A study published in the September 2009 issue of Qualitative Health Research claims that some women's tendency to binge eat is "not about the food." The team of authors from Melbourne, Australia, led by Shane McIver, analyzed the personal journal writings of 25 women who were enrolled in a 12-week yoga treatment program. The authors of the study reported that, "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."

Here's the stunner about this study: "There was a deliberate effort to not offer any information regarding the selection of foods, nor dietary advice, nor any discussion concerning weight loss." No special diet? No harping about weight loss? So, this must have been one of those sweaty, heart pounding intense yoga workouts? Wrong.

The women received weekly hatha yoga sessions. "The primary aim of the yoga program was to encourage the women to develop a daily yoga practice in three distinct, yet overlapping domains: physical awareness through movement and stillness (asana), breath awareness (pranayama), and concentrative meditation (dharana and dhyana). This latter domain included meditation instructions for eating mindfully, which were given at the program's commencement. Instructions involved four main steps to be followed at each meal: (a) to begin by removing all distraction (such as television or reading), (b) to notice how much food was placed in the mouth, (c) to notice the taste, and (d) to not take another mouthful prior to swallowing the last."

This yoga program was all about cultivating the body sense, our ability to stay connected to our inner physical sensations and emotional states without intervening thoughts or judgments. With respect to food, this means slowing down to actually feel the smell, look, and taste of food. Body sense means being in the present moment with the feeling of food moving down the esophagus and feelings of hunger and satiety, empty or full. No matter what is on your plate or who is around you, body sense is the cultivation of an inner knowing of when to eat, how to enjoy it, and when to stop eating.

How would one know when it is time to stop eating? Feeling full is one way, but this is not always easy to sense, especially when there is more food available or if others around you are eating. I, personally, am more likely to notice that eating becomes effortful long before I notice that I am full. At the start of a meal, if I'm hungry, I am tuned in to selecting foods that enhance pleasurable sensations of taste and smell and texture. I notice if foods are soft or chewy, warm or cool, spicy or bland. At some point in the meal, these pleasures begin to diminish. I become aware of the effort of lifting the food to my mouth, chewing, and swallowing. That effort probably was there from the start of the meal, but I did not notice it because I was enjoying the food. So, when the effort is the most salient body sense, I stop eating. My body sense of effort is confirmed because when I stand up and walk around, I begin to notice the heavy fullness of my belly.

There are other forms of effortful (as opposed to sensual) eating to which women are especially vulnerable. Women, on average, are more likely to feel like they have to make an effort to fit in to social pressures. Women prone to overeating compared to those who were not, for example, were more likely to order dessert at a restaurant following a filling meal if other people in the group were planning to order dessert. Some forms of binge eating reflect subversive and unconscious urges to eat while attempting to diet in order to please others. Not only has the individual suppressed normal nutritional needs but they also have suppressed negative emotions surrounding the stressful demands from others. The effort to please others outweighs the body sense of whether the food feels good and is good for you.

As if that is not enough, women spend most of their lives making an effort to look good in order to please others. Girls as young as 5 years were more likely to endorse statements showing dissatisfaction with their own bodies after experimental exposure to thin Barbie dolls and to thin female images in the media. As girls reach adolescence, body dissatisfaction can be exacerbated or lessened, depending upon whether the peer group and family is focused on external ideals and criticism or supporting an embodied awareness sense of personal well-being.

You would think that the effort to look good would have salutary effects on a woman's relationship to food. To look good, eat a balanced diet that agrees with the body sense of food, right? In your dreams, maybe. The reality is that a woman's attention is directed outward to what others think about her body and away from what her body feels like and what her body needs to be healthy. In the early phases of the yoga study, one of the participants put it this way: "How is it possible to be so unconscious of the way you appear, yet be so obsessed with it? I think I disassociate from my body 90% of the time." Another said, "I hate what I'm doing to myself. I recognize it as self-punishment/mutilation but my intellect and emotions aren't communicating with each other. The urge to overeat is overriding all other considerations, even vanity. . . . Body feels awful. Aches + pains all over, bloated, constipated, flatulent, headaches, nausea, puffy ankles."

This inability to connect with the body sense, and a fear of focusing inward on one's own body, led to another paradoxical research finding. When women exercise in environments with mirrors, for example, they actually feel less positive about themselves, offsetting any mood improvement benefits of exercise per se. Why? Negative body image has a direct impact on self-esteem. Women who feel less satisfied with their breast size, their facial attractiveness, and their sex appeal are less likely to express their opinion (on any topic) in public. They are less confident in their ability to succeed, feel more self-conscious and more ashamed of their bodies. They are also less likely to feel satisfied in their sexual relationships and show less assertiveness regarding their own sexual needs. These effects, by the way, are not related to how the woman looks to others, nor to her age, but entirely based on how she feels about herself.

That's the bad news. The good news is that by the end of the 12 week yoga program focused on developing body sense, most of the women noted dramatic and surprising results. How about this statement: "I feel peaceful and hopeful. I'm eating like a normal person, enjoying what I eat and not obsessing like usual. I'm really enjoying eating fresh fruit + vegies, grainy bread, soy products. I'm cooking regularly and am not currently afraid of feeling hungry. Sometimes I enjoy the feeling of hunger as my body digests the lovely healthy food I've just fed it." Overall, women reported being more in control of their bodies, they showed less fear of being around food, they often left food on the plate (a totally new experience for many of the participants), and expressed a greater sense of well being.

This research study -- and others cited in this blog post and in the previous post on embodied eating in this blog series on body sense - show the importance of cultivating the body sense for health. In another post on embodied exercise, I showed that body awareness during exercise enhances its overall benefits. The yoga study suggests that the key factor in many forms of human health improvement may be the body sense. Why is body sense so important? The psychophysiology of the body sense is intimately tied to neural circuits that regulate all the major functions of the body including digestion, respiration, immune function, and mental health. When we are sensually and emotionally in touch with ourselves, our natural systems of self-regulation can perform without the interference of expectations and judgments.

Having completed the 12 week program, will the participants remain connected to their bodies and maintain their newfound positive self-image? Maybe, but only if they continue to practice cultivating the body sense: mindfulness around eating and other body functions. Sorry folks, but there is no pill or easy one-time cure. Body sense practice, contrary to the old maxim, does not make perfect. Practice, however, is more likely to help us stay in balance and connected to our bodies most of the time. Practice yoga. Practice meditation. Practice tai chi. Practice moving with awareness. Practice exercising with awareness. Practice eating with awareness. Practice anything that helps you stay aware and keeps you coming back after you (inevitably but hopefully only temporarily) lose yourself. Practice, practice, practice.

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