Sex Roles

https://doi.org/10.1007/s11199-018-0917-5

ORIGINAL ARTICLE

Does Yoga Help College-Aged Women with Body-Image Dissatisfaction

Feel Better About Their Bodies?
Aviva H. Ariel-Donges 1 & Eliza L. Gordon 1 & Viviana Bauman 1 & Michael G. Perri 1

# Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract
A majority of U.S. college-aged women experience body-image dissatisfaction, which puts them at heightened risk for the
development of an eating disorder. However, evidence-based psychological interventions for body-image dissatisfaction in this
population are not broadly available due to the limited number of trained counselors. We evaluated the efficacy of yoga as a novel
treatment for body-image dissatisfaction in otherwise healthy U.S. college-aged women. Female participants between the ages of
18–30 were randomly assigned to twice weekly yoga classes for 12 weeks or to a wait-listed control condition. Compared to
participants in the control condition, participants in the yoga condition reported significantly greater improvements in appearance
evaluation and satisfaction with specific body areas at post-test. Participants in the yoga condition also reported larger reductions
in the amount of time and energy spent preoccupied with their appearance. The results of the current study suggest that yoga,
which is widely available across the country, could help college-aged women develop healthier relationships with their bodies.
Health professionals and college administrators may want to encourage young women with body-image dissatisfaction to
practice yoga in order to improve their self-image.

Keywords Body image . Yoga . College students . Human females

Body-image dissatisfaction, defined as a negative self-attitude
about one’s physical appearance, is rampant among young
women (Johnson et al. 2015; Neighbors and Sobal 2007).
Fully 87% of U.S. college-aged women report body-image
dissatisfaction (Runfola et al. 2013), and 40% report they
would consider undergoing cosmetic surgery in the near future
(Sarwer et al. 2005). Although gender-based body ideals neg-
atively affect both men and women, research has shown the
prevalence and severity of body image disturbance is higher in
women than in men (Corson and Anderson 2002; Stice et al.
2013). Objectification theory posits that women are accultur-
ated from childhood to accept others’ views on their ideal
physical presentation such that they internalize their body as
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11199-018-0917-5) contains supplementary
material, which is available to authorized users.
* Aviva H. Ariel-Donges
ahariel@phhp.ufl.edu
1
Department of Clinical and Health Psychology, University of Florida,
P.O. Box 100165, Gainesville, FL 32610-0165, USA
a sexual object (Fredrickson and Roberts 1997). Specifically,
the normative performance of femininity in Western cultures
involves displaying certain beliefs and behaviors related to the
body, dieting for weight loss is very common among women
regardless of their actual body weight, and women are more
likely to discuss their own and others’ weight, body size, and
shape (Chrisler and Johnston-Robledo 2017).
Given that negative body image is a robust predictor of
eating disorders in women (Dakanalis et al. 2016), effective
treatments for body-image dissatisfaction have the potential to
prevent both the psychological distress caused by eating pa-
thology and the significant financial burden associated with
treatment (Levine and Piran 2004; Stice and Shaw 2002).
However, the positive impact of current gold-standard treat-
ments for body-image dissatisfaction in college-aged women
(i.e., cognitive dissonance and media literacy interventions) is
limited by the finite number of trained interventionists
(Becker et al. 2017; Kilpela et al. 2014). As such, it is critical
that more broadly available interventions for body-image dis-
satisfaction in young women are developed (Douglass 2009;
Halliwell 2015; Smith-Jackson et al. 2014).
Yoga is easily accessible in the United States via gyms,
community centers, and private studios, and it has the

