“I come across the stereotype about vegans having eating disorders more so among my fellow health-care professionals than I do the public,” said Chicago-based vegan registered dietitian Taylor Wolfram.
That stereotype has long been a barrier to securing treatment for vegans who do have such disorders. Until recently, most eating disorder treatment centers wouldn’t accept vegan clients — especially those who need more intensive inpatient treatment — unless they were willing to start eating animal products. This is a big problem, because when someone who follows a vegan diet is rejected for treatment, it’s an average of two years before they try to seek help again, said Tammy Beasley, vice president of clinical nutrition services for Alsana Eating Disorder Treatment & Eating Recovery Centers.
Fortunately, more treatment centers have started to accept vegan patients and allow them to remain vegan, including Alsana, which made the change last fall after more than a year of planning. “We decided that we were going to do this and do it right,” Beasley said. “It’s so critical to remove as many barriers as possible when they get the confidence to seek treatment.”
Beasley said that before she dug into the research, she had the same biases against vegan diets as many in the eating disorder field. “I think as a profession we decided that A plus B must equal C,” she said, pointing to a 2003 research paper that concluded that college-age women who become vegetarian may be more likely to develop an eating disorder. That research has received criticism for its design — eating one meatless meal a week was enough to earn participants a “semi-vegetarian” label, and the study population of young, white females was already at higher risk statistically of developing an eating disorder. The researchers also used dietary assessment tools that weren’t designed for use with vegetarians.
“I think that often people think that vegan diets and vegans are more ‘extreme’ than they really are,” said Seattle-based registered dietitian Ginger Hultin, a spokeswoman for the Academy of Nutrition and Dietetics and owner of Champagne Nutrition. “The majority of vegans and vegetarians likely have healthful, balanced diets that meet their needs.”
When Beasley recently informally surveyed fellow dietitians who specialize in eating disorders, 98 percent were seeing eating disorder clients who were also vegan. But more than 90 percent of those clients started following a vegan diet after they developed an eating disorder. “We know that often the eating disorder and veganism overlap, but they also may not,” she said.
Wolfram said one red flag she watches for is when a vegan isn’t willing to eat what she calls “vegan fun foods” such as vegan meats, cheeses and ice creams. “There can be fearmongering around these foods, just like non-vegan fun foods, and it’s important to open up access and permission to all vegan foods,” she said. “Additionally, if someone is trying to be a ‘perfect vegan,’ that’s never going to happen in our world. People who go down this path often experience anxiety and guilt. I like to help folks figure out where they want to realistically draw the line and how they can best help animals while prioritizing their mental health as well, which looks different for everyone.”
Two recent studies on vegan diets and orthorexia — an unhealthy obsession with eating healthy — contradicted each other. One found that vegan diets were associated with orthorexia, but the other did not; the authors in the second study concluded this was probably because most people pursuing veganism do so for ethical, rather than dietary, reasons.
That said, Wolfram said that even if someone became an ethical vegan long before their eating disorder developed, that doesn’t mean that their ethics and eating disorder haven’t become entangled, which makes a nuanced approach important. “Unfortunately, even if someone is vegan for ethical reasons, they’re still vulnerable to diet culture just like someone who isn’t vegan,” she said. “And with all the disordered messages within the plant-based space, which overlaps with the vegan space, it can get messy.”
Beasley said it’s important for clients to be able to talk about how their veganism may or may not contribute to their eating disorder in a safe, supportive environment. Also important is preparing for life beyond treatment. “We live in a non-vegan world,” she said. “They need to learn to think and plan ahead, so the eating disorder doesn’t get the upper hand.”
Of course, as the dietitians interviewed point out, any type of diet or “lifestyle plan” that eliminates entire food groups — not just veganism — may increase the risk of an eating disorder in someone who is susceptible because of genetics and social environment. This includes ketogenic, Whole 30, paleo and many other popular diets.
“If you’re on any type of self-restricted diet, one that’s not medically indicated or necessary for a health condition, and you’re feeling socially isolated, you can’t eat out with friends or you spend a large amount of time prepping food, thinking about food or obsessing over food, then it might not be working for you,” Hultin said. “Any diet can be unhealthy if it’s interfering with your quality of life.”