Vegetarianism and Eating Disorders
Written by ‘Ai Pono Hawaii Staff Writer
Are you wondering if there’s a relationship between vegetarianism and eating disorders? If so, the answer is YES—there is indeed a complex interrelationship between vegetarianism and eating disorders.
Studies have shown that people who struggle with an eating disorder (compared to control groups) were significantly more likely to have adopted a vegetarian diet or currently follow it. Research has shown that the diagnosis of an eating disorder can come before the switch to a vegetarian diet, which supports the idea that vegetarianism facilitates food restriction (in contrast to causing an eating disorder). Adopting a vegetarian lifestyle is sometimes also seen as promoting restriction among people with an eating disorder since it comes with a clear set of do’s and don’ts when it comes to eating.
Despite those findings, lots of research is still needed to validate the connection between vegetarianism and eating disorders. Also, keep in mind that most studies so far have shown a correlational (instead of causal) relationship between the two.
However, regardless of which came first—the switch to vegetarianism or the onset of an eating disorder—it’s clear that the two are inextricably linked to one another.
Defining Vegetarianism
Vegetarianism is a blanket term that includes several diets, all of which eliminate meat products to some degree (on the other hand, meat-eaters are called omnivores).
Some of the most common types of vegetarians include:
VeganS
Completely cut out all meat, eggs, dairy, fish, poultry, and foods that contain those items from their diet (and often, even in their clothing choices).
Semivegetarians (sometimes called flexitarian)
Mainly follow a plant-based diet but eat some dairy, meat, eggs, fish, or poultry on certain occasions or in small quantities; or avoid or limit consumption of specific meats, such as red meat.
Pescatarians
Cut out meat products from their diet but continue to consume eggs, fish, and milk.
Lacto-vegetarian
Avoid meat, eggs, fish, and poultry products, but still consume dairy in the form of cheese, milk, butter, yogurt, etc.
Ovo-vegetarian
Avoid meat, dairy, seafood, and poultry products, but consume eggs.
Lacto-ovo vegetarian
Eliminate animal flesh from their diet, but consume eggs and milk.
The vegetarian diet has been touted for its myriad of health benefits, such as weight loss and better blood sugar levels. It’s also linked to a lower risk of obesity, cardiovascular disease, and diabetes. Research has shown that vegetarians tend to have a lower risk of getting cancer, and live an overall longer lifespan compared to meat eaters.
In teenagers, those who are vegetarian consumed more fruits and vegetables and less saturated as well as total fat. Moreover, they are found to be less likely to use illegal drugs, alcohol, or cigarettes. Young adults who are vegetarians are also more likely to have healthy weights.
In the past decades, there has been a rise in the rates of vegetarianism around the globe as news of its benefits spread. Many people have switched to some form of vegetarianism because of health benefits, but there are many other reasons why people may choose to adopt a vegetarian diet.
Moral and ethical reasons (particularly related to animal welfare) are a leading motivator. Some do it because they feel that it’s closely aligned with their personal values, and even provide them with fulfillment or a deep sense of purpose. Other reasons cited by vegetarians include medical concerns (e.g., to avoid animal growth hormones or antibiotics), economic reasons, religious beliefs, sensory issues about the texture or taste of meat, and others.
Anyone who decides to switch to vegetarianism can benefit from receiving psychoeducation and guidance in living as a ‘healthful vegetarian’.
The Link Between Vegetarianism and Eating Disorders
From the perspective of experts in treating eating disorders, people who choose to adopt a vegetarian diet mainly for non-weight reasons (such as sympathy for animals, ethics, or environmental sustainability through helping lower carbon emissions) cause less concern compared to people who become a vegetarian for health- or weight-related reasons.
However, in people who are showing signs and symptoms, or are already diagnosed with an eating disorder, the switch to vegetarianism is considered a red flag. Whenever people with a suspected or diagnosed eating disorder suddenly decide to follow a vegetarian diet, healthcare experts get concerned that this decision may be their way to avoid food without social judgment or sounding alarm bells. After all, removing an entire food type from one’s diet allows a person with an eating disorder to lower food consumption without gaining unwanted attention.
Going on a diet in order to lose weight is a risk factor for developing an eating disorder. Whenever a person cites ‘health’ or ‘weight’ as their reason for going vegetarian, there is also a possibility that they regard good health and low body weight as synonymous. As a form of dietary omission, vegetarianism may serve patterns of rigidity and restriction, which are common features of eating disorders.
It’s important to examine whether a person’s pre-existing beliefs and attitudes about food and dietary patterns led him or her to switch to the vegetarian diet. Doing this can help the treatment team to assess whether the person is actually adopting vegetarianism as a form of avoidance strategy.
