- Therapeutic Yoga and Eating Disorders
- Eating Disorders: A Background
- Why Use Yoga as an Adjunct Treatment for Eating Disorders?
Eating disorders are a form of mental illness that are characterised by a dysfunctional relationship with food and subsequently disordered eating behaviours. Although there are only a limited number of research trials exploring the direct effect of yoga for eating disorders, health professionals increasingly view yoga as a potentially helpful approach in a patient’s road to recovery.
A complex mix of distorted body image, compulsive behaviours and low self-esteem, eating disorders are often all-consuming and extremely dangerous to those who experience them. Anorexia nervosa has the highest mortality rate of any mental health issue (1) and eating disorders are both a physical and mental illness – and therefore, particularly challenging to treat.
In order to help people recover from eating disorders, health professionals must take an interdisciplinary approach to tackle the physical and psychological symptoms, as well as offering significant initial intervention (including inpatient care) and continued outpatient support. Because the experience of this illness is so individualised, the response to it must be individualised too.
It is within this context that yoga can help people recover from issues such as bulimia and anorexia. Yoga offers another “tool in the toolbox” (2) for health professionals, helping to augment the multidisciplinary approach they must take when confronted with the complicated task of lifting patients out of the self-destructive cycle of an eating disorder.
Therapeutic Yoga and Eating Disorders
Using yoga for eating disorders can be beneficial in a variety of ways. Initial research suggests that yoga can be helpful in the formation of a healthy body image, with one study focusing on 12 weeks of yoga (4) for women between the ages of 18-30. In this case, the study participants tended to see a reduction in body-image dissatisfaction and spent less time focused on their appearance. With body-image dissatisfaction resulting in a heightened risk of developing an eating disorder, this is an encouraging indication that yoga could be helpful in prevention and recovery.
Yoga teachers are not advised to teach people with eating disorders without additional training unless the student in question is in a much later stage of recovery, and no longer meets the diagnostic criteria for an eating disorder. Highly-trained yoga therapists (with medical knowledge of eating disorders) are most appropriately placed to engage with patients during the more vulnerable points in their treatment. However, general yoga classes could still have their place in a person’s recovery.
For instance, people who are ready to continue their practice of yoga outside of a clinical setting could benefit from the feeling of community and focus on holistic, non-judgemental health in a yoga class. They also provide students with the means to develop their yoga practice, which further enhances their ability to manage and regulate their emotions and behaviour. Yoga teachers can also make themselves aware of the warning signs, helping students who appear to be in danger of developing an eating disorder by suggesting other services.
Heartbreakingly for both sufferers and the yoga community, people experiencing an eating disorder can sometimes be drawn to yoga. Intensive asanas can play into the compulsion to over-exercise, hot yoga holds some attraction to those who want to lose water weight and yoga retreats sometimes offer “juice cleanses” or “clean eating” – which is highly problematic for obvious reasons.
Awareness of eating disorders within the yoga world and signposting those who appear vulnerable to psychological and medical professionals could help people access early intervention – something which can make a huge difference to their recovery. It is also vital that yoga teachers and influencers do not give nutritional advice that they are unqualified to give, and that we collectively endeavour to promote a message of body positivity and inclusivity.
But while, in some cases, yoga can be subverted and used self-destructively, it’s potential as a therapeutic pathway for certain individuals living with eating disorders is still profound.
Eating Disorders: A Background
It would be difficult to deny that we live in something of a “diet culture”. As a society we idolise leanness as the ultimate sign of health and beauty, ascribe almost religious purity to certain lifestyles (with a strict categorization of “good” and “bad” food) and associate weight gain with negative character traits. Within this worldview, eating seen as an inherently shameful act which must be compensated for by carefully choosing only the most “healthy” and pure foods – as well as embarking on regular fasts and fitness regimes.
While it would be far too simplistic to suggest that certain diet trends and beauty standards cause eating disorders, they certainly weave into the cultural tapestry which contributes to poor body image and enables disordered behaviours around food. It is within this context that genetics, personality traits, low self-esteem and the experience of trauma (alongside other factors) all converge to contribute to the development of eating disorders.
Eating disorders include Anorexia, Bulimia, Binge Eating Disorder (BED), Restrictive Food Intake Disorder and Eating Disorders Not Elsewhere Classified (OSFED).
