Who has the healthiest thoughts, attitudes, and habits regarding food?
Are Vegetarians at Risk for Eating Disorders?
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
At the turn of the century, if you would have asked teens why they chose to eat vegetarian, most might say they do it because they don’t want to kill animals, followed by wanting to eat a healthier diet. More recently, “to help the environment” became a leading reason among young people, followed by eating healthier, and then animals. A smaller fraction gave weight loss as a reason. Yeah, they might think it’s healthier, and care about animals and the environment, but they also might be doing it for weight-loss reasons. Yes, we’re in the midst of an “obesity epidemic,” but there’s also been a rise in eating disorders. Might vegetarianism be a red flag for the presence of an eating disorder?
A survey of adolescent and young adult vegetarians found they tended to eat better and have healthier body weights, but those who ate vegetarian were also more likely to report eating disorder-type behaviors. “It’s important, however,” commentators were quick to point out, “not to suggest that vegetarian diets cause eating disorders.” When people start eating more plant-based, their risk for chronic diseases goes down, not up. Maybe it’s the “children who have not yet adopted a vegetarian diet who require [our] special attention, as they have poorer diets and are at significantly higher risk for obesity.”
To which the authors responded, yes, they “agree that vegetarianism does not cause eating disorders”; they’re just saying that one should explore with them why they’re doing it. “While it is important to recognize the potential health benefits, it is also important to investigate a teen’s motives for adopting a vegetarian diet.” See, “studies have shown that adolescents who have symptoms of eating disorders may [then go on to] adopt a vegetarian diet as a weight-loss method, as a socially acceptable way of avoiding eating.” So, rather than an increased prevalence of eating disorders among those who eat vegetarian, there may be an “increased prevalence of vegetarianism” among those with eating disorders.
See, the study was just a snapshot in time; so, they couldn’t tell which came first. Might eating vegetarian just be “a way to disguise food restriction during the early stages of an eating disorder? Or does experience with vegetarianism increase vulnerability for the development of eating disorders in the first place?” To answer the question, you need to know which came first. And, in most cases, eating vegetarian came at least a year after the first eating-disorder symptoms. Similarly, in a series of anorexics, in fewer than 1 in 10 “did meat avoidance predate the onset of their [disease].”
It’s this kind of data that led the Academy of Nutrition and Dietetics to conclude that “prior use of a vegetarian or vegan diet does not appear to increase the risk of an eating disorder.” In fact, they may have even lower dietary restraint scores. “Dietary restraint represents the conscious limitation of food intake,” the perception of constantly having to limit food intake “to prevent weight gain.” Perhaps the reason vegetarian women exhibited less restrained eating is because they really didn’t need to worry as much, because plant foods are just calorically less dense. “This could translate into less concern or stress [when it comes to] eating,” which may, in turn, help explain why they saw fewer ovulatory disturbances among women eating vegetarian. In fact, maybe that’s one of the reasons vegans report less stress and anxiety. Perhaps one of the reasons increasingly restricting animal foods is associated with better mood is that vegans reported dieting significantly less, and that’s one of the things that seems to be stressing women out.
And vegans and true vegetarians didn’t just have significantly lower levels of restrained eating, but also less emotional eating, less compulsive eating, and “greater levels of acceptance in relation to food.” “This highlights previously unacknowledged positive aspects of adhering to a completely meat or animal product free diet” when it comes to thinking about food—though we don’t know if this actually translates into protection “against developing disordered eating.” “Vegans appear to have the healthiest attitudes towards food, closely followed by vegetarians.”
But no one had actually taken a large sample of vegans and just put them through the EDE-Q, which is one of the most widely used diagnostic tools…until now. “[T]he first large sample of vegans to complete the [official Eating Disorder Examination Questionnaire]. And…vegans scored significantly lower, significantly better, consistent with the data showing vegans tended to diet less frequently. “Taken together, these findings suggest that vegans and omnivores don’t differ markedly in reported eating attitudes and behaviors, and when they do, vegans appear to endorse overall healthier thoughts and habits.”
Please consider volunteering to help out on the site.
- Perry CL, Mcguire MT, Neumark-sztainer D, Story M. Characteristics of vegetarian adolescents in a multiethnic urban population. J Adolesc Health. 2001;29(6):406-16.
