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Yoga as a treatment for binge eating disorder: A preliminary study

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Abstract

To examine the efficacy of a 12-week yoga program aimed at reducing binge eating severity. A randomised trial was undertaken assigning participants to yoga (n=45) or wait-list control (n=45) groups. Of these, 25 in each group were analysed. A community-based sample of women between 25 and 63 years of age who identified with diagnostic criteria for binge eating disorder (BED) and a BMI>25 were recruited for the study. Primary outcomes included the Binge Eating Scale (BES) and International Physical Activity Questionnaire (IPAQ). Secondary outcomes comprised measures for BMI, hips and waist. For the yoga group, self-reported reductions in binge eating and increases in physical activity were statistically significant. Small yet statistically significant reductions for BMI, hips and waist measurement were obtained. The wait-list control group did not improve significantly on any measures. In conjunction with formal weekly sessions, home-based yoga programs are potentially efficacious for the treatment of binge eating.

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... The QEWP has been shown to work best when used for the screening of BED, with interviews used to confirm the disorder (Yanovski, Marcus, Wadden, & Walsh, 2015). Binge eating severity can also be assessed using the Binge Eating Scale (BES), a valid and reliable self-reported measure of assessment (Mclver, Halloran, & McGartland, 2009) . Total BES scores above 27 indicate a serious binge eating problem, while scores between 18-26 indicate a moderate binge eating problem, and scores below 17 indicate the absence of a binge eating problem (Mclver et al., 2009). ...
... Binge eating severity can also be assessed using the Binge Eating Scale (BES), a valid and reliable self-reported measure of assessment (Mclver, Halloran, & McGartland, 2009) . Total BES scores above 27 indicate a serious binge eating problem, while scores between 18-26 indicate a moderate binge eating problem, and scores below 17 indicate the absence of a binge eating problem (Mclver et al., 2009). There are also clinical ways to assess and diagnose BED including physical exams and interviews with questions related to BED characteristics described in the DSM-5 (Gluck et al., 2004). ...
... With stress being the most commonly reported trigger of binge eating, and evidence correlating high cortisol levels with abdominal fat and food intake after laboratory stress, researchers are spending valuable time and resources analyzing how mindfulness interventions can effect behaviors associated with binge eating disorder (Gluck et al., 2004). Mclver, Halloran, and McGartland (2009) completed a randomized trial with ninety women measuring the effects of a 12-week yoga program on reducing binge eating severity (Mclver et al., 2009). For this study, yoga was defined in a broad definition that included all major approaches and paths reflecting the pedagogical framework of yoga provided by Gowans (Mclver et al., 2009). ...
Article
This literature review examines the impact of various mindfulness-based interventions (MBIs) on the obesity-related eating behaviors of stress eating, emotional eating, and binge eating. With the inconsistency of the weight loss industry to provide long-term weight loss results, the United States is in need of alternative methods of weight loss and weight maintenance to combat the current overweight and obesity epidemic. MBIs are thought to be beneficial when targeted at behaviors of weight gain because mindfulness promotes an individual’s awareness of present physical and emotional sensations within the body, including hunger and satiety cues. Self-acceptance and stress reduction are also targeted outcomes of mindfulness and are linked to the benefits of MBIs on obesity-related eating behaviors. Results show that MBIs may be beneficial to improving the targeted eating behaviors which have been linked to weight gain. However, when weight change is the goal, MBIs have been shown to be most effective when used in conjunction with other weight loss methods such as dietary and physical activity and education modifications. To date, studies are few and contain a variety of definitions for both eating behaviors and MBIs. Future research with a narrowed scope of view and greater variation within the study populations will be beneficial. Although more research is needed, current evidence exists to support the use of MBIs to reduce the frequency and severity of stress eating, emotional eating, and binge eating.
... Uno de los posibles motivos es la práctica disfuncional o compensatoria de EF en BN, causada por la necesidad de controlar el peso corporal (32) que afecta al 20-40% de personas con BN (33). Los estudios existentes sobre el EF como tratamiento complementario para los TCA son escasos (27,34), donde se observa que se utiliza una combinación de entrenamientos aeróbicos y de fuerza para obtener beneficios sobre la condición física y la salud (35,37). Además, la AF no sólo reduce los episodios de atracón, sino que puede suponer una reducción de peso (26), y una mejora en los sentimientos de autopercepción (38). ...
... Además, la AF no sólo reduce los episodios de atracón, sino que puede suponer una reducción de peso (26), y una mejora en los sentimientos de autopercepción (38). Por tanto, actividades como el yoga o el pilates, que conectan el cuerpo, la respiración y la mente, pueden mejorar la salud general (35). Siendo, fundamentales para tratar los TCA. ...
... Resulta relevante que tan solo en el estudio de Mathisen et al., (46), se valoró el deterioro clínico (CIA 3.0), los síntomas de depresión (Inventario de depresión de Beck "BDI-Ia), y la calidad de vida (Escala de la Satisfacción de vida "SWLS"). En la literatura científica, existen diferentes documentos relacionados con ejercicios para combatir la depresión y la ansiedad (35,52), siendo dos de las comorbilidades más habituales entre las personas con TCA. Para ello, es fundamental las actitudes positivas hacia la práctica físico-deportiva en personas con TCA (53). ...
Article
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Eating Disorders (ED) are a severe mental illness that causes physical and psychosocial problems. This illness has a higher prevalence among young women, and between athletes. cognitive behavioural therapy (CBT) is the current treatment for this type of disorder. However, more and more programs are including physical exercise (PE) and nutritional therapy (TN) for eating disorders treatment. Objective. To carry out an exploratory systematic review of the literature that allows us to know the current state of intervention programs through physical exercise and nutritional therapy for the treatment of eating disorders. Materials and methods. For the reference search thesame search phrase was used. The terms were entered in English in the following computerized databases: SCOPUS, Web of Science, and PubMed. To limit the search, four inclusion criteria were introduced. Results. The review included five scientific articles related to the study topic, which met the inclusion criteria. Conclusion. Intervention programs for the treatment of eating disorders that include physical exercise and nutritional therapy are shown as an alternative or complementary tool to conventional therapy. These programs involve a reduction in the severity of ED symptoms and an improvement in anthropometric parameters and physical condition. More studies that combine PE and TN programs for people with ED are required.
... Characteristics of the sample, interventions, and outcome assessment are shown in Table 1 and 2. Eight of the included studies were randomized controlled trials, [65][66][67] and four were uncontrolled trials. 68,69 Of the twelve studies that were included, eight originated from the USA, 65,67-72 one from Norway, 73 one from India, 74 one from Tunisia, 75 and one from Australia. ...
... 68,69 Of the twelve studies that were included, eight originated from the USA, 65,67-72 one from Norway, 73 one from India, 74 one from Tunisia, 75 and one from Australia. 66 The studies included a total of 495 participants; sample sizes ranged from 8 to 113 with a median sample size of 31. Participants in eight studies were diagnosed with eating disorders including binge eating disorder, 66 anorexia nervosa, 65,69 bulimia nervosa 65,69 , eating disorders not otherwise specified, 65 or any eating disorder. ...
... 66 The studies included a total of 495 participants; sample sizes ranged from 8 to 113 with a median sample size of 31. Participants in eight studies were diagnosed with eating disorders including binge eating disorder, 66 anorexia nervosa, 65,69 bulimia nervosa 65,69 , eating disorders not otherwise specified, 65 or any eating disorder. 68 The remaining study involved participants with disordered eating and/or body dissatisfaction but without a formal diagnosis of an eating disorder. ...
Article
Background: The question of whether yoga practice ameliorates or even aggravates eating disorders is currently under debate. The aim of this review was to systematically assess and the effectiveness and safety of yoga in patients with eating disorders. Methods: Medline/PubMed, PsycINFO, and the Psychological and Behavioral Science Collection were screened through July 2018 for randomized controlled trials, non-randomized controlled trials and longitudinal observational studies on yoga for patients with eating disorders and other individuals with disordered eating and/or body dissatisfaction. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Scale. Results: Eight randomized trials and four uncontrolled trials involving a total of 495 participants were included. Risk of bias was mixed. Comparing yoga to untreated control groups, effect sizes ranged from negligible effects of d = 0.02 to very large effects of d = 2.15. However, most effects were small to moderately sized and in most cases not significant. No safety-related data were reported. Conclusions: There is limited evidence on the effectiveness and safety of yoga in patients with eating disorders. Yoga can be preliminarily considered as an additional treatment option in multimodal psychiatric treatment programs.
... The criteria for exclusion were:  studies other than Randomized Controlled Trial  multiple interventions given simultaneously to study group 339  control groups receiving some other intervention Finally 15 articles were eligible to be included for review. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Data was extracted from the selected articles and sorted according to outcomes studied and arranged in tables in chronological sequence. Though inclusion criteria were kept as publications in past 50 years, only 2 studies published in the last millennium were eligible to be included. ...
... They have also shown significant reduction of eating disorder and Binge Eating Disorder. 8,[10][11][12][13] (Table 2) Following courses of yoga and meditation reduction in outcomes under study viz. alcohol use, craving for alcohol and dependence on alcohol, was reported. ...
... However, there was no difference between the two groups in overall weight and abdominal fat/trunk-leg fat ratio as reported by one researcher. 10,12,18 (Table 4) Potentially relevant articles identified, on the basis of Inclusion Criteria:- ...
... Of the eight selected studies, five were intervention studies and three were observational studies. Five of the studies originated from the USA [40,42,[44][45][46], two were from Australia [41,43], and one was from Switzerland [39]. The duration of the RCTs' intervention and follow-up periods varied from 12 weeks to 16 months. ...
... Lastly, Pendleton et al. [43] recommended performing aerobic exercises such as brisk walking at home three times a week and adding self-monitoring with the possibility of gym training. Furthermore, the study conducted by McIver et al. [41] had an intervention that included 1 h of yoga once a week and a recommendation to engage in a daily 30-min session of home-based practice. ...
... The risk of bias assessment made on the five RCT studies (Fig. 2a) revealed that three studies had insufficient information to permit judgment of low or high risk for the random sequence generation and allocation concealment [39,42,43]. The other two studies were judged as high risk of bias for having explicitly unconcealed procedures for allocation [40,41]. Only two studies were classified as a high risk of bias for having no reason for missing outcome data likely to be related to true outcomes, with an unbalance in numbers [41,42] and one for selective reporting because of a lack of analysis in the control group compared to the intervention group [42]. ...
Article
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Purpose of review: Our systematic review aims to assess the overall evidence available in the literature regarding the role of physical activity (PA) in individuals with binge eating disorder (BED) and better understand the potential underlying mechanisms of action. Recent findings: Currently, the most effective and well-established psychological treatment for BED is cognitive behavioral therapy (CBT) with a remission rate around 80%. CBT is sometimes combined with pharmacotherapy targeting comorbidities associated with BED, such as obesity and depression. Another avenue of treatment that has been less studied is PA. It has been suggested that PA addresses the underlying mechanisms of BED and, thus, increases treatment efficiency. This systematic review provides additional knowledge concerning the benefits of PA in the treatment of individuals with BED including reduction of binge eating (BE) episodes and improvement in other associated comorbidities. Potential mechanisms of action of PA include neurochemical alterations affecting the reward system, reduction of negative affect, and its anorexigenic effects.
... More recently, adolescent females from an eating disorder clinic participated in six to 12 weekly Yoga classes, and experienced decreases in anxiety, depression, and body image disturbance (Hall, Ofei-Tenkorang, Machan, & Gordon, 2016). McIver, O'Halloran, and McGartland (2009) conducted one of the first RCTs in which they compared the effects of a 12-week Yoga program to a waitlist control amongst 50 women self-identifying with a binge eating problem. Compared to waitlist controls, Yoga participants experienced decreased binge eating frequency that was maintained at a three-month follow-up. ...
... This finding is consistent with the conclusions of two meta-analyses investigating the use of mindfulnessbased interventions in the treatment of binge eating (Godfrey, Gallo, & Afari, 2015;Katterman, Kleinman, Hood, Nackers, & Corsica, 2014). The decrease in binge eating episodes experienced by the Yoga participants is also consistent with existing research exploring the use of Yoga in the treatment of BED (Clarke, 2008) and women reporting problematic binge eating behavior (McIver et al., 2009). It is important to note that similar to the present study, the Clarke (2008) and McIver et al. (2009) studies did not involve an active control condition. ...
Article
Yoga has begun to be incorporated into the treatment of eating disorders despite limited empirical support for this practice. The purpose of this study was to investigate the efficacy of incorporating Yoga into the treatment of eating disorders. This preliminary randomized controlled trial investigated the benefits of participating in an eight-week Kripalu Yoga program for 53 women with symptoms of bulimia nervosa and binge eating disorder. Compared to waitlist controls, Yoga participants experienced decreases in binge eating frequency, emotional regulation difficulties and self-criticism, and increases in self-compassion. Yoga participants also experienced increases in state mindfulness skills across the eight weeks of the Yoga program. While these results are encouraging and suggest Yoga may have a valuable role to play in the treatment of eating disorders, it is important to stress their tentative nature. Further research, adopting a more rigorous design, is needed to address the limitations of the present study and expand on these findings.
