Yoga as a treatment for binge eating disorder: A preliminary study
Introduction
Binge eating disorder (BED) is characterised by several criteria,1 including the consumption of large amounts of food, accompanied by feelings of lack of control. Clinic, community and population-based studies have reported that binge eating is associated with being overweight, the early onset of obesity, and more severe adiposity.2, 3, 4 Approaches to treating BED have been typically based on cognitive–behavioural therapy, interpersonal therapy, or dietary-led weight-loss therapies.5 Whilst there is considerable support for the efficacy of some cognitive–behavioural and interpersonal treatment programs for treating binge eating,6, 7 these approaches may not be effective for as many as 40–50% of BED patients.8 Whilst dietary-led treatment models have achieved high success rates for weight reduction, there is evidence that these improvements were frequently only sustained in the short term.5
Therefore, there is certainly scope for the development of alternative strategies, given a holistic approach could potentially influence the complex nature of binge eating's physical and psychological co-morbidities in a positive way. Indeed, encouraging evidence has emerged regarding the use of meditation-based therapies for treating binge eating, notably involving eating mindfully.9 However, whilst research pertaining to eating mindfully continues to expand,10, 11, 12, 13, 14, 15, 16 few studies assess complementary and relevant outcomes such as changes in physical activity.
Yoga is also a meditation-based modality, but takes the therapeutic model a step further by introducing physical movement that is easily adapted for an overweight and obese population. Indeed, yoga has been applied as a therapeutic model to a wide range of physical and psychological conditions.17, 18 The term ‘yoga’ is used here in its broadest definition, including all the major approaches and paths which form its discipline, such as hatha yoga, reflecting the pedagogical framework provided by Gowans.19
Given yoga typically incorporates concentration and meditation practices, physical awareness and movement, as well as breath awareness,20 it was possible yoga could have a positive effect on the maladaptive eating behaviours associated with binge eating. For example, yoga has been reported to improve eating attitudes among a cohort with disordered eating.21 However, to the investigators’ knowledge, no study at the commencement of this project had specifically examined the effects of a yoga-based program as a treatment for binge eating behaviour among a community-based adult sample. Therefore, a randomised, 12-week trial was undertaken to compare the effects of a yoga program with a wait-list control group on binge eating severity and physical activity among a sample of women who were overweight or obese.
Given that yoga promotes joint space, flexibility, and full range of motion,19, 22 it was also of interest to examine if the current program could facilitate increased activity for participants. Thus, binge eating severity and physical activity levels were the primary outcome measures. Studies have indicated yoga promotes weight attenuation and potentially, even weight loss.23, 24 Therefore, secondary outcomes included anthropometric measurements, such as BMI, waist and hips.
Section snippets
Method
A community-based sample of women who were overweight or obese with a binge eating problem were recruited through suburban newspaper and radio press releases between August 2005 and May 2006, since women tend to report the highest rates of obesity and binge eating.25 The targeted number of participants (n = 90) was based on an estimated large effect for this type of program relating to binge eating (d = 2.1),26 an estimated power of .8, and a 30–40% attrition rate.27 A random numbers table method28
Outcome measures
Binge Eating Scale (BES).31 The BES is generally accepted as a valid and reliable measure for assessing self-reported binge eating severity. It has been reported as an appropriate screening tool,33 and is responsive to changes over time.34 The BES is a 16-item measure, scored by adding individual values (ranging from 0 to 3 per item from a scoring key), with high scores (>27) indicating high severity of binge eating. Strong psychometrics support of the validity of this measure.35, 36
The short (7
Secondary outcomes
Anthropometric measures: BMI, waist and hips measurement. Instruments included a scale for weight accurate to two decimal places, a stature meter for height, plus a thin measuring tape for hips and waist. Measurements were obtained during baseline and post-test data collection sessions with trained assistants. A further measure was employed as a screening tool, the Lie Scale from Form A of the Eysenck Personality Inventory.32 This questionnaire has been frequently employed by exercise studies
The yoga intervention
The assessment battery was concurrently administered to all participants at baseline and post-test (12 weeks following baseline) at specifically scheduled questionnaire sessions. Following the final assessment participants were invited to participate in the same 12-week yoga program as the yoga group. Participants in the yoga group participated in a weekly 60-min session of yoga for 12 weeks. Whilst the yoga literature reports interventions spanning 5 days to 2 years, Jacobs et al.’s39
Analysis
First, a per-protocol analysis was conducted to examine the intervention's potential maximum effect among a compliant cohort. Therefore, a series of statistical analyses were conducted to examine potential changes from baseline using SPSS Version 13.0.41 Two-way repeated measures analyses of variance (ANOVAs), with group as the between-subjects variable and time as the within-subjects variable, were used to assess differences between groups for all primary and secondary outcomes. In the event
Primary outcomes: binge eating and physical activity
The two-way repeated measures ANOVA (see Table 2), in conjunction with the Tukey test (critical value 2.8), revealed that whilst pre to post-test mean scores for the control group remained relatively unchanged there was a significant decrease in binge eating scores for the yoga group (p < .001).
Further, according to Cohen's43 criteria, the effect size (d = 2.2) for this change would be considered large. For physical activity, the pattern of change was significantly different between the yoga and
Discussion
For the yoga group, reductions in self-reported binge eating were large and statistically significant. An increase in self-reported physical activity was also statistically significant, with a large effect size. Improvements on these measures were also maintained at 3-month follow-up for the yoga group. Further, at post-test, these changes were accompanied by statistically significant, albeit small, reductions for BMI and hip and waist measurements for the yoga group. In addition, as results
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