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Vegetarianism and Eating Disorders

Healthy lifestyle choice or eating disorder in disguise?

In a country where meat has been a mainstay for more than a century, about 5 percent of Americans step outside the box with the choice of being vegetarian or vegan. In a 2002 poll by Time magazine, 32 percent of Americans reported choosing a vegetarian lifestyle for health reasons, 3 percent specifically to lose weight. The environment, concerns about meat processing and love of animals are also among the top reasons people swear off meat.

But a significant number of people “go veg” for very different reasons. A 2012 study published in the Journal of the Academy of Nutrition and Dietetics found that women suffering from eating disorders are four times more likely to be vegetarian than women without eating disorders. More than half (52 percent) of women with a history of eating disorders had been vegetarians at one point in their lives.

Other studies have found similar associations. In Project EAT, an ongoing study that assessed eating and weight-related behaviors in adolescents from 31 Minneapolis schools, about 6 percent of students reported being vegetarians. Of those, 35 percent did so to lose weight. Vegetarians also were more likely to be involved in unhealthy weight control behaviors, such as binge eating, vomiting, and using laxatives or diet pills. Some pro-anorexia websites go so far as to promote vegetarianism as a weight-loss strategy.

A Twist on Extreme Dieting

With its strict dietary restrictions, vegetarianism has a natural appeal for those with tendencies toward disordered eating. It is a socially acceptable way to cut out a number of specific food groups and to restrict fat and calorie intake. Especially for teens, vegetarianism may be perceived as a socially and environmentally conscious choice that draws less concern from parents and other meddlesome adults. In other words, vegetarianism is a perfect cover for anorexia and other eating disorders.

In other cases, people adopt a vegetarian diet for all the right reasons only to find that they become obsessed with labeling certain foods as “good” and “bad” and cutting troublesome categories out of their diet. We have long known that regular or extreme dieting is linked to the development of eating disorders. Like other diets, if taken to extremes, a vegetarian diet could prompt restrictive or obsessive eating patterns.

Let’s be clear: Vegetarianism does not cause eating disorders. In fact, done properly, it can be a healthy choice at any stage of life. Vegetarians tend to consume an overall healthier diet and have a lower risk of obesity and related health problems like heart disease, hypertension and diabetes. But it has to be done right.

Cutting out meat and replacing it with processed junk food does not promote good health but rather fatigue and malnourishment. Healthy vegetarians find substitutes for the nutrients they’re missing, such as calcium, protein, omega-3 fatty acids, vitamin B12 and iron. When their diet contains a wide variety of nutritious foods, it tends to be higher in fruits, vegetables, fiber and complex carbohydrates and lower in saturated fat and cholesterol than a non-vegetarian diet.

Still, the association between a vegetarian diet and eating disorders should not be ignored. Like compulsive exercise and orthorexia (an obsession with healthy eating), vegetarianism may seem like a positive lifestyle choice, but for some people the underlying mechanisms – such as obsession, control and low self-esteem – can be a sign of mental illness.

A Decision Worth Investigating

The purpose of pointing out the link between eating disorders and vegetarianism is not to discourage meatless eating, but to emphasize the importance of doing so healthfully. In some cases, the choice to avoid meat can be a symptom of an eating disorder that should be explored by clinicians and other health care providers. What is the patient’s motivation for becoming vegetarian? If the primary goal is to lose weight, this may be a red flag for disordered eating.

If an eating disorder exists, the most important thing is prompt identification and treatment. Knowing that vegetarianism may be a disguise for disordered eating can help health care providers, parents and other concerned individuals recog