Q & A: Vegetarianism: Does It Contribute to Eating Disorders?

Q: We work with adolescent women and have noticed an increasing number who are professing various forms of vegetarianism. Does vegetarianism predispose girls or young women to eating disorders? (A.D., Chicago)

A: Your question is actually quite involved. First, there are numerous cultural complexities to vegetarianism. Although I’m unaware of research specifically addressing this issue, my overall sense is that vegetarianism does not predispose to eating disorders among cultural subgroups that subscribe to vegetarianism as a whole, for example among some Hindus, Jains, Sihks, Seventh Day Adventists or individual families, where it’s generally practiced by most family members in conjunction with various philosophical and health beliefs. More interesting to me is whether “spontaneous vegetarianism” among young women indicates an elevated risk of eating disorders. Here, too, the question is complicated because many young women identify with contemporary peer groups in which vegetarianism is becoming increasingly prominent for philosophical and/or health reasons. Clearly, vegetarians may be as healthy, if not healthier, than non-vegetarians.

That being said, a recent survey of 143 college women conducted at Cal Poly, San Luis Obispo, CA, revealed that median EAT scores (Eating Attitudes Test) among the 30 self-reported vegetarians were significantly higher than among the 113 non-vegetarians, and that 38% of vegetarians had EAT scores greater than 30 (indicating eating disorder risk), compared to only 8% of non-vegetarians. Of note, 23 of these “vegetarians” were actually “semi-vegetarians”, at least willing to consume chicken and/or fish but no red meat. The rest were lacto-ovo-vegetarian; there were no strict vegans in this sample. Nearly 19% of the vegetarians chose vegetarianism for weight control purposes in the first place, and this may skew the results. (Klopp SA et al, J Am Dietetic Association 2003;103:745 )

For clinicians, the important point is to assess the origins and intentions of vegetarianism, and to see how much the patient’s initial goal in changing eating behavior was primarily to restrict calories and food choices. But, remember, vegetables are good for you, and you should all eat your vegetables.

—J.Y.