potential to reduce body objectification, body-image dissatis-
faction, and negative affect by introducing young women to
mindfulness skills (Boudette 2006; Douglass 2009; Dijkstra
and Barelds 2011; Germer 2004; Stewart 2004). Moreover,
yoga is a popular form of exercise that is not associated with
the stigma of seeking mental health treatment (Douglass
2009). Yoga is defined as an integrative physical and spiritual
practice that aims to connect a person’s mind, body, and spirit
(Salmon et al. 2009). Although the many approaches to and
types of yoga practice (e.g., Hatha, Ashtanga, Iyengar,
Bikram) make it difficult to establish a broadly accepted de-
scription of yoga, there are three core elements shared by the
various forms: controlled breathing, meditative techniques,
and physical postures (Ospina et al. 2007; Pascoe et al.
2017). Mindfulness is a key meditative component in tradi-
tional yoga classes such that yoga is often considered
Bmindfulness in movement^ (Germer 2004, p. 28).
Originally derived from ancient Buddhist practices,
mindfulness is the skill of being non-judgmentally aware of
internal and external experiences in the current moment
(Germer 2004).
Studies using yoga as an intervention for body-image dis-
satisfaction, however, are preliminary at best (Neumark-
Sztainer 2014). Although it has been reported that women
who regularly participate in yoga are less likely to report body
dissatisfaction than those who do not engage in yoga (Dittmann
and Freedman 2009; Hafner-Holter et al. 2008; Neumark-
Sztainer et al. 2011), extant studies of the body-image benefits
of yoga are largely cross-sectional or non-experimental. For
example, Daubenmier (2005, p. 207) found that women who
self-identified as yoga practitioners reported higher Bawareness
of and responsiveness to bodily sensations, lower self-objecti-
fication, greater body satisfaction, and fewer disordered eating
attitudes^ than did female aerobic exercisers and sedentary
women. In another cross-sectional study, Delaney and Anthis
(2010) surveyed female yoga practitioners at five yoga studios
in Connecticut and found that greater self-reported internaliza-
tion of yogic principles is associated with greater body satisfac-
tion and higher levels of sense of body control. For their non-
experimental longitudinal study, Impett et al. (2006) followed
women enrolled in a 2-month yoga immersion program in
California and found that they experienced significantly re-
duced self-objectification, improved self-acceptance, and in-
creased life satisfaction. Additionally, a qualitative study of
women with obesity and binge eating disorder who partic-
ipated in 12 weeks of yoga classes reported increased
connections to their body, more energy, and improvements
in their ability to relax (McIver et al. 2009).
In an experimental study of yoga for female breast cancer
survivors’ body-image dissatisfaction, participants qualita-
tively reported positive changes in body image after 75-min
weekly yoga sessions for 2 months, but the effects were not
statistically different from a light exercise control group (van
Sex Roles
Puymbroeck et al. 2011). Only one control trial study that
used random assignment, to our knowledge, has evaluated
the effect of a yoga intervention on body-image dissatisfaction
in college-aged women. Mitchell et al. (2007) randomly
assigned female undergraduates who reported dissatisfaction
with their bodies into one of three conditions: a cognitive
dissonance intervention, a once-weekly yoga class interven-
tion, or a wait-listed control condition for 6 weeks. The cog-
nitive dissonance intervention elicited significant decreases in
symptoms of disordered eating, drive for thinness, and body-
image dissatisfaction, but the yoga intervention was not
associated with any significant changes in the measured
variables. Despite their null findings regarding yoga, the
authors concluded that additional research on yoga in
this population is needed because it is likely that the dose
of the yoga intervention was insufficient (i.e., 270 min of
yoga; Mitchell et al. 2007).
With the current experiment, we aimed to determine the
effect of a 12-week yoga intervention on body-image dissat-
isfaction in U.S. college-aged women compared to a wait-
listed control condition. Based upon consultation with the
experienced yoga instructors involved in the study, the current
intervention increased the dosage of yoga from Mitchell et al.
(2007) by more than 400% (i.e. from 270 total minutes of
yoga offered to 1440 min total) in an attempt to reach a thresh-
old that would result in changes in body-image dissatisfaction
while being compatible with an undergraduate academic
schedule. We hypothesized that participants in the yoga inter-
vention would report significantly greater improvements in
body-image dissatisfaction than those in the wait-listed con-
trol condition. Secondary aims included examining changes in
depressive symptomatology, disordered eating, mindfulness,
and multidimensional measures of body-image dissatisfac-
tion. The present research is significant because it fills a gap
in the literature regarding the efficacy of yoga as an interven-
tion for body-image dissatisfaction in otherwise healthy
young women.
Method
Participants
A total of 75 women were randomly assigned to either a yoga
condition (n = 37) or a waitlist control (n = 38). There were no
significant between-group differences at baseline in age (over-
all M = 21.3, SD = 2.5 years), p = .92; BMI (M = 24.3, SD =
