Disordered eating behavior among group fitness instructors: a health-threatening secret?

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.

Health Motivation in the Influencer Era: Analyzing Entertainment, Personal, and Social Media Role Models

This research explored how personal and entertainment role models motivate an individual's health goals, and how following a role model on social media affects this process. A survey of 404 adults revealed that identifying a personal role model, such as a family member, friend, or healthcare professional, had a stronger influence on health motivation in comparison to identifying an entertainment role model. Additionally, our findings indicated that following any role model on social media, whether a personal acquaintance or a celebrity, enhanced motivation. Role model attributes that mediated these relationships included perceived similarity, and in some instances, positive and negative norm deviance. This study highlights the importance of leveraging role model relationships in health communication campaigns and developing authentic influencer-driven health initiatives that feature relatable entertainment figures. Additionally, this research supports the need for further examination of how a role model's perceived positive or negative norm deviance influences motivational capability. We discuss implications for the motivational theory of role modeling, health promotion, and entertainment education.

One size may not fit all: A mapping review of yoga-based interventions for the treatment of eating disorders

BACKGROUND

While research investigating the potential benefits of yoga for eating disorders (EDs) has expanded, a systematic approach examining how yoga has been implemented for this cohort has not yet been conducted. This research therefore aimed to synthesize the current understanding of how yoga has been implemented for individuals with EDs, with regards to the feasibility, acceptability, and safety of yoga for this cohort.

METHODS

This study utilised mapping review technology. The following electronic databases were searched within the month of September 2021 and December 2022: PsycINFO, MEDLINE, CINAHL, and Embase. Articles that applied and documented the use of yoga for the EDs were selected.

RESULTS

The review identified ten unique studies. Details regarding the application, feasibility, acceptability, and safety of these yoga programs were extracted. This resulted in an evidence map or visual summary of how yoga has been applied for the EDs.

CONCLUSION

While limited, the current literature suggests that yoga is a safe, acceptable, and feasible transdiagnostic intervention for EDs. These findings provide pragmatic support for safely applying yoga for the EDs into clinical practice to support ED recovery.

Perceived Body Image towards Disordered Eating Behaviors and Supplement Use: A Study of Mauritian Gym-Goers

Purpose: Individuals with body image distortions tend to develop an obsession with calorie intake and weight, leading to compounded coping strategies such as modified eating behaviors, supplement use, and excessive exercise. In the local context, little is known about the equation connecting body image to improper eating behaviors and other potential coping mechanisms. This study primarily aims at critically identifying the nexus between features of disordered eating behavior including supplement use, and body image. Methodology: A probabilistic randomized sample of 305 gym members was assessed based on their level of body satisfaction and its influence on their eating habits and supplement use through a structured survey. Findings: Only 37% of the participants were satisfied with their body image. The results concurred with the notion of a poor body image influencing body esteem (χ2 (10) = 137.21, p < 0.05; Cramer V = 0.474). While exercise motivated the use of supplements, a significant relationship was also observed between disordered eating habits and supplement use (χ2 (4) = 48.63, p < 0.05; Cramer V = 0.399). A predictive model was successfully drawn inclusive of the disordered eating behaviors dimensions as a potent predictor of body image (χ2 (56) = 397.12, p < 0.001. Implications: This study presents an in-depth analysis of the magnitude of disordered eating behaviors with respect to individuals in the local fitness industry, and the need for professional support programs toward the re-alignment of body image in an effort to curtail the development of eating disorders in Mauritian gym-goers.