... Nevertheless, the time is ripe for partnering with body-positive yoga professionals making inroads in inspiring individuals of diverse body sizes and shapes to come to the practice (Pickett & Cunningham, 2017). Further, it is critical to expand the limited corpus of yoga scholarship focused on strengthening the experiences of positive embodiment and adaptive eating behavior among higher-weight individuals (McIver et al., 2009a(McIver et al., , 2009bNeumark-Sztainer et al., 2018;Webb et al., 2018a). ...
... tional quality of food choices(McIver, McGartland, & O'Halloran, 2009a;McIver, O'Halloran, & McGartland, 2009b;Neumark-Sztainer et al., 2018; Webb, Padro, Rogers, Vinoski, Etzel, & Putz, 2018a).In this context, those trailblazers at the forefront of the grassroots sizeinclusive yoga movement have strategically infiltrated alternative spaces such as books (e.g., Mega Yoga;Garcia, 2006; Yes! Yoga Has Curves: Volumes 1 and 2:;Smith, 2014Smith, , 2016 Curvy Yoga: Guest-Jelley, 2017; Every Body Yoga: Stanley, 2017; Fat Yoga: Harry, 2017), popular social media platforms (e.g., Instagram:Stanley, 2018;Webb et al., 2018b;Webb, Vinoski, Bonar, Davies, & Etzel, 2017c) ...
Article
In the 21st 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.
... It is promising to see that young adults who have body image concerns and engage in disordered eating behaviors are choosing to practice yoga, given the underlying tenets of yoga, in addition to research findings suggesting that yoga may be helpful in terms of promoting a stronger sense of self and positive embodiment (22,39,64). Furthermore, some longitudinal and intervention studies have suggested that yoga may be effective in improving body image and disordered eating behaviors (37,38,60,61,65,66). Although findings do not consistently show the benefits of yoga (30, 31), we are not aware of research findings showing that yoga can be harmful in terms of worsening these outcomes. ...
... In prior qualitative research, young adults practicing yoga discussed how yoga helped with increased awareness of their bodies' needs, the selection of more nourishing foods, attentiveness to internal signs of hunger or fullness, and greater presence while eating (46). A randomized, controlled trial examining the impact of yoga among adults engaging in binge eating (65) found that yoga was associated with decreased binge eating. Likewise, qualitative interviews with study participants indicated perceived improvements in eating behaviors, including greater presence and mindfulness while eating (67). ...
Article
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.
... It is promising to see that young adults engaging in disordered eating behaviors are choosing to practice yoga, given the underlying tenets of yoga, in addition to research ndings suggesting that yoga may be helpful in terms of promoting a stronger sense of self and positive embodiment (17,39,60). Furthermore, some longitudinal and intervention studies have suggested that yoga may be effective in improving body image and disordered eating behaviors (37,38,57,58,61,62). Although ndings do not consistently show the bene ts of yoga (30, 31), we are not aware of research ndings showing that yoga can be harmful in terms of worsening these health outcomes. ...
... In prior qualitative research, young adults practicing yoga discussed how yoga helped with increased awareness of their bodies' needs, the selection of more nourishing foods, attentiveness to internal signs of hunger or fullness, and greater presence while eating (63). A randomized, controlled trial examining the impact of yoga among adults engaging in binge eating (61), found that yoga was associated with decreased binge eating. Likewise, qualitative interviews with study participants indicated perceived improvements in eating behaviors, including greater presence and mindfulness while eating (64). ...
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Background: Yoga may be beneficial for young people at risk for body dissatisfaction and unhealthy behaviors aimed at changing one’s body shape and size. This study explores associations between yoga practice and body image, mindful eating, disordered eating, and muscle-enhancing behaviors among a population-based sample of emerging adults from diverse socio-economic and ethnic/racial backgrounds. Methods: Survey data were collected from 1,568 ethnically/racially diverse emerging adults (18-26 years) as part of the EAT 2010-2018 study (Eating and Activity over Time). Results: Practicing yoga at least 30 minutes/week was reported by 12.7% (n=210) of the sample. In models adjusted for sociodemographic characteristics, yoga practitioners had higher levels of mindful eating and body satisfaction than non-practitioners. Of concern, yoga practitioners were more likely to use steroids to enhance the size or tone of their muscles than those not practicing yoga (4.2% vs. 0.8%, p<.001). Furthermore, 35.4% of yoga practitioners used protein powder or shakes in the past year as compared to 25.0% of those not practicing yoga (p=.005). Yoga practitioners had similar levels of unhealthy weight control behaviors and binge eating to those not practicing yoga. Associations between yoga practice and body satisfaction, mindful eating, disordered eating, and muscle-enhancing behaviors were similar across ethnic/racial groups. Conclusions: In order to promote yoga among diverse populations, and enhance its safety and benefits for weight-related health, it is crucial for settings in which yoga is offered, and yoga teachers, to have awareness of the high prevalence of concerning disordered eating and muscle-enhancing behaviors among students and to address accordingly.
... 12 Preliminary clinical trials have demonstrated a positive influence of yoga interventions on symptoms of eating disorders, including reduced symptoms of eating disorders and increased body satisfaction. [13][14][15][16][17][18][19] An early systematic review reported decreased risk for eating disorders and related symptoms after yoga interventions. 10 This was corroborated by a recent meta-analysis that demonstrated reduced drive for thinness as well as body dissatisfaction in patients with eating disorders after yoga interventions. ...
... Prior clinical trials have shown that yoga can reduce drive for thinness, body dissatisfaction and symptoms of eating disorders and increase body satisfaction. 10,[13][14][15][16][17][18][19][20] This is in line with trials on other mind-body medical intervention such as mindfulness that also can positively influence eating disorders. [29][30][31][32] At the same time more effects of yoga on the symptoms of eating disorders are revealed, including reduced of the excessive movement urge or the development of the ability to perceive and allow emotions. ...
Article
Eating disorders are among the most common psychosomatic diseases and are often associated with negative health consequences. The use of yoga as a treatment method in eating disorders is controversial discussed. The interviewee was a 38 year old female patient suffering on anorexia nervosa and various psychosomatic-psychiatric diagnoses in her medical history. The patient reported that yoga recovered the soul contact which she lost and she had learned to perceive and feel herself again. She stated that yoga helped her to find access to her body and its needs and to cope with her traumatic experiences. She also reported that attitudes have changed in relation to her stomach in the treatment of her anorexia. The case report confirmed the positive effect of yoga on eating disorders. Research should pay particular attention to taking into account the influence of individual's co-morbidities, as eating disorders usually occur in association with co-morbidities.
... According to previous studies, individuals with higher Body Mass Index (BMI) present less mindfulness than those who practice yoga and meditation. Besides, mindful eating is strongly associated with yoga and exercise [38][39][40]. ...
... The results highlighted that practicing yoga and meditation, which include components of mindfulness, constructively impact reducing fatigue, increasing body awareness, and managing patients' stress [8]. It can also be associated with lower BMI [38][39][40]. ...
Article
Full-text available
Background: Wrong eating behaviors increase the risk of numerous chronic diseases. This study aims to determine the validity and reliability of the Mindful Eating Questionnaire (MEQ) in the Iranian population. Methods: In a validation study at the University of Guilan City, Iran, in 2019-2020. First, the MEQ was translated based on the forward-backward method. After applying the changes to the Persian version of MEQ (P-MEQ), 50 participants responded to the P-MEQ twice with an interval of 3 weeks. Then, 384 Iranian students selected by the two-stage cluster sampling method completed the P-MEQ to determine its construct validity. Sixty participants simultaneously filled the P-MEQ and the Freiburg Mindfulness Inventory (FMI-SF) to determine concurrent validity. To determine known-group validity, 23 very obese participants and a Body Mass Index (BMI) [W1] of over 35 kg/m2 were compared to individuals with a healthy weight (BMI: 18.5-24.9 kg/m2. Results: The test-retest reliability of the P-MEQ was obtained as 0.59 for the total score, and it ranged from 0.58 to 0.79 for the subscales. The first-order confirmatory factor analysis (CFA) results indicated that after removing four items with weak factor loading, the five-factor P-MEQ model had appropriate goodness of fit (χ2/df=2.516, RMSEA=0.067, AGFI=0.835, IFI=0.924, & CFI=0.916). The second-order CFA revealed that the latent components of awareness, distraction, disinhibition, emotional response, and external cues reflected the concept of higher levels of mindful eating acceptably (χ2/df=2.545, RMSEA=0.067, AGFI=0.825, IFI=0.912, ‌& CFI=0.905). However, there was a poor relationship between the total score of P-MEQ and FMI-SF (r=0.24, P=0.07). Conclusion: Regardless of concurrent validity, the Persian version of MEQ has proper construct validity, test-retest reliability, and internal consistency.
... Scalable, effective evidencebased body image interventions that are remotely delivered are particularly needed during the era of the COVID-19 pandemic and beyond. Extending previous lines of theory and research [e.g., (28,35,(42)(43)(44), the present study aimed to evaluate the feasibility, acceptability and preliminary efficacy among completers (i.e., per-protocol analysis) of this integrative online mind-body program in a sample of ethnically-diverse college women of higher weight. We prioritized a per-protocol analysis for this early phase evaluation of efficacy given the anticipated moderately high attrition (71), that the project was not specifically powered to detect specific effects apriori, and given the more real-world considerations of self-selection for remaining engaged in a low-intensity, web-based self-help intervention (77). ...
... First, limited yoga intervention research has specifically targeted the inclusion of higher weight college women who may feel stigmatized and alienated in practicing yoga in conventional mainstream wellness spaces (44,60). Our study expands upon the work of McIver and colleagues from a more weight-neutral perspective that does not center eating pathology and weight management as a major emphasis (42). Notably, in support of their earlier efforts, we found that our brief online intervention yielded benefits for strengthening participants' orientation towards physical activity more broadly and in particular a more positive and empowered connection to one's experience of the physical body (43). ...
Article
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The present pilot randomized controlled trial (RCT) evaluated the feasibility, acceptability, and preliminary efficacy of a 4-week online yoga and body gratitude journaling intervention for strengthening positive embodiment among racially-diverse higher weight college women. Seventy-five participants were initially randomized to either the yoga condition (n = 36) or to a wait-list control (n = 39). Participants completed measures of positive and negative body image, weight bias internalization, self-compassion, drive for leanness, and physical activity acceptance at both baseline and post. Preliminary results among the 42 analyzed completers (mean age = 20.9, SD = 2.4; 30% Black or African American) revealed acceptable feasibility given the low-intensity nature of the intervention reflected in a 36% attrition rate. Self-reported adherence was strong for the yoga component with 81% of participants indicating that they practiced with the videos > 3-4 times per week as suggested. Although 71% reported completing the body gratitude journal > 1-2 times per week, daily adherence was minimal. Acceptability was also high among participants randomized to the yoga condition as indicated by 86% expressing at least moderate levels of satisfaction with the overall program. Qualitative feedback from participants further supported the acceptability of the program and pointed to important areas in further refining the protocol in the future. Preliminary efficacy was supported by significant reductions in internal body shame and gains in body appreciation, functional body appreciation, functional body satisfaction, functional body awareness, and behavioral commitment to physical activity engagement among the yoga versus wait-list control participants. These promising findings once replicated in larger, higher-powered trials may have important implications for extending the reach and accessibility of mind-body wellness practices like yoga to benefit racially-/ethnically-diverse college women of higher weight. This research is further responsive to the growing need for efficacious remotely-delivered, and scalable behavioral health interventions in the ongoing era of the COVID-19 pandemic. However, additional research is warranted to explore ways of enhancing engagement of participants with lower levels of positive embodiment and to further incentivize the journaling component of the intervention.
... According to previous studies, individuals with higher Body Mass Index (BMI) present less mindfulness than those who practice yoga and meditation. Besides, mindful eating is strongly associated with yoga and exercise [38][39][40]. ...
... The results highlighted that practicing yoga and meditation, which include components of mindfulness, constructively impact reducing fatigue, increasing body awareness, and managing patients' stress [8]. It can also be associated with lower BMI [38][39][40]. ...
Article
Full-text available
Background: Wrong eating behaviors increase the risk of numerous chronic diseases. Objectives: This study aims to determine the validity and reliability of the Mindful Eating Questionnaire (MEQ) in the Iranian population. Materials & Methods: In a validation study at the University of Guilan City, Iran, in 2019-2020. First, the MEQ was translated based on the forward-backward method. After applying the changes to the Persian version of MEQ (P-MEQ), 50 participants responded to the P-MEQ twice with an interval of 3 weeks. Then, 384 Iranian students selected by the two-stage cluster sampling method completed the P-MEQ to determine its construct validity. Sixty participants simultaneously filled the P-MEQ and the Freiburg Mindfulness Inventory (FMI-SF) to determine concurrent validity. To determine known-group validity, 23 very obese participants and a Body Mass Index (BMI) of over 35 kg/m2 were compared to individuals with a healthy weight (BMI: 18.5-24.9 kg/m2). Results: The test-retest reliability of the P-MEQ was obtained as 0.59 for the total score, and it ranged from 0.58 to 0.79 for the subscales. The first-order Confirmatory Factor Analysis (CFA) results indicated that after removing four items with weak factor loading, the five-factor P-MEQ model had appropriate goodness of fit (χ2/df=2.516, RMSEA=0.067, AGFI=0.835, IFI=0.924, & CFI=0.916). The second-order CFA revealed that the latent components of awareness, distraction, disinhibition, emotional response, and external cues reflected the concept of higher levels of mindful eating acceptably (χ2/df=2.545, RMSEA=0.067, AGFI=0.825, IFI=0.912, & CFI=0.905). However, there was a poor relationship between the total score of P-MEQ and FMI-SF (r=0.24, P=0.07). Conclusion: Regardless of concurrent validity, the Persian version of MEQ has proper construct validity, test-retest reliability, and internal consistency.