Among different eating disorders, anorexia is considered to have the strongest association with vegetarianism. People struggling with anorexia often restrict the food items that they consume, and vegetarianism may serve to mask their disordered eating patterns.
Studies have shown that around 50% of people with anorexia nervosa adopted some type of vegetarian diet, compared to only around 6-34% of adolescents and young female adults. A study reported that around half of participants with anorexia switched to vegetarianism years before the onset of their eating disorder.
A study discovered that female college students who are vegetarian are more likely to be overly concerned with their weight, experience guilt after eating, binge eat, and exhibit other unhealthy behaviors such as vomiting, extreme exercising, and abusing laxatives.
Eating disorder patients have reported that vegetarianism enabled them to lower their caloric intake, lose weight, and maintain their disorder. They also reported that vegetarianism helped them feel a sense of control, a key factor involved in the development and maintenance of eating disorders.
There is also evidence that vegetarianism can maintain or prevent recovery from eating disorders. In a study, women who were previously diagnosed with anorexia and not in remission were much more likely to report being vegetarian compared to those who were in remission. Because of this, many healthcare providers discourage patients from adopting a vegetarian diet when they are still recovering from an eating disorder (especially anorexia).
Distinguishing Vegetarianism from Eating Disorders
Is it simple vegetarianism or an eating disorder? There can be a fine line between choosing to become a vegetarian and having an actual eating disorder. Luckily, there are ways to determine whether we or our loved one is already suffering from disordered eating patterns, or simply making a major lifestyle change.
It’s important to ask yourself or your loved one whether the decision to switch to a vegetarian diet is rooted in an ideological or personal philosophy, or simply an excuse to restrict food, which is common in eating disorders.
Here are a few questions you can ask yourself or your loved one:
What are your reasons for deciding to become a vegetarian?
Are you happy with how your body looks?
Are you hoping to lose some weight? If yes, why?
Does meat taste or feel weird or different to you?
Do you think a vegetarian diet will be better for your physical and mental health?
Do you feel stomach pains or other discomfort whenever you consume meat?
Does eating meat make you feel bloated or nauseated?
How do you feel about animal cruelty? How much does it bother you?
Besides animal products, are you avoiding or limiting other food groups?
Do you have a family history of eating disorders?
If you or your loved one is already a vegetarian, you can ask these questions:
Ever since you shifted to vegetarianism, did you notice greater concern or preoccupation with your body or weight?
Do you think you’re able to get enough nutrition from your current diet? If not, would you be willing to eat a greater variety of foods in order to meet your nutritional needs?
Do you truly enjoy being a vegetarian? Why or why not?
How would you feel if you’re required to eat non-vegetarian food items?
Do your new eating habits affect your ability to eat and socialize with others?
Do you experience guilt or shame when you fail to stick to vegetarianism?
Do you sometimes binge on forbidden food products?
Those questions can guide you in determining whether vegetarianism is supportive of your physical, psychological, and emotional health. After all, the best type of diet is one that supports our holistic health and wellbeing.
Some warning signs that it could be an eating disorder and not just vegetarianism include the following:
Displaying other disordered eating behaviors like excessive exercise, binging, or vomiting
Displaying no other lifestyle changes related to vegetarianism besides the change in eating choices (e.g., choosing to wear animal fur instead of avoiding it)
Refusing to search for non-animal sources of animal proteins and fats or other necessary supplements
Having other strict food rules or restrictions besides vegetarianism (including severely limiting intake of gluten, processed foods, sugar, etc.)
Declining to consume vegetarian alternatives like vegan meat, ice cream, pizza, etc.
Having no interest in talking about the ethics behind vegetarianism
In addition, if you or your loved one has decided to become a vegetarian and display other behavioral changes (like eating much less food, preferring to eat alone, or having rituals surrounding food), it’s important to consult mental health professionals as soon as possible.
Why Vegetarianism is Not Typically Recommended When/While Recovering from an Eating Disorder
Most experts say that a vegetarian lifestyle can be practiced if preferred, but ideally after recovering from the eating disorder. It’s possible to follow a vegetarian diet while recovering from an eating disorder, but it can be extremely challenging. However, with meticulous planning and proper execution, vegetarians can enjoy a healthy diet that meets their nutritional and caloric requirements.
Keep in mind, though, that being a vegetarian while healing from an eating disorder requires professional guidance and resources, which may not be always available. Also, due to its extremely restrictive nature, a vegan diet is not recommended for people who are struggling with an eating disorder or currently receiving treatment for it.
Another thing to remember is that plant items can provide the same number of calories and essential nutrients as animal foods, but often require consumption of much greater quantity. For instance, you can get the same amount of protein found in two (2) eggs by eating six (6) cups of broccoli; you can get the same amount of protein in a chicken breast by consuming 15 cups of kale; and so on. In addition, many plant foods can cause gastrointestinal distress due to their high fiber content, which can lead to excess gas, bloating, and changes in bowel habits.
