Women with a history of an eating disorder had significantly different vegetarianism-related experiences than women without an eating disorder history. Rates of ever having been vegetarian among those with an eating disorder history were similar to rates of vegetarianism in samples with AN (7
) and higher than rates among those without an eating disorder history. The finding regarding differences in motivations for becoming vegetarian is novel, never before having been examined in groups distinguished by a history of an eating disorder.
There were fewer differences related to vegetarianism when eating disorder recovery groups were examined. One exception was the higher rates of current vegetarianism in the active eating disorder group compared to the fully recovered group. This finding is in contrast to prior work that found vegetarianism still prominent among those recovered from AN (5
). Differing definitions of recovery could explain this discrepancy.
Most of the eating disorder sample with a history of vegetarianism reported that the eating disorder preceded the adoption of a vegetarian diet, as was found in some prior work (8
). This finding is in line with research suggesting that vegetarian diets may be used to facilitate ongoing restriction rather than cause eating pathology (3
); however, prospective research is needed for etiological clarity.
In addition to longitudinal work, diagnostic differences (e.g., AN, BN) should also be considered in the future given the centrality of food restriction in AN and the finding that zinc deficiency resulting from vegetarianism among individuals with AN may influence eating disorder chronicity (20
). Perhaps vegetarianism has a different meaning and is related differently to eating disorder tenacity among individuals with AN compared to those with BN.
The study findings have several practice-based implications. The finding that none of the controls who had ever been vegetarian were primarily motivated by weight-related reasons, in contrast to almost half of those with an eating disorder history, suggests the importance of attending to primary motives for becoming vegetarian. From an eating disorders perspective, individuals who are sincerely motivated to adopt vegetarianism for primarily non-weight reasons (e.g., ethics) may be less concerning than individuals with weight-based motives. Practitioners may also want to be mindful that vegetarianism is more likely adopted by individuals with preexisting disordered eating attitudes/behaviors, rather than being the cause of such pathology. Thus, when an adolescent begins a vegetarian diet or expresses interest in making this dietary choice, a close examination of her/his general eating attitudes/behaviors may shed light on whether concern is warranted. Exploration of existing patterns of eating, attitudes about food, and the function vegetarianism may serve would shed light on the trajectory of the individual’s relationship with food and whether vegetarianism may provide the individual with additional “good food”/“bad food” dichotomies that would simply her/his life. Collaboratively exploring whether a vegetarian lifestyle is an avoidance strategy for food may prompt a practitioner to challenge distorted thoughts surrounding “forbidden” foods. To the extent that becoming vegetarian signals more extreme weight control behavior (9
) and eating disorder chronicity (8
), practitioners would be well-advised to engage individuals in frank discussions regarding their eating habits. If an individual is firm in the decision to become vegetarian, she/he should be provided with psychoeducation and guidance in becoming a healthful vegetarian. Lastly, practitioners should take heed of the different rates of current vegetarianism between the fully recovered and active eating disorder groups. In cases when an individual working toward eating disorder recovery is still adhering to a vegetarian diet, practitioners may wish to engage her/him in a discussion regarding how a restricted food repertoire, including vegetarianism, may affect the recovery process.
This exploratory study contributes to the very limited literature on vegetarianism and eating disorders and is novel in being the first to examine aspects of vegetarianism using a comprehensive definition of eating disorder recovery. The examination of multiple aspects of vegetarianism (i.e., history of, primary reason for, age at becoming vegetarian) is also a strength. Limitations include the cross-sectional design, the small sample size, the lack of differentiation of eating disorder diagnoses, the group differences in age and interview modality, the definition of vegetarianism, and the lack of a validated measure for assessing aspects of vegetarianism. Given the small number of vegetarians in the recovery groups, the findings for stages of recovery should be considered preliminary and need to be replicated in larger samples. Further, asking about vegetarianism using more precision (e.g., semi-vegetarian, vegan, etc.) would help identify if certain types of vegetarianism are more strongly connected to eating disorders or eating disorder recovery.