5.1 kg/m2), p = .06; race (73.3% White), p = .65; ethnicity
(24.0% Latina), p = .95; student status (96.0% current stu-
dents), p = .57; depressive symptomatology (M = 7.6, SD =
3.7, on BDI-2), p = .72; mindfulness (M = 35.5, SD = 7.0 on
FMI), p = .85; or disordered eating (M = 8.4, SD = 6.2, on
EAT-26), p = .93.
Sex Roles
Procedure and Measures
Recruitment
College-aged women were recruited from a large southeastern
university in the U.S. via electronic, paper, and in-person an-
nouncements. The study was advertised as free yoga classes
for young women Binterested in feeling better about their
bodies.^ Of the 196 participants screened for the study, 78
were eligible for inclusion; 3 eligible participants withdrew
before the intervention began. (More detailed recruitment
and retention information is available in the online
supplement.)
Participants were eligible if they were female, ages 18–30,
had little or no prior experience practicing yoga (i.e., ≤ 3 yoga
classes over the past 6 months), could safely participate in
physical activity, reported normal eating behaviors over the
past 6 months, had a non-depressed mood (i.e., Beck
Depression Inventory-Second Edition score ≤ 13), and reported
body-image dissatisfaction (i.e., Multidimensional Body-Self
Relations Questionnaire-Appearance Evaluation score ≤ 3.0).
Participants were excluded if they reported a history of inpa-
tient hospitalization for an eating disorder or other psychiatric
reasons, had a current clinical diagnosis of Major Depressive
Disorder, or had a current clinical diagnosis of another psychi-
atric disorder that could interfere with participation.
Random Assignment
After signing an IRB-approved informed consent, participants
completed screening measures online using the secure elec-
tronic data capture tool, Research Electronic Data Capture
(REDCap; Harris et al. 2009). Eligible participants were ran-
domly assigned to receive either a 12-week group yoga inter-
vention or to be in a 12-week wait-listed control condition. (A
flowchart of participant recruitment, random assignment, and
retention is available in the online supplement.)
Yoga Condition
Three certified female yoga instructors (ages 69, 28, and 21)
led four yoga classes each week, and participants in the yoga
condition were asked to attend two of the classes weekly for
12 weeks (i.e., 24 yoga classes total). The 60-min yoga classes
focused on breathing, meditation, and active poses for begin-
ner students in the Vinyasa and Ashtanga yoga styles. The
yoga instructors based the intervention’s format and tone on
classes they typically taught at local community studios (i.e.,
5–15 min warm up, 30–50 min flow of poses, and 5–15 min
cool down and final relaxation). The yoga instructors avoided
making comments about weight, body shape, or physical at-
tributes; commentary was limited to general affirmations and
statements about body acceptance. The yoga classes were held
in a private, dimly lit classroom space on the campus of a large
U.S. southeastern state university. Yoga mats, blocks, and
straps were provided to participants for in-class use. Soft
acoustic music was played throughout each class, and the
yoga instructors read pre-selected poems related to mindful-
ness themes (e.g., acceptance, present-moment focus, non-
judgment) at the end of each class.
Over the course of the intervention period, participants
attended classes taught by at least two of the three instructors
to avoid bias due to instructor effects, and participant atten-
dance varied at each yoga class to avoid bias introduced by
within-class interactions. All sessions were audio recorded to
allow for replication by other researchers. A trained re-
search coordinator evaluated six yoga classes (12.5% of
classes offered) using a treatment fidelity checklist
based upon Sherman’s (2012) guidelines to assess con-
sistency across instructors and adherence to the proto-
col; no issues were identified, and feedback was provided
to the instructors.
Wait-Listed Condition
Wait list participants abstained from practicing yoga during
the 12-week intervention period. Participants randomly
assigned to the wait-listed condition were given the opportu-
nity to participate in free yoga classes after completing their
post-test assessment.
Schedule of Assessments
Baseline measures (i.e., demographics, health behaviors,
MBSRQ-AS, BDI-2, EAT-26, FMI, and anthropometry) were
collected during an in-person meeting via REDCap up to
10 weeks before the intervention period began. Post-test mea-
sures (i.e., demographics, health behaviors, MBSRQ-AS,
BDI-2, EAT-26, FMI, and anthropometry) were collected dur-
ing an in-person meeting via REDCap within 2 weeks of the
intervention period’s completion. All measures were adminis-
tered at both time points in the order listed in the following.
Attendance, Demographics, and Health Behaviors
Of the 37 participants in the yoga condition, 18 (48.7%)
attended 20 or more yoga classes (M = 20.7, SD = 1.1 classes);
13 participants (35.1%) attended 10–16 classes (M = 12.2,
SD = 2.1 classes); and 6 participants (16.2%) attended five
or fewer classes (2.5 ± 1.6 classes). Overall, mean attendance
in the yoga condition was 14.73 classes (SD = 6.9,
range = 0–24, mode = 20, median = 16). All participants
reported age, race, ethnicity, current student status, prior
experience with yoga, medical conditions that would
limit ability to do yoga safely, and dieting behaviors
over the prior 3 months.