- Robinson-o'brien R, Perry CL, Wall MM, Story M, Neumark-sztainer D. Adolescent and young adult vegetarianism: better dietary intake and weight outcomes but increased risk of disordered eating behaviors. J Am Diet Assoc. 2009;109(4):648-55.
- Zuromski KL, Witte TK, Smith AR, et al. Increased prevalence of vegetarianism among women with eating pathology. Eat Behav. 2015;19:24-7.
- Janelle KC, Barr SI. Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women. J Am Diet Assoc. 1995;95(2):180-6, 189, quiz 187-8.
- Barr SI, Janelle KC, Prior JC. Vegetarian vs nonvegetarian diets, dietary restraint, and subclinical ovulatory disturbances: prospective 6-mo study. Am J Clin Nutr. 1994;60(6):887-94.
- Beezhold B, Radnitz C, Rinne A, Dimatteo J. Vegans report less stress and anxiety than omnivores. Nutr Neurosci. 2015;18(7):289-96.
- Barnard ND, Levin S. Vegetarian diets and disordered eating. J Am Diet Assoc. 2009;109(9):1523.
- Bardone-cone AM, Fitzsimmons-craft EE, Harney MB, et al. The inter-relationships between vegetarianism and eating disorders among females. J Acad Nutr Diet. 2012;112(8):1247-52.
- Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116(12):1970-1980.
- O'connor MA, Touyz SW, Dunn SM, Beumont PJ. Vegetarianism in anorexia nervosa? A review of 116 consecutive cases. Med J Aust. 1987;147(11-12):540-2.
- Timko CA, Hormes JM, Chubski J. Will the real vegetarian please stand up? An investigation of dietary restraint and eating disorder symptoms in vegetarians versus non-vegetarians. Appetite. 2012;58(3):982-90.
- Heiss S, Coffino JA, Hormes JM. Eating and health behaviors in vegans compared to omnivores: Dispelling common myths. Appetite. 2017;118:129-135.
- Skidmore PM, Yarnell JW. The obesity epidemic: prospects for prevention. QJM. 2004;97(12):817-25.
Image credit: iprachenko via Adobe Stock Photos. Image has been modified.
Motion graphics by Avocado Video
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
At the turn of the century, if you would have asked teens why they chose to eat vegetarian, most might say they do it because they don’t want to kill animals, followed by wanting to eat a healthier diet. More recently, “to help the environment” became a leading reason among young people, followed by eating healthier, and then animals. A smaller fraction gave weight loss as a reason. Yeah, they might think it’s healthier, and care about animals and the environment, but they also might be doing it for weight-loss reasons. Yes, we’re in the midst of an “obesity epidemic,” but there’s also been a rise in eating disorders. Might vegetarianism be a red flag for the presence of an eating disorder?
A survey of adolescent and young adult vegetarians found they tended to eat better and have healthier body weights, but those who ate vegetarian were also more likely to report eating disorder-type behaviors. “It’s important, however,” commentators were quick to point out, “not to suggest that vegetarian diets cause eating disorders.” When people start eating more plant-based, their risk for chronic diseases goes down, not up. Maybe it’s the “children who have not yet adopted a vegetarian diet who require [our] special attention, as they have poorer diets and are at significantly higher risk for obesity.”
To which the authors responded, yes, they “agree that vegetarianism does not cause eating disorders”; they’re just saying that one should explore with them why they’re doing it. “While it is important to recognize the potential health benefits, it is also important to investigate a teen’s motives for adopting a vegetarian diet.” See, “studies have shown that adolescents who have symptoms of eating disorders may [then go on to] adopt a vegetarian diet as a weight-loss method, as a socially acceptable way of avoiding eating.” So, rather than an increased prevalence of eating disorders among those who eat vegetarian, there may be an “increased prevalence of vegetarianism” among those with eating disorders.
See, the study was just a snapshot in time; so, they couldn’t tell which came first. Might eating vegetarian just be “a way to disguise food restriction during the early stages of an eating disorder? Or does experience with vegetarianism increase vulnerability for the development of eating disorders in the first place?” To answer the question, you need to know which came first. And, in most cases, eating vegetarian came at least a year after the first eating-disorder symptoms. Similarly, in a series of anorexics, in fewer than 1 in 10 “did meat avoidance predate the onset of their [disease].”
