Can you pick an eating disorder by a person's dietary preference?
At first glance it seems that you can. A cross-sectional study has found that individuals with a history of eating disorders are considerably more likely to have been vegetarian in the past, vegetarian now and primarily motivated by weight.
Furthermore, 68 per cent of those who had had an eating disorder perceived that their vegetarianism was related to it.
"[The] results shed light on the vegetarianism-eating disorders relation and suggest intervention considerations for clinicians [such as investigating motives for vegetarianism]," the researchers wrote in The Journal of the Academy of Nutrition and Dietetics.
The vegetarianism-eating disorders relation comes from various studies including one published in the Journal of Adolescent Health. Researchers found that the most common reason teens gave for vegetarianism (a loose term given that some still ate chicken or fish) was to lose weight or prevent gaining it.
"I'm not really surprised," says the dietitian Tara Diversi of the findings. "My area is eating disorders and I tend to see that in practice quite a lot . . . [taking a whole] food group out of the diet is a socially acceptable way to reduce food."
Dr Sloane Madden, co-director of The Eating Disorder Service at The Children's Hospital at Westmead, agrees. "I'm certainly not saying that being vegetarian equates with eating disorders . . . [but] it sits with a fixation around food and weight and calories," he says. "The motivation seems to be tied up with a belief that vegetables are lower in calories and healthier and more likely to facilitate weight loss."
It makes sense that some sensitive young minds may associate meat with physical as well as literal beefiness. But, as satisfying as it is to slap labels on life choices, it is rarely cut and dried.
The director of the Australian Vegetarian Society, Mark Berriman, says. "it does make sense insofar as young women seeking to reduce weight would perceive the reduction/elimination of animal fat as a significant step for them to take, making vegetarianism attractive".
However, he says, "so often the premise is set by the nature/intention of the study, which obfuscates rather than clarifies what may be a considerably more complex situation".
Indeed. In an op-ed in Psychology Today, Adia Colar writes that as a 12-year-old the allure of being vegetarian was multifaceted.
"Not long before I decided to become a vegetarian, I started wanting to lose weight," she wrote. "Did I want to stop eating animals because I genuinely didn't want these creatures to suffer? Yes. Was all of it a tangled web of empathy, guilt, health and self-image? Probably. Did I think, I can become a vegetarian and lose weight in the process? Absolutely."
Diversi stresses the importance of seeking professional advice when making the transition. "It is very healthy and it's a very healthy way to live, if you do it properly... It's important to ask what are your reasons? If reasoning is valid and it is for ethical or ethical/moral reasons [then great]."
If, on the other hand, a person is simply trying to find foods to eliminate, it is unlikely they will stop at animals.
"Even vegetarians with eating disorders will avoid certain foods, like potatoes," Madden says.
What this suggests is that anyone with an eating disorder will want to try diets that are restrictive.
People who are anxious about food are not only more likely to avoid dairy and meat, but carbohydrates as well, Madden says. "And it's increasingly common to see concern about food allergies . . . and gluten."
In fact, Diversi says the vegetarian/eating disorder relationship may reflect our cultural and generational food focuses.
"Many baby-boomer parents are fat-phobic, so [their kids] tend to be fat-phobic," she says. "They know that vegetables are low in calories and that meat, cheese and dairy are quite high.
"It will be interesting to see what happens with the [children of] Gen X and Y parents, who are carb-phobic. I wonder whether, in future, we'll see more carb-phobic eating disorders."
It may be a case of the chicken or the egg when it comes to diet-related eating disorders, but to say vegetarianism creates or equates to eating disorders seems tenuous at best.
"People who are vegetarian for religious or cultural reasons aren't at increased risk [of an eating disorder]," Madden says. However, "people who have a real focus on what they're eating do have increased risk".
Or as Diversi says: "A true vegetarian eats a wide variety of food. It's not just cutting out a food group – there's a big difference."