Body-Image Dissatisfaction
The Multidimensional Body-Self Relations Questionnaire-
Appearance Scales (MBSRQ-AS; Cash 2000) is a 34-item
self-report measure for women over 14-years-old that evalu-
ates attitudinal, cognitive, and behavioral components of
body-image dissatisfaction. The MBSRQ-AS contains five
subscales: Appearance Evaluation (7 items), Body Areas
Satisfaction (9 items), Appearance Orientation (12 items),
Overweight Preoccupation (4 items), and Self-Classified
Weight. (Self-Classified Weight was not included in the pres-
ent study given that changes in weight status were not expect-
ed to occur during the 3-month intervention period.)
Individual items are rated by the respondent on a 5-point
Likert scale from 1 (definitely disagree) to 5 (definitely agree).
Overall subscale scores on the MBSRQ-AS subscales are
means of item scores, with select items reversed for scoring.
For Appearance Evaluation (e.g., BI like my looks just the way
they are^) and Body Areas Satisfaction (e.g., BHow dissatis-
fied or satisfied are you with each of the following areas or
aspects of your body: …Face^), lower scores indicate greater
dissatisfaction with one’s appearance and specific body parts.
For Appearance Orientation (e.g., BI check my appearance in a
mirror whenever I can^) and Overweight Preoccupation (e.g.,
BI constantly worry about being or becoming fat^), higher
scores indicate greater preoccupation with one’s appearance
and weight. Internal consistency across studies is appropriate
with Cronbach’s alphas for the MBSRQ-AS subscales ranging
from .84 to .89 (Brown et al. 1990; Cash 2000; Cash and
Hrabosky 2003; Engeln-Maddox 2006), and 1-month test-re-
test reliability of .91 has been established (Cash 2000). In the
present study, the coefficient alphas for the MBSRQ-AS sub-
scales were .75 for Appearance Evaluation, .85 for Body
Areas Satisfaction, .80 for Appearance Orientation, and .66
for Overweight Preoccupation. Given that the alpha for
Overweight Preoccupation was below .70 and that the inter-
action effect for this subscale did not yield significant results
(p = .25), analyses for this subscale are not presented in the
present paper.
Depressive Symptomatology
The Beck Depression Inventory-Second Edition (BDI-2;
Beck et al. 1996) consists of 21 self-report items to assess
the presence and intensity of depressive symptoms over the
past 2 weeks. Each item on the BDI-2 lists statements ar-
ranged in increasing severity about a particular symptom of
depression (e.g., hopelessness, fatigue, or suicidal ideation).
Total scores on the BDI-2 are a sum across all items. In
college-aged students, the BDI-2 has shown high internal con-
sistency and concurrent validity with other self-report mea-
sures of depression and anxiety (Storch et al. 2004). In the
present study, the coefficient alpha was .82.
Sex Roles
Disordered Eating
The Eating Attitudes Test-26 (EAT-26; Garner et al. 1982) is a
26-item self-report measure of symptoms and concerns related
to eating disorders (e.g., BI am preoccupied with a desire to be
thinner^ or BI feel that food controls my life^). Individual
items are rated by the respondent on a 6-point Likert scale
from 1 (never) to 6 (always), with select items reversed for
scoring, and total EAT-26 scores reflect a sum of individual
item scores. Higher EAT-26 scores indicate greater risk for a
clinical eating disorder. The EAT-26 has been shown to have
satisfactory reliability and construct validity (Garner et al.
1982; Koslowsky et al. 1992). In the present study, the coef-
ficient alpha was .84.
Mindfulness
The Freiburg Mindfulness Inventory (FMI; Walach et al.
2006) is a 14-item self-report measure that assesses mindful
presence, non-judgmental acceptance, openness to experi-
ence, and insight (e.g., BI am open to the experience of the
present moment^). Individual items are rated by the respon-
dent on a 4-point Likert scale from 1 (rarely) to 4 (almost
always), with select items reversed for scoring. The total
FMI score is a sum of all items, and higher scores on the
FMI indicating greater use of mindfulness principles. In the
present study, the coefficient alpha was .90.
Anthropometry
A trained research coordinator measured participants’ body
height (to the nearest .1 cm) and weight (to the nearest
.25 kg) using a calibrated Health-o-Meter Professional
stadiometer and balance beam scale. Height and weight were
used to calculate body mass index (BMI; kg/m2), which is
commonly included in explanatory models of body dissatis-
faction (e.g., Stice and Bearman 2001). Baseline BMIs ranged
from 16.5–45.1 kg/m2 (median = 23.5 kg/m2, mode = 22.5 kg/
m2). As noted previously, there was no statistical difference
between the yoga and wait-listed participants’ BMIs at base-
line, t(73) = −1.90, p = .062.
Statistical Analyses
Data were analyzed with SPSS® 24.0 for Windows (SPSS
Inc., IL). Measure x Time x Treatment Condition ANOVAs
were used to examine main effects and interactions for
Appearance Evaluation, Body Areas Satisfaction,
Appearance Orientation, mindfulness, depressive symptom-
atology, and disordered eating. Intent-to-treat analyses includ-
ed all 75 participants regardless of how many yoga sessions
those in the yoga condition attended (e.g., even if they only
attended three of the 24 sessions). Per-protocol analyses were
Sex Roles
further conducted to illustrate outcomes and effect sizes under
