Is Veganism an Eating Disorder? An Overview of All Angles

Estimated read time: 13 minutes

By Tiffany Bruno

 

Eating disorders can present in many forms, such as restricting, avoiding, binge eating, and purging; they are ALL dangerous and should be addressed by medical professionals. Although we like to focus on the benefits and positive aspects of following a vegan lifestyle, we also present unbiased facts based on evidence. Veganism sometimes gets associated with eating disorders, so we decided to take a deeper look into all angles. 

2024 Update

We have been following researchers in this field and are excited about the recent development of a screening tool specifically for vegans and vegetarians who have symptoms of an eating disorder. As you’ll read in Part 3, there are flaws in the current validated screening methods. While this tool is not yet validated for clinical or research purposes, its initial findings show reliability and promise. We are optimistic this will be invaluable in helping individuals get the proper care they deserve, and it’s hopeful to see professionals have more of an open mind and heart than ever before. Check back for updates and future research breakthroughs.

Part 1: Is there a link between eating disorders and following a plant-based or vegan diet?

There is limited reliable research into any link between plant-based diets and eating disorders at this time. Anyone who speaks to a definitive connection is making unsubstantiated claims. We break down the evidence into four categories: mixed results, harmful relationship, no connection, and beneficial relationship.

Mixed results 

Many studies do not establish a clear link, in any direction, between plant-based diets and eating disorders.

• The physical health benefits of plant-based eating are well-established, but some clinicians and researchers are unsure about whether these eating patterns are problematic for people who have, or at risk for, eating disorders (1).
• A team of researchers led by a psychologist at the University of Chicago School of Medicine recently determined that evidence on this topic is “decidedly mixed.” (1)
• This finding was echoed across the globe by an Australian psychiatric research team, which agreed that the notion that plant-based eating is linked to increased rates of disordered eating “has not been well established.” (2)

Harmful Relationship

Yes, some research suggests that plant-based diets are linked to eating disorders. However, we will later go into more details about the inherent flaws and inaccuracies in Part 3.

• Some studies indicate that approximately half of adolescents and young adults with anorexia nervosa, especially females, report having followed some form of a plant-based diet (3,4). 
• A recent systematic review of the topic also found that “Vegetarianism seems to be associated with eating disorders.” (5) Does this mean that avoiding meat causes eating disorders? Absolutely not. In fact, the authors caution against such a takeaway, underscoring that, “due to the cross-sectional design, a causal link between eating disorders and vegetarian status cannot be established.” (5) We’ll go into more details below.

No connection

These studies did not find any link between plant-based diets and eating disorders.

• Multiple studies, according to the aforementioned systematic review, have found “no correlation between eating disorders and vegetarianism.” (5) And it’s not just vegetarian diets, but vegan diets, as well as other permutations of plant-based eating; Multiple studies have found no differences in eating disorder rates, symptoms, or severity between people eating or avoiding animal foods (6-9). This has led some researchers to conclude that plant-based eating “is not associated with an increased risk of eating disorder symptoms, particularly in women.” (10)
• Indeed, the first systematic review to examine the link between vegetarianism, veganism, and disordered eating in adults of all ages was published earlier this year and arrived at “no consensus as to whether meat avoidance was associated with higher rates of disordered eating.” (2)

Beneficial relationship

Some research suggests people following plant-based diets have healthier relationships with food and eating than those eating omnivorous diets.

Over a decade ago, Towson University researchers found that “Vegans appear to have the healthiest attitudes towards food, closely followed by vegetarians.”

• Over a decade ago, Towson University researchers found that “Vegans appear to have the healthiest attitudes towards food, closely followed by vegetarians.” (11) Research published a few years later found that vegans reported dieting less than omnivores (12).
• These findings were replicated in 2017 when the first large group of vegans completed the EDE-Q (13), a diagnostic tool for eating disorders that we’ll discuss in detail below. Vegans scored significantly better than meat-eaters, ”which is consistent with recent work showing that vegans tended to diet somewhat less frequently than omnivores.”
• Findings published last year in the journal Appetite (10) further aligned: Despite maintaining healthier body weights, vegetarian women expressed fewer concerns about weight control and reported fewer eating disorder-related thoughts than their omnivorous counterparts. Rather than focusing on body weight, women who followed vegetarian diets were more motivated by health and the value of a more natural diet.
• “Taken together, these findings suggest that vegans and omnivores do not differ markedly in reported eating attitudes and behaviors, and when they do, vegans appear to endorse overall healthier thoughts and habits.” (13)

These findings suggest that vegans and omnivores do not differ markedly in reported eating attitudes and behaviors, and when they do, vegans appear to endorse overall healthier thoughts and habits.

