Without having experienced an eating disorder, it can be difficult to understand how all-consuming it can be. This mental illness is a public health concern due to the high prevalence and risk of fatality.1 Unfortunately, despite standard multi-disciplinary care, such as behavioural therapy, medical management and dieticians, symptoms often continue or relapse after treatment.2 This suggests that an ongoing, accessible and enjoyable treatment is a necessity.
Yoga is widely associated with improving body dissatisfaction and eating disorder symptoms.3 A review of previous research suggests that yoga has positive effects on both the prevention of risks of eating disorders and as an effective treatment for existing eating disorders.4 The practice of yoga promotes healthy eating patterns in numerous ways. For example, through increasing mindfulness practitioners improve their mindful eating. Regular practice also increases mind-body connection to help the practitioner listen to and respect their body.5 These benefits are reflected through the frequent use of yoga in eating disorder treatment facilities.6
Yoga classes are socially acceptable, compared to some therapies which can be stigmatised. They can be used to take the practitioner’s mind off intrusive thoughts, whilst working therapeutically on a subconscious level. Yoga teachers can incorporate body positive messages into their regular classes, such as self-acceptance and responsiveness to one’s own needs. A class specifically for those in treatment for eating disorders requires a more subtle approach to avoid inducing negative self-talk. For example, bringing attention to the sensations within the body and appreciation of the functions of the body during practice. Positive affirmations like this can gradually be built up to be more and more body positive and become a part of the practitioner’s day-to-day thoughts to aid recovery.
Yoga has the potential to recognise and respond in a healthy way to feelings of both hunger and satiety. This was found in an observational cross-sectional study, where adult yoga practitioners were found to be more likely to eat mindfully, in comparison to non-practitioners.7 It has been found that yoga practitioners have greater body awareness, responsiveness and satisfaction with their body than non-practitioners or those taking part in aerobic activities.8
An important study examined one-to-one yoga classes for outpatient adolescents receiving treatment for eating disorders.9On a questionnaire given before and after the yoga classes, those who received yoga interventions on top of standard treatment recorded lower food preoccupation scores after the class. These adolescents also recorded significantly lower scores on the Eating Disorder Examination compared to the control group at four weeks after the intervention ended.
There is a chance that members of a yoga class will compare their body to others or compare their ability to other more experienced practitioners. This could leave them feeling worse about themselves than when they came into class. Despite this risk, it has been observed that yoga practitioners develop less self-objectification than non-practitioners or those doing aerobics activities.10
Another encouraging study,11 looked at a randomised control trial of women with binge eating disorder who received a twelve-week yoga-based intervention. This showed that their binge eating score dropped from 29.9 at the beginning to 14.5 at the end of the twelve weeks, compared to the waiting-list control group whose score lowered from 28.6 to 27.2. A qualitative report was created from the participant’s journals, common themes included a developing connection between the participant and their body and food consumption.12
It is important to look at qualitative studies to gain a better understanding of how yoga can help those with eating disorders. Quotes from one such study include: ‘Yoga has been the only thing that has significantly helped me deal with my [body image] issues’. ‘Before I found the practice, my body seemed more like a foreign space that I live in. Now I see my body as a tool, home … ’. ‘Yoga gives me a higher level of acceptance for what physically I have to work with’.13
A useful resource for yoga teachers looking to work with students with eating disorders is the fourteen-week curriculum for: ‘Girls Growing in Wellness and Balance: Yoga and Life Skills to Empower’.14 Previous research indicates that regular and intensive yoga is associated with factors which protect individuals from eating disorders and disordered eating behaviours,15 such as improving wellbeing,16 and increasing body awareness and responsiveness.17 Yoga teachers should aim to incorporate positive language which helps students to appreciate their body and be responsive to what it is telling them,18 as well as avoiding negative language which draws attention to comparison. Talk of eating patterns, such as detoxification or cleansing, should be avoided to not trigger students’ negative thought patterns.19
Unfortunately, due to the research into this topic typically having small sample size and using observational design, preliminary research has not been consistent. However, the research so far indicates positive results which should promote further studies into the topic. One point to address in future research is the lack of inclusion of men in studies on eating disorders. Men should be included equally in future research to find out whether yoga interventions are universally effective as an eating disorder treatment.
Yoga is accessible, low-cost and low risk. It’s effectiveness as a tool in prevention or management of disordered eating has been demonstrated and will hopefully continue to help many people with eating disorders recover long-term.