ideal circumstances; per-protocol analyses only utilized par-
ticipants in the wait-listed condition who completed both as-
sessments (n = 37) and only participants in the yoga condition
who attended at least 20 of the 24 yoga sessions (≥ 80%
attendance as instructed in the informed consent; n = 18).
Chi-square tests for independence were utilized to determine
whether the proportion of participants reporting post-test im-
provements in body-image dissatisfaction and the proportion
of participants reporting body image satisfaction at post-test
differed significantly across treatment conditions. Pearson
product moment correlations were utilized to characterize
the association between yoga attendance, change in
body-image dissatisfaction, and mindfulness. All post
hoc analyses were Bonferroni-corrected to adjust for
multiple comparisons.
Missing Data
There were no missing data at baseline. At post-test, 6.7% of
participants (n = 5) did not complete their assessment: 3 par-
ticipants in the yoga condition and 1 participant in the wait-
listed condition were lost to follow-up, and 1 participant in the
wait-listed condition only completed the MBSRQ-AS
Appearance Evaluation subscale at post-test. Data are be-
lieved to be missing at random with a non-significant Little’s
MCAR test, p = .94. Baseline values were carried forward for
missing post-test weight data. Given that mean imputation,
list-wise deletion, and 10 multiple imputations in SPSS®
yielded comparable results for all analyses, mean imputation
statistics are presented in the following. Original scores, as
well as the imputed scores, were normally distributed with
non-significant skewness and kurtosis.
Results
Zero order correlations varied by treatment group and assess-
ment time point. For example, better Appearance Evaluation
at pre-test was associated with better Body Areas Satisfaction
in both the yoga and wait-listed control groups, and these
associations remained significant at post-test (ps < .001). In
the yoga condition, better Appearance Evaluation was also
associated with less disordered eating symptomatology and
lower BMI at pre-test (ps < .05), yet none of these pre-test
associations were significant in the wait-listed condition. In
the yoga condition, better Appearance Evaluation was associ-
ated with lower BMI at post-test (p < .05); in the wait-listed
condition, better Appearance Evaluation was associated with
higher mindfulness and less depressive symptomatology at
post-test (ps < .001). Pre- and post-test correlations among
all study variables within the yoga and wait-listed control
conditions are presented in Table 1.
Appearance Evaluation
There was a significant main effect of Time on Appearance
Evaluation, F(1,73) = 74.54, p < .001, ηp2 = .505, such that
participants across treatment conditions experienced signifi-
cant improvements in Appearance Evaluation, ps < .001 (see
Table 2a). There was also a significant Time x Treatment
Group interaction effect for Appearance Evaluation,
F(1,73) = 8.96, p = .004, ηp2 = .109 (see Fig. 1). Although
there were no significant between-group differences in
Appearance Evaluation at baseline, p = .77, participants in
the yoga condition reported significantly higher post-
test Appearance Evaluation than did participants in the
wait-listed condition, p = .003. In the per protocol sen-
sitivity analyses, both the main effect of Time,
F(1,53) = 58.67, p < .001, ηp2 = .525, and the Time x
Treatment Condition interaction effect for Appearance
Evaluation remained significant, F(1,53) = 9.93, p = .003,
ηp2 = .158.
Treatment condition also had a significant effect on the
proportion of participants reporting positive post-test
Appearance Evaluation (i.e., > 3.0 on the subscale), χ2(1) =
11.23, p = .001, Cramer’s V = .39; a significantly greater pro-
portion of participants in the yoga condition reported positive
post-test Appearance Evaluation compared to participants in
the wait-listed condition (70.3% vs. 31.6%; see Table 3).
Among those in the yoga condition, higher attendance was
associated with greater improvement in Appearance
Evaluation at post-test, r = .398, p = .015. Number of yoga
classes attended predicted change in Appearance Evaluation
at post-test, F(1,35) = 3.98, p = .015, R2 = .158, such that sub-
scale scores increased by .032 points for each yoga class
attended.
Body Areas Satisfaction
There was a significant main effect of Time on Body Areas
Satisfaction, F(1,73) = 51.47, p < .001, ηp2 = .413, such that
participants across treatment conditions reported significant
increases in Body Areas Satisfaction (see Table 2b). There
was also a significant Time x Treatment Condition interaction
effect for Body Areas Satisfaction, F(1,73) = 7.40, p = .008,
ηp2 = .092. Although there were no significant differences at
baseline, p = .26, participants in the yoga condition reported
significantly higher post-test Body Areas Satisfaction than did
participants in the wait-listed condition, p = .002. In the per
protocol sensitivity analyses, both the main effect of Time,
F(1,53) = 35.70, p < .001, ηp 2 = .402, and the Time x
Treatment Condition interaction effect for Body Areas
Satisfaction remained significant, F(1,53) = 6.56, p = .013,
ηp2 = .110. Treatment condition also had a significant effect
on the proportion of participants reporting positive post-test
Body Areas Satisfaction (i.e., > 3.0 on the subscale), χ2(1) =
 Sex Roles