RISK OF EATING DISORDERS AND BODY DISSATISFACTION AMONG GYM-GOERS IN ANKARA, TURKEY

ABSTRACT Introduction: Although regular exercise is widely recommended to promote optimal health, it is thought that gym-goers are at risk for body dissatisfaction and eating disorders. Objective: This study assessed the risk of eating disorders and the prevalence of body dissatisfaction in gym-goers enrolled in a gym located in the city of Ankara, the capital of Turkey. Methods: This cross-sectional study was conducted with 206 gym-goers, 102 males (mean age of 25.8±7.86 years) and 104 females (mean age of 26.5±9.07 years), who regularly exercised at least twice a week at this gym during the years 2018 to 2019. Demographic characteristics and exercise status of the participants were collected through face-to-face interviews via a questionnaire form. The REZZY (SCOFF) questionnaire was administered to determine the risk of eating disorders and the Stunkard Figure Rating Scale was administered to determine body dissatisfaction. Results: The mean REZZY score in females (1.4±1.21) was higher than in males (0.8 ± 1.05) (p<0.01). In males, 26 out of 102 (25.5%) had a score indicating a risk of eating disorders. In females, 44 out of 104 (42.3%) had a score indicating a risk of eating disorders. The risk of eating disorders is higher in females than in males (p<0.05). While 49.0% of males stated that their current body size is greater than the ideal body size, 76.0% of females said that their current body size is greater than the ideal body size. Conclusion: Consequently, it was determined that gym-goers were a risk group in terms of eating disorders and body dissatisfaction. Level of Evidence: III; Cross-sectional study.

Exercise Dependence and Body Image Concerns Amongst Group Fitness Instructors: A Self-Determination Theory Approach

Introduction

Despite the fact that group fitness instructors serve as significant role models with potentially great impact on class participants' motivation for exercise, they are a very under-researched group. The aim of this study was therefore to examine group fitness instructors' motivational regulations for exercise, and how these motivational regulations can predict symptoms of exercise dependence and body image concerns.

Methods

Group fitness instructors from the largest fitness companies in Norway (n = 837, response rate: 57%) completed an online survey with reference to the Situational Motivation Scale (SIMS), the Exercise Dependence Scale (EDS), the Eating Disorders Inventory subscales drive for thinness (EDI-DT) and body dissatisfaction (EDI-BD), and their weekly amount of exercise and instruction.

Results

The instructors scored high on identified regulation and intrinsic regulation for exercise. EDS total score was positively correlated with all SIMS subscales and weekly instruction was positively correlated with Intrinsic regulation. Multiple hierarchical regression analyses found that both self-determined motivational regulations as well as external regulation positively predicted their EDS score. External regulation positively predicted EDI-DT, and EDI-BD.

Conclusion

Group fitness instructors seem highly intrinsically motivated for exercise, which is hypothesized to have a positive impact on group fitness class participants. High self-determined exercise behavior does not seem to buffer against symptoms of exercise dependence within this specific population. There is a need for awareness of group fitness instructors who show high exercise dependency scores due to the link to body image concerns, amotivation and external regulated motivation.

Yoga participation associated with changes in dietary patterns and stress: A pilot study in stressed adults with poor diet

BACKGROUND AND PURPOSE

Stress contributes to dietary patterns that impede health. Yoga is an integrative stress management approach associated with improved dietary patterns in burgeoning research. Yet, no research has examined change in dietary patterns, body mass index (BMI), and stress during a yoga intervention among stressed adults with poor diet.

MATERIALS AND METHODS

Objectively-measured BMI and a battery of self-report questionnaires were collected at four time points during and following a 12-week yoga intervention (N = 78, 71% women, mean BMI = 25.69 kg/m2±4.59) - pre-treatment (T1), mid-treatment (6 weeks; T2), post-treatment (12 weeks; T3), and at 3-month follow-up (24 weeks; T4).

RESULTS

T1 to T3 fruit and vegetable intake, BMI, and stress significantly declined in the overall sample. Reduction in vegetable intake was no longer significant after accounting for reductions in caloric intake, and reduction in caloric intake remained significant after accounting for reductions in stress.

CONCLUSION

Findings may be interpreted as yoga either encouraging or adversely impacting healthy dietary patterns (i.e., minimizing likelihood of future weight gain vs. decreasing vegetable intake and overall caloric intake among individuals who may not need to lose weight, respectively). Continued research is warranted, utilizing causal designs.

Compulsive exercise and mental health challenges in fitness instructors; presence and interactions

BACKGROUND

Some physically active people exercise compulsively, which can be associated with several mental health challenges. Fitness instructors are considered important role models for an active, healthy lifestyle; yet little is known about their exercise motives and mental health. The aim of this study was to examine the presence of compulsive exercise and mental health challenges, and their interaction, in fitness instructors.

