Veganism and eating disorder recovery

8 February 2022

12 min reading time

Alright, this is a big subject to broach, so here we go. As a plant-based dietitian, I work with many clients who experience a wide range of eating disorders. I often get questions like:

Is veganism the cause of my eating disorder?
Can I stay vegan during my eating disorder recovery?
Am I at increased risk for disordered eating if I’m vegan?

My answer is, it really depends. And it’s complicated.

Veganism is a movement that aims to eliminate animal exploitation and suffering. Ethical vegans – vegans that choose to follow this diet for ethical reasons instead of health reasons – do so out of compassion and social justice.

However, it is not uncommon to see people turn to veganism for weight loss, various perceived health reasons, and to gain “more control” over their diet. These can sometimes be red flags for underlying disordered eating.

Considering that veganism is a lifestyle that severely impacts food choices, it can certainly be interpreted as dieting or disordered eating. Sometimes this interpretation is wrong, while sometimes it might be correct.

Let’s dive in to make the distinction.

What eating disorders are (and what they are not)

Approximately 1 million Canadians meet the diagnostic criteria for an eating disorder (ED). These are a lot more common, unfortunately, than you might think. Also, about 80% of individuals with eating disorders are girls or women.

Eating disorders usually involve extreme concerns about weight and shape, extreme weight control behaviours, abnormal relationships with food, and evaluating one’s worthiness by weight and shape. They come with complex, strongly held beliefs about food and painful emotions surrounding appearance and self-esteem.

As you’ll see below, there are many types of EDs. They are not exclusive to those who exist in a thin body and they are not something a person can simply “grow out of”. Eating disorder recovery requires exposing painful and raw emotions of self-loathing, sadness, fear, guilt, shame, and anger.

Importantly, EDs are not a choice. No one ever asks for an ED.

Disordered eating vs eating disorders

It is common to hear a co-worker mention they were “bad” for having had a pastry in the break room, or to hear family members mention they need to go to the gym the next day to work off a big meal.

Disordered eating, unfortunately, has become all-too common in our diet and weight-centric approach to healthcare and culture in general. Without realizing it, we often make food out to be the enemy, which turns it into something to be feared. This paves the way for disordered eating behaviors.

Disordered eating is present when an individual engages in abnormal food behaviours on a regular basis but may or may not have an official ED diagnosis. The main differences are the clinical frequency and intensity of engaging in these methods to control one’s body weight, shape or size. This does not generally apply to those with certain food intolerances, allergies, or health problems, who might have no choice but to adhere to a certain diet.

People often end up eating in a disordered way to cope with uncomfortable emotions. They might begin focusing on weight and calorie intake to distract themselves from difficult feelings of inadequacy. However, we know 99% of diets don’t work and inevitably, lower goal weights are set and more stringent rules are created. This is how eating disorders can develop.

Those with disordered eating behaviours, regardless of whether they fit the diagnostic criteria for an ED, often feel extreme anxiety around food. They might track their daily food intake obsessively and act emotionally if they exceed a daily target, exercise compulsively, or avoid certain social situations in which food will be present.

The most common disguise of a disordered relationship with food or body is when a person actively pursues a change in their body, weight, shape, or size. This might be disguised as “wellness”, “getting healthy”, “clean eating”, or certain diets like keto, intermittent fasting, or in our case, veganism. These can all be signs and symptoms that a person may be engaging in disordered eating and body weight preoccupation that can be disordered.

Breaking disordered eating habits before they lead to an eating disorder is important and can be accomplished.

When following a vegan diet, it’s important to be non-judgemental and introspective with yourself. Reflect on your motivations for eating this way and truly assess if it is related to any disordered eating patterns or thoughts.

Types of eating disorders

Let’s discuss the four main types of EDs that I see as an eating disorder nutritionist. Mental health professionals use a manual called the ‘Diagnostic and Statistical Manual of Mental Disorders’ to diagnose eating disorders. This is a tool that lays out all the criteria and common manifestations of all the types of EDs.

Note that this manual also recognizes other types of EDs but I am only mentioning the most common ones I see in this article.

Anorexia Nervosa

Anorexia nervosa (AN) is an ED characterized by weight loss, difficulties maintaining an appropriate body weight, and, in many, distorted body image. People with AN generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Those suffering with AN often have an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though they may have a significantly low weight. They experience disturbances in the way in which their body weight or shape is experienced and are in denial of the seriousness of their current low body weight.

Bulimia Nervosa

Bulimia nervosa (BN) is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Those with BN binge large amounts of food and experience a loss of control over eating during the episode. They then engage in compensatory behaviours in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

To meet the official diagnosis, the binge eating and inappropriate compensatory behaviours both must have had to occur, on average, at least once a week for 3 months or twice a week for 6 months. There are varying levels of severity of BN from mild to extreme.

Binge Eating Disorder (BED)

Binge eating disorder (BED) is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort), a feeling of a loss of control during the binge, and experiencing shame, distress or guilt afterwards. In BED there are usually less (or no) unhealthy compensatory measures (e.g., purging) to counter the binge eating than in BN. Binge eating disorder is the most common eating disorder in Canada.

