Q&A: Yoga: Useful in Treatment for Eating Disorders?

Q. I’ve read many articles about the benefits of moderate and supervised exercise for patients with eating disorders. One of my patients, who has a history of bulimia nervosa (BN), has asked about joining a local yoga class that meets once a week. I haven’t seen much in the literature on this topic. Can you help? (SLW, Houston)

A. It is true that little has been written about yoga and its effect on treatment of patients with eating disorders. In a recently published study (Complement Ther Med. 2019; 42:145), T. Ostermann and colleagues reported good results in their case report of a 38-year-old female patient with anorexia nervosa and several psychosomatic diagnoses in her medical history. The patient reported that yoga “recovered the soul contact” she had lost and as a result of yoga classes she found access to her body and it needs and also helped her deal with her traumatic experiences. She also had changes in her attitude in relation to her stomach during treatment for her anorexia.  The authors feel the report confirms the positive effect yoga can have in the treatment of eating disorders.  They also suggest that it is important to take into consideration the influence of an individual patient’s  co-morbidities, which usually occur with eating disorders.

An earlier study explored the effects of yoga sessions provided in a 16-bed residential eating disorders facility (Eat Disord.2017; 25:37). In this study by C.R. Packanowski, of the University of Delaware et al., 20 of the 38 individuals in the study received 1 hour of yoga before dinner for 5 days. Therapeutic yoga classes were taught for 1 hour during the 5-day intervention period immediately before dinner by eating disorder sensitive, trained yoga teachers. The training for this sequence occurred at 3 levels: in person group instruction, a recorded version of selected postures for reference, and a typed sequence. Each class began with a standing start, to meet clients at a heightened anxiety state and then began to reduce this state with succeeding postures. The postures varied, depending on the size of the class and emotional issues that arose during the class, for example.

Dr. Packanowski and colleagues reported that residential clients with eating disorders showed significantly lower negative affect before dinner when taking a yoga class designed to target eating disorder symptoms compared to a group that received usual care (n=18). The findings were particularly marked, according to the authors because the clients only participated in 5 one-hour yoga classes. Greater negative mood is related to poorer eating disorder symptoms at meals, as shown by Ranzenhofer et al. (Appetite. 2013;68:30), and Steinglass et al. (Appetite. 2010;55:244).

These results suggest that your patient might benefit from participation in a yoga class, although the yoga in these reports may not be representative of all yoga classes. More research will undoubtedly bring us more information on this promising addition to treatment for eating disorders. (Also see the article, “Is Yoga Beneficial for Eating Disorders Patients?” elsewhere in this issue.)

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