[Em]power yoga: reclaiming our bodies through yoga and its potential role in eating and weight disorders

An essay by Dr Daniela Mercado Beivide (GLYS graduate, 2020)

Background

Yoga and mindfulness have been recognised by the clinical and scientific community as potential adjunct therapies for many mental health problems. Examples include eating and weight disorders (EDs) ranging from anorexia nervosa (AN), to obesity and binge eating disorder (BED).

AN is a psychiatric disorder recognised by extremely low body weight and fear of food/weight gain. On the other side of the weight spectrum, obesity and BED are characterised by a high body mass index (BMI) and impulsive overeating episodes. One of the traits AN and obesity/BED have in common is a disconnection with the body’s signals of its internal state. For example, people with AN tend to supress feelings of hunger and prefer to maintain a state of self-starvation, while people with obesity/BED can have large quantities of food without feeling physically hungry. It is suggested that the potential of yoga and mindfulness lies on improving the miscommunication between body and mind, consequently impacting eating behaviour.

Evidence of mindfulness meditation in eating and weight disorders

Several westernised versions of meditation have been created in order to legitimise ancient eastern philosophies and gain credibility amongst scientists. A specific example of these techniques targeting eating habits is the Mindfulness-Based Eating awareness Training (MB-EAT), which has shown some good results in reducing overeating episodes in people with obesity and BED. This intervention trains people to pay close attention to the whole process of eating, from smelling the food, to feeling the sensations of flavour. In essence, this approach aims to bring awareness back to the present moment and therefore “tune in” with the body. This, in turn, allows for the identification and disentanglement of hunger caused by an energy deficit, and emotional hunger caused by feelings of sadness, stress, anxiety, etc.

Neuroimaging studies suggest that after practicing mindfulness meditation techniques such as MB-EAT, there is increased activation in areas of the brain that inform us of the visceral state of the body (i.e. the insula) as well as areas related to self-control (i.e. the dorso-lateral prefrontal cortex, DLPFC). This translates into more awareness of signals of hunger/satiety and reduced impulsive or emotional eating.

In the case of AN, there is less evidence to support the potential clinical role of sitting meditation and mindfulness techniques, and in some cases, these techniques have shown to have anxiety-provoking effects. This could be in part because patients with AN tend to have high levels of anxiety and depression, which are typically accompanied by constant rumination thoughts (i.e. internal chatter). In theory, meditation can help to reduce rumination thoughts by reducing brain activity in the default mode network (DMN), which is the hub of mind wandering. However, it makes sense to infer that sitting still and listening closely to those self-destructing thoughts could be a source of anxiety in itself. Arguably, a potential better suited solution for people with AN (and people with anxiety and depression in general) could be applying the same principles but instead of sitting still, learning to train the mind while moving the body through a series of postures (aka yoga asana).

Yoga as a tool to still the mind

The physical aspect of yoga (i.e. asana) has been recognised for its effects in physical health more than in mental health. While it makes sense that moving through postures in sync with the breath would influence blood pressure and glucose levels, the fact that the whole purpose of yoga is to train the mind is sometimes forgotten. For people with AN, yoga asana could be a good and less stressful starting point to the yoga philosophy and stillness of the mind. The focus on breathing, bandhas, alignment and drishti, gives way to a moving meditation that temporarily (and with time) clears the mind from intrusive thoughts without having to focus on them. However, it is likely that for people with AN, practicing yoga could represent another way to perpetuate the disorder (i.e. by burning non-consumed calories) and the concept of tapas or discipline can disguise the obsessive nature of practicing yoga every day. Still, in the same way that yoga starts as a “workout” for some people, it is possible that for people with eating disorders, yoga can become a tool to silence the judgmental voice and to accept and respect their bodies rather than wanting to change them. At the same time, realising what the body can do when it is not limited by the mind, can empower people to challenge what they thought they were capable of, including changing maladaptive behaviours that contribute to the persistence of their disorder.

However, caution must be taken when considering yoga as standalone therapy to treat mental health problems like EDs. While it can be a strong technique to change maladaptive behaviour, in most cases it is still necessary to seek professional help. A holistic treatment approach including gold standard treatments like cognitive behavioural therapy (CBT) in conjunction with yoga, holds the promise of better and more sustained clinical effects.

Conclusion

Mindfulness and yoga hold the potential to help people with EDs to reconnect with their bodies and to listen to what the body needs. As a starting point, different approaches might be more suitable for people with different psychopathology. While sitting in silent meditation could work for some, moving the body can be more approachable for others.

Ultimately, practicing mindfulness through either sitting or moving meditation (or both), allows us to pay attention to the fluctuations of the mind and to recognise thoughts as products of consciousness rather than identifying with them. This skill for people with eating and weight disorders can be a powerful tool to help change the way they relate to food and their body, as well as letting go of the ingrained cognitions and behaviours that constitute disordered eating.