... The fourth was excluded as it assessed the effect of yoga, rather than a mindfulnessspecific intervention on PA 106 Firstly, in terms of study quality, 18 studies (45%) were considered "weak"; ...
Article
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Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness‐based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines to investigate the evidence for the potential of mindfulness‐based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross‐sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness–physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness‐based interventions (n = 20) suggested positive between‐subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow‐up. Mindfulness‐based interventions were more likely to be successful if they were physical activity‐specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness–physical activity relationship reliably.
... [1] Body unawareness can lead to the development of body dissatisfaction, the highest and most robust risk factor related to ED, and therefore, the promotion of body awareness is of particular importance in therapy. [2] Yoga cultivates a direct experience of the body, which may be particularly effective in increasing body awareness to counteract body dissatisfaction and development of ED. [3,4,5] Encouraging evidence has emerged regarding the therapeutic potential of yoga in ED treatment [6,7,8] by reducing binge eating and food preoccupation, increasing awareness of binge eating triggers, and using of yoga techniques as an affect regulator. ...
Article
Aim of the study: The aim of this study is to examine the effect of yoga treatment of eating disorders (EDs). Methods: Adult females meeting the Diagnostic and Statistical Manual-IV criteria for bulimia nervosa or ED not otherwise specified (n = 30) were randomized to 11-week yoga intervention group (2 × 90 min/week) or a control group. Outcome measures, the Eating Disorder Examination (EDE)-Interview and Eating Disorders Inventory-2 (EDI-2) scores, were administered at baseline, posttest, and at 6-month follow-up. There was a dropout rate of 30% (posttest) and 37% (6-month follow-up). Results: The intervention group showed reductions in EDE global score (P < 0.01), the EDE subscale restraint (P < 0.05), and eating concern (P < 0.01) compared to the control group. The differences between the groups increased at 6-month follow-up. There were no differences between the groups in the EDI-2 score. Conclusion: The results indicate that yoga could be effective in the treatment of ED.
... A systematic review study on the effectiveness of yoga exercises on eating disorders confirmed the positive effects of yoga, and although these effects were small, yoga did not seem to harm patients with eating disorders (38). Another study on BED and yoga showed that weekly yoga exercises at home are very effective in the treatment BED (39). ...
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Background: Eating disorders are one of the most common psychological/psychosomatic disorders that cause many problems for physical health, mental functioning and quality of life. Eating disorder is identified by severe chaotic eating behaviors and includes anorexia nervosa and bulimia nervosa. The use of complementary medicine, such as yoga, has always been of interest to researchers in clinical sciences and has been proposed as a new approach to the treatment of eating disorders. Yoga essentially means connectivity and continuity. Through mind- and body-based techniques, yoga can be effective in the achievement of therapy goals in feeding and eating patients. Methods: The data for the present review study was collected through a search in electronic resources and databases as well as manual search of library resources. The search for relevant articles and studies was performed on the internet in relevant websites and scientific/research journals using a number of keywords. This study will address yoga therapy and its relationship with and effects on eating disorders after a review of the definition, classification, epidemiology and pathophysiology of different types of eating disorders. Results: The results showed that eating disorders are caused by emotional disorders and stress and, essentially, by subjective factors. Many people achieve relaxation and body, soul and mind balance with yoga. This practice makes it more possible to fight eating disorders. Conclusion: Yoga creates self-confidence and a positive feeling about one’s body and appearance. Yoga has a holistic attitude toward human-beings and provides different, continuous and simple techniques for humans’ health, development, preparation and balance and is thus effective in improving nutrition and eating disorders.
... We also gradually introduced physical activity goals, as physical activity has been shown to reduce binge episodes (Moulton, 1996;Pendleton, Goodrick, Poston, Reeves, & Foreyt, 2002) and encourage weight loss (Fossati et al., 2004;McIver, O'Halloran, & McGartland, 2009;Moulton, 1996;Pendleton et al., 2002). In keeping with these findings, as well as standard recommendations for physical activity in BWL interventions (Brownell, 2000; D. P. P. R. Group, 2002; L. A. R. Group, 2006), we gave participants information about the benefits of exercise and advised them to progressively increase their exercise throughout treatment, with the ultimate aim to engage in moderate to vigorous physical activity 5 days per week for 50 minutes per day (Jakicic, Winters, Lang, & Wing, 1999;Jeffery, Wing, Thorson, & Burton, 1998). ...
Article
Binge eating (BE; i.e., the consumption of a large amount of food in a discrete time period, accompanied by a sense of loss of control) is highly comorbid with overweight or obesity and is the primary symptom of binge eating disorder (BED). Current gold-standard treatment for BED (i.e., CBT) does not produce meaningful weight loss, thus failing to address a critical treatment target. This article describes the development of a novel acceptance-based behavioral treatment (ABBT) for individuals with clinically significant BE desiring to reduce BE symptoms and achieve concurrent weight loss. We discuss the development and structure of the novel treatment approach, and describe the test of a proof of concept version of the treatment in a clinical case series of four individuals. In the context of each clinical case description, we present initial acceptability of the treatment and challenges faced in treatment development and delivery. Finally, we discuss future research directions for the treatment, which could improve BE symptoms and weight loss outcomes for individuals with BE pathology.
... For instance, a study where yoga was practiced at a small dosage (45 min per week for 6 weeks) had no significant effects on eating disorder symptomatology [40]. Interventions that offered higher yoga dosages (60 min per week for 12 weeks: [41]; 2 h per week for 8 weeks: [42]; 60-90 min per week for 12 weeks: [43]) yielded positive results in decreasing disordered eating symptomatology or increasing positive body image. ...
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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.
... Inclusive Criteria  All participants should be adolescent girls i.e. age group [11][12][13][14][15][16][17][18][19] year  Girls with the symptoms of eating disorder Exclusive criteria  Girls above the age group of 20 years cannot participate in this study  Girls with severe psychological problem cannot participate ...
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Background: Eating disorder is very common among western countries but now-a-days it is introducing in India too due to the effect of globalization, Media, Magazine and tendency to have a perfect body shape which results in different health hazards. Aims: To examine the effect of yogic practises on eating disorder cognitions among adolescent girls in India. Method: All subjects (11 to 19 years) were taken from Tata Nagar (Jharkhand). Firstly 120 subjects selected for the study from 1056 subjects. Randomly they were divided into two groups, 40 subjects for control group and 80 subjects for experimental group. During yogic intervention most of subjects left the group for their personal reason. Lastly the experiment carried out on 40 subjects. Results: Significant effects of yogic practises on experimental group were found and no effect was found on the subjects who belonged to control group. Conclusions: These finding demonstrated that the effect of yoga has a positive impact on eating disorder cognitions among adolescent girls in India.
... Yoga has been incorporated as an adjunct to treatment for many psychological (Büssing, Michalsen, Khalsa, Telles, & Sherman, 2012) and physiological concerns (Banerjee et al., 2007;Field, 2011;Park, Braun, & Siegel, 2015), and is one of the most popular complementary medicine practices in the United States. Notably, yoga has also been incorporated as part of eating disorder (ED) treatment (Frisch, Herzog, & Franko, 2006) and empirical support for the use of yoga during ED treatment is amassing (see Carei, Fyfe-Johnson, Breuner, & Marshall, 2010;Hall, Ofei-TEnkorang, Machan, & Gordon, 2016;McIver, O'Halloran, & McGartland, 2009;Pacanowski, Diers, Crosby, & Neumark-Sztainer, 2017). ...
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Yoga practice is associated with improvements in eating disorder (ED) symptoms and body dissatisfaction. This study continued to evaluate this relationship while also assessing changes in variables negatively associated with ED symptoms (self-compassion, mindfulness, body appreciation, self-efficacy) that are emphasized throughout yoga. Men were also included in this study given studies have predominantly focused on women. Participants (N = 99, 77.8% women) were recruited from a university-implemented yoga course and completed assessments at the beginning (Time 1 (T1)) and end (Time 2 (T2)) of an eight-week yoga course meeting three times a week for fifty minutes. Body dissatisfaction (ps <.05) and ED pathology (p = .02) were lower at T2. Body appreciation (p < .001), self-compassion (p = .01), yoga self-efficacy (p = .004) were higher at T2. Some gender differences emerged. Men reported greater reductions in concern with being overweight, (Overweight Preoccupation) from T1 (M = 2.46, SD = 0.61) to T2 (M = 2.13, SD = 0.61) compared to women, T1 (M = 2.75, SD = 0.98) to T2 (M = 2.69, SD = 0.97) associated with yoga practice. Men also reported greater improvements in body satisfaction (Appearance Evaluation) from T1 (M = 3.60, SD = 0.49) to T2 (M = 3.90, SD = 0.34) compared with women, T1 (M = 3.48, SD = 0.58) to T2 (M = 3.39, SD = 0.52) associated with yoga practice. Results suggest yoga may be associated with concurrent changes in protective and risk factors for ED in a college population.
... Re-establishing practical experience with healthy exercise, along with enhancing the theoretical understanding of exercise physiology may induce a more positive attitude towards exercise [4]. Some studies [17,[23][24][25][26][27] report on interventions adding structured physical exercise to treatment of BN or BED, but only one study has reported on pre-post effects on attitudes towards exercise [28]. Here, a reduction of dysfunctional attitudes towards exercise was found after completing a supervised inpatient treatment programme consisting of varied, low impact PA. ...
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Background Dysfunctional thoughts- and use of physical activity (PA) are core symptoms of the eating disorders (ED) bulimia nervosa (BN) and binge eating disorder (BED). The compulsive desire for PA complicates a favourable treatment outcome; hence, regular, adapted PA led by personnel with competence in exercise science is rarely part of treatment of BN and BED. The present study compared cognitive behaviour therapy (CBT) with a new treatment combining physical exercise and dietary therapy (PED-t) with respect to the short- and long-term changes in the level of compulsive exercise and actual level of PA in women with BN or BED. Methods We enrolled 187 women with BN or BED, aged 18–40 years, with BMI 17.5–35, in an outpatient randomised controlled therapy trial. Participants were randomised to PED-t or CBT, while waitlist participants served as a control group during the treatment period. The treatment covered 16 weeks, with 6- and 12 months follow-up, and outcomes included self-reported compulsive exercise (CE) and objectively measured PA, analysed by linear mixed regression models. Results Both CBT and PED-t reduced CE from baseline (P < 0.01, Hedges g ~ 0.4), but with no difference to control group. Compared to baseline, only PED-t significantly reduced the number of patients who scored above cut-off rating for CE, but with no between-group differences. The proportion of participants complying with the official recommendation for PA neither changed following treatment, nor emerged different between the treatment arms. Conclusion Both therapies resulted in significant improvements in compulsive exercise, a change not found in the control group, however there were no between-group differences. The findings are tempered by the low statistical power due to a small control group size. The number of participants complying with the recommendation for PA were stable throughout the study, and no change in total PA was found. Presence and intensity of CE decline with treatment, but a need to increase PA towards healthy levels remains unsolved. Trial registration Approved by the Norwegian Regional Committee for Medical and Health Research Ethics (ID: 2013/1871, 16th of December 2013); registered in Clinical Trials (ID: NCT02079935, 17th of February 2014).
... These findings are in line with prior studies showing that convenience samples of yoga practitioners more often demonstrated such health behaviors than the national norm [26], as well as with earlier nationally representative samples that confirmed associations of yoga practice with non-smoking and exercising [19,20]. While the cross-sectional nature of this analysis precludes definite causal interpretation of the findings, they are in line with a number of longitudinal clinical trials showing positive shortterm effects of yoga/meditation interventions on exercise behavior [27], and unhealthy eating patterns [28][29][30][31]. Thus, the practice of yoga might positively influence health behavior, potentially by improving body image and body connectivity [32] as well as self-caring and selfcompassion [33]. ...
Article
Objectives: To examine the relationship between yoga/meditation practice and health behavior in Australian women. Methods: Women aged 19-25years, 31-36years, and 62-67years from the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behavior; and whether they practiced yoga/meditation on a regular basis. Associations of health behaviors with yoga/meditation practice were analyzed using multiple logistic regression modelling. Results: 11,344, 8200, and 9151 women aged 19-25years, 31-36years, and 62-67years, respectively, were included of which 29.0%, 21.7%, and 20.7%, respectively, practiced yoga/meditation. Women practicing yoga/meditation were significantly more likely to report at least moderate physical activity levels (OR=1.50-2.79), to follow a vegetarian (OR=1.67-3.22) or vegan (OR=2.26-3.68) diet, and to report the use of marijuana (OR=1.28-1.89) and illicit drugs in the last 12 months (OR=1.23-1.98). Conclusions: Yoga/meditation practice was associated with higher physical activity levels, a higher likelihood of vegetarian or vegan diet use, and a higher likelihood of drug use. While health professionals should keep the potential vulnerability of yoga/meditation practitioners to drug use in mind, the positive associations of yoga/meditation with a variety of positive health behaviors warrant its consideration in preventive medicine and healthcare.