1 López-Guimerà, G., Neumark-Sztainer, D., Hannan, P., Fauquet, J., Loth, K., & Sánchez-Carracedo, D. (2013). Unhealthy weight-control behaviours, dieting and weight status: a cross-cultural comparison between North American and Spanish adolescents. European eating disorders review : the journal of the Eating Disorders Association, 21(4), 276–283. https://doi.org/10.1002/erv.2206
2 Cassidy, N. “The Efficacy of Yoga as an Adjunctive Therapy to Standard Multidisciplinary Care in the Treatment of Female Patients Presenting with Cognitive Eating Disorder Symptoms” (2020). Capstone Showcase. 8.
3 Kramer, Rachel & Cuccolo, Kelly. (2019). Yoga Practice in a College Sample: Associated Changes in Eating Disorder, Body Image, and Related Factors Over Time. Eating Disorders. 28. 1-19. 10.1080/10640266.2019.1688007.
4 Perey, Iris & Cook-Cottone, Catherine. (2020). Eating disorders, embodiment, and yoga: a conceptual overview. Eating disorders. 28. 315-329. 10.1080/10640266.2020.1771167.
5 Neumark-Sztainer, D., Wall, M., Story, M., & Standish, A. R. (2012). Dieting and unhealthy weight control behaviors during adolescence: associations with 10-year changes in body mass index. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 50(1), 80–86. https://doi.org/10.1016/j.jadohealth.2011.05.010
6 Borden, A., & Cook-Cottone, C. (2020). Yoga and eating disorder prevention and treatment: A comprehensive review and meta-analysis. Eating disorders, 28(4), 400–437. https://doi.org/10.1080/10640266.2020.1798172
7 Framson, C., Kristal, A. R., Schenk, J. M., Littman, A. J., Zeliadt, S., & Benitez, D. (2009). Development and validation of the mindful eating questionnaire. Journal of the American Dietetic Association, 109(8), 1439–1444. https://doi.org/10.1016/j.jada.2009.05.006
8 Daubenmier, J.J. (2005), The relationship of yoga, body awareness, and body responsiveness to self-objectification and disordered eating. Psychology of Women Quarterly, 29: 207-219. https://doi.org/10.1111/j.1471-6402.2005.00183.x
9 Carei, T. R., Fyfe-Johnson, A. L., Breuner, C. C., & Brown, M. A. (2010). Randomized controlled clinical trial of yoga in the treatment of eating disorders. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 46(4), 346–351. https://doi.org/10.1016/j.jadohealth.2009.08.007
10 Daubenmier, J.J. (2005), The relationship of yoga, body awareness, and body responsiveness to self-objectification and disordered eating. Psychology of Women Quarterly, 29: 207-219. https://doi.org/10.1111/j.1471-6402.2005.00183.x
11 McIver, S., O’Halloran, P., & McGartland, M. (2009). Yoga as a treatment for binge eating disorder: a preliminary study. Complementary therapies in medicine, 17(4), 196–202. https://doi.org/10.1016/j.ctim.2009.05.002
12 McIver, S., O’Halloran, P., & McGartland, M. (2009). Yoga as a treatment for binge eating disorder: a preliminary study. Complementary therapies in medicine, 17(4), 196–202. https://doi.org/10.1016/j.ctim.2009.05.002
13 Dittmann, K. A., & Freedman, M. R. (2009). Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga. Eating disorders, 17(4), 273–292. https://doi.org/10.1080/10640260902991111
14 Catherine Cook-Cottone (2015): Embodied self-regulation and mindful self-care in the prevention of eating disorders, Eating Disorders, DOI: 10.1080/10640266.2015.1118954
15 Bucchianeri, M. M., & Neumark-Sztainer, D. (2014). Body dissatisfaction: An overlooked public health concern. Journal of Public Mental Health, 13(2), 64–69. https://doi.org/10.1108/JPMH-11-2013-0071
16 Impett, E.A., Daubenmier, J.J. & Hirschman, A.L. Minding the body: Yoga, embodiment, and well-being. Sex Res Soc Policy 3, 39–48 (2006). https://doi.org/10.1525/srsp.2006.3.4.39
17 Daubenmier, J.J. (2005), The relationship of yoga, body awareness, and body responsiveness to self-objectification and disordered eating. Psychology of Women Quarterly, 29: 207-219. https://doi.org/10.1111/j.1471-6402.2005.00183.x
18 Bucchianeri, M. M., & Neumark-Sztainer, D. (2014). Body dissatisfaction: An overlooked public health concern. Journal of Public Mental Health, 13(2), 64–69. https://doi.org/10.1108/JPMH-11-2013-0071
19 Bucchianeri, M. M., & Neumark-Sztainer, D. (2014). Body dissatisfaction: An overlooked public health concern. Journal of Public Mental Health, 13(2), 64–69. https://doi.org/10.1108/JPMH-11-2013-0071