Which Came First, the Eating Disorder or Vegetarianism?: Vegetarianism and Eating Disorders among U.S. Youths

For youths in the U.S., there is evidence that choosing a vegetarian diet and having an eating disorder are linked. As a researcher and as an advocate (for both women’s health and animal protection), this finding concerns me. It has also left me wondering if there is a causal link between eating disorders and vegetarianism and, if so, in which direction the link operates. In other words, does being an adolescent vegetarian increase the likelihood of an eating disorder, or do disordered eating and body image patterns increase the likelihood of choosing a vegetarian diet?

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Most research reveals that vegetarianism and veganism have clear health benefits. Groups like the American Dietetic Association have examined and conducted research as to the health effects of eating vegetarian and vegan (veg'n) diets. Most research that examines vega'n diets find that a balanced vegan diet is healthier than a balanced diet that includes meat and dairy. This fact is documented consistently by research that systematically examines nutrition and health. Perhaps most notable is The China Study by Dr. T. Colin Campbell. This is was the first large-scale epidemiological study to examine how diet is linked to a variety of health outcomes and found that meat and dairy consumption are directly related to some of the biggest killers in the U.S., including cancer and heart disease.

At the same time that evidence shows meat-free is the healthy way to be, the correlation between vegetarianism and eating disorders for adolescents is clear. In a 2001 research study over 4,700 adolescents were interviewed; 6% identified as vegetarian. The vegetarian adolescents were more likely to be female, not black, to have considered or attempted suicide, to be weight and body conscious, dissatisfied with their bodies, involved in a number of weight control behaviors, and to have been told by a physician that they have an eating disorder. A more recent study corroborates this finding. A survey of over 2,500 15-23 year olds found vegetarian youths had healthier diets, but they were also more likely to binge eat, and former vegetarians may be overly concerned with and engaged in extreme weight control behaviors.

The correlation is clear, but the important question is the direction of this relationship. At first glance, the abstract to the later study makes it appear as if the authors attribute the eating disorders to the vegetarianism: "…[C]urrent vegetarians may be at increased risk for binge eating with loss of control, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors."

However, closer reading of the study shows that the relationship between the two is complicated. For example, the age when someone became vegetarian plays a role, with those who became vegetarian at younger ages more likely to engage in disordered eating. Importantly, the study does not time the onset of each behavior (vegetarianism and eating disorder) so the direction of the relationship remains unclear, but the authors note that it is often the case that the eating disorder precedes the vegetarianism, with vegetarianism being embraced as part of the eating disorder:

"In some instances, the practice of vegetarianism may precede disordered eating behaviors, although it is generally understood that some adolescents may choose a vegetarian diet as method of masking disordered eating behaviors. Being a vegetarian can be a socially acceptable way to avoid eating certain foods.”

It is important that as adult advocates we support adolescents and young adults who become vegetarian. This means that we encourage their healthful eating practices but stay attune to their reasons for engaging in them. If the rhetoric accompanying vegetarianism includes a focus on body image and caloric intake then these negative attitudes need to be addressed. At the same time, the choice to avoid eating animal products should not be discouraged.

While there might be a link between vegetarianism and eating disorders among U.S. youths, it is important to remember that most young people with eating disorders are not vegetarians and most vegetarian youths do not have eating disorders. In the aforementioned study, fewer than 20% of the vegetarian youths indicated that they were interested in vegetarianism for weight concerns. As important as it is to be vigilant and identify any possible eating disorder problems that might be associated with the decision to embrace vegetarianism, it is also important to support the good reasons behind this choice, including good health, the environment, and animal protection.