... Preliminary results, also among patients affected by eating disorders, suggest that yoga holds promise of becoming a complementary therapy to standard care [14,15]. In particular, studies exploring yoga in the population with eating disorders (both on adults and adolescents) have found improvements in depression, anxiety, quality of life and shape concerns [16,17]. For this reason, its use in treatment centers for eating disorders has significantly grown over the last few years. ...
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PurposeTo evaluate interoceptive accuracy (Iac) before and after a single yoga class in a population of patients with anorexia nervosa (AN) and in a population of healthy controls (HC).Methods Fifteen patients with AN and twenty HC were included in the study. All individuals participated in a single yoga class. Before (T0) and after (T1) the yoga class, they underwent the heartbeat detection task for the evaluation of Iac. At T0, all participants also underwent a psychological assessment, including evaluation of depression, anxiety, body awareness, alexithymia, self-objectification and eating disorders psychopathology.ResultsPatients with AN had lower Iac than HC at T0. A significant improvement of Iac at T1 was found in the HC group but not in the group of patients with AN.Conclusion We infer that our findings might be linked to the fact that patients with AN, differently from HC, did not properly attend to their bodies, despite the yoga class. This hypothesis is consistent with previous studies showing that patients with AN have decreased Iac during self-focused behavior because of body-related avoidance. Moreover, we surmise that HC might be keener to improve their perception of internal body signals even after a single yoga class because their emotional awareness system is not impaired. Patients with AN, on the contrary, may have an intrinsic impairment of their emotional awareness, making it harder for them to modulate their Iac.Level of evidenceLevel III, evidence obtained from well-designed cohort or case–control analytical studies.
... RCTs in nondiabetics have shown improved dietary outcomes after yoga interventions. [17][18][19][20] A systematic review of yoga studies among adults with T2DM (found 12 RCTs encompassing 864 patients), 21 concluded that while overall results showed a significant reduction in HbA1c and fasting blood glucose (FBG), there was significant heterogeneity among studies due to methodological weaknesses. A more recent review (included 8 RCTs with a total of 842 participants) reiterated this same conclusion; 22 that while studies of yoga as a method for improving glycemic control have shown promise overall, there is great heterogeneity between studies. ...
Article
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Objectives: This study:Healthy Active and in Control (HA1C), examined the feasibility and acceptability of yoga as a complementary therapy for adults with Type-2 Diabetes (T2DM). Design: A 2-arm randomized clinical trial comparing Iyengar yoga with a supervised walking program. Setting: Hospital based gym-type facility and conference rooms. Interventions: Participants were randomized to a 12-week program of either; (1) a twice weekly Iyengar yoga, or (2) a twice-weekly program of standard exercise (SE). Main outcome measures: Primary outcomes assessed feasibility and acceptability, including enrollment rates, attendance, study completion, and participant satisfaction. Secondary outcomes included HbA1c, physical activity, and measures of diabetes-related emotional distress, self-care and quality of life (QOL). Assessments were conducted at baseline, end of treatment, 6-months and 9-months post-enrollment. Results: Of 175 adults screened for eligibility, 48 (30 women, 18 men) were eligible and enrolled. The most common reasons for ineligibility were orthopedic restrictions, HbA1c levels <6.5 and BMI > 42. Session attendance was high (82% of sessions attended), as was follow-up completion rates (92%). Program satisfaction rated on a 5-point scale, was high among both Yoga (M = 4.63, SD = 0.57) and SE (M = 4.77, SD = 0.52) participants. Overall 44 adverse events (26 Yoga, 18 SE) were reported. Of these, six were deemed "possibly related" (e.g., neck strain, back pain), and 1 "probably related" (ankle pain after treadmill) to the study. Yoga produced significant reductions in HbA1c. Median HbA1c at 6 months was 1.25 units lower for Yoga compared to SE (95% CI: -2.54 -0.04). Greater improvements in diabetes self-care, quality of life, and emotional distress were seen among Yoga participants than among SE participants. Increases in mindfulness were seen in Yoga but not in SE. Conclusions: The yoga intervention was highly feasible and acceptable, and produced improvements in blood glucose and psychosocial measures of diabetes management.
... 173)" [54] by creating a safe environment using modified yogic techniques that include reduction or elimination of corrective touch, focus on client choice, and language inviting the clients to try rather than to accomplish specific actions [11]. Clinicians have successfully utilized traditional and TS yoga practice in the treatment of various psychiatric conditions [9], including anxiety disorders [18], eating disorders [26], and insomnia [46]. A recent study by Rousseau and Cook-Cottone [45] indicated strong acceptability by clients and feasibility in the use of TS yoga in conjunction with trauma interventions in an international context. ...
... A combination of yogic postures and deep breathing practices cannot only handle these disorders but also channelize immense energy towards creative thinking and pro social activities. Yoga can be helpful for reducing the symptoms of eating disorders among teenagers [35]. Students experiencing examination anxiety can benefit from Yoga [36]. ...
... A recent review on physical activity in BED highlighted that a combined aerobic and yoga exercise training can reduce weight through physiological reactions to increased caloric expenditure and lead to a reduction of binge episodes [11]. Debate exists about the amount (e.g., volume, frequency, intensity, and duration) and type (e.g., structured exercises vs lifestyle physical activity) of physical exercise needed to obtain physical and psychological benefits in BED [12], as well in other pathological populations [13]. ...
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The aim of this study was to investigate the combined effects of aerobic exercise training and traditional treatment on body mass index (BMI) and aerobic capacity compared to the traditional treatment alone in patients with binge-eating disorder (BED). Fourteen BED patients were divided into Intervention Group (IG, n = 6) and Control Group (CG, n = 8). All patients participated into the weekly multidisciplinary program. In addition, IG underwent an aerobic exercise-training period of 6 months. At baseline and after 6 months of intervention, both groups underwent measurements of BMI and six-minute walk test (6MWT). BMI reduced in both groups (47.2 ± 5.5 and 42.7 ± 5.1 kg/m² in IG PRE and IG POST, respectively; p < 0.01; 46.6 ± 6.9 and 44.3 ± 6.1 kg/m² in CG PRE and CG POST, respectively; p < 0.01), but IG obtained a greater reduction than CG. Indeed, a BMI reduction of −4.50 kg/m² in IG occurred while in CG decreased by −2.30 kg/m² (p < 0.05). The IG improved the 6MWT (435.9 ± 106.2 and 519.1 ± 151.5 m in IG PRE and IG POST, respectively; p < 0.01). In addition, the CG improved 6MWT (455.5 ± 114.9 and 502.5 ± 110.7 m in CG PRE and CG POST, respectively; p < 0.01) probably because of the influence of diet and changes in body composition, even though the difference did not achieve statistical significance. Changes induced by the combined intervention were significantly greater than traditional treatment alone, suggesting that the addition of physical exercise constitutes a novel potential therapeutic approach in eating disorders.
... According to the study, people with a higher body mass index demonstrate less mindful eating than the people who practice yoga and meditation. Further to this, other authors demonstrate that mindful eating is highly related to yoga and sport practice (Daubenmier, 2005;Kristal et al., 2005;McIver, O'Halloran, & McGartland, 2009). ...
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Mindful eating concerns an awareness of our dietary habits, while its absence is typically associated with anxiety, negative affect and binge eating. The objective of this study was to analyze these variables in a sample of 216 individuals, divided in four groups: students who practiced sport regularly, university athletes, yoga practitioners and persons suffering from obesity. They were assessed by a semi-structured interview and the questionnaires MEQ, BES, PANAS and BAI. Statistical analyses included descriptive statistics, Pearson correlation, ANOVA and multiple regression. Results demonstrated that people who have less awareness of their eating habits are generally more overweight, more anxious and have higher levels of negative affect, while they demonstrate less control over their eating habits. Moreover, these variables can predict binge eating. The model obtained was significant (p<.001) and its predictive capacity through R square corrected was .51. This means that the model predicts a 51% of binge eating from mindful eating, body mass index, anxiety and negative affect.
... For example, research has found that participation in an embodying activity such as yoga helps cultivate a positive relationship with one's body. Indeed, yoga is related to reduced concerns with body weight and shape, less self-objectification, less body dissatisfaction, less eating disorder symptomatology, and increased motivation to make healthier food choices (Carei et al., 2010;Daubenmier, 2005;Impett et al., 2006;Mahlo & Tiggemann, 2016;McIver et al., 2009;Watts et al., 2018). ...
Article
Body image and eating patterns begin to develop early in life and are mainly shaped by the family environment. Research on the pivotal role that parents play in transmitting norms, beliefs, values, knowledge, attitudes, and behaviors related to food is of critical importance given that eating habits and body image established during childhood and adolescence often persist into adulthood. To date, studies in this area have largely concentrated on parents’ contribution to children’s concerns about body shape, weight, and eating, yet a growing body of research explores how parents can also protect their children from those concerns and support positive body image and eating behaviors. The present article contributes to this recent shift by offering an overview of research on parental practices related to body image, strategies for creating a positive family climate around food, and food parenting practices that develop healthy eating behaviors in children. By focusing on practices that support positive body image and eating behaviors, we aim to highlight how parents can contribute to children’s resilience against diet culture and be allies in the fight against societal body-related pressures. Public Significance Statement—Research often focusses on the negative influence parents can have on their children’s weight and risk for eating disorders. We review the research on how parents can promote a positive body image and a healthy relationship with food. We describe three major outcomes for children: body acceptance and appreciation, pleasant family mealtime atmosphere, and nutritious dietary intake, and discuss parent practices that foster these outcomes. L’image corporelle et les habitudes alimentaires commencent à se développer tôt dans l’enfance et sont principalement façonnées par le contexte familial. La recherche sur le rôle déterminant que jouent les parents dans la transmission des normes, des croyances, des valeurs, des connaissances, des attitudes et des comportements à l’égard de l’alimentation est d’une importance capitale, étant donné que les habitudes alimentaires et l’image corporelle s’établissent durant l’enfance et l’adolescence, et se maintiennent souvent à l’âge adulte. À ce jour, les études dans ce domaine se sont largement concentrées sur la contribution parentale quant aux préoccupations relatives à la forme corporelle, au poids et à l’alimentation, mais une quantité croissante d’études explorent la façon dont les parents peuvent également protéger leurs enfants contre ces préoccupations et favoriser une image corporelle et des habitudes alimentaires positives. Le présent article contribue à cette récente tendance en offrant un aperçu de la recherche sur les pratiques parentales se rapportant à l’image corporelle, aux stratégies visant à créer un climat familial positif à l’égard de la nourriture, ainsi que sur les pratiques parentales qui favorisent des habitudes alimentaires saines chez les enfants. En nous concentrant sur les pratiques qui soutiennent une image corporelle et des habitudes alimentaires positives, nous voulons mettre en relief les façons dont les parents peuvent contribuer à prémunir leurs enfants contre la culture des régimes alimentaires et être des alliés dans la lutte contre les pressions sociales concernant le corps. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
... Research has shown positive effects of yoga on stress, anxiety, depression, and associated physiological measures [22]. Preliminary evidence also suggests that yoga may be beneficial to people with a variety of psychiatric disorders, including mood disorders [23], anxiety disorders [24], OCD [25], PTSD [26], ADHD [27], and eating disorders [28]. Though the precise mechanisms mediating positive changes as a result of yoga practice are unknown, research suggests that yoga positively impacts the neurobiological mechanisms related to stress and mood reactivity [22], possibly through its effect on cortisol release [29], and may confer neuroprotective effects [30][31][32]. ...
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Purpose of Review Schizophrenia is a debilitating psychiatric illness requiring multimodal treatments. Besides pharmacotherapy, several adjunct treatments have been recommended, including yoga. We review recent findings speaking to yoga’s efficacy and towards gaining a better understanding of why yoga may affect positive change, evidence on putative neurobiological mechanisms. Recent Findings Recent research with schizophrenia patients suggests that yoga may lead to improvements in symptoms, cognition, and functioning. These changes may occur through a variety of mechanisms including yoga-induced changes in neural plasticity, the neural mechanisms supporting internal mentation, oxytocin release, BDNF, and other factors. We review reports of possible mechanisms through which yoga is believed to impact response in schizophrenia. Summary Our current review cannot provide a conclusive statement on the use of yoga as a standard treatment for schizophrenia; however, the available evidence suggests that yoga may positively impact aspects of the illness in patients with schizophrenia. Further research with adequately powered randomized controlled trials is essential.
... There is preliminary evidence to suggest that yoga can be beneficial in reducing levels of anxiety, depression and general eating disorder symptoms including self-objectification, body dissatisfaction, and drive for thinness in eating disordered populations [13][14][15][16][17][18][19][20][21][22][23]. Yoga is a practice traditionally rooted in Indian philosophy and spirituality comprising of ethical guidelines for living with an ultimate goal of attaining unification of mind, body and spirit [24]. ...