Anorexia and bulimia are the most well-researched eating disorders, although binge eating disorder is thought to be the most common. There appears to be a strong link between eating disorders and the experience of trauma or abuse (3), while vulnerability to developing an eating disorder also appears to be increased in certain professions – such as ballet dancers.
Although most common in women in their teens and early adulthood, eating disorders can occur in people of any gender, racial/ethnic background and age – and are not necessarily always linked to being a certain weight. For example, although anorexia is highly associated with extreme weight loss, it can be unhelpful to focus on this too much when people are seeking support. People experiencing the initial symptoms of anorexia can feel as if they need to become dangerously underweight before they are taken seriously.
Skipping meals, using laxatives, punitive exercise regimes, crash diets, secrecy around food and expressing shame in concern to eating are all red flags of an eating disorder. Dysfunctional eating can then go on to create further symptoms, often associated with malnutrition. Starvation and weight loss may change the way the brain works in vulnerable individuals, which can perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.
A full recovery is entirely achievable for people with eating disorders, and while successful treatment can be difficult, it is not by any means impossible.
Why Use Yoga as an Adjunct Treatment for Eating Disorders?
Eating disorders often co-occur with anxiety, depression and trauma, creating intense emotions that people with eating disorders can find difficult to manage. Ritualistic behaviour around eating and exercise can provide them with soothing (if ultimately self-destructive) relief to unpleasant feelings – for example, racing thoughts might be calmed through bingeing, or depression might be temporarily lifted by intense exercise.
Yoga can offer value to patients by providing a more stable and ultimately healing way to cope with these feelings. The movements involved in yoga can help people regulate their emotions (5), while multiple studies point towards yoga’s efficacy in helping people to reduce and manage their anxiety. It is also a means through which people can decrease the symptoms associated with depression (6) and cope with the psychological impact of trauma (7).
Yoga therapists can also gain additional training in working with the physical issues which often affect those suffering from eating disorders, such as postural hypotension and osteoporosis. This helps yoga therapists to guide the client in developing a healthy relationship with their body – through establishing positive goals, introducing relaxation techniques, practising self-acceptance and developing positive self-talk – without the risk of injury or discomfort.
Within a clinical setting (such as inpatient care), yoga professionals can liaise directly with medical teams and ensure their proposed yoga program for particular individuals are approved. With this approval, yoga therapists can work confidently with vulnerable individuals and enhance their ability to overcome their illness by placing the body as a key part of their mental wellbeing.
With increased body awareness and emotional regulation, those living with eating disorders may find that yoga helps them to move forward from their illness and become more comfortable within themselves. Through yoga and other methods they can develop a healthy mental image of their body and experience bodily sensations (such as hunger) without fearing loss of control – ultimately becoming more self-accepting.
If you’re a yoga, health or psychology professional (or other interested party) and would like to find out more about how yoga can be used to help your clients, you can read more about the use of yoga therapy in the treatment of eating disorders with Yoga for Mental Health. If you are recovering from an eating disorder and are interested in working with a yoga therapist, please see our Minded Clinic.
(1) Arcelus, Mitchel, Wales & Nelson. (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.
(2) Neumark-Sztainer D1, Eisenberg ME, Wall M, Loth KA. (2011) Yoga and Pilates: associations with body image and disordered-eating behaviors in a population-based sample of young adults.
(3) Caslini M1, Bartoli F, Crocamo C, Dakanalis A, Clerici M, Carrà G. (2015) Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis.
(4) Aviva H. Ariel-Donges,Eliza L. Gordon, Viviana Bauman, Michael G. Perri (2019) Does Yoga Help College-Aged Women with Body-Image Dissatisfaction Feel Better About Their Bodies?
(5) Shafir T1, Tsachor RP2, Welch KB3 (2016) Emotion Regulation through Movement: Unique Sets of Movement Characteristics are Associated with and Enhance Basic Emotions.
(6) da Silva TL1, Ravindran LN, Ravindran AV (2009) Yoga in the treatment of mood and anxiety disorders: A review.
(7) Kolk, B. D. V. (2014) The Body Keeps The Score: Brain, Mind and Body in the Healing of Trauma. New York, Penguin.