METHODS

A total of 270 fitness instructors from Norwegian fitness clubs were recruited for this cross-sectional study. Inclusion criteria were operating as instructors within the current year and understanding Norwegian language. Data were collected by an electronic questionnaire and included demographic information, hours of classes instructed and of personal physical activity, Compulsive Exercise Test (CET), Symptom Check List - 10 (SCL-10), Beck Depression Inventory (BDI), and Eating Disorder Examination Questionnaire (EDE-Q)).

RESULTS

Females had higher CET scores than males, and 9% of all respondents had CET score above clinical cutoff. Respondents with clinical CET score had higher SCL-10, BDI and EDE-Q global- and subscale scores compared with their counterparts. Although CET was positively and significantly associated with BDI, SCL-10, and EDE-Q, only the latter explained the CET score (ß = 1.23, 99% CI = 0.87, 1.59).

CONCLUSION

About one out of eleven instructors were above clinical CET cut-off, revealing symptoms of compulsive exercise. EDE-Q significantly contributed in a model explaining 43% of the variation of compulsive exercise.

Body Figure Idealization and Body Appearance Pressure in Fitness Instructors

PURPOSE

The fitness centers are settings for health promotion, yet may serve as a stage for counterproductive figure idealization. Such idealization may take the form of a drive toward the thin, the muscular, or lean body figure ideal, which all hold the potential to impel an experience of body appearance pressure (BAP) and body dissatisfaction. The aim of this study was to explore figure idealization, body dissatisfaction, and experience of BAP in fitness instructors.

MATERIALS AND METHODS

Fitness instructors, 70 (23%) males and 236 (77%) females, were recruited through their facility chief executive officer and social media for a digital survey on mental health. Results are presented for body appreciation (BAS-2), body dissatisfaction (EDI-BD), drive for muscularity (DM), drive for leanness (DLS), questions on BAP, symptoms of eating disorders (EDE-q), and history of weight regulation and eating disorders (EDs).

RESULTS

Attempts to gain body weight were reported by 17% of females and 53% of males, whereas ∼76% of males and females, respectively, reported to have attempted weight reduction. Reasons for body weight manipulation were predominantly appearance related, and 10-20% reported disordered eating behavior. Mean BAS-2 and EDI-BD were acceptable, but 28% of females were above clinical cutoff in EDI-BD, and mean DLS were high in both sexes. In total, 8% of females were above clinical cutoff in EDE-q, which corresponded well with the self-reported ED. Approximately 90% of the sample perceived BAP to be a societal issue and reported predominantly customers and colleagues to be the cause of their personal experience of BAP. Fewer than 50% knew of any actions taken by their employer to reduce BAP. There were few differences according to profession or educational level.

CONCLUSION

Fitness instructors report BAP to affect them negatively, which may put them at risk of impaired mental health. Educational level did not protect against figure idealization and BAP. To care for their employees and to optimize their position as a public health promoter, the fitness industry should target BAP in health promotion programs.

Difficulties in Emotion Regulation, Alexithymia, and Social Phobia Are Associated With Disordered Eating in Male and Female Undergraduate Athletes

Investigations of disordered eating in the athlete population tend to focus on females and the influence of sport level. This leaves unanswered whether, and how, team interdependence (i.e., whether the competition is engaged with one person or as a team) may differentially impact male athletes. In the present study, we recruited a sample of non-athletes, individual athletes, and team athletes and examined the interaction of gender and teammate interdependence on established psychosocial risk factors for disordered eating, including social phobia, alexithymia, and emotion regulation. Although we identified a significant main effect of gender, there was no main effect of team type, nor was there a significant interaction of gender and team type. Using descriptive discriminant analysis, these variables significantly discriminated between genders. Women were defined by higher scores than men on drive for thinness, body dissatisfaction, and emotion recognition and men were defined by relatively higher scores on emotion dysregulation and binge eating. When we combined all athletes and compared them with non-athletes, a significant interaction of gender and athlete status emerged such that female athletes, compared to male athletes and women non-athletes, were defined by higher scores on drive for thinness, emotion dysregulation, and binge eating. Conversely, male athletes, compared to female athletes, were defined by greater difficulty identifying feelings and body dissatisfaction. Non-athletes were not well defined by the discriminant function. These results highlight that emotional processes convey risk of eating disorders in men and women, particularly in athletes, and these risk factors are not uniform.

