Yoga, Eating Disorders & Body Image
Recently a pilot study, published in the Journal of Adolescent Health, found that yoga was effective in treating adolescents with anorexia, bulimia and eating disorder not otherwise specified (or EDNOS, the grab bag category, which includes eating disorders that don’t fit the criteria for anorexia or bulimia).
Specifically, the study looked at two groups: one group received standard care, which involved an appointment with a physician or dietician every other week; the second received standard care plus yoga.
Immediately after the yoga sessions, teens reported being less preoccupied with food. At 12 weeks, these teens also had lower scores on the self-report questionnaire, Eating Disorder Examination. While the teens who didn’t practice yoga experienced an initial decline in scores, they returned to their baseline at week 12. Also, importantly, the teens didn’t lose any weight. The researchers concluded that, “Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.”
Q&A with Eating Disorder Specialists
To learn more, I emailed with Sharon Behl, MA, LPC., E-RYT, primary therapist and yoga therapist at the Eating Recovery Center and Kenneth L. Weiner, MD, CEDS, co-founder and medical director of the Eating Recovery Center.
1. I was under the impression that inpatient centers typically prohibit exercise because it can become a method of purging (if it isn’t already). Even though the study was done in outpatient treatment, it seems counterintuitive to recommend yoga for individuals with eating disorders. What are your thoughts?
Behl: This is a concern that we hear occasionally. However, studies show that a low level of exercise can actually contribute to better overall patient experience in treatment.
It’s important to understand that yoga is more than the postures and poses we typically identify with the practice. Yoga also involves breathing, focus, relaxation and guided imagery. This contemplative practice increases an individual’s sense of well-being. People with eating disorders often feel disconnected from their bodies…yoga helps them to reconnect, offering moments of “being okay” in their bodies.
2. What is it about yoga that may have helped in reducing eating disorder symptoms?
Behl: At the physiological level, yoga allows a patient’s relaxation response to kick in. This process can reduce the debilitating effects of anxiety and stress, emotions that are typically extreme in people with eating disorders. These individuals have a very difficult time modulating their tolerance for distress. Participating in yoga, with its focus on breathing and relaxation, helps patients create a healthy set of interventions that can be used to increase distress tolerance.
In my opinion, patients can participate in yoga from day one of treatment. We want them to at least begin to practice deep breathing, which not only helps them relax, it delivers more oxygen to their brain and helps them to think more clearly.
3. What are the most effective standard treatments for eating disorders?
Dr. Weiner: Successful treatment relies on a coordinated interplay among weight restoration, therapy, nutrition education, disease management, and in severe cases, medical stabilization.
Initially, eating disorder treatment usually focuses around restoring a healthy weight. Due to the nutritional depletion that typically occurs in an eating disordered individual, a lack of brain functionality can exist, preventing full treatment until a necessary weight is reached.
As weight is restored, it’s important to address the idea of what maintains an eating disorder. Eating Recovery Center works with patients to break through emotional and psychological barriers to ensure a lasting recovery.
At Eating Recovery Center, we teach what we refer to as the three pillars of recovery. The first is a focus on values. This means having patients identify their values so that they can organize their treatment around what’s really important in their lives. The second pillar is mindfulness. We encourage patients to take a step back and really reflect on what they’re thinking. The final pillar is connectedness. We help patients build connection with their bodies, with the people that surround them, and with the community.
4. Can you talk about other alternative treatments that have shown efficacy in treating eating disorders?
Dr. Weiner: At Eating Recovery Center, we’ve found a number of alternative treatments to be extremely effective in mitigating eating disorder symptoms. We’ve taken what we believe to be the best of the contemplative practices available and combined them in a way that helps our patients rebuild their self-esteem and recapture a little bit of joy from being in their bodies. Contemplative practices we use include Tai Chi and moving meditation.
Art therapy has also proven to be an extremely effective form of treatment. Through the creation of artwork about their experiences, patients are better able to integrate their emotional and wise (or reasonable) minds.
Psychodrama, another effective method we employ, allows patients to explore internal conflicts by acting out their emotions and interpersonal interactions in a group setting.
5. Anything else you’d like readers to know about this study or eating disorders in general?
Behl: Many people in the U.S., including a number in the eating disorders field, think of yoga as simply a form of physical exercise and movement. We emphasize that yoga is not about standing on your head…it’s about being able to stand on your own two feet. This concept is especially important as it relates to people in recovery from eating disorders
For more on yoga and eating disorders, The Center for Eating Disorders at Sheppard Pratt has a great interview with a yoga therapy practitioner and meditation instructor.
Eating Disorder Treatment
Again it’s important to emphasize that yoga is just one part of a comprehensive treatment for eating disorders. For more on treatment:
- Something Fishy lists the various types of treatments here.
- The National Eating Disorders Association (NEDA) has good tips for individuals seeking treatment and their loved ones here.
- It’s important to understand what “evidence-based” treatment is. The term basically refers to treatment that has been well-researched and found to be effective. Here’s a good overview of evidence-based treatment for eating disorders.
- The American Psychiatric Association reviews the evidence for eating disorder treatment here.
Yoga & Body Image
Yoga has tons of health benefits. I’ve only recently gotten into yoga, but already it’s taught me to slow down and become more aware of my body. The breathing helps me soothe tension and alleviate anxiety. Even if I’m having a tough time with a pose, I’ve learned not to get frustrated with my body. Our yoga instructor emphasizes the importance of respecting and being kind to your body. She says it’s OK to be out of your comfort zone with a pose, but you shouldn’t feel uncomfortable.
Many of us use yoga to also get in shape. Body image expert Sarah Maria offers the following excellent tips for using yoga to “befriend your body” instead of another tactic to beat it into skinny submission. You’ll find the entire article here. (By the way, stay tuned for my interview with her about building a healthy body image and her recently published book, Love Your Body, Love Your Life). She writes:
Let go of images of what your body and your yoga practice should look like
Yoga images can be just as harmful as other media images, depending on how we view them. It is easy to find thin, svelte, beautiful images of women plastered on yoga magazines and calendars. It is also easy to feel deficient if you don’t feel good about your own body.
Remind yourself that yoga is not about developing the perfect body. Use your yoga practice to love and appreciate your body as it is, right now, and you will gradually become infatuated with the miracle that is you.
Focus on the present moment
Our yoga practice can help us to see all the ways that we flee the present moment, or it can itself serve as an escape. Don’t let yoga become an escape for you, instead, notice where you feel uncomfortable. Use your practice to uncover and address pain as well as pleasure through present moment awareness.
Be mindful of your inner dialogue
Yoga can help us to become increasingly aware of our own inner dialogue. Do you attack yourself for not being good enough or not doing enough? Do you critique your body and your asana practice? Or do you offer words of compassion, encouragement, and love to yourself? Do you offer nurturance and affection to yourself? Become aware of how you talk to yourself and transform your dialogue to offer love and understanding.
Take time to meditate
It is easy to focus on asana practice, but don’t neglect meditation. Yoga historically has always been about meditation. Through meditation we can begin to access the silence and stillness that is our true nature. With regular meditation practice this stillness will infiltrate your yoga practice as well as the rest of your life.
For those of you who practice yoga, what do you like about it? Has it helped to boost your body image?
Tartakovsky, M. (2009). Yoga, Eating Disorders & Body Image. Psych Central. Retrieved on July 30, 2016, from http://blogs.psychcentral.com/weightless/2009/11/yoga-eating-disorders-body-image/