“As I was entering puberty, I started doubting myself and my self-esteem and battled with an eating disorder. It wasn’t until I moved to NYC and discovered yoga that I was able to fully accept myself as I am and learn to love myself from the inside out. I have been teaching yoga for the past 12 years and brought yoga to the MTV generation as the star of MTV’s Yoga and Pilates workouts. I most recently produced my own Bendigirl Yoga, which is specifically geared for young girls. I work with girls in their tweens and teens and have seen the profoundly positive effects yoga has on their self-esteem and body image. I want to continue to spread yoga to as many young girls as possible to help them develop an inner sense of beauty and hopefully fend off any type of eating disorder or self-esteem issues before they begin.
” There are seldom any mirrors in yoga class, as the focus is inward. Girls learn to get in touch with themselves and befriend their breath, calm their minds, and cherish their bodies. There is no competition in yoga and every girl learns to love the shape she has and to foster unique strengths. There is never any discussion about weight or external appearance in Kristin’s yoga classes, only breath and movement and the feeling of being alive and aligned.” 1

Over the past several years, yoga has received increased recognition and a surge in popularity. In addition to its benefits as an exercise, yoga has been found in preliminary research to be beneficial in augmenting mental and medical support in the prevention and treatment of eating disorders.2 One of the most crucial aspects of the recovery process in disordered eating treatment is reintegration and reestablishment of the mind-body connection. Disconnection between mind and body lies at the core of eating disorders; the detachment of the two is similar to a drug that numbs emotions. Yoga serves as a metaphor to living, enabling one to challenge a fear. With practice and persistence, yoga can help heal disordered eating.3
The prevalence of eating disorders ranges from 3% to 10% among at-risk females (i.e., those between 15 and 29 years of age[O1] ).4 The occurrence of partial eating disorders is at least twice that of diagnosed eating disorders[O2] .4 In fact, weight-related behaviors have been reported to occur as early as fourth grade. Body dissatisfaction and excessive psychological investment in one’s physical appearance, especially weight and shape, serve as precursors to eating disorders. For this reason, improvement of body image is an important component of the treatment as well as prevention of eating disorders, starting at the grade school level.2,5

Improving the Mind-Body Connection
Traditional disordered eating treatment programs have relied heavily on didactic presentations, which provide factual information targeting the risk factors of eating disorders. These have shown little effect in decreasing disordered eating attitudes and behaviors; in fact, disordered eating behaviors may be unconsciously increased.4[O3]
More recent prevention programs have consisted of curricula blending information on healthy bodies, eating, and exercise. This model promotes healthy eating attitudes and behaviors, whereas the traditional model educates about the dangers of eating disorders. Because persons at risk for eating disorders are a vulnerable population, the traditional treatment model actually may have posed the risk of promoting eating disorders. The addition of the active and mentally uplifting practice of yoga to the curriculum improves physical self-esteem and healthy mind-body awareness.4
In a study reported in Psychology of Women Quarterly,[O4] Daubenmier affirmed the importance of the mind-body connection.6 The release of tension that yoga provides is a healthy way to dispel negative emotions and establish self-love. Daubenmier’s research suggested that through yoga, participants may intuitively discover an ability to move beyond negative messages, such as the notion that thin and beauty equate to success and happiness. Participants of yoga reported significantly higher body awareness, responsiveness, and satisfaction and less self-objection when compared with individuals participating in aerobic training or the control participants. In fact, those who participated in aerobic exercise (i.e., running and aerobics classes) were at greater risk for disordered eating behaviors.6[O5] In particular, those with anorexia nervosa had strong feelings of self-loathing. Yoga enabled this population to become more aware of their bodies, improve flexibility (physically, mentally, and emotionally), and maintain a calmer state of mind.

The Exercise Aspect of Yoga
The poses and style of yoga, especially initially, should be kept simple to prevent the compulsive patient from using yoga as an aid to purging. In comparison to relaxation exercises such as meditation, yoga also offers total body conditioning[O6] . In particular, hatha yoga focuses on the unification of mind-body-breath, strength, flexibility, and balance.7 This is helpful because many other physical activities are restricted for the patient with anorexia. Yoga requires movement, whereas relaxation is more passive.
Yoga is also beneficial in positively managing hyperactivity and reducing anxiety[O7] . In a study by Smith et al, yoga was proven to be as effective as relaxation techniques in reducing anxiety and stress and increasing physical and mental health and sleep ability.7
Patients with eating disorders who embark on yoga during therapy are less compelled to over-exercise in a private setting, such as in bed or in the shower, even when exercise is restricted, as in the case of severe underweight.8,9

