The aim of this study was to explore the prevalence of practicing yoga and associations with body image, mindful eating, disordered eating, and muscle-enhancing behaviors in a diverse population-based sample of emerging adults. Findings among this primarily low-income and ethnically/racially diverse population-based sample indicate that yoga practitioners had higher levels of mindful eating and body satisfaction than those not practicing yoga. However, and of concern, young adults practicing yoga had similar levels of unhealthy weight control behaviors and binge eating, and were more likely to use steroids or protein powders/shakes to enhance the size or tone of their muscles than those not practicing yoga. After further adjustment for BMI, which was lower among yoga practitioners than non-practitioners, yoga practice was not associated with body satisfaction and was associated with higher levels of less extreme unhealthy weight control behaviors. These patterns did not differ significantly across ethnic/racial subgroups of the population. While yoga may offer many health benefits broadly (25–29) and in terms of body image, disordered eating, and weight-related health (37, 57, 58), it is important that yoga teachers are aware that many of their students may be engaging in unhealthy behaviors aimed at changing their body shape or size. Yoga teachers and yoga practitioners, themselves, can take steps toward the promotion of greater body acceptance and appreciation.
To the best of our knowledge, this is the first population-based study that has examined associations between yoga practice and the use of muscle enhancers such as steroids or protein powders/shakes. Just over a third of emerging young adults practicing yoga used protein powders or shakes to enhance the size or tone of their muscles. While there is a lack of clarity about what they were consuming and potential adverse health consequences, findings suggest a preoccupation with muscle enhancement. The higher use of steroids to enhance muscles among yoga practitioners is of great concern, particularly given the known adverse consequences of using steroids (59). While further research in different populations is needed to confirm these findings, results from the current study suggest that yoga teachers would do well to avoid any language likely to increase concerns about physique.
Similarly, it is of concern that equal or higher percentages of young adults practicing yoga engage in disordered eating behaviors as compared to those not practicing yoga. 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 findings 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 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 health outcomes. Our findings suggest the need for yoga teachers to be aware of the high percentage of their students who may be engaging in disordered eating behaviors and engage in teaching practices likely to help, and not harm, their students. For example, given that internal critique and comparative critique during yoga class have been identified by yoga practitioners as factors with the potential to harm one’s body image, teachers are encouraged to use language to help students focus inward and minimize students’ tendencies to make comparisons with either the teacher or other students (14). Furthermore, work by Halliwell and colleagues (37), suggests the value of intentionally inserting language to support an improved body image to enhance the positive impact of yoga (e.g., practicing gratitude for all the things one’s body can do or envisioning the body as a guesthouse for the soul).
In the current study, yoga was associated with higher levels of mindful eating. 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). Further work is needed to determine if yoga can lead to more mindful eating and, in turn can help reduce binge eating behaviors in the general population.
Body satisfaction was found to be higher among emerging adults practicing yoga in analyses adjusted for sociodemographic characteristics but not after further adjustment for weight status. The difference between these two analyses can be attributed to the lower mean BMI among yoga practitioners and the inverse associations that tend to exist in our society between BMI and body satisfaction (65). The first analysis indicates that young adults practicing yoga have higher levels of body satisfaction after adjusting for any differences in socio-demographic characteristics. The second analysis, with additional adjustment for weight status, informs us that if young adults practicing and not practicing yoga were similar with regard to their weight status, there would not be differences in body satisfaction across the groups. What remains unclear from the current analysis is whether young adults with lower BMI values choose to engage in yoga more often than their counterparts, or whether yoga has helped them reduce their BMI. There is some evidence that yoga can help in reducing BMI (66), with two population-based studies suggesting that yoga can help with weight gain prevention (67, 68). However, it is also highly likely that the mean difference in BMI between the yoga practitioners and the non-practitioners is due to young adults with lower BMI values being more likely to choose to engage in yoga. Persons living in larger bodies may not feel comfortable at some settings in which yoga is taught. For example, in one of these population-based studies, among young adults practicing yoga, those with higher BMI values were less likely to practice at yoga studios than yoga practitioners with lower BMI values (68). Yoga settings need to be proactive in helping persons from diverse backgrounds, and of diverse body shapes, sizes, and abilities, to feel more welcome and comfortable (39, 69–72).
Study strengths and limitations should be taken into account in interpreting the findings. An important strength of the current study is the large size and diverse nature of the study population. There has been a dearth of research on yoga among low-income and ethnically/racially diverse populations. The assessment of a broad array of attitudes and behaviors related to body image is also a study strength. We are unaware of any studies that have examined yoga in relation to muscle enhancing behaviors in any population-based studies. Young people from diverse ethnic/racial and low socio-economic backgrounds have been found to be at high risk for problematic eating and weight-related outcomes (2, 7–11), but may be underserved with regard to prevention and treatment interventions (73, 74). It is crucial to learn more about how to help in promoting a healthy body image and prevent and reduce unhealthy muscle-enhancing and disordered eating behaviors among diverse and potentially underserved populations.
While the diverse nature of the study population is a study strength, it is important to note that in order to properly examine patterns of relatively rare behaviors (e.g., steroid use) by yoga practice, within separate ethnic/racial groups, larger numbers will be needed. Likewise, while utilizing a community-based sample allows for a determination of who is practicing yoga, the mean frequency of practicing yoga among such a broad sample tends to be low, with relatively few respondents reporting practicing an average of more than two hours a week. While we conducted a dose-response analysis, and did not see trends suggesting that those practicing more often were better off, the numbers of young adults practicing frequently was low, leading us to interpret the findings cautiously. Additionally, the cross-sectional nature of the study needs to be considered in interpreting findings; inferences about directionality of associations or causation cannot be inferred. Further longitudinal work is needed to detect changes over time following a consistent period of yoga practice. Finally, it is important to replicate these findings in other study populations and to examine differences in associations by characteristics of the yoga practice (e.g., intensity, focus), teaching styles, and locations of practice (e.g., home vs. studio). As previously noted, we are unaware of any other studies that have examined muscle enhancing behaviors in population-based samples and it will be important to replicate our findings and explore in more depth.