Consensus-based recommendations for yoga as adjunct therapy in eating disorder treatment: a Delphi study

Objective: This study aimed to develop consensus-based statements, combining the expertise of eating disorder (ED) clinicians and yoga instructors, on key considerations for applying yoga for individuals with anorexia nervosa, bulimia nervosa, and binge-eating disorder. Method: A two-round modified Delphi technique was conducted via an online survey platform. Participants rated the importance of various yoga components to ensure the safety and therapeutic usefulness of yoga for the EDs. Survey items covered key aspects of yoga, including style, frequency, duration, environmental factors, safety precautions (e.g., medical monitoring), language and expression, instructor qualifications, postures, breathwork, and meditation practices. A total of 12 ED clinicians and 16 yoga instructors participated in the first round, with 10 clinicians and 13 instructors completing the second round. Results: General recommendations were developed for both the transdiagnostic and disorder-specific application of yoga. These were organized into six core areas: yoga style, environmental factors, dosage, language and expression, the instructor's role, and the integration of yoga into ED treatment. Additionally, the yoga panel provided technique-specific recommendations addressing postures, breathwork, and meditation practices for both transdiagnostic and disorder-specific application across the ED spectrum. Discussion: This study offers preliminary recommendations for integrating yoga into ED treatment through developing consensus-based statements. The findings emphasize both transdiagnostic and disorder-specific considerations for EDs, while highlighting the importance of trauma-informed, individualized approaches. Further research is needed to develop comprehensive guidelines for the therapeutic use of yoga in eating disorder treatment.