Yoga at Every Size: A Preliminary Evaluation of a Brief Online Size-inclusive Yoga-based Intervention for Higher Weight College Women

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1 Yoga at Every Size: A Preliminary Evaluation of a Brief Online Size-inclusive Yoga-based Intervention for Higher Weight College Women Jennifer B. Webb, Ph.D. UNC Charlotte Department of Psychological Science Health Psychology Ph.D. Program APA Division 35 Symposium Presentation August 6, 2017

2 Student Co-Authors Meagan P. Padro, BS, BA Courtney B. Rogers, MA Erin R. Vinoski, MPH Lena Etzel, BA

3 Research Aims To evaluate the preliminary efficacy of a brief, minimally-guided, online size-affirming yoga-based intervention versus a wait-list control for increasing positive body image, self-compassion, and intuitive eating among higher weight college women To assess the feasibility and acceptability of this integrative mind-body approach

4 Conceptual & Empirical Foundations Body Functionality/Internal Body Orientation (Alleva et al., 2015; Avalos & Tylka, 2006; Rubin & Steinberg, 2011) The Developmental Theory of Embodiment (Piran & Teall, 2012)/The Embodiment Model of Positive Body Image (Menzel & Levine, 2011) Health at Every Size Health Promotion Model (ASDAH, 2013; Bacon, 2010) Brief Web-based Guided Self-help Mindfulness and Selfcompassion-based Intervention Science (Albertson et al., 2014; Cavanagh et al., 2013) Yoga and Embodiment Scholarship (Klein & Cook-Cottone, 2013; Neumark-Sztainer, 2014; Mahlo & Tiggemann, 2016)

5 Yoga and Embodiment: What about higher weight women? Binge eating and physical activity (McIver et al., 2009b) Perceived food choices, healthy reconnection to food and positive evaluation of physical well-being (McIver et al., 2009a) Perceived Barriers to Access Mismatch with body type (Ipsos Public Affairs, 2016) Media (mis)representations of the yoga body (Vinoski et al., 2017; Webb et al., 2017a, Webb et al., 2017b) Limited size-diverse yoga clothing/athletic wear options

6 Advancing Body Positivity & Health Through Size-Inclusive Yoga

7 Size-Inclusive Yoga: Breaking Barriers and Challenging Stereotypes

8 Method Participants 66 undergraduate women between with a BMI of at least 25 kg/m 2 42 completers (21 per condition; 36% attrition) Mean Age = 20.9 years (SD = 2.4) Mean BMI = 30.9 kg/m 2 (SD = 5.5) 50% White/European American, 31% Black/African American 50% senior class status 81% non-psychology majors

9 Method Measures Demographic Questionnaire Body Appreciation Scale-2 (Tylka & Wood-Barcalow, 2015) Functional Body Awareness and Appreciation Scales (Rubin & Steinberg, 2011) Body Image-Acceptance and Action Questionnaire (Sandoz et al., 2013) Self-compassion Scale (Neff, 2003) Intuitive Eating Scale-2 (Tylka & Kroon Van Diest, 2013) Feedback Questionnaire (Yoga Group only) Incentives $10 Amazon gift card (baseline) $20 Amazon gift card (post) Yoga equipment kit (block, strap, and mat; Yoga Group only)

10 Method 4-Week Intervention Components 3, 15-minute Curvy Yoga Practice Videos featuring Anna Guest-Jelley Daily Body Positive Motivational Image Daily Body Gratitude Journaling Motivational Wristband: Yoga is for EVERY Body! No weigh-in Necessary!

11 Results: Baseline Differences Completers (N = 42) vs. Attriters (N = 24) Body Image Flexibility (p =.001; C > A) Yoga Group (N = 21) vs. Wait-list Control (N = 21) BMI (p <.10; YG > WL) Functional Body Awareness (p <.10; WL > YG)

12 Results Body Image Flexibility Time: F (1, 40) = 5.15, p <.05 Baseline Mean: 49.1 (SD = 13.1) Post Mean: 53.1 (SD = 15.4) Self-compassion Time: F (1, 40) = 5.45, p <.05 Baseline Mean: 2.81 (SD = 0.55) Post Mean: 2.98 (SD = 0.61) Intuitive Eating No significant effects

13 Results: Body Appreciation Yoga Group Wait-list Baseline Post Group x Time: F (1, 40) = 5.47, p <.05, d = -.75 (Yoga Group)

14 Results: Functional Body Awareness Yoga Group Wait-list Baseline Post Group x Time: F (1, 40) = 7.09, p <.05, d = -.73 (Yoga Group)

15 Results: Functional Body Appreciation Yoga Group Wait-list 3 Baseline Post Group x Time: F (1, 40) = 4.67, p <.05, d = -.61 (Yoga Group)

16 Results: Adherence and Acceptability 81% practiced the yoga videos at least 3-4 times per week 76% wrote in their body gratitude journal at least 1-2 times per week 81% were at least moderately satisfied with the program overall 72% found the daily images at least somewhat motivating or encouraging 52% wore the motivational wristband at least 1-2 times per week 76% reported having the yoga equipment supplied to them was very helpful

17 Discussion Evidence of preliminary efficacy for improving certain aspects of positive body image Greater intensity, direct guidance, and content focus may be warranted to achieve improvements in other outcomes. Most young women reported good adherence and were satisfied with their experiences in the program. Attrition was comparable to other brief, lowintensity online mindfulness-based guided selfhelp interventions.

