Disordered eating behaviours and correlates in yoga practitioners: a systematic review

The impact of yoga on body image in adults: A systematic review of quantitative studies

Evidence suggests that yoga can be used as an intervention to improve body image. This systematic review evaluates the evidence of the efficacy of yoga in improving body image among adults. Authors followed PRISMA guidelines, searching Pubmed, Ovid MEDLINE, Embase, Cochrane, CINHAL, PsycInfo, and grey literature up to December 2, 2023 and identifying 446 unique records. Eligibility criteria included English-language, peer-reviewed studies with quantitative data on adult populations. Twenty-nine studies were eligible for inclusion and were evaluated for methodological quality using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Interventions focused solely on yoga varied in length, frequency, and style. Our synthesis revealed that yoga is associated with improved body satisfaction and appreciation, as well as reduced body dissatisfaction, across diverse adult populations, including those with clinical or subclinical levels of body dissatisfaction. Most low- and moderate-quality studies reported significant improvements, and some suggested a dose-response relationship. However, the evidence is limited by methodological weaknesses, such as a lack of blinding and inadequate reporting. Despite these limitations, findings support yoga as a promising intervention for improving body image in adults. Future research should aim for methodologically rigorous studies that use validated outcome measures and more inclusive populations.

Associations between mind-body practice engagement and diet quality: Exploring the mediating roles of eating behaviour traits and regulation styles for eating behaviours in the PREDISE study

While engaging in Mind-Body Practices (MBPs) may be related to better diet quality, its association with eating behaviours is unclear. This cross-sectional study explores whether eating behaviour traits and regulation style of eating behaviours mediate the association between MBP engagement and diet quality. A total of 418 women and 482 men, aged between 18 and 65 years and recruited as part of the PREDISE study cohort, reported whether they currently practice one or more MBP (e.g., yoga or meditation). Canadian Healthy Eating Index (C-HEI) was calculated from three 24h dietary recalls. Intuitive Eating Scale (IES-2), and Regulation of Eating Behaviour Scale were completed online. Mann-Whitney tests were conducted to compare C-HEI scores of individuals who currently engage in MBPs (practitioners) to those who do not (non-practitioners). Multiple regression analyses and bootstrapping were performed to test whether eating behaviours and regulation style of eating behaviours mediate the association between MBPs and diet quality. Overall, 88 women and 43 men were practitioners. They had higher C-HEI scores than non-practitioners (62.9 ± 13.0 vs. 55.6 ± 14.3; p = 0.001). Parallel mediation model showed significant indirect effects of the IES-2 subscale relating to Body-Food Choice Congruence (β = 1.57, SE = 0.41, 95% CI: 0.86, 2.43), self-determined motivation (β = 1.51, SE = 0.39, 95% CI:0.81, 2.32) and non-self-determined motivation (β = 0.39, SE = 0.21, 95% CI: 0.03, 0.85) on the association between practitioner status and C-HEI. These findings suggest that the current practice of MBPs is associated with better diet quality, mainly through practitioners' higher intuitive eating skills and more self-determined regulation of eating behaviours. Further studies should investigate the potential impacts of MBPs on the development and maintenance of positive eating habits.

Complementary and Integrative Medicine and Eating Disorders in Youth: Traditional Yoga, Virtual Reality, Light Therapy, Neurofeedback, Acupuncture, Energy Psychology Techniques, Art Therapies, and Spirituality

Eating disorders (EDs) are a non-heterogeneous group of illnesses with significant physical and mental comorbidity and mortality associated with maladaptive coping. With the exception of lisdexamfetamine (Vyvanse) for binge eating disorder, no medications have been effective for the core symptoms of ED. ED requires a multimodal approach. Complementary and integrative medicine (CIM) can be helpful as an adjunct. The most promising CIM interventions are traditional yoga, virtual reality, eye movement desensitization and reprocessing, Music Therapy, and biofeedback/neurofeedback.

Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program

Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.