Part 2: Why have I heard that veganism is an eating disorder?

Some studies draw unfair parallels between eating disorders and choosing to follow a vegan lifestyle. Questionnaires used by professionals for diagnosis commonly measure restraint in one’s diet. By intentionally omitting animal-based foods, this style of eating may be misinterpreted to appear restrained. 

Let’s look at two validated tools that professionals use to examine cognitive restraint (i.e., intending and/or attempting to restrict calorie intake) (1).

• EDE-Q (Eating Disorder Examination Questionnaire)
  • The EDE-Q is commonly used to explore eating disorders in plant-based individuals. To quote a scientist currently conducting research at Yale University School of Medicine however, “Questions on the EDE-Q are designed to quantify pathological eating behavior, but some items may be inappropriate or misleading specifically to vegans. For example, the EDE-Q asks ‘have you tried to exclude from your diet any foods …’ and ‘have you tried to follow definite rules regarding your eating …’ While both questions contain qualifiers specific to shape and weight, they may nevertheless be misleading to vegan participants, as their diet is by its nature exclusionary and rule-based. As such, the EDE-Q may unfairly pathologize what should be considered normative eating behaviors in this population, which may result in differences in the observed factor structure and the measure specifically in vegans.” (14)
  • In other words, “at its core, [plant-based eating] involves a high level of cognitive restraint to consciously regulate and restrict several food groups.” (2) Therefore, “commonly used eating disorder measures in clinical settings (e.g., EDE-Q) include items, particularly around food exclusion and following food rules, which may unfairly pathologize vegans.” (15) 

Commonly used eating disorder measures in clinical settings (e.g., EDE-Q) include items, particularly around food exclusion and following food rules, which may unfairly pathologize vegans.

• EAT-26 (Eating Attitudes Test)
  • The EAT-26 is another tool used in this context, and “the EAT-26 asks respondents to rate the extent they display self-control around food or feel that others pressure them to eat. Such items could be capturing vegan-motivated food choices, rather than eating disorder-motivated food choices, thus overinflating vegans EAT-26 scores. In line with this idea, EDE-Q eating concern and EPSI cognitive restraint were significantly related to an increased probability of being vegan, while the EPSI body dissatisfaction was significantly related to a decreased probability of being vegan. This finding suggests vegans may feel more positive and compassionate towards their bodies than omnivores.” (15)

This finding suggests vegans may feel more positive and compassionate towards their bodies than omnivores.

In summary, “It is possible that some eating disorder scales may be capturing normal [plant-based]-motivated food choices and behaviors such as higher levels of cognitive restraint due to a heavy avoidance of certain food groups. This could result in inaccurate estimates of the prevalence of eating disorders in these populations.” (2) 

Instead, “it is possible that vegetarians simultaneously demonstrate cognitive and behavioral restrictive eating patterns and an overall positive psychosocial functioning with low anxiety, a sense of well-being, and life satisfaction.” (10) Accordingly, “it remains important for clinicians to gain an in-depth understanding of [plant-based] patients’ reasons around food exclusion and dietary rules to ensure their eating habits are not being over-pathologized for simply following a [plant-based] diet.” (2) 

Part 3: Flaws in questionnaires and research studies when looking at plant-based eaters

Unsurprisingly, the questionnaires most commonly used to explore eating disorders have not been validated in people following plant-based diets. How useful, then, can they really be?

• • Eating disorder questionnaires are inadequate at measuring what they intend to measure in plant-based populations.

• A recent systematic review “showed that the relationship between vegetarianism, veganism, and disordered eating differed depending on the assessment measure employed. … it may be the case that the EDE-Q is not measuring the same latent construct of disordered eating across vegetarian, vegan, and omnivore groups.” (2)

• • To this point, there is a “less than adequate fit in both omnivores and vegans alike across nearly all proposed original and alternative EDE-Q factor structures, which is in line with past research.” (14)
• Without a validated tool for plant-based populations, it should come as no surprise that results have been conflicting.
  • Researchers at the University of Albany agree, noting that “past research has produced largely inconclusive or conflicting findings … likely due in part to usage of measures of eating disorder symptoms not yet validated in these specific subgroup of eaters.” (14)
• Let’s wait to draw meaningful conclusions about plant-based diets and eating disorders until we have capable tools.
  • “Until eating disorder scales have undergone stringent psychometric testing in both vegetarian and vegan populations, caution must be taken when interpreting their results in research and clinical settings. … There is not enough evidence to support the use of [eating disorder] scales in [vegetarians and vegans].” (2)

Inadequate sampling methods have also produced a lot of “noise.”