Yoga and Meal Times
Yoga is especially useful during meal times. For the person with anorexia nervosa, meal times often are filled with apprehension. During the refeeding stage, patients initially feel physical discomfort from the increased volume of food. In addition, this physical discomfort is often associated with feelings of guilt and failure. Scheduling yoga around meal times (i.e., before and after) has been shown to ease tension and aid positive transitions.9

Tuning Into Body Sensations, Not Appearance
Yoga introduces the patient to an experience of relaxation and a deep sense of peace of mind and body as well as a sense of freedom. [O8] Patients learn to tune into their body as it moves through the poses, placing an emphasis on the body’s abilities rather than physical appearance.6
Yoga enables the individual to look at his or her body in a different light. In the midst of a culture that promotes dissatisfaction with physical appearance, yoga helps people respect their body shape regardless of the size. At-risk individuals often have a disconnection not only with their body, but also with their feelings, appetite, and soul. Yoga helps recreate the individual’s relationship with his/her body and inner self.[O9] 3
It is during an authentic yoga class (one without mirrors) that participants are forced to tune into their internal sensations, becoming more aware of how the body feels rather than how it looks. In particular, females with eating disorders display negative emotional and cognitive reactions when looking at their reflection in the mirror. One patient participating in yoga stated that she began to see things more through a wide-angle lens; the “little things” no longer seemed so big and could more easily be put into perspective.3,10
In the treatment of eating disorders, the incorporation of yoga into the recovery process takes direction from the practitioner. Matching the patient with an appropriate yoga class is vital because some classes focus on a physical versus spiritual experience. For example, a patient with a competitive and perfectionist personality would thrive in a class with less emphasis placed on the physical and more on the meditative aspects of yoga. A patient with depression would benefit more from a class that includes movement and flow, with an emphasis on self-pacing and acceptance. The goal for both situations is to promote balance and disrupt destructive habits and behaviors.

A “Laboratory” for Examining Behavior
Yoga requires living in the moment, letting go of judgement, accepting personal limits, and knowing when to let up or challenge oneself more. Tolerating the discomfort of a yoga pose is metaphoric for the feelings of fullness during the refeeding process of disordered eating treatment. At the same time, refusing a posture that causes pain or emotional distress may help the patient become more assertive in the recovery process. Yoga becomes an “experimental laboratory” for examining behavior, and that can lead to positively changing patterns. All of what yoga offers—including stretching, strength-building, relaxation, meditation, and breathing techniques—provides opportunities for self-awareness and acceptance, which are vital in the recovery process.3[O10]

_____________________________
Chrissy Barth, RD, CFT, RYT, is founder and president of Live Breathe Nutrition, a nutrition consulting practice in Scottsdale, Ariz. Her clients include several sports teams and training facilities, various medical practices, health clubs, and spas. Chrissy is also a clinical dietitian at the Mayo Clinic, and was named Arizona’s 2007 Recognized Young Dietitian of the Year.

References

1. McGee K. Notes shared with the author with Kristen McGee’s permission. November 7, 2007.
2. Mitchell KS, Mazzeo SE, Rausch SM, Cooke KL. Innovative interventions for disordered eating: evaluating dissonance-based and yoga interventions. Int J Eat Disord. 2007;40:120-128.
8. Neale H. Eating-disorder patients heal through yoga. Straight.com. June 2, 2005. Available at: http://www.straight.com/content.cfm?id=10570. Accessed on October 15, 2007.
5. Nye S, Cash TF. Outcomes of manualized cognitive-behavioral body image therapy with eating disordered women treated in a private clinical practice. Eat Disord. 2006;14:31-40.
4. Scime M, Cook-Cottone, Kane L, Watson, T. Group prevention of eating disorders with fifth-grade females: impact on body dissatisfaction, drive for thinness, and media influence. Eat Disord. 2006;14:143-155.
9. Giles GM. Anorexia nervosa and bulimia: an activity-oriented approach. J Occup Ther. 1985;39:510-517.
10. Vocks S, Wachter A, Wucherer Maike, et al. Look at yourself: can body image therapy affect the cognitive and emotional response to seeing oneself in the mirror in eating disorders? Eur Eat Disorders Rev. August 22, 2007.
3. Boudette R. Question & Answer: Yoga in the treatment of disordered eating and body image disturbance: how can the practice of yoga be helpful in recovery from an eating disorder? Eat Disord. 2006;14:167-170.
6. Daubenmier J. The relationship of yoga, body awareness, and body responsiveness to self-objectification and disordered eating. Psychol Women Quarterly. 2005;29:207-219.
7. Smith C, Hancock H, Blake-Mortimer J, et al. A randomized comparative trial of yoga and relaxation to reduce stress and anxiety. Complem Ther Medicine. 2007;15:77-83,

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