Table 1 Correlations among

study variables by yoga and wait- Correlations
list conditions
Variables 1 2 3 4 5 6 7

(a) Pre-test
1. Appearance evaluation – .51*** .00 .26 −.11 −.46** −.52***
2. Body areas satisfaction .60*** – −.33* −.05 −.10 −.43** −.49**
3. Appearance orientation .20 .03 – .01 −.04 .22 −.05
4. Mindfulness .30 .03 .22 – .15 −.17 −.16
5. Depressive symptomatology −.21 −.08 −.11 −.30 – .14 −.23
6. Disordered eating .03 .15 .04 .34* −.10 – .48**
7. Body mass index (BMI) −.01 .13 −.11 −.03 −.25 −.08 –
(b) Post-test
1. Appearance evaluation – .70*** .02 .25 −.02 −.32 −.62***
2. Body areas satisfaction .84*** – −.29 .28 −.27 −.59*** −.48**
3. Appearance orientation .00 .02 – −.13 .39* .38* −.08
4. Mindfulness .55*** .46** .07 – −.49* −.09 .02
5. Depressive symptomatology −.62*** −.5*** −.07 −.49** – .51*** −.03
6. Disordered eating −.27 −.18 .34* −.03 .33* – .24
7. Body mass index (BMI) −.21 −.20 .01 −.21 .03 .07 –

Correlations for participants in the yoga condition are reported above the diagonal of the correlation matrix; for
those in the wait-listed control condition, below the diagonal
*p < .05. **p ≤ .01. ***p ≤ .001