Healing from an eating disorder while sticking to a vegetarian diet can be particularly difficult in the initial stages of re-feeding and recovery, or if weight restoration is required, because following a vegetarian diet can make it hard to meet one’s nutritional requirements (in terms of both the amount and type of nutrients) and caloric needs. Hence, people who consume certain vegetarian diets (most especially, a vegan diet) typically need nutritional guidance and supplementation of essential nutrients.
Certain nutrients are of particular concern and should be given enough attention by vegetarians (especially by vegans). These are iron, protein, omega-3 fatty acids, and zinc.
Protein: Some good plant sources of protein are tofu and other soy products, seeds, legumes (peas, beans, and lentils), nuts and nut butters, meat alternatives, and grains (like quinoa and wild rice). Lacto-ovo-vegetarians, lacto-vegetarians, and ovo-vegetarians can usually get enough protein from consuming eggs and/or dairy products.
Iron: Iron from plants (called non-heme iron) is not absorbed as easily as that found in animal products (called heme iron), which can be a concern for vegetarians, especially women who are menstruating. Also, note that iron is better absorbed when taken with foods rich in vitamin C (like broccoli, citrus fruits, and tomatoes). Some good plant-based sources of iron are leafy green vegetables (like spinach), soy products (like soy milk, tofu, and tempeh), seeds, nuts and nut butters, fortified breads and cereals, whole grains, legumes (peas, beans, and lentils), and dried fruits (like raisins, dried apricots, and dried figs).
Omega-3 fatty acids: Plant-based sources of omega-3 fatty acids include flaxseed and flaxseed oil, soy products (like tofu, soy milk, and soybean oil), walnuts, chia seeds, and canola oil. Vegetarians often have lower levels of omega-3 fatty acids DHA and EPA because the main source of these is fish. Lacto-ovo-vegetarians and ovo-vegetarians may have better levels of these if they eat eggs that are rich in omega-3s.
Zinc: Just like iron, plant-based sources of zinc are not absorbed as easily as animal sources. Some good sources of zinc for vegetarians are soy products, whole grains, seeds, nuts and nut butters, legumes (peas, beans, and lentils), and fortified cereals and bread. Lacto-ovo-vegetarians and lacto-vegetarians can obtain enough zinc from dairy products like cheese, milk, and yogurt.
Because they have more food restrictions, vegans should also make sure that they're receiving enough of these nutrients: vitamin D, calcium, and vitamin B12.
Vitamin D: Vitamin D is crucial for bone health. The best source of this vitamin is sun exposure, particularly during summer and spring, since the human body naturally creates vitamin D when we expose our skin to sunlight. A limited number of foods contain vitamin D naturally (e.g., eggs), but some foods are fortified with it, such as cereals and breads, dairy products (like milk and yogurt), plant-based milks (like almond milk and soy milk), and orange juice. Taking a vitamin D supplement can be helpful, particularly in winter and fall. Talk with your healthcare provider and/or dietitian to find out if you need a supplement.
Calcium: Together with Vitamin D, calcium is essential for bone health; however, milk and dairy products are its leading sources. For vegans, plant-based sources of calcium are leafy green vegetables (like kale, cabbage, bokchoy, and collard greens), calcium-enriched tofu, broccoli, almonds and almond butter, and calcium-fortified products like cereals, breads, and orange juice.
Vitamin B12: Lastly, vitamin B12 is mainly found in animal foods (including eggs and dairy products). However, there are sources of vitamin B12 for vegans, such as fortified cereals and breads, as well as fortified soy products like tofu and soy milk. Vitamin B12 supplements are also available and often recommended to vegans, but it’s best to consult your healthcare provider and/or dietitian to confirm.
Final Words on Vegetarianism and Eating Disorders
Keep in mind that becoming a vegetarian can be a truly healthy and wise decision for anyone as long as one’s holistic health is not adversely affected by this lifestyle change.
Nonetheless, the link between vegetarianism and eating disorders should not be taken lightly. Like orthorexia (i.e., unhealthy obsession with healthy eating) and extreme exercise, vegetarianism may seem like a healthy lifestyle choice, but for some people the underlying motivation for adopting this diet (low self-esteem, need for control, obsession, etc.) can be a sign of an eating disorder and require special attention, and even necessary treatment.
Receive Holistic Treatment for Your Eating Disorder
Located in Maui, ‘Ai Pono Hawaii eating disorder recovery center has more than 35 years of success in providing holistic and effective treatment for a variety of eating disorders. We have extensive experience in helping patients with all types of background, including those who are following a vegetarian diet.