It’s this kind of data that led the Academy of Nutrition and Dietetics to conclude that “prior use of a vegetarian or vegan diet does not appear to increase the risk of an eating disorder.” In fact, they may have even lower dietary restraint scores. “Dietary restraint represents the conscious limitation of food intake,” the perception of constantly having to limit food intake “to prevent weight gain.” Perhaps the reason vegetarian women exhibited less restrained eating is because they really didn’t need to worry as much, because plant foods are just calorically less dense. “This could translate into less concern or stress [when it comes to] eating,” which may, in turn, help explain why they saw fewer ovulatory disturbances among women eating vegetarian. In fact, maybe that’s one of the reasons vegans report less stress and anxiety. Perhaps one of the reasons increasingly restricting animal foods is associated with better mood is that vegans reported dieting significantly less, and that’s one of the things that seems to be stressing women out.
And vegans and true vegetarians didn’t just have significantly lower levels of restrained eating, but also less emotional eating, less compulsive eating, and “greater levels of acceptance in relation to food.” “This highlights previously unacknowledged positive aspects of adhering to a completely meat or animal product free diet” when it comes to thinking about food—though we don’t know if this actually translates into protection “against developing disordered eating.” “Vegans appear to have the healthiest attitudes towards food, closely followed by vegetarians.”
But no one had actually taken a large sample of vegans and just put them through the EDE-Q, which is one of the most widely used diagnostic tools…until now. “[T]he first large sample of vegans to complete the [official Eating Disorder Examination Questionnaire]. And…vegans scored significantly lower, significantly better, consistent with the data showing vegans tended to diet less frequently. “Taken together, these findings suggest that vegans and omnivores don’t differ markedly in reported eating attitudes and behaviors, and when they do, vegans appear to endorse overall healthier thoughts and habits.”
Please consider volunteering to help out on the site.
- Perry CL, Mcguire MT, Neumark-sztainer D, Story M. Characteristics of vegetarian adolescents in a multiethnic urban population. J Adolesc Health. 2001;29(6):406-16.
- Robinson-o'brien R, Perry CL, Wall MM, Story M, Neumark-sztainer D. Adolescent and young adult vegetarianism: better dietary intake and weight outcomes but increased risk of disordered eating behaviors. J Am Diet Assoc. 2009;109(4):648-55.
- Zuromski KL, Witte TK, Smith AR, et al. Increased prevalence of vegetarianism among women with eating pathology. Eat Behav. 2015;19:24-7.
- Janelle KC, Barr SI. Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women. J Am Diet Assoc. 1995;95(2):180-6, 189, quiz 187-8.
- Barr SI, Janelle KC, Prior JC. Vegetarian vs nonvegetarian diets, dietary restraint, and subclinical ovulatory disturbances: prospective 6-mo study. Am J Clin Nutr. 1994;60(6):887-94.
- Beezhold B, Radnitz C, Rinne A, Dimatteo J. Vegans report less stress and anxiety than omnivores. Nutr Neurosci. 2015;18(7):289-96.
- Barnard ND, Levin S. Vegetarian diets and disordered eating. J Am Diet Assoc. 2009;109(9):1523.
- Bardone-cone AM, Fitzsimmons-craft EE, Harney MB, et al. The inter-relationships between vegetarianism and eating disorders among females. J Acad Nutr Diet. 2012;112(8):1247-52.
- Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116(12):1970-1980.
- O'connor MA, Touyz SW, Dunn SM, Beumont PJ. Vegetarianism in anorexia nervosa? A review of 116 consecutive cases. Med J Aust. 1987;147(11-12):540-2.
- Timko CA, Hormes JM, Chubski J. Will the real vegetarian please stand up? An investigation of dietary restraint and eating disorder symptoms in vegetarians versus non-vegetarians. Appetite. 2012;58(3):982-90.
- Heiss S, Coffino JA, Hormes JM. Eating and health behaviors in vegans compared to omnivores: Dispelling common myths. Appetite. 2017;118:129-135.
- Skidmore PM, Yarnell JW. The obesity epidemic: prospects for prevention. QJM. 2004;97(12):817-25.
Image credit: iprachenko via Adobe Stock Photos. Image has been modified.
Motion graphics by Avocado Video
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Are Vegetarians at Risk for Eating Disorders?
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Content URLDoctor's Note
What about so-called “orthorexia”? I’ve got a whole series of videos coming about that—stay tuned!
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