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Background There is preliminary evidence to suggest that yoga can be beneficial in reducing anxiety, depression and general eating disorder symptoms in people with Anorexia Nervosa (AN). It is unclear whether the therapeutic benefits of yoga are supported or utilised in the treatment of AN amongst clinical experts. The present study aimed to explore and synthesise expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with AN. Methods A Delphi methodology was employed, with clinicians considered experts in the treatment of AN recruited internationally to form the panel ( n = 18). The first iteration of questionnaires comprised of four open-ended questions concerning the experts’ understanding of the term yoga and opinions on its’ use in therapy generally and more specifically in the treatment of AN. Using content analysis, statements were derived from this data and included as Likert-based items in two subsequent rounds where panellists rated their level of agreement on each item. Seventeen out of 18 respondents completed all three iterations. Results Consensus (level of agreement defined at ≥ 85%) was achieved for 36.47% of the items included in the second and third rounds. The panel reached consensus on items defining yoga and pertaining to its’ general benefits. The panel agreed that yoga is a adjunct therapy for various problems, consensus was not achieved on the specific use of yoga as an adjunct therapy in the treatment of comorbid anxiety, depression or trauma in patients with AN. Although the expert panel acknowledged a number of benefits for use of yoga in AN, they strongly endorsed that future research should evaluate the potential risks of using yoga as an embodied practice. Conclusions It is possible that yoga could be considered for inclusion in future guidelines if supported by empirical research. We conclude that there seems to be enough consensus that such further scientific investigation is warranted. Plain English summary This study aimed to explore expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with Anorexia Nervosa (AN). Clinicians considered experts in the treatment of AN recruited internationally to form the panel ( n = 18). Experts were asked about their understanding of the term yoga and their opinions on its’ use in therapy. The panel reached consensus on items defining yoga and pertaining to its’ general benefits. Although the panel agreed that yoga is a nice additional therapy for various problems, consensus was not achieved on the use of yoga as an additional therapy in the treatment of specific problems like anxiety, depression or trauma in people with AN. The expert panel acknowledged a number of benefits for use of yoga in AN. However the panel strongly considered that future research should evaluate the potential risks of using yoga as an embodied practice. The areas of collective agreement gained in the study can serve as preliminary guidelines for the use of yoga in AN whilst guiding future research directions.
... Similarly, more mindful individuals have reported that they consume smaller serving sizes of calorie-dense foods (Beshara et al., 2013). Moreover, studies also demonstrate that yoga and sport practice is highly related to mindful eating (Daubenmier, 2005;Kristal et al., 2005;McIver et al., 2009). One study which evaluated the effects of a multi-faceted 5-day yoga program on mindfulness, nutrition behaviors, physical activity, stress management and mood disturbance suggested significant improvement in all these outcomes after the program. ...
Article
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Mindful eating is a phenomenon to describe a nonjudgmental awareness of physical and emotional sensations while eating or being in a food-related environment. Nowadays, weight-related psychological and physiological health problems are gradually increasing. It is considered that mindful eating is one of the key components to struggle against dysfunctional eating patterns. The aim of the current study was to adapt the original five-factor structure of the MEQ and the abbreviated two-factor structure of the MEQ to Turkish culture and to determine its psychometric properties. The sample of the study was 362 university students aged between 18 and 27 (M = 20.82, SD = 3.83). Of the participants 249 (68.8%) were women, 110 (30.4%) were men, and three participants stated their sex as "other". Participants were asked to fill the Mindful Eating Questionnaire (MEQ), Eating Disorder Examination Questionnaire (EDE-Q), Intuitive Eating Scale (IES) and Brief Symptom Inventory (BSI). Results of confirmatory factor analysis showed an acceptable model fit for the correlated two-factor structure of the MEQ compared to its original five-factor structure. Internal consistency coefficient values for the overall MEQ and awareness and recognition subscales were .82, .71 and .82, respectively. The MEQ sub-scales' scores were found to be associated with EDE-Q, IES, and BSI scores, confirming the validity of the scale. The Turkish version of the two-factor MEQ could be evaluated as a valid and reliable measurement to assess mindful eating for further research and would also provide support to cross-cultural research.
... Similarly, more mindful individuals have reported that they consume smaller serving sizes of calorie-dense foods (Beshara et al., 2013). Moreover, studies also demonstrate that yoga and sport practice is highly related to mindful eating (Daubenmier, 2005;Kristal et al., 2005;McIver et al., 2009). One study which evaluated the effects of a multi-faceted 5-day yoga program on mindfulness, nutrition behaviors, physical activity, stress management and mood disturbance suggested significant improvement in all these outcomes after the program. ...
Article
Mindful eating is a phenomenon to describe a nonjudgmental awareness of physical and emotional sensations while eating or being in a food-related environment. Nowadays, weight-related psychological and physiological health problems are gradually increasing. It is considered that mindful eating is one of the key components to struggle against dysfunctional eating patterns. The aim of the current study was to adapt the original five-factor structure of the MEQ and the abbreviated two-factor structure of the MEQ to Turkish culture and to determine its psychometric properties. The sample of the study was 362 university students aged between 18 and 27 (M = 20.82, SD = 3.83). Of the participants 249 (68.8%) were women, 110 (30.4%) were men, and three participants stated their sex as "other". Participants were asked to fill the Mindful Eating Questionnaire (MEQ), Eating Disorder Examination Questionnaire (EDE-Q), Intuitive Eating Scale (IES) and Brief Symptom Inventory (BSI). Results of confirmatory factor analysis showed an acceptable model fit for the correlated two-factor structure of the MEQ compared to its original five-factor structure. Internal consistency coefficient values for the overall MEQ and awareness and recognition subscales were .82, .71 and .82, respectively. The MEQ sub-scales' scores were found to be associated with EDE-Q, IES, and BSI scores, confirming the validity of the scale. The Turkish version of the two-factor MEQ could be evaluated as a valid and reliable measurement to assess mindful eating for further research and would also provide support to cross-cultural research.
... Similarly, more mindful individuals have reported that they consume smaller serving sizes of calorie-dense foods (Beshara et al., 2013). Moreover, studies also demonstrate that yoga and sport practice is highly related to mindful eating (Daubenmier, 2005;Kristal et al., 2005;McIver et al., 2009). One study which evaluated the effects of a multi-faceted 5-day yoga program on mindfulness, nutrition behaviors, physical activity, stress management and mood disturbance suggested significant improvement in all these outcomes after the program. ...
Article
Full-text available
Mindful eating is a phenomenon to describe a nonjudgmental awareness of physical and emotional sensations while eating or being in a food-related environment. Nowadays, weight-related psychological and physiological health problems are gradually increasing. It is considered that mindful eating is one of the key components to struggle against dysfunctional eating patterns. The aim of the current study was to adapt the original five-factor structure of the MEQ and the abbreviated two-factor structure of the MEQ to Turkish culture and to determine its psychometric properties. The sample of the study was 362 university students aged between 18 and 27 (M = 20.82, SD = 3.83). Of the participants 249 (68.8%) were women, 110 (30.4%) were men, and three participants stated their sex as "other". Participants were asked to fill the Mindful Eating Questionnaire (MEQ), Eating Disorder Examination Questionnaire (EDE-Q), Intuitive Eating Scale (IES) and Brief Symptom Inventory (BSI). Results of confirmatory factor analysis showed an acceptable model fit for the correlated two-factor structure of the MEQ compared to its original five-factor structure. Internal consistency coefficient values for the overall MEQ and awareness and recognition subscales were .82, .71 and .82, respectively. The MEQ sub-scales' scores were found to be associated with EDE-Q, IES, and BSI scores, confirming the validity of the scale. The Turkish version of the two-factor MEQ could be evaluated as a valid and reliable measurement to assess mindful eating for further research and would also provide support to cross-cultural research.
... Randomized trials with adults at risk for cardiovascular disease and with binge eaters have shown improved dietary outcomes after yoga intervention. [28][29][30][31] Thus, yoga may positively affect stress, diet, and other self-care tasks that contribute to improved glycemic control. 32 Recent studies on yoga have shown promising results in glycemic control among patients with T2DM. ...
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Diabetes is the seventh leading cause of death in the United States. For most patients, medication alone is not sufficient to achieve glycemic control; attention must also be paid to multiple healthy behaviors including diet, regular physical activity, and stress management. Yoga, a mindfulness practice with emphasis on relaxation, meditation, and deep breathing, may have special relevance to people with type 2 diabetes mellitus (T2DM). Yoga practice may positively affect stress and other self-care tasks that will contribute to improved glycemic control. The Healthy, Active, and in Control (HA1C) study is designed to examine the feasibility and acceptability of yoga among adult patients with T2DM. In this pilot randomized controlled trial, adults with T2DM were randomly assigned to either a 12-week Iyengar Yoga intervention given twice weekly, or a twice-weekly 12-week program of traditional exercise (e.g., walking, stationary cycling). Assessments are conducted at the end of treatment (12 weeks) and at 3 and 6 months postintervention. The HA1C study will assess feasibility and acceptability (e.g., attendance/retention rates, satisfaction with program), glycemic outcomes (e.g., HbA1c, fasting blood glucose, postprandial blood glucose), and changes in physiological (e.g., salivary cortisol) and behavioral factors (e.g., physical activity, diet) relevant to the management of T2DM. Focus groups are conducted at the end of the intervention to explore participants' experience with the program and their perception of the potential utility of yoga for diabetes management.
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Los trastornos de la conducta alimentaria (TCA) engloban aquellas patologías en las que la obsesión por la delgadez y el miedo a la obesidad condicionan la aparición de un patrón de alimentación inadecuado y de conductas patológicas ligadas al control del peso. El ejercicio ha sido históricamente considerado como uno de los síntomas en esta enfermedad, y por ello se ha excluido como tratamiento en estos pacientes. Dentro de los TCA, podemos observar un comportamiento problemático al ejercicio (ejercicio compulsivo) y no necesariamente se da en todos los pacientes que sufren esta patología. Hay evidencia de que la participación en programas de ejercicios estructurados y supervisados (ejercicios de alta intensidad o yoga) puede ser de gran utilidad en esta población clínica, ya que reduce la psicopatología, mejora la fuerza muscular, la calidad de vida, el bienestar psicológico y facilita el cumplimiento y la adherencia al tratamiento.
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This study explored the potential for yoga to promote body satisfaction in a general population of young adults. The sample included 1664 participants (M age: 31.1, SD = 1.6 years) in Project EAT, a 15-year longitudinal study. Data from the third and fourth waves (EAT-III and EAT-IV), collected five years apart, were utilized. Practicing yoga (≥30 min/week) was reported by 16.2% of young adults. After adjusting for EAT-III body satisfaction and body mass index, yoga practitioners had higher concurrent body satisfaction at EAT-IV than those not practicing yoga (difference: 1.5 units [95% CI: 0.1-2.8], p = .03). Among participants within the lowest quartile of prior (EAT-III) body satisfaction, there was preliminary evidence that body satisfaction at EAT-IV was higher among yoga practitioners than in other young adults. Findings suggest that yoga may be associated with improved body satisfaction, particularly among young adults with low prior body satisfaction.
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The rapid globalisation and race to excel in each and every field by the people around the globe has several negative influences on their mental and physical health. Eating disorder cognitions among adolescent girls is one of such concerns which need to be addressed since this particular group plays very vital role in the society and directly or indirectly affects a larger segment of the society. Eating disorders are common among adolescent girls in western countries. But from past few years it has been introducing in India too. In India the information regarding these disorders is very limited but it is increasing very rapidly day by day due to the effect of media and westernization. And because of its effect, adolescents are very keen to have a perfect body figure by adopting wrong eating habits and sometimes by starving themselves. This research paper aims to show the prevalence of eating disorder cognitions among Indian adolescent girls in the present scenario. It also delves into BMI classification and population distribution of samples and impact of various sub-scales of eating disorder on population distribution of samples.
Article
This study explored the perceived impact of yoga on body image. Young adults (n = 34 female, 12 male; Mage = 30.6 [SD = 1.6]) practicing yoga were interviewed and data were analyzed for emerging themes across weight status. In general, participants discussed the positive impact of yoga on their body image, but some described both a positive and negative impact. Yoga was perceived as having a positive impact on body image via perceived physical changes, gratitude for one's body, a sense of accomplishment within one's yoga practice, self-confidence, and witnessing different types of bodies practicing yoga. Yoga was perceived to have a negative impact on body image via comparative critique (e.g., upward comparisons with others) and inner critique (e.g., negative self-talk). Themes were generally similar across weight status; exceptions were that participants at higher weight status were more likely than those at lower weight status to discuss accomplishment within one's yoga practice as a positive impact on body image and comparative critique as a negative impact on body image. Yoga studios and instructors can take steps to further enhance the positive impact of yoga and to provide environments that are inclusive of participants with diverse body shapes and sizes.
