As a practitioner specialising in plant-based diets, and with a counselling background in addition to my nutrition and Lifestyle Medicine training, I frequently see vegans who are battling with eating disorders.
It’s actually quite heart-rending to listen to them describe the almost universally terrible experiences that they have when seeking treatment for their eating disorder within the mental health system.
Unfortunately, within the eating disorder treatment community, veganism itself is seen as an eating disorder – that is, choosing not to eat foods of animal origin is framed as a psychologically unhealthy self-imposed restriction on ‘normal’ dietary intake. After all, what everyone else in the herd is thoughtlessly doing must be normal and healthy, right? Hmmmmm. Didn’t these mental health professionals’ mothers ever ask them if they’d jump off a cliff just because everyone else was doing it too?
Consequently, people who have chosen to eat a vegan diet, but happen to be dealing with an eating disorder, are told that in order to recover they must give up veganism and resume eating an omnivorous diet.
Can you imagine anything more gut-wrenching for a person who has lifted the veil on the horrors of factory farming, learned about the devastating impact of animal agriculture on every environmental crisis facing the planet, and also discovered that they’ve been lied to all their lives about the necessity for animal-derived foods in the human diet, than to be told that they won’t receive treatment and have no hope of recovery unless they abandon their moral principles and go back to eating meat, eggs and dairy products?
Yet this is the dilemma faced by vegans with eating disorders today. Eating disorder treatment units simply refuse to serve vegan meals to inpatients, even though high calorie vegan food supplements are available when required to refeed severely underweight individuals. You won’t be discharged until you submit to eating animal products.
But what evidence is there that a vegetarian or vegan diet predisposes people to eating disorders, or that vegans suffering from eating disorders can’t recover unless they revert to omnivory? A study published in the journal Appetite suggests exactly the opposite, finding that
“vegans appear to have the healthiest attitudes towards food, closely followed by vegetarians”
while semi-vegetarians had the highest levels of eating-related pathology.
The researchers administered a battery of psychological tests to the almost 500 participants, who were recruited from universities, health food stores and via Internet sites devoted to psychology or vegetarianism/veganism.
The researchers noted that previous studies of the prevalence of disordered eating among various dietary groups have recruited low numbers of true vegans and vegetarians, and therefore lumped them in with semi-vegetarians (that is, people who avoid particular types of animal flesh, such as red meat, but consume other types, such as chicken or fish).
In most older studies, this mixed group showed more disordered eating behaviour than omnivores; however the vast majority of so-called vegetarians in these studies were not vegetarian at all – they simply restricted certain food groups, for a variety of motives.
The researchers took great pains in this study to accurately identify ‘true’ vegans and vegetarians, to ascertain the motivations of vegans, vegetarians and semi-vegetarians for following their chosen diets, and to analyse the responses of each distinct dietary group to the questionnaires separately from each other.
The participants were asked to complete questionnaires that assessed their degree of emotional eating, external eating (i.e. food intake that was prompted by external cues – such as smelling appetising food or seeing other people eat – rather than internal cues – such as feeling hungry) and restrained eating (deliberately eating less than they desired, and/or monitoring food intake obsessively eat due to concern about weight gain); dieting behaviour and bulimic behaviours; the power of food in the environment to affect their thoughts, feelings and behaviour; drive for thinness; asceticism (placing a high value on self-control and self-denial); self-esteem; and depression, anxiety and stress level.
There were no significant differences between dietary groups on the questionnaires related to dieting and bulimic behaviours or asceticism.
However, omnivores were found to have the highest drive for thinness, while also having the highest body mass index (BMI) of all the groups.
Vegans had significantly lower scores for external eating and the power of food than all other groups, indicating that they were more likely to eat simply because they were hungry, not because their appetite was being artificially stimulated by eating cues in their environment. Vegans and vegetarians were also found to be more able to tolerate food cravings without giving into them than other dietary groups.
The greatest observed difference was in dietary restraint:
“Vegans had significantly lower levels of restraint than semi-vegetarians… semi-vegetarians, in turn, had higher levels of restraint than omnivores.”
In other words, despite having the lowest BMI of any of the dietary groups, vegans were the least likely to be deliberately under-eating due to concerns about weight gain.
When asked why they had chosen to restrict animal products, many participants nominated multiple reasons. However, the vast majority of true vegans and vegetarians nominated ethical concerns as their primary reason for starting and maintaining their diet. In contrast, semi-vegetarians were almost as likely to have chosen to restrict meat for health reasons as for ethical reasons, and more likely to continue to restrict it for health reasons than for ethical reasons.
While this is just one study, and more research definitely needs to be done on eating disorders and veganism, both the family members of people with eating disorders and the professionals charged with their care can draw reassurance from this very comprehensive study. Vegans, on the whole, are better at listening to their own bodies when it comes to food intake, and more likely to achieve a healthy body weight without unhealthy dieting practices.
My clinical experience has clearly demonstrated that vegans with eating disorders can make a full recovery while maintaining their vegan diet. A person who has chosen a vegan diet for ethical reasons, and also happens to be vegan, should not be doubly pathologised by being told that their ethical veganism is part and parcel of their eating disorder – it is not.
Health care providers should get themselves better informed about how to guide vegans with eating disorders toward a nutritionally sound vegan diet and a healthy relationship with food, eating, and their bodies.
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