One of the main idiosyncrasies of eating disorders is the sudden claim to eating healthy. Suddenly your child has decided they are vegetarian, gluten-free, lactose-free, vegan or some other dietary requirement. My happy carnivour daughter became vegetarian, swearing it was a healthy choice. But interestingly she couldn’t provide one normal and accepted reason for becoming one. I used to argue this point with her pointing out it was the anorexia making the call not her. It wasn’t a life choice, animal choice decision. It was all fueled by the anorexia. Parents/carers need to be wary of sudden dietary changes in their kids. Weigh up the decision with what else is happening, notice the intensity about the new diet and find out the reasons behind it. Often you will find that it is an eating disorder in the early stages. It is smart enough to use accepted dietary intake restrictions to cover it’s tracks whilst it gets a hold on your loved one.
A recent article in ED HOPE, states that almost half of anorexia suffers are ‘vegetarian’ but when it gets down to the nitty gritty, it is the anorexia that is deciding the vegetarian diet. My daughter after freeing herself from the worst of the anorexic behaviour, now eats meat happily and has a full diet. She doesn’t even consider wanting to be a vegetarian. Most of the research article is below for those who want the full article go to: http://www.eatingdisorderhope.com/information/anorexia/vegan-vegetarian-relationship-rates
Article Contributed By Christopher D. Keiper, M.A.[1],[2], Lauren M. Cash, B.S.2, and David M. Garner, Ph.D.1 of River Centre Clinic
Vegetarianism (eliminating meat and/or animal products from a person’s diet) has become popular in recent years. According to the latest U.S. Gallup Poll, approximately five percent of Americans define themselves as vegetarian (Newport, 2012). This number underestimates those who may be termed “semi-vegetarians”- those that consume some animal-based products but rely mostly on plant-based diets. For people struggling with eating disorders (EDs), vegetarianism is much more prevalent. About half (45 to 54 percent) of patients seeking treatment for anorexia nervosa (AN) reported practicing some form of a vegetarian diet (Bardone-Cone, et al., 2012). This becomes critical for treatment because it means that ED professionals must tease out a person’s motivations for being vegetarian while balancing respect for his or her autonomy. In the ED field, vegetarianism has been viewed suspiciously, as it seems to give those struggling with restricting food a way of masking attempts to lose weight. Is being vegetarian a part of a person’s path towards an ED, or is vegetarianism a lifestyle choice that aids in overall health? Most importantly, is vegetarianism a risk for developing an ED?
Who is a ‘Real Vegetarian’?
The term “vegetarian” is problematic, mostly because of the many variations people have for the diet. Most see the term as covering a broad range of dieting practices that eliminate some form of animal product. Technically, however, Timko, Hormes, and Chubski (2012) define a person who also eliminates eggs but no dairy as an “ovo-vegetarian” and a person who eliminates only dairy a “lacto-vegetarian”. “Semi-vegetarian” refers to a group that eliminates some meat, but may include fish or poultry, and “vegans” exclude all meat and animal products from their diet. According to Timko and his colleagues, very few scientific studies have looked at true vegetarians (eating no meat products), or vegans (eating no animal products at all) with regard to EDs. What is more, much of the research done on vegetarianism in ED has defined vegetarians as those simply excluding red meat, which does not accurately describe what most define as a vegetarian diet.
While the reasons people choose to become vegetarian are also complex, the majority of individuals cite health concerns. For example, 67 percent of first-year college students claimed that their reasons for being vegetarian were health-related, while 45 percent said their reasons were ethical in nature. Twenty-five percent said their primary reason for being vegetarian was weight loss (Gilbody, Kirk, & Hill, 1999). However, listing “health” as a motivation can be vague, since individuals may consider low body weight and health as synonymous (Gilbody et al., 1999; Martins et al., 1999). Indeed, dieting to lose weight in general is a risk factor for later development of an ED and some have believed dieting could be related to vegetarianism (Jacobi, Hayward, Zwaan, Kraemer, & Agras, 2004; Gilbody et al., 1999). Bardone-Cone and his colleagues (2012) found that although nearly half of those with an ED history and a vegetarian diet had chosen vegetarianism for weight-related reasons, none of their counterparts without an ED reported this reasoning. In other words, this study seemed to indicate that individuals with an ED who were vegetarian might be more likely to choose to eat vegetarian for weight purposes than vegetarians with no ED history.
