Plant-based lifestyles, such as Vegetarianism and Veganism, are marketed as a method for bettering the environment, stopping animal cruelty, and improving your health. For someone struggling with an eating disorder, this lifestyle may cater to behaviors of restriction or food avoidance. Eating disorders (anorexia nervosa, bulimia nervosa, and Eating Disorder Not Otherwise Specified) are usually associated with restrictive diets and are more commonly observed in adolescents and young adults .
This is not to say plant-based diets cause eating disorders, but rather to promote a deeper look into the motivation when choosing drastic lifestyle changes. According to the available literature, 45 to 54% of adolescents and young adults with anorexia nervosa followed a vegetarian diet, especially females . This staggering statistic highlights the need to start a conversation exploring the motivations behind plant-based lifestyles, the complications of restricting, and asking how will keeping this lifestyle serve recovery?
Motivation Behind Choosing Plant-Based Lifestyles:
The main motives for following a meat-free diet include health, moral, economy, ecology, environment, society, culture, ethics, and religion . However, when an eating disorder is happening simultaneously, there must be a moment of pause to ask, could there be another motive? It has been suggested that when subjects with a suspected or diagnosed eating disorder follow a vegetarian diet, health care professionals should worry that this behavior may be used as a socially acceptable way to legitimize food avoidance and avoid certain eating situations . In doctor appointments, therapy sessions, or nutrition counseling, are these tough questions being asked?
It is essential to acknowledge that those suffering from an eating disorder may not know of the confusion between their choice to follow a plant-based lifestyle and their desire to avoid certain foods. They may understand that it is easier to eat when eating these foods because their fears or anxieties dissipate. For some individuals, adopting a vegetarian diet is a socially acceptable attempt to mask their disordered eating behaviors . Foods those suffering from an eating disorder may avoid include butter, eggs, meat, fish, and dairy. These are all foods a plant-based lifestyle recommends limiting or removing altogether.
Health Complications Plant-Based Lifestyles Coupled with Eating Disorders may Present:
According to the Academy of Nutrition and Dietetics an appropriately planned vegetarian, including a vegan diet, is healthful, nutritionally adequate. It may provide health benefits for the prevention and treatment of certain diseases . What if the person following this lifestyle isn’t appropriately planning their meals and snacks? When following vegetarian or vegan diet, considerations need to be taken around the following nutrients: protein, fatty acids, iron, zinc, iodine, calcium, vitamin D, and vitamin B12 .
Complications that may result from these nutrient deficiencies include:
- Compromised immune system
- Decline in function and maintenance of heart, brain, and kidneys
- Hypothyroidism and goiter
- Dry skin, brittle hair, and nails
- Muscle breakdown and risk of injury
- Osteopenia or osteoporosis 
With medically supervised treatment, many of these complications may resolve, yet some may remain long-term. In the resolution of difficulties, the priority is to increase energy intake from all nutrients, including proteins, carbohydrates, and fats. Healing may also require bridging nutritional gaps with supplementation. For example, if anemia is present, iron or vitamin B12 supplementation may be recommended. It is advised to seek guidance from an experienced eating disorder physician and registered dietitian for these recommendations.
Can Recovery and Plant-Based Lifestyles Coexist?
To answer this question, each individual’s recovery journey must be explored based not on a standard but their personal experiences. One study revealed recovered patients who followed vegetarian-type diets tended to eat more restrictively and were more prone to following a diet . Now, this may not hold true for all those recovering from an eating disorder but does point to the need for exploration. Health care providers, families, friends, and those suffering from disordered eating need to explore by asking the deeper, tougher questions such as:
- At what age did you start following a plant-based diet, and at what age did your eating disorder start?
- What influenced your choice to follow a plant-based diet?
- Do you use a plant-based diet as a form of restriction?
- Do your eating habits affect your social life or cause you to avoid social situations?
- How often are you preoccupied with thoughts around food you have eaten or will eat?
- Would you be willing to create a list of foods to reintroduce into your diet in order to heal your body?
These are just a few of many questions necessary to ask on the road to recovery. These questions may provoke defense by threatening food restriction or food avoidance if suffering from an eating disorder. The rigidity of eating disorders blocks flexibility and freedom with food. Freedom with food not only refers to the amount of food, but also the type, the way it is prepared, who you are eating with and where you are eating.
If the motivation for following a plant-based lifestyle is entangled with disordered beliefs, then exposure to foods that the plant-based lifestyle restricted will serve in healing. Again, each individual will struggle with different fears and anxieties. It’s the responsibility of not only the medical professional but also the person suffering from an eating disorder to shed light on the barriers to recovery. Asking, are you truly in recovery if you continue to restrict what, where and when you are eating?
Recovery for all will be reintroducing different types and amounts of food. For some, this will mean no longer following the restrictive nature of a diet while for others, it will mean repairing their relationship with food before determining if a plant-based lifestyle truly aligns with their beliefs and values.
Resources: Brytek-Matera, A. (2020). Interaction between Vegetarian Versus Omnivorous Diet and Unhealthy Eating Patterns (Orthorexia Nervosa, Cognitive Restraint) and Body Mass Index in Adults. Nutrients, 12(3), 646. https://doi.org/10.3390/nu12030646  Hansson, L. M., Björck, C., Birgegård, A., & Clinton, D. (2011). How do eating disorder patients eat after treatment? Dietary habits and eating behaviour three years after entering treatment. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 16(1), 1–8. https://doi.org/10.1007/bf03327514  Mehler, P. S., & Andersen, A. E. (2017). Eating Disorders: A Guide to Medical Care and Complications (third edition). Johns Hopkins University Press.  Melina, V., Craig, W., & Levin, S. (2016). Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. Journal of the Academy of Nutrition and Dietetics, 116(12), 1970–1980. https://doi.org/10.1016/j.jand.2016.09.025  Sergentanis, T. N., Chelmi, M. E., Liampas, A., Yfanti, C. M., Panagouli, E., Vlachopapadopoulou, E., Michalacos, S., Bacopoulou, F., Psaltopoulou, T., & Tsitsika, A. (2020). Vegetarian Diets and Eating Disorders in Adolescents and Young Adults: A Systematic Review. Children, 8(1), 12. https://doi.org/10.3390/children8010012
About the Author:
Raylene Hungate, RD/N, LD/N is a registered dietitian dedicated to providing the utmost care and support to those struggling with mental health. As a supporter of the Health at Every Size movement and the idea that all foods fit, she is passionate about helping others explore a life full of nourishment and bursting with flavor.
As an eating disorder dietitian, Raylene works not only in Private Practice, but also as a contractor with Reasons Eating Disorder Center. She finds great joy in guiding others through an empowering journey of self-discovery and healing.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published May 3, 2021, on EatingDisorderHope.com
Reviewed & Approved on May 3, by Jacquelyn Ekern MS, LPC