Prevalence of Risk for Orthorexia in Athletes Using the ORTO-15 Questionnaire: A Systematic Mini-Review

The article aims to summarize the literature about the profile of risk of orthorexia in athletes using the ORTO-15 questionnaire. The search was performed at PubMed, Embase, Web of Science, and Sport Discus databases, using the terms “orthorexia” AND “athletes” with the respective entry terms. A multistage process of selection followed the PRISMA 2020 recommendation. A total of 688 articles were identified, and six studies were available for the final process. The prevalence of risk for orthorexia was assessed by the articles by the ORTO-15 questionnaire and ranged between 38 and 35 points. The comparison between male and female athletes and, athletes and non-athletes was not significant in the six articles. In conclusion, the review highlights that athletes from different sports, included in the review, do not present a risk of orthorexia nervosa considering the cutoff of 40 points, but not 35 points. Also, athletes present the same orthorexic behavior compared to non-athletes, demonstrating that orthorexia is an issue that needs to be considered in the general population. Moreover, a special focus should be given on the ORTO-15 questionnaire, about the sensitivity to diagnose the prevalence of orthorexia, especially in athletes.

Internalized weight stigma and intuitive eating among stressed adults during a mindful yoga intervention: associations with changes in mindfulness and self-compassion

Purpose

Internalized weight stigma (IWS) is common in the United States of America across body weight categories, and is implicated in the development of distress and unhealthy eating behaviors (e.g. overeating, disordered eating) that can foster poor cardiometabolic health. While emerging intervention research shows early promise in reducing IWS, long-term efficacy is unclear and novel strategies remain needed. This analysis examined whether participation in a mindful yoga intervention was associated with reduced IWS and increased intuitive eating, an adaptive eating behavior, and whether these changes correlated with each other or with changes in mindfulness and self-compassion.

Methods

Participants were stressed adults with low fruit and vegetable intake (N = 78, 64.1% White, M. Body Mass Index  25.59 ± 4.45) enrolled in a parent clinical trial of a 12-week mindful yoga intervention. Validated self-report measures of IWS, intuitive eating, mindfulness, and self-compassion were administered at pre-treatment, mid-treatment (8 weeks), post-treatment (12 weeks), and 4-month follow-up (24 weeks).

Results

Linear mixed modeling revealed significant improvements in IWS and intuitive eating across the four timepoints (p < .001). Reduced IWS correlated with increased intuitive eating pre- to post-treatment (p = .01). Improved self-compassion and mindfulness correlated with intuitive eating (both p = . 04), but not IWS (p = .74 and p = .56, respectively).

Conclusion

This study offers preliminary support for the hypothesis that mindful yoga may promote intuitive eating and reduce IWS among stressed adults with poor diet, and suggests that changes in these factors may co-occur over time. Further investigation with controlled designs is necessary to better understand the temporality and causality of these relationships.Trial registration: ClinicalTrials.gov identifier: NCT02098018.

Personality Profile in Orthorexia Nervosa and Healthy Orthorexia

Little is known about orthorexia in both its pathological (orthorexia nervosa, OrNe) and adaptive (healthy orthorexia, HeOr) forms. To date, few studies have been carried out to analyze the personality profile associated with orthorexia, and the results have been contradictory. The aim of the present study was to explore the characteristic pathological personality traits associated with OrNe and HeOr. A total of 297 participants (M_age = 30.8 years; 94.6% women) from the general population completed the Teruel Orthorexia Scale (TOS) and Personality Inventory for DSM-5-Short Form (PID-5-SF) questionnaires. Results showed significant low-medium correlations between OrNe and the four personality factors (Negative Affectivity, Detachment, Disinhibition, and Psychoticism) (rs range [0.08, 0.36]). In the regression analysis, the predictors of OrNe were Neuroticism and, to a lesser extent, Psychoticism. For HeOr, the associations were lower (rs range [−0.13, 0.05]) and negative, except Psychoticism. Only the relationship with Disinhibition was statistically significant, although after controlling for OrNe, Negative Affectivity and Antagonism also became significant. In the regression analysis, the predictors of HeOr were Disinhibition (negative direction) and Psychoticism (positive direction). The findings show that OrNe is associated with a pathological personality pattern characterized by difficulty in regulating emotions and negative affect (Negative Affectivity), as well as eccentricity, feeling special, and holding beliefs outside the norm (Psychoticism). However, HeOr seems to be related to the tendency toward high responsibility, self-control, the ability to maintain the focus of attention (low Disinhibition), and Psychoticism. Future studies should confirm whether this combination is a key component underlying the development and maintenance of orthorexia.