Assessing prevalence of urinary incontinence in Scottish fitness instructors and experience of teaching pelvic floor muscle exercises: an online survey

Background

The aim of this study was to assess the prevalence of urinary incontinence in fitness instructors, experience of teaching pelvic floor muscle exercises (PFME), and attitudes to incorporating such exercises into classes.

Method

An online survey was undertaken of fitness instructors working in Scotland based on the Urinary Incontinence Short Form (ICIQ-UI).

Results

The survey was at least partially completed by 106, of whom 73.6% (53/72) were female and 52.8% (38/72) were in the 35–54 years age group. Prevalence of UI was 28.2% (24/85), and severity based on ICIQ-UI scores was ‘slight’ 65.2% (15/23), or ‘moderate’ in 26.1% (6/23). Leakage of urine was associated with physical activity in 36% (9/25), of whom 31.8% (7/22) had not taken actions to reduce the impact, and 86.4% (19/22) had not sought professional advice or treatment. There was widespread willingness to incorporate PFME into classes if given appropriate training 86.1% (62/72), and 67.1% (49/73) would be happy to recommend a PFME app.

Conclusion

A significant proportion of fitness instructors are in need of PFME and those who perform PFME do so at a level below that which is recommended. However, many have had some training on PFME or are willing to provide this.

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

PURPOSE

Yoga has been increasingly used as a complementary therapy for eating disorders. However, it is still not clear whether yoga is effective in the prevention and treatment of eating disorders, as some studies suggest that yoga practitioners show elevated levels of disordered eating behaviours. The goal of this systematic review is, thus, to analyse the occurrence of disordered eating behaviours and correlates in yoga practitioners.

METHOD

PRISMA guidelines for systematic reviews were used. Search was conducted in several databases and specific journals.

RESULTS

Twelve articles, all cross-sectional, were identified, following PRISMA guidelines. Results across studies were inconsistent. Yoga practice was usually associated with healthier eating behaviours, lower disordered eating symptoms, and higher positive body image and body satisfaction, suggesting that yoga practitioners may be at a lower risk of developing eating disorders. However, other studies suggested that a high dosage of yoga practice may be associated with a higher prevalence of disordered eating behaviours.

CONCLUSIONS

As yoga is increasingly used as therapy for eating disorders, understanding the relationship between yoga dosage and disordered eating behaviours is critical to guide treatment recommendations and establish yoga as a valuable complementary therapy.

LEVEL OF EVIDENCE

Level I, systematic review.

Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes

Objectives

To explore associations betweenexercise dependence, eating disorder (ED) symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes.

Methods

Fifty-three healthy well-trained male cyclists, triathletes and long-distance runners recruited from regional competitive sports clubs were included in this cross-sectional study. The protocol comprised the Exercise Dependence Scale (EXDS), the ED Examination Questionnaire (EDE-Q), measurements of body composition, resting metabolic rate, energy intake and expenditure and blood analysis of hormones and glucose.

Results

Participants with higher EXDS score displayed a more negative energy balance compared with subjects with lower EXDS score (p<0.01). EXDS total score was positively correlated with EDE-Q global score (r=0.41, p<0.05) and the subscale score for restraint eating (r=0.34, p<0.05) and weight concern (r=0.35, p<0.05). EXDS total score and the subscales lack of control and tolerance were positively correlated with cortisol (r=0.38, p<0.01, r=0.39, p<0.01 and r=0.29, p<0.05, respectively). The EXDS subscales withdrawal and tolerance were negatively correlated with fasting blood glucose (r=-0.31 and r=-0.32, p<0.05, respectively), while intention effect was negatively correlated with testosterone:cortisol ratio (r=-0.29, p<0.05) and positively correlated with cortisol:insulin ratio (r=0.33, p<0.05).

Conclusion

In this sample of healthy male athletes, we found associations between higher EXDS scores, ED symptoms and biomarkers of RED-S, such as a more pronounced negative energy balance and higher cortisol levels.