001) lower health-related QOL in all domains (mean [SD] total score, 67 [16.3] for obese children and adolescents; 83 [14.8] for healthy children and adolescents). Obese children and adolescents were more likely to have impaired health-related QOL than healthy children and adolescents (odds ratio [OR], 5.5; 95% confidence interval [CI], 3.4-8.7) and were similar to children and adolescents diagnosed as having cancer (OR, 1.3; 95% CI, 0.8-2.3). Children and adolescents with obstructive sleep apnea reported a significantly lower health-related QOL total score (mean [SD], 53.8 [13.3]) than obese children and adolescents without obstructive sleep apnea (mean [SD], 67.9 [16.2]). For parent proxy report, the child or adolescent's BMI z score was significantly inversely correlated with total score (r = -0.246; P =.01), physical functioning (r = -0.263; P<.01), social functioning (r = -0.347; P<.001), and psychosocial functioning (r = -0.209; P =.03). Severely obese children and adolescents have lower health-related QOL than children and adolescents who are healthy and similar QOL as those diagnosed as having cancer. Physicians, parents, and teachers need to be informed of the risk for impaired health-related QOL among obese children and adolescents to target interventions that could enhance health outcomes.
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              Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association.

              Aaron S Kelly, Sarah Barlow, Goutham Rao … (2013)
              Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Children (Basel)
                Journal ID (iso-abbrev): Children (Basel)
                Journal ID (publisher-id): children
                Title: Children
                Publisher: MDPI
                ISSN (Electronic): 2227-9067
                Publication date (Electronic): 04 July 2018
                Publication date Collection: July 2018
                Volume: 5
                Issue: 7
                Electronic Location Identifier: 92
                Affiliations
                [1 ]Jane B. Pettit Pain and Headache Center, Department of Anesthesiology and Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA; sweisman@ 123456mcw.edu
                [2 ]Department of Orthopedics, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA; xliu@ 123456chw.org
                [3 ]Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA; psimpson@ 123456mcw.edu
                [4 ]Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Liyzhang@ 123456mcw.edu
                [5 ]Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; aswartz@ 123456uwm.edu
                [6 ]Department of Educational Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; Linnema7@ 123456uwm.edu
                [7 ]Department of Psychology, DePaul University, Chicago, IL 60614, USA; susan.tran@ 123456depaul.edu
                [8 ]Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA; gmedrano@ 123456uic.edu
                [9 ]Santosh Yoga, LLC, Brookfield, WI 53005, USA; bryant@ 123456santoshyoga.com
                Author notes
                [* ]Correspondence: khainswo@ 123456mcw.edu ; Tel.: +1-414-266-6306
                Author information
                https://orcid.org/0000-0001-5501-6825
                Article
                Publisher ID: children-05-00092
                DOI: 10.3390/children5070092
                PMC ID: 6068554
                PubMed ID: 29973555
                SO-VID: 1740722c-df81-44e4-8efd-b3064f920e63
                Copyright © © 2018 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 29 April 2018
                Date accepted : 25 June 2018
                Categories
                Subject: Article

                Keywords: yoga,obesity,pediatrics,biomechanics,health-related quality of life
                Data availability:
                Keywords: yoga, obesity, pediatrics, biomechanics, health-related quality of life

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