[How Should Yoga in Anorexia Nervosa Treatment be Applied? A Qualitative Pilot Study on Yoga Strategies Perceived to be Beneficial from Patients' Perspective]

An altered interoception is a central correlate of anorexia nervosa (AN) and addressing this issue offers a promising approach in the treatment of AN. First results have shown the effectiveness of yoga as a body-focused intervention in the treatment of AN. However, to date there is a lack of empirical evidence regarding the question how yoga strategies and yoga elements (postures, relaxation, breath, meditation) should be applied. Against this background, we conducted a qualitative pilot study with n=6 female patients with AN undergoing treatment in a specialist unit supporting re-insertion subsequent to a preceding inpatient AN treatment. Study participants received a weekly one-hour hatha-yoga intervention over at least 12 weeks. After the yoga intervention, semi-structured interviews (1/2 to 1 hour) were conducted to assess the experiences of the study participants during the yoga intervention. The data were analyzed using Grounded Theory. At the upper level of analysis, four categories were differentiated: information regarding 1) study participants' symptoms, 2) aspects of the setting experienced to be beneficial, 3) yoga strategies perceived to be beneficial and 4) perceived consequences of yoga strategies. With regard to the yoga strategies perceived to be beneficial, analyses revealed 4 subcategories: features of 1) postures and movements, 2) breath and meditation exercises, 3) relaxation exercises and 4) general information about the setting. The results give first indications regarding the conceptualization of yoga in the treatment of AN and potential mechanisms. Further qualitative and quantitative studies are needed, e.g., with regard to effectiveness, contraindications, mediators or moderators to better evaluate the potential of yoga in the treatment of AN.

Trait mindfulness differentiates the interest in healthy diet from orthorexia nervosa

BACKGROUND

Obsessive healthy eating and its extreme form orthorexia nervosa are epidemiologically significant problems. Mindfulness, the focused, non-judgmental attention to and awareness of present events, may be an important psychological contributor to (orthorexic) eating habits.

METHODS

In this cross-sectional survey-based study, 314 women and 75 men (mean age_{total sample} = 27.17 years, SD = 10.64) provided data on mindfulness (Freiburg Mindfulness Inventory, presence and acceptance subscale) and orthorexic eating (Teruel Orthorexia Scale, healthy orthorexia and orthorexia nervosa subscale).

RESULTS

In this study, we found a positive relation between mindfulness and healthy orthorexia, the non-pathological interest in eating healthy. By contrast, orthorexia nervosa, the pathological obsession with healthy eating, was negatively associated with mindfulness. Gender differences appeared neglectable.

CONCLUSION

Taken together, these results confirm previous research showing that mindfulness encourages eating healthy and may protect against eating-related pathologies. Result also support the notion that orthorexia has two dimensions, healthy and nervosa, which are differently related to psychological factors, herein mindfulness.

LEVEL OF EVIDENCE

Level III, cohort study.

Orthorexia nervosa in yoga practitioners: relationship with personality, attitudes about appearance, and yoga engagement

PURPOSE

Disordered eating symptoms and a high prevalence of orthorexia nervosa can be found in yoga practitioners. Given that yoga is increasingly used as a complementary treatment for eating disorders (ED), understanding the relationship between yoga practice and the development of disordered eating is crucial to guide treatment recommendations. The goal of this work is, therefore, to study the relationships between orthorexia nervosa (ON) and potential risk factors for ON, in an international sample of experienced yoga practitioners.

METHOD

An online questionnaire that included several psychometric instruments was responded by 469 yoga practitioners. Instruments used were the Teruel orthorexia scale, Yoga immersion scale, Passion scale, Frost multidimensional perfectionism scale, Self-discipline scale of NEO-PI-R, Drive for thinness scale of EDI, and Beliefs about appearance scale. Descriptive statistics, correlational analysis and multiple regression were used to evaluate relationships between ON and the other variables.