18 Limitations Use of self-reported BMI for randomization No follow-up assessment Self-reported adherence measures Equipment (e.g., scale, BP cuffs) Multi-component intervention

19 Future Directions Evaluate potential effects on reducing negative body image and difficulties with embodiment. Make explicit that yoga is the basis of the intervention in recruitment materials. Consider using a stratified randomization procedure. Hold an in-person group yoga class led by a size-inclusive yoga instructor at the outset. Consider using body image flexibility scores as a screening tool. Include a follow-up assessment. Revise functional body appreciation journaling prompt. Include additional measures Experiences of Embodiment (Piran & Teall, 2012) Body Compassion (Altman et al., 2017) Intuitive Exercise (Reel et al., 2016)

20 Thank you! Ideas? Comments? Questions?

21 References Albertson, E. R., Neff, K. D., & Dill-Shackleford, K. E. (2015). Self-compassion and body dissatisfaction in women: A randomized controlled trial of a brief meditation intervention. Mindfulness, 6, doi: /s Alleva, J. M., Martijn, C., Van Breukelen, G. J., Jansen, A., & Kairos, K. (2015). Expand Your Horizon: A programme that improves body image and reduces self-objectification by training women to focus on body functionality. Body Image, 15, Altman, J. K., Linfield, K., Salmon, P. G., & Beacham, A. O. (2017). The Body Compassion Scale: Development and initial validation. Journal of Health Psychology. Advance online publication. Association for Size Diversity and Health (2013). HAES principles. Retrieved from Avalos, L. C., & Tylka, T. L. (2006). Exploring a model of intuitive eating with college women. Journal of Counseling Psychology, 53, Bacon, L. (2010). Health at Every Size: The surprising truth about your weight. Dallas, TX: BenBella Books. Cavanagh, K., Strauss, C., Cicconi, F., Griffiths, N., Wyper, A., & Jones, F. (2013). A randomized controlled trial of a brief online mindfulness-based intervention. Behaviour Research and Therapy, 51, doi: /j.brat Ipsos Public Affairs (2016). The 2016 Yoga in America Study. Retrieved from Yoga in America Study RESULTS.pdf Klein, J., & Cook-Cottone, C. (2013). The effects of yoga on eating disorder symptoms and correlates: A review. International Journal of Yoga Therapy, 23, Mahlo, L., & Tiggemann, M. (2016). Yoga and positive body image: A test of the Embodiment Model. Body Image, 18, doi: /j.bodyim McIver, S., McGartland, M., & O'Halloran, P. (2009a). "Overeating is not about the food": Women describe their experience of a yoga treatment program for binge eating. Qualitative Health Research, 19, doi: / McIver, S., O Halloran, P., & McGartland, M. (2009b). Yoga as a treatment for binge eating disorder: A preliminary study. Complementary Therapies in Medicine, 17, doi: /j.ctim Menzel, J. E., & Levine, M. P. (2011). Embodying experiences and the promotion of positive body image: The example of competitive athletics. In R. M. Calogero, S. Tantleff- Dunn, & J. K. Thompson (Eds.), Self-objectification in women: Causes, consequences, and counteractions (pp ). Washington, DC: American Psychological Association. Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, doi: / Neumark-Sztainer, D. (2014). Yoga and eating disorders: Is there a place for yoga in the prevention and treatment of eating disorders and disordered eating behaviors? Advances in Eating Disorders: Theory, Research and Practice, 2, doi: / Piran, N., & Teall, T. L. (2012). The developmental theory of embodiment. In G. McVey, M. P. Levine, N. Piran, & H. B. Ferguson (Eds.), Preventing eating-related and weightrelated disorders: Collaborative research, advocacy, and policy change (pp ). Waterloo, ON: Wilford Laurier Press. Reel, J. J., Galli, N., Miyairi, M., Voelker, D., & Greenleaf, C. (2016). Development and validation of the Intuitive Exercise Scale, Eating Behaviors, 22, doi: /j.eatbeh Rubin, L. R., & Steinberg, J. R. (2011). Self-objectification and pregnancy: Are body functionality dimensions protective? Sex Roles, 65, Sandoz, E. K., Wilson, K. G., Merwin, R. M., & Kellum, K. K. (2013). Assessment of body image flexibility: The Body-Image Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science, 2, doi: /j.jcbs Tylka, T. L., & Kroon Van Diest, A. M. (2013). The Intuitive Eating Scale-2: Item refinement and psychometric properties. Journal of Counseling Psychology, 60, doi: /a Tylka, T. L., & Wood-Barcalow, N. L. (2015). The Body Appreciation Scale-2: Item refinement and psychometric evaluation. Body Image, 12, org/ /j.bodyim Vinoski, E. R., Webb, J. B., Warren-Findlow, J., Brewer, K. A., & Kiffmeyer, K. A. (2017). Got yoga?: A longitudinal analysis of thematic content and models appearance-related attributes in advertisements spanning four decades of Yoga Journal. Body Image, 21, 1-5. doi: /j.bodyim Webb, J. B., Vinoski, E. R., Warren-Findlow, J., Burrell, M. I., & Putz, D. Y. (2017a). Downward dog becomes fit body, inc.: A content analysis of 40 years of female cover images of Yoga Journal. Body Image, 22, doi: 10:1016/j.bodyim Webb, J. B., Vinoski, E. R., Warren-Findlow, J., Padro, M. P., Burris, E. N., & Suddreth, E. M. (2017b). Is the Yoga Bod the new skinny? A comparative content analysis of mainstream yoga lifestyle magazine covers. Body Image, 20, doi: /j.bodyim

Running head: FUNCTIONALITY FOCUS AND THE THIN IDEAL. A Pilot Study Investigating Whether Focusing on Body Functionality Can Protect Women

Running head: FUNCTIONALITY FOCUS AND THE THIN IDEAL. A Pilot Study Investigating Whether Focusing on Body Functionality Can Protect Women This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/