• In order to attain findings that reach statistical significance, most research lumps all types of plant-based diets together. This is problematic because different groups experience different motivations, leading to differences in eating disorder symptoms.
  • To quote researchers at the University of Albany, “To maximize statistical power, most research on meat-avoidance groups together all types of vegetarians, ranging from semi-vegetarian (i.e., eats some meats, but restricts others) to vegans. Recent work has revealed this to be problematic, as subgroups of vegetarians seem to differ in meaningful ways, especially when it comes to eating disorder symptoms. Specifically, semi-vegetarians appear to be the most pathological in comparison to all other eaters, whereas vegans present as slightly less disordered compared to omnivores.” (14)
• Results differ depending on the sample size: Small studies found disordered eating in plant-based individuals, but larger, more adequately powered studies did not.
  • Researchers at top medical schools made the following observation: “Notably, all of the studies that reported an association between vegetarianism and restraint/disordered eating were limited by small sample sizes of vegetarians (e.g., n’s ranging from 15 to 119). The studies that found no differences or that vegetarians reported lower levels of eating disorder symptomatology tended to employ larger samples of vegetarians, although some still relied on small vegetarian samples (e.g., n’s ranging from 79 to 318).” (1)
  • Why consider the results of studies with fewer participants in higher regard than larger studies?

Part 4: It’s highly unlikely that plant-based diets cause eating disorders

Timelines, overlap, and masking are important factors to consider.

• Which typically comes first, eating disorders or adherence to a plant-based diet? If plant-based eating usually comes first, perhaps it truly does cause eating disorders. If not, we may be witnessing an artifact via reverse causality.
  • Discussion of a study of 116 consecutive patients with anorexia nervosa (16) found that, “as a rule, the avoidance of red meat did not predate anorexia nervosa.” (5) 
  • Researchers further referenced five studies when asserting that “numerous individuals with disordered eating habits and a history of vegetarianism report that the adoption of a vegetarian diet followed their disorder. It seems therefore that … individuals with eating disorders might become vegetarians as a means to control weight, as a strategy of food avoidance, but also for non-weight reasons.” (5) 
  • In other words, as several research teams have noted, vegetarian and vegan diets may act as a socially acceptable “cover,” or way to restrict food intake and camouflage an eating disorder (1,2,5,9). Plant-based diets didn’t cause eating disorders; they were just used to “mask” them.
• “There are no naturalistic or representative longitudinal data showing the temporal relationship between the onset of vegetarianism and disordered eating,” (1) and “Without longitudinal research, it remains unclear whether [vegetarianism or veganism] increases the risk of developing an eating disorder, or vice versa.” Thankfully, randomized trials can help us see whether putting people on a plant-based diet truly causes eating disorders…

Clinical trials reveal no differences in restraint and potential risk of eating disorder development between people randomized to an omnivorous or plant-based diet.

• Two experimental studies help elucidate the role of restraint in relation to plant-based eating (17,18). In these studies, overweight or obese patients were randomized to vegetarian or omnivorous calorie-restricted diets. “In both studies, comparable increases in restraint were observed over the course of the intervention across vegetarian and non-vegetarian groups. These findings suggest that weight loss motivations and reduced caloric intake, not vegetarianism per se, are associated with cognitive restraint and possible risk for the development of an eating disorder in individuals with obese-range BMIs.”
• In other words, switching to a plant-based diet is no more problematic for eating disorders than maintaining an omnivorous diet. This was found in a weight loss setting, though there is no evidence to support the notion that this would be any different in other contexts, including athletic populations.

Switching to a plant-based diet is no more problematic for eating disorders than maintaining an omnivorous diet.

Conclusion

“It has long been thought that vegetarianism and veganism are related to an elevated risk of disordered eating; however, past research does not necessarily support this notion.” (2) Rather, as described above, high-quality research is lacking due to major flaws in experimental design, not the least of which are psychometric tools that have not been validated in the populations they’re used. “Vegetarianism is not an eating disorder, and there is no evidence to suggest that becoming a vegetarian is a standalone risk factor for developing an eating disorder.” (1) Until or unless such evidence surfaces, suggestions that transitioning to plant-based diets puts people at risk of eating disorders is nothing more than baseless conjecture.

Resources and help

Eating disorders are a very serious condition that can affect anyone, regardless of age, gender identity, race, weight, or diet. If you or a loved one is struggling, please seek support and help. 

National Eating Disorders Association

Alsana Eating Disorder Treatment

Podcast Episode – The Truth About Eating Disorders & Treatment With Dr. Ron Thompson