RESULTS

The main predictors of orthorexia nervosa were the drive for thinness and a healthy orthorexia, suggesting that, like in anorexia and bulimia, orthorexic individuals are also concerned with food quantity and physical appearance, rather than just food quality.

CONCLUSIONS

The potential effects of yoga on eating behaviours and attitudes of long-term practitioners, particularly the high prevalence of orthorexia nervosa and the concern for physical appearance, should be taken into consideration when using yoga as prevention or treatment for eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Yoga practice among ethnically/racially diverse emerging adults: Associations with body image, mindful and disordered eating, and muscle-enhancing behaviors

BACKGROUND

This study explores cross-sectional associations between yoga and body image, mindful eating, disordered eating, and muscle-enhancing behaviors among a population-based sample of ethnically/racially diverse emerging adults.

METHOD

An ethnically/racially diverse population-based sample of 1,568 emerging adults (18-26 years) completed surveys as part of EAT 2010-2018 (Eating and Activity over Time). Models were adjusted for sociodemographic characteristics and body mass index (BMI).

RESULTS

Practicing yoga at least 30 min/week was reported by 12.7% (n = 210) of the sample. Yoga practitioners had higher levels of mindful eating than those not practicing yoga. Although effect sizes were small, yoga practitioners were more likely than non-yoga practitioners to use steroids (3.8 vs. 0.7%, p < .001, h = 0.22) or protein powder/shakes (35.1 vs. 25.3%, p < .010, h = 0.21) to increase their muscle size/tone. Body satisfaction, unhealthy weight control behaviors, and binge eating tended to be similar among yoga practitioners and non-yoga practitioners. There was a significant interaction between BMI and yoga in predicting body satisfaction with a trend toward a positive impact among yoga practitioners at higher BMI values. Interactions between yoga practice and all body image attitudes and behaviors across gender and ethnicity/race were not statistically significant.

DISCUSSION

Young people from diverse ethnic/racial backgrounds who practice yoga are more likely to engage in mindful eating but have equal or elevated levels of unhealthy body image attitudes and behaviors as compared to non-yoga practitioners. Further research should explore how yoga is best taught and practiced to ensure that it is beneficial for body image and related behaviors.

Realizing Yoga's all-access pass: a social justice critique of westernized yoga and inclusive embodiment

In the 21^st century, the ancient mind-body practice of yoga has surged in popularity among western enthusiasts for its numerous health benefits. Particularly, a growing evidence base supports yoga for cultivating positive embodiment and reducing risk for disordered eating. Nevertheless, amidst its rise are concerns about yoga's departure from its spiritual foundations and increasing assimilation into the appearance- and commercial-driven exercise and fitness culture. Consequently, an exclusionary identity has been perpetuated in shaping norms surrounding who can and does practice yoga, which contradicts earlier egalitarian visions of a yoga for all. Therefore, we adopt a social justice lens in offering a focused analysis of the intersection of yoga, embodiment, and inclusion for select marginalized social identities typically underrepresented among yoga practitioners and in yoga scholarship. Data are synthesized from both qualitative and quantitative sources and integrate an understanding of how confined media representations of "the yoga body" and other practical constraints may undermine the perceived access to the practice for members of diverse groups. We conclude with inviting future considerations towards fostering more interdisciplinary community-based research partnerships among the variety of stakeholders invested in advancing the accessibility and inclusion of yoga and positive embodiment for all bodies.

Eating disorders, embodiment, and yoga: a conceptual overview

Yoga and its relation to embodiment and disordered eating has only recently received research attention. Nevertheless, early research indicates that yoga is an effective tool in the prevention and treatment of eating disorders. It is assumed that yoga ameliorates eating disorder symptoms and facilitates a shift from negative towards positive body image and well-being by cultivating positive embodiment (i.e., the ability to feel a sense of connection between mind and body). In order to provide the context of the constructs of disordered eating, embodiment, and yoga, this article presents a brief overview and conceptualization of these constructs. The three major eating disorders and current treatment methods are described. Further, the philosophical roots and theoretical models of embodiment are delineated and their communal core features are outlined. Lastly, the origin, basic principles, and modern interpretations of yoga are discussed.