To meet the official diagnosis, binge eating must occur on average, at least once per week for three months or twice per week for six months.

Bingeing ‘stuffs’ difficult feelings down for a few moments or hours, temporarily providing a distraction from them. A person affected by bingeing may have an initial heightened response to the taste of foods, but experience little pleasure or satisfaction as food is eaten. They often feel immense shame and guilt afterwards, prompting further restrictions and further fuelling the diet-binge cycle.

Orthorexia

Orthorexia is not formally recognised in the DSM-5, but it is a serious and dangerous form of disordered eating marked by an obsession with healthy eating.

A hyper-focus on “clean” and “healthy” eating may mean cutting out food seen as unhealthy or unsafe and feeling highly anxious and/or guilty when healthy food is not available. Several studies have found that vegans tend to display more orthorexic tendencies than omnivores.

Causes of eating disorders

It is probably no surprise to you that there is no single cause of EDs. Eating disorders are complex mental illnesses. Many factors are involved, including a person’s personality, mental health, genetic and biological factors, and social environment. The causes are different for each person.

Family history of mental illness or type 1 diabetes, specific personality traits such as perfectionism and low self-worth, as well as family-related beliefs and discussions around weight are just some of the many risk factors.

Does veganism cause eating disorders?

The brief answer to this complex question is no. Because remember, as stated above, there is never just one reason why someone is affected by an eating disorder.

Nonetheless, there is a relationship between veganism and eating disorders. Among those with EDs, the percentage of people who report being vegan is higher than that of the general population. But as always, this doesn’t paint a clear picture of what came first – the ED or the diet.

We also have to be careful about confusing correlation with causation. There are many factors that contribute to eating disorders, and to say veganism causes them would be an oversimplification.

Sometimes, people will engage in veganism as a way to mask their eating disorder and belong to a community in which dietary restriction is accepted. Some people also report choosing veganism as a way to feel “more in control”.

Most people with eating disorders have tried different ways of eating (low carb, keto, gluten- or sugar-free, etc). Veganism is often just another manifestation of the eating disorder, but that certainly doesn’t make it the cause.

Tips for vegans in eating disorder recovery

All in all, you need to reflect deeply and honestly about your reasons for following a vegan diet. If you are doing so exclusively for the animals, then you can certainly fully recover from your ED on a vegan diet. But if your veganism is intertwined with some desire to lose weight, change your appearance, and exude control over your life, I suggest you consider putting veganism on the back burner during your recovery.

There is no easy answer to this complex question – you need to do the work and reflect on your values. It’s totally okay to prioritize yourself and put yourself first in this challenging time.

1. Structure

A balanced recovery eating plan should include regular meals and a variety of foods to meet your body’s nutritional needs. While it might be tempting to restrict calories or certain foods, this is ineffective and counterproductive to your recovery.

For BED and BN in particular, regular eating is one of the best tools to prevent bingeing. Studies have shown that individuals who consume three meals per day engage in less bingeing and compensatory behaviours than those who neglect one or more meals per day. You can do this on a vegan diet as long as you eliminate the desire to restrict for “health” purposes.

It can also help to combine planning with flexibility in eating during recovery. I recognize that vegan diets require more planning than do omnivore diets, which can be helpful in avoiding impulsive eating choices.

But it is also important to allow yourself some flexibility. It’s okay to give yourself the freedom from time-to-time to eat the foods your body is craving.

2. Seek out professional support

The earlier you get help for an ED, the better your odds are for recovery. It’s important to know the warning signs of EDs and to seek help as early as possible.

An eating disorder dietitian can help you develop an ED recovery meal plan that aligns with your values. They can also help you honestly assess your motivations for following a vegan diet and can work with you to personalize your recovery.

For some, letting go of veganism will open them up to not only a less restrictive diet, but also to a less restrictive lifestyle. For others who are vegan out of purely ethical reasons, recovery might be totally separate from veganism. A registered dietitian can help you make this distinction.

3. Re-learning how to eat “normally”

How would you feel about replacing the words “good” or “bad” foods with the words “variety” or “nutrition”? How does it make you feel if you are to include ALL foods in your home and treat them all equally?

Depending on where you are on your journey, you can work towards being open to challenging your fears around ‘types’ or categories of foods. Be willing to challenge your ED learning to enjoy vegan desserts, snack foods, and ‘fun foods’ that can be consumed simply for the taste or social event or pleasure in the moment.

Part of so-called “normal eating” is also avoiding emotional eating. A recovery eating plan should focus on eating when hungry and avoiding in response to negative emotional triggers.

Need one-on-one nutrition counselling for eating disorder recovery?

An ideal complete treatment team for EDs is composed of family/caregivers, a medical doctor, a therapist, and a registered dietitian.

A dietitian specialized in vegan eating disorder recovery can help demystify nutrition myths that would otherwise be entangled in your recovery from anorexia nervosa, binge eating disorder, orthorexia, or bulimia nervosa. They can also help you explore your experiences around hunger, fullness, metabolism, feared foods, nutrition messages, body image, and more while guiding you along a healthy journey in regards to veganism.