Complementing Behavioral Weight Loss with Breath-based Yoga: A Proof-of-Concept and Initial Feasibility Study

Background: Yoga may support changes in dietary intake and/or physical activity levels, supporting sustainable weight loss. However, previous research has focused on yoga postures (asanas) rather than breathing practices (pranayama). This study used the proof-of-concept stage in the ORBIT model to evaluate feasibility, acceptability, and preliminary efficacy of a breath-based yoga program integrated within a behavioral weight loss (BWL) intervention. Methods: Fifteen participants with overweight or obesity (BMI: 31.3 +/- 4.3, 80% female) were enrolled in a 16-week, single-arm, group-based BWL intervention which included four breath-based yoga sessions/week, individualized daily goals for energy intake reduction, and progressive aerobic exercise recommendations. Primary outcomes included prespecified benchmarks enrollment, retention, adherence, and acceptability. Secondary outcomes included changes in body weight and composition, metabolic health indices (e.g., blood pressure, fasting glucose, abdominal obesity), physical activity, appetite, and dietary intake. Results: Mean percent weight loss was 6.5 +/- 6.0%, exceeding the pre-defined proof-of-concept benchmark. Recruitment and adherence exceeded established benchmarks, with mean in-class attendance of 84.1 +/- 14.6% and adherence to the prescribed duration of at-home yoga sessions averaging 85.5 +/- 38.4%. However, retention was lower than the pre-specified benchmark (73% vs 80%). Positive changes were observed in waist circumference, blood pressure, and appetite traits. Self-reported satisfaction with the program and outcomes were acceptable (mean ratings >6/10). Conclusions: A BWL with a breath-based, low-intensity yoga can lead to acceptable weight loss with potential benefits in key behavioral and metabolic health indices. Recruitment, high adherence, and satisfaction demonstrated feasibility.