For some time, clinicians have observed an increase in the number of eating disorder patients presenting as being vegan. There is evidence to support that there is a greater number of vegans within an ED population compared to the general population. An Australian study back in 2012 (1) found that 52% of ED patients had been vegetarian at some point compared to 12% of general population. A Greek study (2) found that 45-50% of ED patients were ‘some form of vegetarian’ including vegan. A Birmingham Eating Disorder clinic recently published (3) that 35% of their patients were vegetarian, vegan or pescetarian. Current estimates of the proportion of vegetarians and vegans in the UK is 7-10% (4). Which has increased from 2-3% in 2012.(5)

As a dietitian working in eating disorders (and as a vegan of 6 years) this is a topic that I am invested in, while also being aware that I hold some internal bias.

When I worked on a CAMHS ward, I had a patient who wanted to be vegan while in the hospital. I had a chat with them about their reasons and my conclusion was: yep, definitely for animal welfare reasons. I advocated for them to the MDT and supported them with this from a dietetic perspective. It was only when the patients ordered McDonalds and this patient ordered the chicken nuggets did I realise I may have had the wool pulled over my eyes… (The best way to learn is by making a mistake… Right?)

It is quite clear that ED patients are more likely to be vegan/ veggie than the rest of us. But what are the reasons for that?

The reasons

The first reason that comes to mind, and something friends of mine with personal experience inform me of is the dietary restriction. Veganism imposes dietary restrictions and rules and is a socially acceptable way to refuse food, so can act as a way to mask disordered eating behaviours. While veganism in current years is a lot less restrictive than it was, for many people rules around food can be problematic. I spoke to one person, who went vegan during their active eating disorder and at the time truly believed that it was due to ethical reasons, however in retrospect realised that subconsciously a big motivation was the ability to restrict their diet. As well as being able to refuse food, vegan meals are typically less energy dense than animal-product containing ones.(6)

Secondly, I think social media has something to answer for in this trend. There are several Instagram influencers who promote a restrictive vegan diet as the ‘healthiest’ way to live. Eating patterns that to health professionals appear extremely orthorexic are shown to be normal on social media. An example of this is the raw vegan movement. A particular example is Yovana Mendoza Ayres ‘Rawvana’, a raw vegan who promoted her ‘extremely healthy’ way of life, that included 25-day water fasts (no food, only water for 25 days). She had 1.3 million followers on Instagram and half a million on Youtube, with many following in her footsteps the diet that she promoted to be so healthful. Yovana ended up being heavily criticized and cancelled online, when a video of her eating fish at a restaurant went viral.

 Yovana came out with an explanation video stating that she was suffering with anaemia, had lost her periods and had severe gut issues. She described having a difficult relationship with food and many food fears, she was advised by doctors to release the restrictions on her diet and include eggs and fish. After following the advice, Yovana got her periods back and her gut issues and anaemia resolved.

We can see that eating disorders may drive an individual towards the vegan diet, but does it work the other way? Can the restrictions imposed by the vegan diet trigger the onset of an eating disorder?

First of all, there is never a single ‘cause’ of an eating disorder, it is a combination of genetics and the environment. Equally, there is no specific evidence pointing at veganism as a causational factor in the onset of eating disorders. Looking at body image, a study found that vegans actually have greater body satisfaction than their omnivorous counterparts(7). We do know that poor body image is a pre-disposing factor to eating disorders.

A study identifying orthorexia in vegans found that in those whose motivation for being vegan was being linked to animal welfare had no greater increase in orthorexia than the general public (8). In those whose motivation for being vegan was for ‘health and healing’ had a greater risk of orthorexia. The study concluded that it was the motivation for being vegan that dictated the risk.

“Veganism is a philosophy and way of living which seeks to exclude—as far as is possible and practicable—all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose; and by extension, promotes the development and use of animal-free alternatives for the benefit of animals, humans and the environment. In dietary terms it denotes the practice of dispensing with all products derived wholly or partly from animals.”- The Vegan society (9)

It is important to also point out that by definition ‘veganism’ is not a diet and is instead a belief system protected by the Equality Act, as shown above. It then may be posited that someone whose motivation for veganism is solely due to health reasons, is not a true vegan as per definition.

The final reason for the increase in vegan eating disorder patients is due to the increase of the vegan population as whole, as shown above. The number of vegetarian and vegans in the UK has increased 2-3-fold in the past 10 years. The majority of these are women within young adulthood, in the 18-34 age bracket(10), which is almost the exact same population group as those suffering with an eating disorder (women, 16-40)(11).