13.52, p < .001, Cramer’s V = .43; a significantly greater pro-
portion of participants in the yoga condition reported positive
post-test Body Areas Satisfaction compared to participants in
the wait-listed condition (81.1% vs. 39.5%; see Table 3).
Among those in the yoga condition, higher attendance was
associated with greater improvement in Body Areas
Satisfaction from baseline to post-test, r = .353, p = .032.
Number of yoga sessions attended predicted change in Body
Areas Satisfaction at post-test, F(1,35) = 5.00, p = .032,
R2 = .125, such that subscale scores increased by .02 points
for each yoga class attended.
Appearance Orientation
There was a significant main effect of Time on Appearance
Orientation, F(1,73) = 2.84, p < .001, ηp2 = .215, such that
participants across treatment conditions reported significant
decreases in Appearance Orientation (see Table 2c). There
was also a significant Time x Treatment Condition interaction
effect for Appearance Orientation, F(1,73) = 10.14, p = .002,
ηp2 = .122. Although there were no significant differences at
baseline, p = .26, participants in the yoga condition reported
significantly lower post-test Appearance Orientation than did
participants in the wait-listed condition, p = .028. In the per
protocol sensitivity analyses, both the main effect of Time,
F(1,53) = 12.05, p = .001, ηp 2 = .185, and the Time x
Treatment Condition interaction effect for Appearance
Orientation remained significant, F(1,53) = 4.70, p = .035,
ηp2 = .081. Treatment condition also had a significant effect
on the proportion of participants reporting healthy post-test
Appearance Orientation (i.e., < 3.0 on the subscale), χ2(1) =
5.36, p = .021, Cramer’s V = .27; a significantly greater pro-
portion of participants in the yoga condition reported healthy
post-test Appearance Orientation compared to participants in
the wait-listed condition (32.4% vs. 10.5%; see Table 3).
However, attendance among those in the yoga condition was
not associated with change in Appearance Orientation at post-
test, p = .88.
Mindfulness
There was a significant main effect of Time on mindfulness,
F(1,73) = 10.60, p = .002, ηp2 = .127, such that participants
across treatment conditions reported significant increases in
mindfulness. The Time x Treatment Condition interaction ef-
fect for mindfulness and the association between treatment
condition and mindfulness at post-test did not approach sig-
nificance, ps ≥ .21. However, change in mindfulness at post-
test was associated with improvements in body-image dissat-
isfaction at post-test, r = .454, p < .001.
Depressive Symptomatology and Disordered Eating
There was no significant main effect of Time on depressive
symptomatology, p = .51. There was no significant main effect
of Time on disordered eating, p = .64.
Sex Roles

Table 2 Change in body-image

dissatisfaction by yoga and wait- Baseline Post-test Within-group change Within-group
list conditions over time M (SD) M (SD) M (SD) t-test

(a) Appearance evaluation

Intent to treat:
Yoga 2.40 (.46) 3.28 (.56) .88 (.55) p < .001
Wait list 2.37 (.52) 2.79 (.78) .43 (.75) p < .001
Between-group t-test p = .77 p = .003
Per protocol:
Yoga 2.48 (.38) 3.54 (.45) 1.1 (.49) p < .001
Wait list 2.35 (.53) 2.79 (.79) .44 (.75) p < .001
Between-group t-test p = .34 p < .001
(b) Body areas satisfaction
Intent to treat:
Yoga 2.70 (.45) 3.25 (.51) .55 (.39) p < .001
Wait list 2.58 (.43) 2.83 (.61) .25 (.55) p = .002
Between-group t-test p = .26 p = .002
Per protocol:
Yoga 2.79 (.40) 3.41 (.42) .62 (.38) p < .001
Wait list 2.59 (.44) 2.83 (.62) .25 (.56) p = .004
Between-group t-test p = .09 p = .001
(c) Appearance orientation
Intent to treat:
Yoga 3.71 (.58) 3.24 (.46) −.47 (.64) p < .001
Wait list 3.57 (.47) 3.49 (.52) −.07 (.41) p = .36
Between-group t-test p = .26 p = .03
Per protocol:
Yoga 3.71 (.70) 3.26 (.55) −.46 (.84) p = .001
Wait list 3.60 (.48) 3.49 (.52) −.11 (.38) p = .26
Between-group t-test p = .47 p = .12

Intent-to-treat analyses include all randomly assigned participants (n = 75); per-protocol analyses (n = 55) only
include participants who completed the post-test assessment and yoga participants with ≥80% attendance
(≥ 20 yoga classes)

Discussion
The current study aimed to determine whether a 12-week yoga
intervention would significantly reduce college-aged
women’s body dissatisfaction compared to a wait-listed con-
trol condition. The results of the current study suggest that
yoga is an efficacious treatment for improving body-image
dissatisfaction in this population. Participants randomly
assigned to the yoga condition reported significantly greater
post-test improvements in several facets of body-image dis-
satisfaction than those in the wait-listed condition did; they
evaluated their appearance more positively, became more sat-
isfied with specific body areas, and decreased the amount of
time and energy spent focused on their appearance. Effect
sizes for these facets of body-image dissatisfaction were mod-
erate (ηp2 ranging from .09–.12), suggesting that yoga likely
addresses some of the psychological and behavioral processes
underlying women’s unhealthy focus on their physical selves.
However, the current study did not find significant between-
group differences in change in mindfulness at post-test, nor
did the study find significant post-test changes in depressive
symptomatology or disordered eating.
Participants in the yoga condition did not endorse signifi-
cantly greater increases in mindfulness as expected. There are
several possible explanations for these null results. It is possi-
ble that participants in both conditions reported increases in
mindfulness due to demand characteristics of a study about
yoga, that mindfulness takes longer than 12 weeks to cultivate,
or that the FMI is not sensitive to short-term intervention
effects in this population. In a systematic review of mindful-
ness measures, Park et al. (2013) reported that the FMI was
developed for audiences with some knowledge of insight
meditation and, therefore, may have limited validity among
populations such as undergraduate college students.
Mindfulness scales with stronger psychometric properties,
such as the Mindful Attention Awareness Scale or the Five

