Eating Disorders and Vegetarianism

Eating Disorders and Vegetarianism Eating Disorders Diagnosis Print Eating Disorders and Vegetarianism: What’s the Connection? By Lauren Muhlheim, PsyD, CEDS facebook twitter linkedin Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. Learn about our editorial policy Lauren Muhlheim, PsyD, CEDS Updated on February 10, 2020 Anjelika Gretskaia, Moment, Getty Images More in Eating Disorders Diagnosis Symptoms Treatment Awareness and Prevention Are you or someone you know a vegetarian? Are you or they struggling with disordered eating or an eating disorder? If you or a loved one has an eating disorder you may be wondering whether you or they should become or remain a vegetarian. In order to make this decision, we must first explore the complicated relationship between eating disorders and vegetarianism. What to Know About Eating Disorders Defining Vegetarians There exists only limited research on the connection between vegetarianism and eating disorders; the research that exists is confounded by a number of factors. The first problem is that most of the research on vegetarians and eating disorders collapses all categories of vegetarians together in order to get large enough sample sizes to draw conclusions. In reality, vegetarianism refers a wide variety of diets that exclude meat products to some degree (with nonvegetarians referred to as omnivores): Vegansâ€"avoid all meat productsOvolactovegetariansâ€"refrain from eating the flesh of animals but consume milk and eggsPescatariansâ€"eat fish, milk, and eggs but avoid other meat productsSemivegetariansâ€"avoid or limit some meat products such as red meat A second problem is that the studies tend to rely entirely on diet self-reporting, which may or may not be accurate. The third problem with most of the research on eating disorders and vegetarianism is that it is correlational. This means that it cannot definitively show whether vegetarianism causes eating disorders or whether eating disorders lead to vegetarianism. The Reasons People Become Vegetarian The most common reasons people report for choosing a vegetarian diet include personal or religious convictions; health concerns; sensory issues related to the taste and feel of meat; and concerns about cost. Moral considerations, primarily around animal welfare concerns, are the most common reason for vegetarianism in the United States, cited by 59% of vegetarians. The second most reported motivationâ€"health concernsâ€"can often be a cover for weight concerns, as many people mistakenly equate thinness and health. People with eating disorders cite health more frequently than those in the general population as their primary motivation for vegetarianism. Rates of Vegetarianism and Eating Disorders Patients with eating disorders report higher rates of vegetarianism than those in the general public. Most of the research has focused on patients with anorexia nervosa. In three chart review studies of patients with anorexia, approximately half of the patients reported adhering to a vegetarian diet. By contrast, a 2018 poll by Gallup poll found that only 5 percent of Americans said they were vegetarian and 3 percent reported they were vegan.?? According to Bardone-Cone and colleagues (2012), compared to control subjects, individuals with an eating disorder history were significantly more likely to ever have been vegetarian (52 percent versus 12 percent). They also reported weight control as their primary reason for being vegetarian. Most reported that their vegetarianism was related to their eating disorder and had emerged after the onset of their illness.?? Adolescent vegetarians have been shown to be four times as likely as nonvegetarians to vomit for weight control. Does Vegetarianism Cause or Contribute to Eating Disorders? Of the various eating disorders, anorexia is most commonly believed to be related to vegetarianism. People with anorexia usually significantly restrict the range of foods that they eatâ€"vegetarianism may be a socially acceptable way for individuals with anorexia to do just that. Bardone-Cone and colleagues found that 60 percent of eating disorder patients who were vegetarians reported that their adoption of a vegetarian diet began at least one year after the onset of eating disorder symptoms. Most (68 percent) felt there was a relationship between vegetarianism and their eating disorder. Those who admitted this relationship reported that being vegetarian helped them lose weight and maintain an eating disorder. They also reported that vegetarianism provided another avenue to decrease caloric intake and contributed to their feeling in control.?? In summary, it appears that vegetarianism may not be a causal factor in the development of an eating disorder, but it can be a symptom of the illness or perhaps a maintaining factor. Does Vegetarianism Affect Recovery From an Eating Disorder? There is some evidence that a vegetarian diet may maintain the illness or impede recovery from an eating disorder. In one study, women who had previously been diagnosed with anorexia and were not in remission were significantly more likely to identify as vegetarian compared to participants