Vegetarianism: Health Trend or Eating Disorder Mask?

There's no disputing all the research that links the myriad health benefits of plant-based eating. You don't have to look any farther than the Academy's position on vegetarian diets if you feel concerns about the nutritional adequacy of a vegetarian or vegan diet.

Yet for many years, clinicians have hypothesized that vegetarianism can sometimes serve as a socially acceptable vehicle for unhealthy food restriction. And for any clinician who actively works in the field of eating disorders, this hypothesis may seem well-founded. At times, I have certainly seen this theory ring true in my own nutrition counseling practice.

For the purposes of this blog post I wanted to answer two questions:

  1. What does the most current research tell us about the relationship between vegetarianism and eating disorders?
  2. What are the most effective ways to identify whether or not a vegetarian diet is leading to concerning disordered eating?

Current Research on Eating Disorders and Planted-Based Diets

Historically, the research on the relationship between vegetarianism and eating disorders has been mixed. But since 2012, two teams of researchers have published their eye-opening findings on the subject. Last year Timko, et al., and Forestell et al., found that "semi-vegetarians" —  defined as those who restrict the type of meat they consume only to a certain extent (i.e. they eat chicken, but not red meat) — are most likely related to disordered eating patterns. However, "true vegetarians" — those who do not ever eat meat — and vegans have the lowest rates of eating pathology.

According to the research, semi-vegetarians' food choices often were motivated by weight control, while true vegetarians and pesco-vegetarians (those who eat fish but no other meat) made food choices motivated by ethical concerns. Another study by Forestell, et al., suggested that by focusing "specifically on semi-vegetarian and flexitarian subgroups, more effective approaches can be developed to ensure that their concerns about weight loss do not lead to unhealthful or disordered eating patterns."

In another study conducted by Bardone-Cone, 59 of the 93 study participants stated that their vegetarianism was related to their eating disorder and admitted their eating disorder pre-dated their vegetarian lifestyle. This suggests that their restriction of some animal products was a byproduct of their eating disorder. In fact, participants with an eating disorder history have far higher rates of past and current vegetarianism when compared with study participants with no eating disorder history.

Is Plant-Based Eating a Sign of an Eating Disorder?

Of course many people adhere to a plant-based diet healthfully and pose absolutely no concern for disordered eating. But the statics above do suggest that some plant-based eating patterns may warrant further investigation to rule out concerns of eating patterns that could become unhealthy. If you or someone you know is eliminating animal-based foods, consider the following questions:

  1. What are your motivations for limiting/cutting out animal-based foods?
  2. If you have reduced or eliminated animal-based foods, are you confident you are meeting your nutritional needs with other foods?
  3. In addition to animal products, are you limiting or avoiding other food groups?
  4. Do your eating habits get in the way of your ability to eat and socialize with friends and family?
  5. Since changing your eating habits have you become more pre-occupied with food?
  6. Do you ever binge on forbidden foods?
  7. Do you have a history of fad or crash dieting?
  8. Do you feel shame or guilt when you deviate from your food plan?
  9. Do you have a personal or family history of disordered eating or eating disorders?

These questions are only a handful of ways to help you investigate whether or not a plant-based is truly supportive of physical, emotional and psychological health. The right eating plan should support a person's health holistically. If you have any concerns about your eating patterns, a registered dietitian nutritionist can help. You may also want to consider working with an RD or RDN who also specializes in eating disorders. The Academy's free RD finder is a great place to start.

Marci Anderson, MS, RD, LDN, is a registered dietitian in private practice in Cambridge, Mass. She manages a group practice specializing in treating a broad spectrum of disordered eating, and she blogs about a variety of topics at MarciRD.com. Follow her on Twitter.


References

  • Anna M. Bardone-Cone, PhD; Ellen E. Fitzsimmons-Craft, MA; Megan B. Harney, MA; Christine R. Maldonado, PhD; Melissa A. Lawson, MD; Roma Smith, LPN; D. Paul Robinson, MD. The Inter-Relationships between Vegetarianism and Eating Disorders among Females. J Acad Nutr Diet. 2012;112:1247-1252.
  • Catherine A. Forestell, Andrea M. Spaeth, Stephanie A. Kane To eat or not to eat red meat. A closer look at the relationship between restrained eating and vegetarianism in college females. Appetite 58 (2012) 319–325
  • C. Alix Timko, Julia M. Hormes, Janice Chubski. Will the real vegetarian please stand up? An investigation of dietary restraint and eating disorder symptoms in vegetarians versus non-vegetarians. Appetite 58 (2012) 982–990.
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Marci Evans
Marci Evans, MS, CEDRD-S, counsels clients and manages her group practice in Cambridge, MA. She also brings her passion and skill in the eating disorders field to students, interns and clinicians with online trainings and clinical supervision. Connect with her at www.marciRD.com and all social media outlets @marciRD.