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Background: Eating disorders (EDs) are among the top ten of the gender and age adjusted global burden of diseases in terms of poor quality of life, affecting young women in particular. Less than half of the persons with bulimia nervosa (BN) or binge eating disorder (BED) are detected and offered treatment for their ED in primary care. Besides low detection rate; low mental health literacy, and long waitlists for special care are important causes to this scenario. Cognitive behavior therapy (CBT) is recognized as the preferred evidence based treatment option for BN and BED, still more than 60% do not fully abstain from symptoms. There is a need to explore new treatment options that circumvent the challenges with low treatment access and poor remission rate. Evidence suggest that regular physical activity effectively prevents and treats physical- and mental morbidity and mortality, contributing to improvements in quality of life. Physical activity is however, rarely incorporated in treatment of EDs out of fear of exacerbating the compulsive and excessive nature of exercise in patients for compensatory or affect regulation purposes. Objectives: To evaluate the effect of a new treatment method for women with BN or BED, combining guided physical exercise and dietary therapy (PED-t), being offered as group therapy. The novel treatment method was compared to the effect of cognitive behavior therapy (CBT), and a waitlist control group. The first paper describes the rationale for, and the specific study protocol from the PED-t trial. The second paper describes the physical fitness in women with BN or BED more thoroughly than previously in the literature. In the third paper we investigated the effect from PED-t or CBT on compulsive exercise and level of physical activity. In the fourth paper we investigated the effect from PED-t or CBT on remission from ED, ED-symptomology, and measures of mood and quality of life. Methods: During 2014-2016 totally 187 women with BN or BED, aged 18-40 and with BMI 17.5-35 were enrolled in this RCT, and allocated to PED-t (n=82) or CBT (n=82), or temporarily placed in a waitlist control group (n=23). Effect from 16 weeks of treatment by either CBT or PED-t, or being in control group, was evaluated and compared at baseline (T1), post-test (T2) and follow-up periods (6 months, T3, and 12 months, T4). Outcomes were blood pressure, cardiorespiratory fitness (CRF), muscle strength (1RM), physical activity, body composition, compulsive exercise (CE), remission from diagnosis, and alleviation of ED-symptoms (by EDE-q) and comorbidity. Measures were by cardiopulmonary exercise testing, 1RM strength tests, DXA, objective registration of physical activity, and questionnaires. Results: In total 156 met for baseline screening, of whom 103 were diagnosed with BN and 53 with BED. Overall, participants with BN or BED displayed adequate physical fitness; however, a high number had high blood pressure, low CRF and unfavorable body composition. The number of randomized participants (n=164) that met for therapy was 149, of whom 112 completed treatment (32% drop out). Dropouts and completers were different by a lower mean (CI95) score for depression amongst completers (-3.08 -5.95, -0.21, g=0.39, p=0.035), and significantly more from CBT were lost to follow-up at T3 and T4 compared to PED-t. About 40-70% of all participants scored above clinical cut-off in the compulsive exercise test (CET) at baseline. CBT and PED-t were equally effective in reducing compulsive exercise after 16 weeks of treatment (P < 0.01, Hedges g ~ 0.4), with sustained long-term effects (T3-T4). The proportion of participants that complied with the official recommendation for physical activity (~47%) neither changed following treatment, nor emerged different between the therapy arms. After treatment mean EDE-q global score improved more in the PED-t group compared to the CBT group (-0.66, [CI99 -1.23, -0.1], g=0.52, p <0.003) and to the control group (-1.15, [CI99 -1.97, -0.34], g=1.00, p<0.001), whereas CBT did not differ from the control group (-0.49 [CI99-1.32, 0.34], g=0.48, p=0.12). Numbers in full- or partial remission were higher in PED-t (29.0% and 19.7%) and CBT (12.4% and 16.7%) compared to control (0.1% and 5.6%), p<0.004. Both therapies resulted in significant improvement in life quality, but mood rating only improved in PED-t with shortlived effect. Long-term effects (T3-T4) from therapies were equally successful in remission rates, alleviation from ED-symptoms and improvements in quality of life. Conclusions: The finding of a high number with impaired physical fitness calls for inclusion of physical fitness evaluation in routine clinical examinations, and for guided physical activity and dietary therapy in the treatment of BN and BED. Both indirect (CBT) and direct (PED-t) approaches may be successful in reducing CE with sustained long-term effect. Neither approaches raised the level of physical activity or compliance with official recommendations for physical activity, hence a need to increase mean physical activity towards healthy levels remains unsolved. The therapeutic effect from PED-t was comparable to the current preferred therapy (CBT), hence it may be an alternative pathway to recovery from BN and BED. A high availability of professionals within exercise medicine and dietetics may attract new segments of ED patients and circumvent the poor access to mental health services.
Article
Binge-Eating Disorder (BED) is a primary diagnosis listed in the Feeding and Eating Disorders chapter of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association [APA], 2013). Although BED is considered one of the most common eating disorders, symptoms often go unrecognized and untreated (Striegel-Moore et al. 2010). In this article, BED criteria are reviewed and guidelines for assessment, diagnosis, and treatment are offered. A case study is also provided to illustrate the application of BED utilizing best practices.
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Cambridge Core - Health and Clinical Psychology - Pseudoscience in Child and Adolescent Psychotherapy - edited by Stephen Hupp
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Pseudoscience in Child and Adolescent Psychotherapy - edited by Stephen Hupp March 2019
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Background: Obesity is a major public health problem whose prevalence has been rapidly increasing in the United States (U.S), and globally. It is one of the leading causes of preventable deaths globally and contributes to the development of many diseases. Methods: The search was limited to studies published in English and other languages involving both animal and human subjects. Articles selected included preclinical studies, randomized clinical trials (RCTs), observational studies, meta-analyses, narrative and systemic reviews providing primary quantitative data with a measure of obesity or food addiction as an outcome. Over 5,000 articles were found in the first round of search which was filtered to 506 articles. Results: Oxidative stress plays a critical role in food addiction and is both a cause and mediator of obesity. Reactive oxygen species and oxidative stress play a direct role in adipogenesis and modulate all factors involved in obesity including genetics, sleep, gut microbiome, insulin, ghrelin, inflammation, adipokines, leptin, stress, HPA axis, and the hypothalamus. Conclusions: The idea of thinking of combating obesity from the lens of calorie count, low carbohydrate, high or low-fat, vegetarian, vegan, plant-based, or animal-based diet is fundamentally wrong. The best way to look at obesity is through the framework of systemic redox homeostasis. Since redox homeostasis is tilted towards increased reactive oxygen species production, and excessive antioxidant intake can result in oxidative stress, an antioxidant and prooxidant food ratio of 2:3 per meal is the ideal nutritional ratio for good health and ideal weight. A ratio of 3:4 is ideal for obese individuals. Regular physical activity, good sleep quality, stress-relieving activities including yoga and meditation, maternal prenatal diet and oxidative stress promoting disease conditions are also important modulators of oxidative stress and obesity.
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Objectives This study examined formal and informal healthcare use (HCU) in community women with disordered eating, and associations of HCU with mental health-related quality of life (MHRQoL), psychological distress, mental health literacy (MHL) and eating disorder (ED) symptoms over time. Hypothesis We hypothesised that HCU would lead to improvement in ED symptom severity, MHRQoL, MHL and psychological distress. Design, setting, participants Data were from years 2, 4 and 9 of a longitudinal cohort of 443 community women (mean age 30.6, SE 0.4 years) with a range of ED symptoms, randomly recruited from the Australian Capital Territory electoral role or via convenience sampling from tertiary education centres. Data were collected using posted/emailed self-report questionnaires; inclusion criteria were completion of the HCU questionnaire at time point of 2 years (baseline for this study). HCU was measured using a multiple-choice question on help seeking for an eating problem. To test the effect of HCU over time on MHRQoL (Short Form-12 score), psychological distress (Kessler Psychological Distress Scale score), ED symptom severity (Eating Disorder Examination Questionnaire score) and ED–MHL, linear or logistic mixed-effects regression analyses were used. Results 20% of participants sought ED-specific help at baseline; more than half of participants sought help that was not evidence based. HCU at baseline was significantly associated with improved MHRQoL and ED symptom severity and decreased psychological distress over time (Cohen’s d all >0.3, ie, small). HCU was not significantly associated with MHL over time. The predictive ability of the fitted models ranged from 32.18% to 42.42% for psychological distress and MHL treatment, respectively. Conclusions Formal and informal HCU were associated with small improvements in ED symptoms, MHRQoL and psychological distress but not with improved MHL. Informal services in ED management should be investigated further along with efforts to improve ED–MHL.
Article
Yoga is frequently used in conjunction with standard treatment approaches for eating disorders. However, yoga's efficacy and effectiveness in preventing and treating eating disorders has remained unclear. The aim of this comprehensive review and meta-analysis is to review the extant literature and assess the effects of yoga in the prevention and intervention of eating disorder symptoms and correlates in both clinical and non-clinical populations. Studies assessing yoga and its effect on eating disorder symptoms and/or body image as related to disordered eating, were eligible for inclusion. The comprehensive review details correlational, non-controlled, non-randomized controlled, and yoga comparison studies. For the meta-analysis, only randomized controlled trials comparing a yoga-based intervention to a non-yoga control group were included. In total, 43 studies are included in this review, with 11 trials involving 754 participants included in the meta-analysis. Results of the comprehensive review and meta-analyses results indicated yoga interventions demonstrated a small, significant effect on global eating disorder psychopathology, a moderate-to-large effect on binge eating and bulimia, and a small effect on body image concerns, as compared to the control conditions. There was no statistically significant effect on dietary restraint in either direction. Additionally, results indicated a small-to-moderate effect on a composite measure of eating disorder-related constructs. These findings suggest that yoga-based interventions may be an effective approach supporting the prevention and treatment of eating disorders.
Article
Objective Research suggests physical activity (PA) improves behavioural, psychological and behavioural symptoms in individuals with binge eating disorder (BED), yet self‐reported PA is notably low. Little remains known about objective rates of PA and subclinical levels of maladaptive PA (i.e., compensatory or driven PA), and few studies have attempted to understand the role that dissatisfaction and overvaluation with shape and weight plays in promoting PA in individuals with BED. We sought to characterize PA and investigate whether elevated rates of shape and weight concerns contribute to rates of PA in individuals with BED. Method Individuals meeting DSM‐5 diagnosis of BED (N = 56) completed the Eating Disorder Examination and wore a Fitbit Flex 2 for 1 week. Results On average, participants recorded 7621.12 (SD = 3034.20) daily steps and 194.30 (SD = 161.45) weekly moderate‐to‐vigorous PA minutes. About 21% of participants reported subclinical levels of maladaptive PA. Greater shape and weight overvaluation predicted lower duration of compensatory PA. Conclusion A small percentage of individuals with BED are engaging in subclinical levels of maladaptive PA, and there is a need to identify factors that influence rates of PA in individuals with BED. Highlights • Objectively measured rates of PA in individuals with BED were greater compared with previous self‐reported rates of PA in individuals with BED • A small percentage of individuals with BED engaged in subclinical levels of maladaptive forms of PA • Greater shape and weight overvaluation predicted lower average duration of compensatory PA. Dissatisfaction with shape and weight did not predict rates of PA
Article
Objective: Most U.S. adults are insufficiently active. One strategy individuals could use to increase physical activity is to exercise mindfully (i.e., while paying attention to present-moment experiences with acceptance (1,2)). A mindfulness-based intervention for exercise can be delivered via an audio recording, which is advantageous in regard to time demands, cost, and dissemination potential. The aims of this parallel two-arm pilot randomized controlled trial were to assess the feasibility and acceptability of an audio-recorded mindfulness-based intervention and to assess whether the intervention resulted in a clinically meaningful difference in physical activity compared to the control condition. Methods: Physically underactive adults (N = 50) were randomized to a mindfulness intervention condition in which they were instructed to exercise while listening to an audio-recorded mindfulness-intervention or an active control group in which they were instructed to exercise while using a heart rate monitor. Participants completed a 30-minute moderate intensity treadmill exercise bout during a baseline in-lab session in the manner in which they were randomized (i.e., mindfulness recording vs. using a heart-rate monitor), and instructed to exercise in this manner for the next week. At follow-up, acceptability was measured by self-report, feasibility by frequency of intervention use, and physical activity using both self-reported physical activity recall and an accelerometer. Results: The audio-recorded mindfulness-based physical activity intervention was rated as acceptable and feasible to use. Compared to the control group, the intervention also resulted in clinically meaningful differences in self-reported moderate-to-vigorous physical activity (MVPA) minutes (M difference = 67.16 minutes) and accelerometer-measured minutes (M difference = 35.48 minutes) during a one-week follow-up. Conclusion: The audio-recorded mindfulness-based physical activity intervention is a promising approach to increasing physical activity with good dissemination potential.
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Objectives This systematic review and meta-analysis sought to evaluate the efficacy of mindfulness-based programs (MBPs) on eating disorder (ED) symptoms and related outcomes such as BMI, body dissatisfaction, emotion regulation, and negative affect. It also examined moderators that predicted larger intervention effects. Methods A search for studies evaluating such MBPs on participants with EDs was conducted in several online databases. In total, 23 articles were included in the systematic review and 22 in the meta-analysis (10 randomized controlled trials). Results Results showed a within-condition effect of MBPs on ED symptoms, emotional eating, negative affect, and body dissatisfaction, and on BMI in anorectic and bulimic participants relative to pre-assessment. A significant within-condition effect sizes ranged from d = .62 (negative affect) to d = 1.05 (ED symptoms). Meta-regression analyses showed that participants with BED and women benefit more of MBPs on mindfulness skills and emotion regulation skills than participants with anorexia nervosa, bulimia, and men. A high risk of bias was correlated with a larger effect of MBPs on mindfulness skills and emotion regulation skills but a smaller effect on restrained eating. Longer treatment was correlated with a larger effect of MBPs on emotion regulation skills. Conclusions Results indicated some positive correlations between MBPs and outcomes but a definitive conclusion cannot be drawn since these results are on within-condition effects and that half of the included studies did not have a control condition. Results identified moderators that may be useful to refine inclusion and exclusion criteria to target those most likely to benefit from MBPs. The field needs more rigorous studies with credible alternative interventions to confirm the efficacy of MBPs for ED patients.
