Overweight and obesity are significant public health problems in the US and contribute to numerous chronic diseases. The National Center for Complementary and Integrated Health (NCCIH) has identified obesity as a priority area for funding, and has issued a Program Announcement (PA-14-182) that uses the R34 mechanism to enhance research in priority areas. This R34 application is designed to build on our pilot studies in the areas of yoga and mindfulness as potential intervention approaches to improve weight loss in adults who are overweight or obese, with these results informing our subsequent R01application. Lifestyle interventions delivered as a standard behavioral weight loss intervention (SBWI) that include diet and physical activity result in weight loss that is associated with improved health-related outcomes. Despite the success of these intervention approaches, there is wide variability in weight loss success. Thus, therapies that are adjunctive to a SBWI approach may be necessary to improve weight loss success. An alternative therapy that may have promise for improved weight control is yoga. Yoga may be beneficial for treating obesity because of its potential to decrease stress, mitigate pain, enhance mood and diminish depression, enhance sleep, and to increase energy expenditure. Despite this potential, few studies have examined the effect of including yoga within the context of a SBWI. In one of the few studies conducted, our pilot study showed that this may contribute to additional weight loss with the context of a SBWI. Within the context of yoga, there are various styles to consider. Our pilot data that included yoga include a restorative style of Hatha yoga. We also have pilot data to demonstrate that Vinyasa yoga, a more vigorous style of yoga, meets the criteria of moderate intensity physical activity, which is consistent across both normal weight, overweight, and obese. However, whether the style of yoga may influence it effectiveness within the context of a SBWI is unclear and has not been examined. Thus, this R34 application build on our very promising pilot data to prepare us for a subsequent R01 by pursing the following aims: 1. We will refine our standard behavioral weight loss intervention to include two forms of yoga (restorative Hatha yoga and Vinyasa yoga). This will be accomplished through: a. Refinement of our yoga interventions to assure that they are appropriate for adults with obesity within the context of a behavioral weight loss intervention, and to develop the yoga videos that will also be used by the participants outside of the in-person clinical sessions to enhance engagement. NOTE: Within these aspects of development and refinement we will seek feedback from independent colleagues with expertise in yoga and mind-body interventions, and we will conduct focus groups of study participants following a short intervention to determine if additional refinement is needed. 2. We will examine the feasibility of randomizing and retaining participants within the context of a behavioral weight loss intervention that also includes either style of yoga (restorative Hatha or Vinyasa). 3. We will examine compliance to the yoga components of the intervention. 4. Based on the information obtained within this R34 we will finalize the study protocol and manual of procedures that will be used in the R01 application. NOTE: Following successful completion of this R34, the aim of the subsequent R01 application will be to examine whether weight loss, compliance to dietary recommendations, and compliance to physical activity is enhanced in adults with obesity when different styles of yoga are added to a SBWI, and to better understand the pathways by which yoga may contribute to weight control and related behaviors (diet and physical activity).
It is important to develop and implement more effective interventions for improving long-term weight loss. There is some evidence that mind-body interventions have the potential to contribute to improved weight loss; however, these interventions have not been extensively studied within the context of a comprehensive behavioral weight loss intervention. This study proposes to conduct additional work related to feasibility and implementation of these intervention strategies for weight loss that will contribute to the development and undertaking of a randomized clinical trial to examine their effectiveness for weight loss and related health outcomes.