Is Yoga Helpful As Part Of Eating Disorder Treatment?

Yoga supported some participants during an eating disorder treatment

Background

Eating disorders are common in the U.S. and notoriously difficult to effectively treat. Eating disorders can have different specific hallmarks, but are generally characterized by chronic preoccupation with body weight and shape that results in disordered eating and/or over-exercising. Although one specific eating disorder, anorexia nervosa, is more often discussed in the media, there are other forms that eating disorders can take. One thing that is common to all eating disorders is the difficulty of finding a treatment plan that works. Recovery rates are, at best, around 50%.

Treatment for eating disorders typically includes multiple modalities. Those might include nutritional guidance and support, medical therapies, and psychological therapies. As with managing nutrition, managing exercise and movement is especially difficult for those with an eating disorder because over-exercising is frequently part of the complex nature of the disorder. Some treatment plans have suggested no exercise at all for those undergoing treatment for an eating disorder, but this prevents people in treatment from experiencing all of the benefits of movement.

Alternatively, when exercise was incorporated as a carefully monitored part of an overall treatment plan, research showed that patients experienced both physical and psychological benefits. Initial research has been unclear on whether yoga is a good fit as part of a treatment plan for people with an eating disorder. The researchers on this study performed a review study to evaluate smaller individual studies as a group to determine whether yoga was beneficial to those in treatment for an eating disorder.

Research question

When is yoga safe, appropriate, and helpful as part of an eating disorder treatment?

Research methods

The research was conducted by a panel of six experts with significant knowledge of yoga and eating disorders. They searched PsycINFO, MEDLINE, CINAHL, and Embase databases for relevant published research to include in a review of individual studies that evaluated yoga’s effects on eating disorders. The research team examined all peer-reviewed studies from 2005 and later. In particular, they reviewed the published studies for feasibility, acceptability, and safety of including yoga as part of an overall treatment plan for the specific population of people living with an eating disorder.

The researchers selected studies for review with patients of any age group and gender. They included published papers with all study types except case studies in their review. For the purposes of selecting studies for their review, the researchers defined yoga as practices that included postures, breathing, and meditation.

Feasibility was measured through yoga participation measures in the individual studies. Acceptability was measured by the perception of yoga participants of yoga as comforting or distressing, complex or accessible, and the yoga instructor as credible. Safety was assessed by evaluating the physical suitability for the population, the type of physical changes during the yoga program, the number of adverse events, and how well the environment was adapted for the population.

Results

A total of eleven studies met the criteria set by the research team and were included in their review.

Feasibility

Feasibility of yoga for study participants with an eating disorder was high. Although the drop-out rates for the individual studies ranged from 0-45%, the average over all the studies was a drop-out rate of only 18%. Some of the reasons participants gave for dropping from the yoga programs supporting eating disorder treatment were functional, such as schedule conflicts and issues with travel. However, others were specifically related to the concerns of the study populations. Some participants left the yoga programs because they experienced shame or discomfort related to body image in the yoga environment.

Acceptability

Generally, participants in the yoga programs designed as part of a treatment plan for eating disorders had a positive experience. In many cases, the yoga programs met participants’ expectations for increased empowerment, confidence, self-acceptance, self-awareness, interoception, and physical strength. Alongside the positive experiences, participants in some yoga programs found the poses difficult to do or reported infrequent pain in some movements.

Additionally, some participants found the focus on their bodies unsettling or uncomfortable. That experience evolved over the course of the yoga program for some participants who eventually felt more connected to their bodies. However, others found that yoga triggered feelings of self-judgement and negative body image.

Safety

Physically, the yoga programs included as part of treatment for eating disorders were safe with minimal to no adverse effects. Various accommodations were made as well to meet the emotional safety needs of the population working with the issues of having an eating disorder. Some of those accommodations included creating a calming physical environment and asking participants to wear loose-fitting clothing and refrain from self-disparaging comments on their appearance.

Why is this relevant to yoga practitioners?

The cultural influences that those with an eating disorder experience often reinforce the context that drew them into an eating disorder in the first place. We are all, to a greater or lesser degree depending on our specific media choices, exposed to that same cultural messaging. Yoga can support us in being more mindful, and it can help us connect to our body in a healthy way. But we can also use it as yet another way to compare ourselves to images in the media, likely generating negative feelings of self-judgement.

In this modern age where we are bombarded with visual imagery, it takes more intention on the part of both yoga teachers and students to use yoga practices to turn inward toward experience, instead of outward, on appearance. As teachers, one of the best gifts we can give our students is an understanding of how to use the tools of yoga to turn inward.

Reference citation

Trethewey, E., S. Evans, S. McIver, J. O’Brien, J. Lowndes, G. Pepin, and M. O’Shea. 2023. One size may not fit all: A mapping review of yoga-based interventions for the treatment of eating disorders. Complementary Therapies in Clinical Practice. 53:101779. 21pgs.