This year, we received a landmark grant in partnership with University at Buffalo from lululemon. The grant will support a two-year research initiative on our programs.
Yoga is the sixth most commonly used complementary health practice among adults.1 About 30 million people practice yoga worldwide, and nearly half of them (14 million, or 6.1% of the American population) report that yoga was initially recommended by a physician or therapist.2 Yoga has been shown to improve quality of life3; reduce stress4; lower heart rate and blood pressure5; help relieve anxiety, depression, and insomnia6; and improve overall physical health, strength, and flexibility.7
Despite the known benefits of yoga, health insurers and governmental healthcare systems do not cover therapeutic yoga programs. Eat Breathe Thrive is only able to secure reimbursement in treatment centers by billing itself a “psychoeducation” program, and our clients report that cost is the main barrier to the program. In order to secure funding from health insurers and national healthcare systems, substantial academic research must show yoga-based interventions can improve the outcome of eating disorders.
There is precedent for adoption of a complementary intervention by insurers and government agencies. Mindfulness-based Stress Reduction (MBSR) is one of the most widely available complementary programs in the world, thanks largely to research on its efficacy. Since its inception thirty-five years ago, more than 2000 studies have been published on the program’s efficacy. The eight-week program has been shown to improve conditions such as anxiety, asthma, cancer, eczema, insomnia, post-traumatic stress.8 Today, insurance companies including Aetna, Cigna, and Blue Shield offer reimbursement for the program.
To date, only two randomized control trials have examined the efficacy of yoga for eating disorders. One examined how five days of therapeutic yoga classes before meals affect mood, and the other explored whether two months of weekly yoga classes improved eating disorder behaviors. Neither studied a systematized yoga program, and only one was done in a residential setting. While the results were promising, both studies were relatively small and had limited effect sizes.
The potential impact of this research cannot be overstated. This will be the largest ever research initiative on a yoga program for food and body image challenges.
Project Summary and Timeline
The goal of the initiative is to complete three studies on the Eat Breathe Thrive program. The studies will focus on three major populations: (1) individuals with clinical eating disorders, (2) adults with “run-of-the-mill” food and body image issues, and (3) college athletes.
This two-year initiative will answer the questions, “Is the program an effective adjunct treatment for eating disorders?” and “Can yoga-based programs help to prevent eating disorders?” and “Does the program support mindful eating, emotional resilience and body confidence?”
Three doctoral students from Dr. Catherine Cook-Cottone’s research team are completing the studies for their dissertations. The project will commence in three phases:
Train researchers at University at Buffalo.
Collect and analyze
data on programs.
Fall 2017 to
Disseminate findings in peer-reviewed journals.
to Fall 2019
Study One: Does the program promote mindful eating, emotional resilience, and body confidence?
This randomized controlled trial will explore whether the program supports mindful eating, body confidence, and emotional resilience in a community sample of adults. Data will be collected at ten community centers where certified facilitators currently run programs. Two hundred individuals will be enrolled in the study. Each participant will be randomly assigned to one of three groups: wait list, six-week program, or two six-week programs. This study will allow us to assess for dosage effects, seeking evidence that the more exposure one has to the program, the better the outcomes.
Study Two: Is the program an effective complementary treatment for eating disorders?
This randomized controlled trial will explore whether the program shortens treatment time and prevents relapse in a group of individuals being treated for eating disorders. The study will be conducted at three eating disorder treatment centers. Data will be collected on a rolling basis for eighteen months. Upon admission to the center, patients will be randomized into either the six-week program or active control group. The active control group will include gentle exercise, nutritional psychoeducation, and interactive activities. This study will allow us to track relapse rates, seeking evidence that the program reduces healthcare costs.
Study Three: Does the program prevent food and body image issues among college athletes?
This controlled trial will explore whether the program prevents eating disorders and promotes a positive relationship with food and body (e.g., reduces injury, supports healthy eating, and improves body image) among college athletes. Data will be collected over the course of five semesters at the University at Buffalo. To ensure adequate recruitment for the study, the Eat Breathe Thrive program will be offered as an undergraduate course to Division I athletes at the university. The control group will consist of college athletes not enrolled in the program. This study will allow us to assess whether the program helps a vulnerable population, seeking evidence the program prevents eating disorders before they start.
Research consistently indicates an increased prevalence of eating disorders in sport; 13.5% of athletes have subclinical to clinical eating disorders.11 Studies suggest that risk factors are particularly pronounced in sports such as gymnastics, wrestling, figure skating, track, and dancing. The average age of onset for eating disorders is between the ages of 19 and 25 years old.12 Based on this evidence, we have chosen to focus specifically on college athletes (rather than the general student population).
We are using a combination of population-specific and common measures in each study. This allows us to make comparisons between each group, as well as amass evidence that the program works as both a complementary treatment and preventative program.
Our measures include:
Third party reports
Includes clinician, coach, and facilitator assessments. This measure will allow us to get an objective measure on each participant’s behavior.
The questionnaires will include scales like the Beck Depression Inventory, Eating Disorder Examination, etc.
Ecological momentary assessment
Involves the use of smartphone technology to monitor participants’ thoughts, feelings, and behavior continuously throughout the day.
Our measures will assess how the program impacts:
▶   Healthy Choices
▶   Body Appreciation
▶   Eating Disorder Behaviors
▶   Self Care Activities
▶   Interoceptive Awareness
▶   Emotional Regulation
▶   Intimacy Skills
▶   Mindful Eating
▶   Treatment Compliance
▶   Social Loneliness
▶   Distress Tolerance
▶   Time in Treatment
▶   Substance Use
▶   Relapse Rates
1 Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report #12. 2008.
2 Macy D (2008) Yoga journal releases 2008 “Yoga in America” market study. Yoga Journal. Available: https://www.yogajournal.com/press-releases/yoga-journal-releases-2012-yoga-in-america-market-study Accessed 20 February 2013.
3 Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Alternative Therapies in Health and Medicine. 2006;12(1):40–47.
4 Kiecolt-Glaser JK, Christian L, Preston H, et al. Stress, inflammation, and yoga practice. Psychosomatic Medicine. 2010;72(2):113–121.
5 Raub, JA. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. The Journal of Alternative and Complementary Medicine. 2002;8(6):797–812.
6 Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. Journal of Alternative and Complementary Medicine. 2010;16(1):3–12.
7 Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al. Hatha yoga for depression: a critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. Journal of Psychiatric Practice. 2010; 16(1):22–33.
8 Paul Grossman, Ludger Niemann, Stefan Schmidt, Harald Walach, Mindfulness-based stress reduction and health benefits, Journal of Psychosomatic Research, Volume 57, Issue 1, 2004, Pages 35-43, ISSN 0022-3999, http://dx.doi.org/10.1016/S0022-3999(03)00573-7.
9 Carly R. Pacanowski, Lisa Diers, Ross D. Crosby & Dianne Neumark-Sztainer (2016): Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial, Eating Disorders, DOI: 10.1080/10640266.2016.1237810
10 Carei T. R., Fyfe-Johnson A. L., Breuner C. C., Brown M. A. Randomized controlled clinical trial of yoga in the treatment of eating disorders. Journal of Adolescent Health. 2010;46(4):346–351. doi: 10.1016/j.jadohealth.2009.08.007.
11 Sundgot-Borgen J., Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004 Jan;14(1):25-32.
12 Hudson JI, Hiripi E, Pope HG, Kessler RC. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological psychiatry. 2007;61(3):348-358. doi:10.1016/j.biopsych.2006.03.040.