The changing vegan diet

Being vegan in 2016, you would feel lucky to find an alpro yoghurt in your local supermarket and would have likely had a home-cooked-wholefoods diet. If you wanted fake meat you would have to make seitan at home or freeze tofu to get a meaty texture! Today we have whole aisles of fake meats, vegan pukka pies, chicken nuggets, fish fingers, chocolate brownies, pizzas, cheese and crème fraiche… I recently went to a vegan Asian supermarket in Elephant and castle (Plantbase store) and they had vegan alternatives for shark, frogs legs and goose meat… Anything can be made vegan as long as there is a demand for it. And demand has certainly increased. ‘Veganuary’ where one goes vegan for the month of January had a record number of participants, 610,000 people registered to do it 2022, and many more unregistered.

I can’t help but think, since veganism has become a lot more accessible and in many ways less restrictive, in the future will we see numbers of ED patients being vegan reduce closer to normal population levels? As it becomes less of a barrier to energy intake?

Summary

·       There are a greater proportion of vegans within an eating disorder population.

·       The popularity of veganism has increased 2-3-fold in the past 10 years.

·       Veganism can be a way to mask symptoms of an eating disorder.

·       The vegan diet is less energy dense compared to normal omnivorous diets

·       Restrictive branches of veganism that may be linked to orthorexia, e.g., raw vegan diets are very popular on social media.

·       Veganism is not shown to be a causal factor in the onset of eating disorders.

·       Vegans may have better body satisfaction than omnivores

·       Vegans whose motivation is for health as opposed to animal welfare are more likely to show orthorexic traits.

·       Veganism is most common in the 18-34 age range, which is very similar to the most common age range of those suffering from an eating disorder.

·       The vegan diet has changed in response to demand and now is less restrictive than it was 5 years ago.

Getting help

If you think you are suffering from an eating disorder, please speak to your GP or local health centre.

If you would like to see an eating disorder dietitian, I would love to help you! To book a discovery call please click here. Alternatively, I would be happy to answer any questions you may have here.

The following charities have resources and helplines that may be of help:

https://www.beateatingdisorders.org.uk/

anorexiabulimiacare.org.uk

papyrus-uk.org

samaritans.org

studentminds.org.uk

https://www.blackmindsmatteruk.com/

The British Dietetic Association has produced guidance for clinicians on Veganism and Eating Disorders https://www.bda.uk.com/

References

1. Bardone-Cone A, Fitzsimmons-Craft E, Harney M, Maldonado C, Lawson M, Smith R et al. The Inter-Relationships between Vegetarianism and Eating Disorders among Females. Journal of the Academy of Nutrition and Dietetics. 2012;112(8):1247-1252.

2. Sergentanis T, Chelmi M, Liampas A, Yfanti C, Panagouli E, Vlachopapadopoulou E et al. Vegetarian Diets and Eating Disorders in Adolescents and Young Adults: A Systematic Review. Children. 2020;8(1):12.

3. Veganism and Eating Disorders | Schoen Clinic UK [Internet]. Schoen-clinic.co.uk. 2022 [cited 8 April 2022]. Available from: https://www.schoen-clinic.co.uk/our-services/help-advice/veganism-and-eating-disorders

4. 4. Meet Britain’s vegans and vegetarians | YouGov [Internet]. Yougov.co.uk. 2022 [cited 8 April 2022]. Available from: https://yougov.co.uk/topics/lifestyle/articles-reports/2022/01/20/meet-britains-vegans-and-vegetarians

5. Facts and Figures | The Vegetarian Society [Internet]. Vegetarian Society. 2022 [cited 8 April 2022]. Available from: https://vegsoc.org/info-hub/facts-and-figures/#:~:text=Our%20current%20position%20is%20that,%E2%80%93%203%25%20of%20the%20population

6. Clarys P, Deliens T, Huybrechts I, Deriemaeker P, Vanaelst B, De Keyzer W et al. Comparison of Nutritional Quality of the Vegan, Vegetarian, Semi-Vegetarian, Pesco-Vegetarian and Omnivorous Diet. Nutrients. 2014;6(3):1318-1332.

7. McLean C, Moeck E, Sharp G, Thomas N. Characteristics and clinical implications of the relationship between veganism and pathological eating behaviours. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. 2021;.

8. Barthels F, Poerschke S, Müller R, Pietrowsky R. Orthorexic eating behavior in vegans is linked to health, not to animal welfare. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. 2019;25(3):817-820.

9. Definition of veganism [Internet]. The Vegan Society. 2022 [cited 8 April 2022]. Available from: https://www.vegansociety.com/go-vegan/definition-veganism

10. Adults following vegan diet by gender GB 2019 | Statista [Internet]. Statista. 2022 [cited 8 April 2022]. Available from: https://www.statista.com/statistics/1062343/adults-following-vegan-diet-in-great-britain-by-gender-and-age/#:~:text=As%20of%202019%2C%20the%20demographic,in%20other%20forms%20of%20use

11. Eating Disorder Statistics [Internet]. Priory. 2022 [cited 8 April 2022]. Available from: https://www.priorygroup.com/eating-disorders/eating-disorder-statistics