Eating disorders and meat avoidance: A call to understand the ‘why’ instead of the ‘what’

To the Editor

The commonly endorsed notion that meat avoidance is a precursor to the development of eating disorders is not based on strong evidence. First conceptualised in the 1980s using retrospective analysis of anorexia nervosa patients, results showed vegetarian patients were significantly more likely to be dietary abstainers than non-vegetarians (Kadambari et al., 1986). Vegetarianism and veganism involve food avoidance to ensure animal products are not consumed; therefore, the idea that meat avoidance may act as a precursor to extreme dietary control, and consequently eating disorders, was soon accepted. Since the 1980s, vegetarian/vegan-focused research has been varied, often contradictory, and scarce, supporting the notion that commonly used diagnostic eating disorder questionnaires may be detecting and pathologising normal vegetarian- and vegan-related eating behaviours.

The common belief that meat avoidance is key to eating disorder development may be detrimental to patient recovery. The requirement to reintroduce meat and/or animal products as part of treatment may negatively impact treatment outcomes in patients following vegetarian or vegan diets. Research has shown that some vegetarians consider their diet to be intertwined with their identity, experience positive feelings about their dietary in-group, and feel negatively judged for following their dietary pattern, with vegans sitting at the more extreme end of these domains (Rosenfeld, 2019). Undoubtedly, weight restoration is more readily achieved with the consumption of meat in underweight patients (Heiss et al., 2017); however, there has been relatively little research conducted on refeeding in the context of vegetarian or vegan diets. This should be explored to help patients maintain their sense of identity during recovery.

Vegetarianism and veganism have become mainstream over the last 40 years, and, as such, adapted treatment options for these populations must become mainstream too. More research is needed to decipher the complex relationship between eating disorders and dietary restraint with vegetarians and vegans at the forefront. Longitudinal research is important to establish the causal relationship between vegetarianism, veganism and eating disorders to support the development of evidence-based treatment options for these populations. We call on clinicians to not only ask ‘what’ foods patients are excluding but also ask ‘why’, as motivations (e.g. animal welfare, religious traditions) may not necessarily relate to eating pathology. We urge clinicians to consider the implications of actively discouraging vegetarian and vegan eating behaviours in patients whose diet is strongly tied to their identity, as it may unfortunately hinder rather than help eating disorder recovery.