who were in remission. According to Bardone-Cone and colleagues, those patients with an active eating disorder were more likely than those in full recovery to be vegetarian (33 percent versus 5 percent). In another small study, half of the patients who were consuming insufficient calories were following a vegetarian or primarily vegetarian diet.?? Should I (Or My Loved One) Stay a Vegetarian? It can be important to first better understand an individual’s motivation for vegetarianism. Specifically looking at when they began eating a vegetarian diet in relation to the onset of their eating disorder. We often say, “If it came in with the eating disorder, it’s likely a part of the eating disorder.” Maintaining a vegetarian diet while trying to recover from an eating disorder (anorexia in particular) is difficult and frequently not recommended. There are four main reasons to reintroduce meat to vegetarian eating disorder patients. To decrease rule-driven eating disorder behaviors.To decrease family conflictTo ensure adequate energy intakeTo ensure adequate nutrients including iron, calcium, and fatty acids Decreasing Rule-Driven Eating Disorder Behaviors Let’s look at each of these in turn. People with eating disorders, especially anorexia, have fears about eating foods they believe will make them gain weight and, hence, follow rigid restrictive dietary rules. Restricting the range and amount of food they eat reduces their anxiety in the short-term and is hence reinforced. Adhering to a vegetarian diet can decrease anxiety by justifying the avoidance of feared foods. Consequently, the reintroduction of meat into the diet as part of treatment expectedly would increase anxiety. Successful recovery from eating disorders involves overcoming dietary rules, increasing eating flexibly, and learning to tolerate short-term anxiety. Successful stable recovery from anorexia is associated with greater flexibility and higher fat in the diet. Decreasing Family Conflict Family conflict can be high when a person with an eating disorder has rigid rules about what foods they will eat. Conflict around meals can ultimately be decreased by helping a family member with an eating disorder overcome rigid rules about eating and conquering meat can be an important step in this process. Ensuring Adequate Energy Intake One of the first practical steps of eating disorder treatment is to increase regular eating, ensure adequate nutrition, and increase weight in those who are weight suppressed. People at the start of recovery from anorexia nervosa are often hypermetabolic, meaning they need very high levels of caloric intake (beyond those of an individual without the diagnosis) in order to gain weight. Generally, vegetarian diets are not recommended during the renourishment process because they are associated with lower-calorie foods and many of the required nutrient-dense foods are found in animal products. Further, patients with anorexia nervosa often experience early fullness and cannot tolerate the volume of vegetarian food that would be required to restore weight. Ensuring Adequate Nutrients When a diet includes meat it is easier to ensure adequate intake of several micronutrients, including iron, calcium, and fatty acids. Anorexia patients entering treatment often have inadequate intake of iron, calcium, and fatty acids, including two omega-3 fatty acids that are important for proper body functioning including building brain matter. These fatty acids are most commonly found in the highest concentrations in eggs, meat, and fish, which are foods commonly excluded by vegetarians and vegans. Also, vegetarians may be at greater risk than nonvegetarians of zinc deficiency. Low zinc intake can affect neurotransmitters in the brain. It is important to ensure that the diet used in refeeding meets the needs of these nutrients. In Conclusion There does not seem to be research that suggests that a vegetarian diet causes eating disorders. However, vegetarian diets can be used to hide an existing eating disorder. It is also likely that it maintains eating pathology and can contribute to a slower and more difficult recovery. A Word From Verywell The decision about whether to remain vegetarian is one that should be made in conjunction with your family and treatment team. The reason you eliminated meat from your diet in the first place should be explored. It should be noted that determining the true motivation for vegetarianism is not always straightforward. If it appears related to eating pathology then it will likely need to be addressed. On the other hand, if your family has been vegetarian for your lifetime, or is vegetarian for religious or other ideological reasons, then you may be able to adhere to a vegetarian diet but will have to work hard to include enough fat and calories and may need nutritional supplements to ensure adequate nutrients. Alternatively, you may decide to put the vegetarianism aside temporarily in the service of recovery. A vegan diet is much harder to recover on and is generally not advised for any person with an eating disorder due it its extremely restrictive nature. How to Manage the Negative Thoughts That Accompany Disordered Eating