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This program, a joint collaboration between the LSI Center for the Study of Health, Religion, and Spirituality at Indiana State University, and independent filmmaker Carolyn Speranza, will use video to express both the range of experiences that are engendered by meditation practice, and the depth of change that even brief training can produce. Meditation is a universal practice that promotes spiritual and practical wisdom by disengaging the mind from conditioned patterns of reactivity and self-concerns. Dr. Kristeller will present an overview of a multi-domain model of meditation effects, illustrated by Ms. Speranza's film "Sight of Stillness" with highly experienced meditators. This video was produced during a series of meditation workshops conducted in Pittsburgh. Ms. Speranza has also worked with Dr. Kristeller to capture on video the personal experiences of individuals participating in an NIH-funded trial that evaluated the effects of a mindfulness meditation based treatment on binge eating disorder. That research has demonstrated how the MB-EAT (Mindfulness Based Eating Awareness Training) program, a 9- week structured experience with mindful eating and other meditation practice, can substantially reduce compulsive eating in obese individuals, while improving depression and sense of self. Videotaped interviews with participants sharing their personal experiences, along with results from the study, will be presented to illustrate how focused meditative practice can produce life changes in relationship to eating and to the self. This paper is highly pertinent to the Dr. Kristeller's presentation and the film. Biography Dr. Jean Kristeller received her doctorate in clinical and health psychology from Yale University in 1983. She is currently Professor of Psychology and Director of the Center for the Study of Health, Religion and Spirituality at Indiana State University. She has been conducting research in the therapeutic uses of meditation for over 20 years. Her research areas also include the role of spirituality in adjustment to cancer. She currently has funding through the NIH Center for Complementary and Alternative Medicine for research on the use of mindfulness meditation in treating binge eating disorder, and from the Metanexus Institute through the Spiritual Transformation initiative.
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How aware are people of food-related decisions they make and how the environment influences these decisions? Study 1 shows that 139 people underestimated the number of food-related decisions they made-by an average of more than 221 decisions. Study 2 examined 192 people who overserved and overate 31% more food as a result of having been given an exaggerated environmental cue (Such as a large bowl). Of those studied, 21% denied having eaten more, 75% attributed it to other reasons (such as hunger), and only 4% attributed it to the cue. These studies underscore two key points: First, we are aware of only a fraction of the food decisions we make. Second, we are either unaware of how our environment influences these decisions or we are unwilling to acknowledge it.
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Mindfulness and acceptance-based approaches to the treatment of clinical problems are accruing substantial empirical support. This article examines the application of these approaches to disordered eating. Theoretical bases for the importance of mindfulness and acceptance in the treatment of eating problems are reviewed, and interventions for eating problems that incorporate mindfulness and acceptance skills are briefly described. Empirical data are presented from a pilot study of mindfulness-based cognitive therapy adapted for treatment of binge eating.
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The efficacy of a 6-week meditation-based group intervention for Binge Eating Disorder (BED) was evaluated in 18 obese women, using standard and eating-specific mindfulness meditation exercises. A single-group extended baseline design assessed all variables at 3 weeks pre-and post-, and at 1, 3, and 6 weeks; briefer assessment occurred weekly. Binges decreased in frequency, from 4.02/week to 1.57/week (p < .001), and in severity. Scores on the Binge Eating Scale (BES) and on the Beck Depression and Anxiety Inventories decreased significantly; sense of control increased. Time using eatingrelated meditations predicted decreases on the BES (r 5 .66, p < .01). Results suggest that meditation training may be an effective component in treating BED.
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Complementary medicine has a different philosophy from conventional medicine, presenting challenges to research methodology. Rigorous evaluation of complementary medicine could provide much needed evidence of its effectiveness. Good design of randomised controlled trials will avoid invalid results and misrepresentation of the holistic essence of complementary medicine. Practitioners need to be recognised as a component in or contributor to complementary treatment. Both specific and non-specific outcome measures with long follow up are needed to adequately encompass the essence of complementary medicine
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The new discipline of whole systems research (WSR) targets the study of complex CAM therapies as system-level phenomena, as opposed to single-agent or uni-dimensional effects. This article describes the pre-defined goals, issues that were developed, and opportunities that were revealed in a workshop held in Vancouver BC, in which scientists, practitioners, and policy makers met to lay the foundations of WSR. Important issues were identified, such as treatment individualization, problems of diagnosis, patient-practitioner interaction, varying therapeutic contexts, and patient-determined outcome values. Research design issues that were addressed included a variety of challenges to the study of intact systems, in relation to both synergy and emergent behaviors, and the opportunities to innovate the conventional RCT. As the network of CAM scientists and practitioners engaged in WSR expands, a common nomenclature and body of techniques will help us to a better understanding of the ways in which whole systems affect healing.
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Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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Although yoga is historically a spiritual discipline, it has also been used clinically as a therapeutic intervention. A bibliometric analysis on the biomedical journal literature involving research on the clinical application of yoga has revealed an increase in publication frequency over the past 3 decades with a substantial and growing use of randomized controlled trials. Types of medical conditions have included psychopathological (e.g. depression, anxiety), cardiovascular (e.g. hypertension, heart disease), respiratory (e.g. asthma), diabetes and a variety of others. A majority of this research has been conducted by Indian investigators and published in Indian journals, particularly yoga specialty journals, although recent trends indicate increasing contributions from investigators in the U.S. and England. Yoga therapy is a relatively novel and emerging clinical discipline within the broad category of mind-body medicine, whose growth is consistent with the burgeoning popularity of yoga in the West and the increasing worldwide use of alternative medicine.
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To determine the efficacy of a dietary supplement ingredient containing proprietary extracts of Magnolia officinalis and Phellodendron amurense in helping overweight, otherwise healthy, premenopausal female adults, who typically eat more in stressful situations manage their body weight. Randomized, double-blind, placebo-controlled clinical study. Setting Miami Research Associates, a clinical research organization consisting of 32 board-certified physicians, Miami, Fla. Healthy, overweight (BMI 25 to 34.9), premenopausal female adults, between the ages of 20 and 50 years, who typically eat more in response to stressful situations and scored above the national mean for women on self-reported anxiety. Two-hundred-fifty-mg capsules or identical placebo capsules 3 times a day for 6 weeks. Salivary cortisol levels, weight change, psychological measures of stress and anxiety. Twenty-eight subjects completed the study. Extracts of M officinalis and P amurense were well tolerated. There was a significant weight gain during the study for the placebo group (P < ,01), but no significant weight gain for the group receiving extracts of M officinalis and P amurense (P < .89). Paired t-tests comparing baseline to post-treatment weight showed an average gain of 1.5 kg in the placebo group and no change in the treatment group (P = .89). When groups were divided into gainers (ie, participants who gained at least 1 kg or more) and maintainers or losers, 75% of the control group were gainers versus 37% of the treatment group (P < .04). There was a nonsignificant trend for lowered average cortisol in the treatment group at the end of the study (group X time interaction, F = 1.1, P < .15). This difference was due to a treatment effect on evening cortisol. There was a marginally significant group X time interaction (P = .06), showing the treatment group tended to have lower levels of cortisol in the evening, whereas the control group tended to have higher levels of cortisol in the evening. Bedtime cortisol levels decreased in the treatment group and increased in the placebo group. Participants in both the treatment and placebo groups had improved scores on a number of psychological measures during the study. There was a correlation between perceived stress and weight change. The results of this pilot clinical study indicate that obese subjects who eat in response to stress may benefit from taking a dietary supplement ingredient containing proprietary extracts of M officinalis and P amurense. The mechanism of action appears to be through reduction of cortisol levels and possibly perceived stress, thereby helping participants maintain body weight. The sample size was small, however, and there was higher attrition in the control group than in the treatment group.
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This chapter discusses the treatment for eating disorders. The Diagnostic and Statistical Manual of Mental Disorders recognizes two primary eating disorders: anorexia nervosa (AN) and bulimia nervosa (BN). It also includes binge eating disorder (BED), sub threshold versions of AN and BN, and other disordered eating patterns. The most widely researched treatments for eating disorders are based on cognitive-behavioral procedures and have focused on BN and BED. Acceptance-based methods for treating eating disorders deserve increased attention, and several interventions that incorporate mindfulness training and acceptance-related procedures. Some of these are adaptations of previously developed interventions. For example, dialectical behavior therapy (DBT) has been adapted for BED and BN; mindfulness-based cognitive therapy (MBCT) has been adapted for BED; and acceptance and commitment therapy (ACT) has been applied to AN. In addition, mindfulness-based eating awareness training (MB-EAT) is developed specifically for BED. MB-EAT is developed by integrating elements from MBSR and CBT with guided eating meditations. The program draws on traditional mindfulness meditation techniques, as well as guided meditation, to address specific issues pertaining to shape, weight, and eating-related self regulatory processes such as appetite and both gastric and taste-specific satiety.
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This edited volume provides chapters on the leading evidence-based mindfulness interventions as of 2006: mindfulness-based stress reduction, mindfulness-based cognitive therapy, dialectical behavior therapy, and acceptance and commitment therapy. Applications for clinical, medical, and nonclinical but stressed populations, as well as children, adolescents, and older adults, are described. Each chapter includes a detailed case study illustrating how the intervention is implemented, conceptual background, empirical support, and a discussion of practical issues that clinicians wishing to use these treatments must consider. A second edition (2014) focusing on MBSR, MBCT, and related treatment programs is also available.
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36 competitive sportsmen and 36 inactive men carried out a maximal exercise test to volitional exhaustion on abicycle ergometer. In a second session, they were randomised to 20 minutes exercise at a high intensity of 70% maximal oxygen consumption (VO2 max), a moderate intensity of 50% of VO2 max or a light exercise control, with 12 sportsmen and 12 inactive men in each condition. Mood was assessed with ratings of tension-anxiety, mental vigour and exhilaration. Sportsmen but not inactive men showed a decrease in tension-anxiety across the maximal exercise test, while exhilaration increased in both groups. Increases in mental vigour and exhilaration were recorded two minutes after exercise at 70% and 50% VO2 max, and these responses were significantly greater than those in the control condition. In the case of exhilaration, effects were maintained after 30 minutes post-exercise recovery. The sportsmen and inactive men did not differ in these responses, nor were there differences between the two exercise intensities. Mood changes were not influenced by negative affectivity, or the intensity of cognitive and somatic anxiety. The relevance of the immediate mood effects of exercise for the understanding of long-term psychological changes with regular exercise is discussed.
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findings related to binge eating in obese individuals are reviewed and unresolved issues are emphasized prevalence of binge eating in obese individuals / binge-eating behavior in obese Ss [diagnostic considerations; binge behavior; purge behaviors; dieting, shape, and weight concerns] / comparisons of obese binge eaters and non-binge-eaters [dietary attitudes and behavior, eating behavior, psychiatric status, response to treatment] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Binge eating is a common problem associated with distress and dysfunction. Mindfulness-based interventions are attracting increasing attention, and the recent empirical literature suggests that they may be effective for a variety of disorders. Current theories about the etiology and maintenance of binge eating suggest that mindfulness training may be helpful for this problem. This report describes the use of mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002) in the treatment Of a client with subthreshold binge eating disorder. Posttreatment and 6 month follow-up data showed excellent improvements in binge eating symptoms as well as increased levels of mindfulness.
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Four hundred fifty-five females from a community-bgased, randomly sampled population were interviewed by telephone to estimate the prevalence of binge eating and to describe demographic and topographical characteristics of binge eating behaviour. Binge eaters were classified according to the DSM-111-R criteria for bulimia, excluding purging behavior. The estimate for subjects meeting criteria was 1.8%, while the percentage of females who met all but frequency criteria was estimated at 3.8%. The majority of binge eaters in this study was found to engage in behaviors typically associated with binge eating episodes. On average, this group of binge eaters was older and heavier than has been reported previously, which supported observed associations between binge eating and overweight in clinical populations [Telch, Agras, & Rossiter (1988). International Journal of Eating Disorders, 7, 115-119]. © 1992 John Wiley & Sons, Inc.
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Diagnostic criteria have been developed for a new eating disorder, binge eating disorder (BED), to describe the many individuals who have problems with recurrent binge eating but do not engage in the characteristic compensatory behaviors of bulimia nervosa, vomiting, or use of laxatives. The results of a multisite field trial involving 1,984 subjects indicate that the disorder is common (30.1%) among subjects attending hospital-affiliated weight control programs, but is relatively rare in the community (2.0%). The disorder is more common in females than in males and is associated with severity of obesity and a history of marked weight fluctuations. Based on these results, the DSM-IV Work Group on Eating Disorders has recommended that the disorder be considered for inclusion in DSM-IV, either as an official category or in an appendix of categories requiring further study.
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Study 1 tested whether yoga practice is associated with greater awareness of and responsiveness to bodily sensations, lower self-objectification, greater body satisfaction, and fewer disordered eating attitudes. Three samples of women (43 yoga, 45 aerobic, and 51 nonyoga/nonaerobic practitioners) completed questionnaire measures. As predicted, yoga practitioners reported more favorably on all measures. Body responsiveness, and, to some extent, body awareness significantly explained group differences in self-objectification, body satisfaction, and disordered eating attitudes. The mediating role of body awareness, in addition to body responsiveness, between self-objectification and disordered eating attitudes was also tested as proposed in objectification theory (Fredrickson & Roberts, 1997). Body responsiveness, but not awareness, mediated the relationship between self-objectification and disordered eating attitudes. This finding was replicated in Study 2 in a sample of female undergraduate students. It is concluded that body responsiveness and, to some extent, body awareness are related to self-objectification and its consequences.