3.5
MBSRQ-AS Appearance Evaluation
*
3.0
2.5
Yoga
Wait List
2.0
Baseline Post-Test
Assessment Timepoint
Fig. 1 Time x Treatment Condition interaction effect for Appearance
Evaluation, p = .004. Gray dotted horizontal line indicates the threshold
between positive and negative Appearance Evaluation (Appearance
Evaluation = 3.0), with scores above the gray line representing positive
body image; error bars represent ±SEM. *p < .05. MBSRQ-AS =
Multidimensional Body-Self Relations Questionnaire-Appearance
Scales.
Facet Mindfulness Questionnaire (Park et al. 2013), may have
been more sensitive to possible intervention effects in the
current study.
Given that mindfulness as measured in the current study
was not statistically associated with improvements in body-
image dissatisfaction, the question remains: How does yoga
exert its positive effects on body-image dissatisfaction? It is
apparent that the current study was not powered to detect
between-group differences on the FMI (post-hoc observed
power = .193), so it is plausible that mindfulness is the under-
lying mediator despite the lack of support in the present study.
Based on sociocultural models of body-image dissatisfaction
(e.g., Puccio et al. 2016, it is also possible that other factors not
measured in the current study (e.g., increased embodiment,
stronger distress tolerance skills, decreased internalization of
the thin ideal, or improved social support) are the true medi-
ators of the relationship between practicing yoga and de-
creased body-image dissatisfaction.
Table 3 Proportion of
participants reporting body-image
satisfaction at post-test
MBSRQ-AS subscales
Appearance evaluation
Body areas satisfaction
Appearance orientation
MBSRQ-AS = Multidimensional Body-Self Relations Questionnaire-Appearance Scales. Body-image satisfac-
tion is indicated by scoring beyond the mid-point for each of the MBSRQ-AS subscales (i.e., > 3.0 for Appearance
Evaluation and Body Areas Satisfaction, < 3.0 for Appearance Orientation)
Sex Roles
Overall, the current findings largely support Mitchell
et al.’s (2007) conclusion that the dose of yoga administered
in their study (i.e., 6 weeks of 45-min weekly sessions) was
insufficient for eliciting meaningful changes in body-image
dissatisfaction. Results from the present study suggest that
consistent yoga attendance over an extended period is neces-
sary to experience changes in body-image dissatisfaction.
Approximately half of the participants randomly assigned to
the yoga condition attended at least 20 yoga classes (≥ 80%
attendance), yet a substantial minority (16.2%) attended five
classes or fewer over the 3-month intervention period.
Therefore, about half of the participants struggled to consis-
tently attend twice-weekly yoga classes, likely due to college-
aged women’s personal and academic responsibilities.
Notably, there appears to be a dose-response for the effects
of yoga on body-image dissatisfaction. Greater percentages of
participants reported body image satisfaction depending on
whether they attended five or fewer classes, 10–16 classes,
or at least 20 classes over the 12-week period (see Table 3).
Although attendance stratification is confounded by self-se-
lection, there appears to be an incremental benefit for attend-
ing more yoga classes, with the strongest effect seen for those
who attended at least 20 yoga classes.
Finally, participants in the current study did not report sig-
nificant improvements in depressive symptomatology or disor-
dered eating. Prior research has established that higher depres-
sive symptomatology predicts disordered eating in college-
aged women (Bergstrom and Neighbors 2006; Bradford and
Petrie 2008; Gitimu et al. 2016; Liechty and Lee 2013; Stice
and Bearman 2001) and that body-image dissatisfaction pre-
dicts the onset of disordered eating (Farrell et al. 2006; Levine
and Piran 2004). However, the current study excluded partici-
pants with elevated depressive symptomatology at baseline in
an effort to isolate the efficacy of yoga for body-image dissat-
isfaction given that the positive effects of yoga on depression
have already been established (Pilkington et al. 2005). As such,
all participants started the intervention with minimal or no de-
pressive symptomatology (BDI-2 ≤ 13), likely causing a floor
effect that limited statistical significance. When the present
Yoga condition Wait list
≥ 20 10–19 ≤5 0
yoga classes yoga classes yoga classes yoga classes
n = 18% (n) n = 13% (n) n = 6% (n) n = 38% (n)
83.33% (15) 69.23% (9) 33.33% (2) 31.57% (12)
83.33% (15) 84.62% (11) 66.67% (4) 39.47% (15)
38.89% (7) 23.08% (3) 33.33% (2) 10.53% (4)
Sex Roles
study excluded participants with clinically relevant depressive
symptomatology at baseline, it appears that participants with
elevated risk for disordered eating were inadvertently excluded
(M EAT-26 score at baseline = 8.4), which limited our ability to
determine the effects of yoga on disordered eating behaviors
and attitudes.
Limitations
There are several limitations to the current study. First, the
study did not compare yoga to the gold standard of cognitive
dissonance treatment (Stice et al. 2013) or a self-help program
(Jarry and Ip 2005) to determine the relative efficacy of each
treatment. Second, the study did not measure thin-ideal inter-
nalization or social pressures for thinness, which have been
identified as key factors in the development and maintenance
of body-image dissatisfaction (Durkin et al. 2007; Grabe et al.
2008; Johnson et al. 2015). Third, although excluding partic-
ipants with clinically-relevant depressive symptomatology
controlled for its potentially confounding effect, it limits gen-
eralizability to non-depressed college-aged women seeking
treatment for body-image dissatisfaction. Generalizability
should also be view in light of the limited racial and ethnic
diversity in the present sample. Fourth, prior experience with
yoga was assessed at baseline, but the study did not assess
whether participants had prior experience with meditation or
mindfulness, which may confound the results of the study.
Finally, the current study did not utilize a follow-up period
in order to determine if improvements in body-image dissat-
isfaction were sustained after the intervention ended.
The current study also had numerous strengths, including
the use of random assignment with a wait-listed control and
high retention of the intent to treat sample (only 6.7% missing
data at post-test). Recruitment from a large state university
allowed for results to be applicable to a large segment of the
female college population in the United States. Additionally,
multiple certified yoga instructors were utilized to avoid bias
due to instructor effects, and the yoga classes were structured
and audio-recorded to allow for reproducibility in future
studies.
Future Directions
Given that research on yoga and body-image dissatisfaction is
nascent, there are numerous directions for future studies.
Researchers should examine whether combining yoga with
cognitive dissonance or media literacy treatment enhances
the effectiveness of either treatment in college-aged women;
whether improvements in body-image dissatisfaction are
sustained over a longer follow-up period; and whether indi-
viduals with clinical depression or other comorbid psychiatric
conditions have differential outcomes. Future studies on the
effectiveness of yoga for body-image dissatisfaction should
also be powered to assess the minimum dose of treatment
needed to cause clinically-relevant improvements and to eval-
uate potential mediators (e.g., mindfulness, embodiment, in-
ternalization of the thin ideal) of the relationship between yoga
and change in body-image dissatisfaction.
Most importantly, further research is needed to determine
which components of yoga represent the Bactive ingredients^
necessary for producing change in body-image dissatisfaction
(i.e., specific poses, breathing, mindfulness teachings, group
contact) and how to adjust these factors according to the needs
of the setting (i.e., colleges, high schools, gyms, community
centers). Potential components to examine include type of
yoga, session length, session frequency, session location,
and instructor style (Klein and Cook-Cottone 2013).
Although the benefits of yoga for women with body-image
dissatisfaction appear promising, more rigorous methodolog-
ical evaluation of these key factors will not only inform the
design of effective interventions, but also increase the likeli-
hood of obtaining stakeholders’ support in establishing pro-
grams (Serwacki and Cook-Cottone 2012). Additionally, giv-
en the substandard alpha for Overweight Preoccupation found
in the current study, analyses were not presented and further
work is needed utilizing this subscale.
Practice Implications
Current gold standard treatments for body-image dissatisfaction
are not available on most college campuses because they re-
quire well-trained group leaders, as well as administrative and
financial resources to organize session materials. Although re-
searchers are working on developing internet-based dissonance
interventions and expanding treatment availability using train-
the-trainer models, most college-aged women do not have ac-
cess to these effective interventions at present (Kilpela et al.
2014). In contrast, yoga is a widely available way for young
women to get physical activity and improve body-image dis-
satisfaction without the barriers and stigma associated with tra-
ditional mental health treatment (Halliwell 2015). Importantly,
yoga is broadly accessible throughout the country at campus
gyms, community centers, and private yoga studios as well as
from community practitioners. College counselors and admin-
istrators may want to consider incorporating yoga into new
student orientations, counseling center offerings, sorority pro-
gramming, and other student-wide initiatives so that young
women will be more readily exposed to its benefits at the start
of their college experience.
Conclusions
The results of the current study largely support prior re-
searchers’ assertions that yoga would be an efficacious
treatment for body-image dissatisfaction in college-aged
women (e.g., Boudette 2006; Stewart 2004). In line with

recommendations for fostering positive body image on col-
lege campuses (Smith-Jackson et al. 2014), it is possible that
recommending yoga for college-aged women with body-
image dissatisfaction would be an effective alternative to tra-
ditional mental health treatment. Whether combined with
existing evidence-based counseling for body-image dissatis-
faction or as a standalone treatment, yoga warrants further
exploration as a way to help college-aged women improve
their body-image dissatisfaction and prevent the development
of eating disorders.
Compliance with Ethical Standards
The research was approved by the University of Florida IRB, and all
procedures were conducted in accordance with the ethical standards of
the IRB and the 1964 Helsinki Declaration.
Informed Consent Informed consent was obtained from all participants
in the study.
Conflict of Interest There are no conflicts of interest to declare.
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