Vegetarianism, ED, and Dietary Restraint
Which comes first, the vegetarian or the ED? Bardone-Cone and colleagues (2012) found that 61 percent of current ED individuals who have had a vegetarian diet said they believe there was a relationship between their ED and choosing to be a vegetarian. These authors found vegetarianism in the history of about half of people who develop AN, and that more AN patients who were vegetarian struggled to complete ED treatment (Bardone-Cone, et al., 2012). However, they also found that people with an ED on a vegetarian diet reported ED symptoms before choosing to be vegetarian with an average of one year between the onset of ED symptoms and eating vegetarian. Consistent with earlier studies (for example, O’Connor, Touyz, Dunn, & Beumont, 1987), these authors suggest that though ED sufferers are more likely to be vegetarian, it seems that vegetarianism is not usually a specific precedent to an ED. Rather, it seems that people who are predisposed to risk for developing an ED are more likely to engage in vegetarian eating patterns (Bardone-Cone, et al., 2012).
Herman and Mack (1975), in their original definition, suggest that “dietary restraint” is the willful restriction of food in order to control body weight. This definition of dietary restraint perhaps elucidates some of the trouble with other definitions: Vegetarians – by their very definition – exclude entire food categories from their diet, such as meat and fish, but not all vegetarians are trying to control their body weight. One key difference, then, between those at high risk for EDs and those with low risk is a person’s desire to control their body shape and weight.
Timko et al. (2012) attempt to tackle this question by comparing a large sample of vegetarians/vegans based upon their primary motivations for choosing their dietary lifestyle. They found no differences in dietary restraint between those who endorsed ethical reasons, health reasons, ethical reasons, weight control reasons, and religious convictions. However, the vast majority of their sample endorsed ethical reasons (59%) started and continued to be vegetarian/vegan for ethical reasons, while health (19%) and weight control (2%) made up much smaller proportions. Unfortunately, no research to date has successfully answered the question of whether the reason one becomes vegetarians/vegan creates greater ED risk. However, experience of many clinicians (e.g., Bardone-Cone et al., 2012; Gilbody et al., 1999) suggests that how a person thinks about controlling their weight in respect to their vegetarianism is crucial to whether a person recovers from an ED. With this consideration, vegetarians who suffer from an ED may consider taking a “holiday” from eating vegetarianism while undergoing treatment in order to best determine how to help them to stop restricting calories. A trained ED clinician should work closely with a person’s motivations for choosing a vegetarian/vegan diet in order to respect his or her personhood while providing the best chance of recovery.
Summary
The information on the role vegetarianism plays in ED is certainly mixed and complex. It is well-established that dieting to lose weight for any reason creates a risk of developing an ED. While most ED patients begin to have symptoms before they start a vegetarian diet, it is likely that the dietary restrictions become subsumed under the all-embracing motivational force that drives the ED. Notably, Bardone-Cone et al. (2012) found that most ED patients report vegetarianism in their history, with those further along the continuum of recovery being less prone to this dietary pattern. This supports the O’Connor et al. (1987) observations made more than 25 years ago that, for most ED patients, avoidance of meat does not precede the onset of the ED symptoms. This indicates that motivation for the dietary restriction in these cases is likely linked to the higher need to seek thinness than other reasons for choosing vegetarianism. This supports treatment recommendations that emphasize the importance of motivational factors in determining the appropriateness of vegetarianism and the idea that a “vegetarianism holiday” may be helpful for those whose onset is clearly or likely after the onset of their ED.