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As part of a larger mixed-methods study, data from 20 personal journals were analyzed to examine the experience of a 12-week yoga treatment program for binge eating among a sample of 25 women who were obese. Qualitative analysis revealed a positive shift experienced by the women during the program, summarized by a general structural description: disconnection versus connection. Women's comments suggested that the program appeared to encourage a healthy reconnection to food, as well as the development of physical self-empowerment, through cultivating present-moment awareness. Specifically, women perceived an overall reduction in the quantity of food they consumed, decreased eating speed, and an improvement in food choices throughout the program. The women also reported feeling more connected to and positive about their physical well-being. These evolving outcomes were summarized through two major themes: the way their physicality changed, and the way their food consumption changed over time. Findings provide insights relevant to therapeutic processes that might occur within eating disorder interventions that draw on meditation-based approaches.
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Obesity arises when energy intake exceeds energy expenditure over a long period. Excess weight has an energy value of 7000 kcal/kg. Theoretically excess weight might be gained either because energy expenditure was too low or energy intake was too high. Many studies have shown that on average obese people expand more energy than normal so, notwithstanding dietary histories to the contrary, they must on average have a higher energy intake to maintain body weight. However it is not possible to show that obese people have any significant defect in short-term regulation of energy intake. The likeliest hypothesis is that obesity is a disorder arising from a failure of the long-term regulation of energy intake, in which cognitive factors play an important part.
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The purpose of this study was to conduct an assessment of binge eating severity among obese persons. Two questionnaires were developed. A 16-item Binge Eating Scale was constructed describing both behavioral manifestations (e.g., eating large amounts of food) and feeling/cognitions surrounding a binge episode (e.g., guilt, fear of being unable to stop eating). An 11-item Cognitive Factors Scale was developed measure two cognitive phenomena thought to be related to binge eating: the tendency to set unrealistic standards for a diet (e.g., eliminating "favorite foods") and low efficacy expectations for sustaining a diet. The results showed that the Binge Eating Scale successfully discriminated among persons judged by trained interviewers to have either no, moderate or severe binge eating problems. Significant correlation between the scales were obtained such that severe bingers tended to set up diets which were unrealistically strict while reporting low efficacy expectations to sustain a diet. The discussion highlighted the differences among obese persons on binge eating severity and emphasized the role of cognitions in the relapse of self control of eating.
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Binge eating is a common problem among obese individuals, and a simple, accurate way to identify obese binge eaters is needed. This study measured the concordance of the Binge Eating Scale (BES) and the Eating Disorder Examination (EDE). Women seeking obesity treatment (N = 126) were identified as binge eaters or nonbinge eaters using the BES, and then interviewed by clinicians blind to BES score using the EDE, a semistructured interview considered to be the "gold standard" for eating disorder diagnosis. The BES accurately identified nonbinge eaters; 39 of 42 (92.9%) BES-identified nonbinge eaters were confirmed by the EDE. However, the BES did not accurately identify binge eaters; only 43 of the 83 (51.8%) BES-identified binge eaters were confirmed by the EDE. Reasons for the discrepancy between the BES and the EDE in the identification of binge eaters were explored, and modifications to the BES that might improve its accuracy were considered.
Article
To assess the methodologic quality of approaches used to allocate participants to comparison groups in randomized controlled trials from one medical specialty. Survey of published, parallel group randomized controlled trials. All 206 reports with allocation described as randomized from the 1990 and 1991 volumes of four journals of obstetrics and gynecology. Direct and indirect measures of the adequacy of randomization and baseline comparisons. Only 32% of the reports described an adequate method for generating a sequence of random numbers, and only 23% contained information showing that steps had been taken to conceal assignment until the point of treatment allocation. A mere 9% described both sequence generation and allocation concealment. In reports of trials that had apparently used unrestricted randomization, the differences in sample sizes between treatment and control groups were much smaller than would be expected due to chance. In reports of trials in which hypothesis tests had been used to compare baseline characteristics, only 2% of reported test results were statistically significant, lower than the expected rate of 5%. Proper randomization is required to generate unbiased comparison groups in controlled trials, yet the reports in these journals usually provided inadequate or unacceptable information on treatment allocation. Additional analyses suggest that nonrandom manipulation of comparison groups and selective reporting of baseline comparisons may have occurred.
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The study was designed with the aim of determining whether extending group cognitive-behavioral therapy (CBT) would enhance outcome among individuals with binge eating disorder (BED) who failed to stop binge eating after an initial 12-week CBT intervention. Forty-six participants who met diagnostic criteria for BED were randomly allocated to either a 12-week group CBT intervention or a waiting list control condition. At the end of 12 weeks, treated participants who met clinical criteria for improvement subsequently received 12 sessions of behavioral weight loss. Remaining participants received 12 additional sessions of CBT for binge eating. Fifty percent of treated participants improved with the initial 12-week course of CBT. There was a strong trend for the extension of CBT to affect improvement in binge eating among initial nonresponders (6 of 14 subjects no longer met diagnostic criteria for BED). Overall, extending CBT led to clinical improvement in 66.7% of all treated participants, with treatment gains occurring through session 20. The results suggest that an extended course of CBT (i.e., longer than 12 weeks) will likely maximize the number of potential responders to treatment.
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Bulimia nervosa and binge-eating disorder are characterized by a persistent course, are associated with comorbid psychopathology, and can result in serious medical complications. Although current treatments for these disorders show promise, they are not effective for approximately 40% of clients. Significant advances have been made in psychosocial research on the etiology and maintenance of bulimia nervosa and binge-eating disorder, as well as on the predictors of treatment response. This article reviews these advances and discusses the clinical implications of these findings. Research on etiology and maintenance suggests that eating-disorder treatments might be improved by focusing greater attention on promoting healthy weight-control techniques, increasing resiliency to sociocultural pressures to be thin, reducing thin-ideal internalization, and fostering adaptive affect-regulation skills. Research on the predictors of response to treatment suggests that matching treatments to client characteristics might further bolster intervention effectiveness.
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For persons with multiple sclerosis (MS), good nutrition has the potential to enhance quality of life and reduce the risk of lifestyle diseases and secondary conditions. The purpose of this study was to describe nutritional intake of women with MS and to determine what factors influenced their intake. Based on 3-day food diary data, participants had an inadequate intake (< 10% lower than recommended) of carbohydrates, dietary fiber, vitamin E, calcium and zinc. In contrast, they consumed saturated fat, protein, vitamin A, vitamin C, folate and iron at higher levels than recommended. Age was significantly related to nutritional intake with older women consuming fewer calories, total fat and saturated fat. Despite evidence supporting the importance of following recommended nutritional guidelines, nutritional intake for participants in this study was not optimum in many important areas. This study supports the need for interventions to promote good nutrition among persons with MS.
Article
This study examined the factors associated with the diagnostic outcome of obese individuals with and without binge eating disorder (BED) 1 year after completing a very low calorie diet (VLCD) program. Participants included 63 individuals with BED, 36 individuals with subthreshold BED, and 29 individuals with no binge eating symptoms. Diagnoses before and after VLCD were obtained using the Structured Clinical Interview for DSM-IV (SCID) interviews. The severity of psychiatric symptoms were assessed using various rating scales. Fifty-six percent (n = 36) of the participants who met criteria for BED at baseline did not meet diagnostic criteria 1 year later. None of the baseline factors were statistically associated with outcome. Although the main hypothesis was not supported, absence of a BED diagnosis at 12-month follow-up after a VLCD diet appears to be associated with less weight gain at 1-year follow-up regardless of baseline diagnosis.
Article
The role of walking, as compared with vigorous exercise, in the prevention of cardiovascular disease remains controversial. Data for women who are members of minority racial or ethnic groups are particularly sparse. We prospectively examined the total physical-activity score, walking, vigorous exercise, and hours spent sitting as predictors of the incidence of coronary events and total cardiovascular events among 73,743 postmenopausal women 50 to 79 years of age in the Women's Health Initiative Observational Study. At base line, participants were free of diagnosed cardiovascular disease and cancer, and all participants completed detailed questionnaires about physical activity. We documented 345 newly diagnosed cases of coronary heart disease and 1551 total cardiovascular events. An increasing physical-activity score had a strong, graded, inverse association with the risk of both coronary events and total cardiovascular events. There were similar findings among white women and black women. Women in increasing quintiles of energy expenditure measured in metabolic equivalents (the MET score) had age-adjusted relative risks of coronary events of 1.00, 0.73, 0.69, 0.68, and 0.47, respectively (P for trend, <0.001). In multivariate analyses, the inverse gradient between the total MET score and the risk of cardiovascular events remained strong (adjusted relative risks for increasing quintiles, 1.00, 0.89, 0.81, 0.78, and 0.72, respectively; P for trend <0.001). Walking and vigorous exercise were associated with similar risk reductions, and the results did not vary substantially according to race, age, or body-mass index. A brisker walking pace and fewer hours spent sitting daily also predicted lower risk. These prospective data indicate that both walking and vigorous exercise are associated with substantial reductions in the incidence of cardiovascular events among postmenopausal women, irrespective of race or ethnic group, age, and body-mass index. Prolonged sitting predicts increased cardiovascular risk.
The increasing drive to adopt evidence-based practice within the mainstream health service creates a sense of urgency for high quality, rigorous research to support CAM. The RCT is seen as the gold standard for allopathic research. However, the tenets of the RCT cannot simply be just picked up and applied to CAM research. Critics of the RCT propose that it fractures and fragments the essence of many complementary therapies. Challenges including standardisation, blinding, randomisation, practitioner influence, placebos, and controls are explored and some possible solutions are presented. CAM researchers need to be creative so that they capture some of the intangibles that currently slip through the reductionist net of the RCT.
Article
The current study assesses concordance between self-administered measures and a diagnostic standard for assessment of binge frequency and diagnosis of binge eating disorder (BED) in a sample of binge eaters. The Questionnaire for Eating and Weight Patterns-Revised (QEWP-R), Binge Eating Scale (BES), two items from the Eating Disorder Examination Questionnaire with Instructions (EDE-Q-I), and the Eating Disorder Examination (EDE) were administered. Participants were 157 adults volunteering for a clinical study, of whom 129 (79%) were diagnosed with BED using the EDE as the diagnostic standard. In the identification of BED, the QEWP-R yielded a sensitivity value of .74 and a specificity value of .35. The BES yielded a sensitivity value of .85 and a specificity value of .20. Frequency of binge eating days and episodes on the EDE-Q-I correlated highly with the EDE (.65 and .48, respectively; p < .001). The accuracy of diagnosis and symptomatology among self-administered questionnaires is variable. The BES and the QEWP-R performed satisfactorily as initial screens for the diagnosis of BED, but were less accurate in identifying non-BED individuals and the frequency of binge eating. The EDE-Q-I most accurately assessed the frequency of binge eating.
Article
Yoga has become increasingly popular in Western cultures as a means of exercise and fitness training; however, it is still depicted as trendy as evidenced by an April 2001 Time magazine cover story on "The Power of Yoga." There is a need to have yoga better recognized by the health care community as a complement to conventional medical care. Over the last 10 years, a growing number of research studies have shown that the practice of Hatha Yoga can improve strength and flexibility, and may help control such physiological variables as blood pressure, respiration and heart rate, and metabolic rate to improve overall exercise capacity. This review presents a summary of medically substantiated information about the health benefits of yoga for healthy people and for people compromised by musculoskeletal and cardiopulmonary disease.
Yoga is promoted or weight maintenance, but there is little evidence of its efficacy. To examine whether yoga practice is associated with lower mean 10-year weight gain after age 45. Participants included 15,550 adults, aged 53 to 57 years, recruited to the Vitamin and Lifestyle (VITAL) cohort study between 2000 and 2002. Physical activity (including yoga) during the past 10 years, diet, height, and weight at recruitment and at ages 30 and 45. All measures were based on self-reporting, and past weight was retrospectively ascertained. Multiple regression analyses were used to examined covariate-adjusted associations between yoga practice and weight change from age 45 to recruitment, and polychotomous logistic regression was used to examine associations of yoga practice with the relative odds of weight maintenance (within 5%) and weight loss (> 5%) compared to weight gain. Yoga practice for four or more years was associated with a 3.1-lb lower weight gain among normal weight (BMI < 25) participants [9.5 lbs versus 12.6 Ibs] and an 18.5-lb lower weight gain among overweight participants [-5.0 lbs versus 13.5 Ibs] (both P for trend <.001). Among overweight individuals, 4+ years of yoga practice was associated with a relative odds of 1.85 (95% confidence interval [CI] 0.63-5.42) for weight maintenance (within 5%) and 3.88 (95% Cl 1.30-9.88) for weight loss (> 5%) compared to weight gain (P for trend .026 and .003, respectively). Regular yoga practice was associated with attenuated weight gain, most strongly among individuals who were overweight. Although causal inference from this observational study is not possible, results are consistent with the hypothesis that regular yoga practice can benefit individuals who wish to maintain or lose weight.
Article
Survey research is demonstrating that binge eating and compulsive eating may be a significant problem in the obese population. There is higher incidence of binge eating among women, associated with subjective distress and poor prognosis for weight control. Despite attendant health risks, researched clinical responses have not been developed. A before and after uncontrolled pilot study aimed to evaluate the effectiveness of group therapy for women who binge eat and compulsively eat. Participants attended a weekly integrative therapy group for 6 months. Measurements before and after the group intervention were taken using the Binge Eating Scale and Clinical Outcomes in Routine Evaluation inventories. Before and after interviews were thematically analysed for changes