Not Always So Healthy

My last supper: a saucy chicken platter at a dive in Beijing. My first meal: chicken fingers and French fries with a sweet dipping sauce at a dive in New Hampshire. Those two poultry dishes book-ended my three less-than-healthy years as a vegetarian.

I hadn’t done the research before making the decision, and I didn’t know the difference between whey and soy protein, or how I would get my daily dose of iron. I embarked upon my vegetarian adventure as clueless as I had been when asked if I was ready to witness a traditional sheep slaughter in Mongolia. So whenever mealtime rolled around, I would hastily scan menus and dining hall offerings for the few vegetarian options and unhappily contemplate my limited choices.

The amount of time I regularly spent thinking about my next meal far exceeded the moments spent actually eating it. Looking back on the experience, my version of vegetarianism trod a thin line between healthy eating and food obsession. And I wondered how close was my vegetarianism to thought patterns consistent with an eating disorder? It turns out that it’s a question that many women are asking themselves since eating disorders, as both medical and mental ailments, are difficult to categorize.

Melainie Rogers, a registered dietitian and the executive director of the BALANCE Eating Disorder Treatment Center in the Flatiron District, explains that eating disorders are present in many forms, “so it’s not as clear cut as you’d think.” Some women lose their period; others continue to menstruate. Binge eating, anorexia nervosa and bulimia nervosa are only a few of the categorizations for a disease that can take very different forms.

Dr. Catherine Baker-Pitts is a founding member of the National Eating Disorders Association, editor of the Eating Disorders Journal of Treatment and Prevention and a practicing psychotherapist in the Upper West Side. She uses relationships as a litmus test. 

“When relationships are avoided because they might interrupt your food plan, healthy considerations start to look more unhealthy and even phobic,” Baker- Pitts explains. “If food is in the foreground of your life most of the time, you are likely avoiding uncomfortable feelings or conflicts that deserve more focus.”

In a fledgling eating disorder, worries about food only begin to take time away from work, friends and hobbies. The demographic most at risk is adolescents between the ages of 12 and 18. But according to Dr. Dara Bellace, a clinical psychologist with the New York- Presbyterian/Weill Cornell Medical Center Eating Disorders Program, she is beginning to see a much younger crowd. “Unfortunately over the years my patients are really becoming younger, so sometimes you’ll see a fullblown eating disorder at 11 or 12,” she says. Earlier onset results in more entrenched thought patterns, according to Bellace, and it becomes much more difficult to change dangerous habits.

With the vegetarian lifestyle gaining national popularity, it may be difficult to believe that disordered eating could be so widespread. In 2008, Vegetarian Times conducted a study to determine the number of vegetarians in America. According to their study, 3.2 percent of adults, which translates to more than seven million people, adhere to a vegetarian diet. Of the vegetarians surveyed by the magazine, more than half were female, and 42 percent were between the ages of 18 and 34. Officially, the American Dietetic Associate believes that an appropriately executed vegetarian or vegan diet can be healthy and nutritionally adequate, while possibly preventing heart disease, hypertension, Type-2 diabetes and obesity, while also lowering cholesterol levels and blood pressure.

But the Journal of the American Dietetic Association has also featured many articles exploring the link between vegetarianism and disordered eating. The title of a 2008 study sums it up fairly well: “Adolescent and Young Adult Vegetarianism: Better Dietary Intake and Weight Outcomes but Increased Risk of Disordered Eating Behaviors.” The study finds that, while vegetarians may be healthier than their meat-eating peers, these same adolescents are more likely to diet or exercise extreme, unhealthy weight control measures.

Conversely, teenagers with eating disorders are also more likely to practice vegetarianism than any other age group. One-fourth of the vegetarians participating in the study, ages 15 to 18, reported using weight control strategies like diet pills, laxatives and forced vomiting. Only one in 10 teens who had never been vegetarians confessed to similar behavior.

The doctors and dietitians I contacted confirmed this diagnosis. When asked if there was a link between vegetarianism and eating disorders, Rogers responded: “For sure.” According to her, vegetarianism is just one kind of creative eating that can be used to legalize disordered eating habits. Bellace explains that a full-blown eating disorder “so easily can form from disordered eating like extreme vegetarianism or veganism or calorie counting... oftentimes people who are vegetarian think of food as very black and white: There are good foods and bad foods, and that kind of thinking can lead to an eating disorder.”

One can progress quickly from a carefully balanced diet to obsessive, controlling behavior. Baker-Pitts blames popular culture.

“Women are instructed by the media culture to care for themselves by obsessing about their bodies, so vegetarianism is often a part of that self-care package which is too often limited to controlling a woman’s appetite and intake,” Baker-Pitts says. “I do think that many people become invested in vegetarianism in order to create a boundary and to assert control over what they will take in, both in a nutritional sense and emotionally.”

As Rogers explains, the difference between healthy vegetarian eating and disordered behavior is subtle. “It’s very easy for people to be fooled by someone who is vegetarian, who is actually practicing restrictive eating.”

A general warning sign is a vegetarian who doesn’t consume an adequate amount of protein, or who is no longer neutral about all food groups. “The red flag comes when someone is using vegetarianism as a systematic way of eliminating food from their diet,” Dr. Bellace says. Youth is a factor, as adults still practicing vegetarianism have usually chosen it as a lifestyle rather than a method of weightcontrol.

Those professions of love for animals or the environment may be masking unhealthy eating behaviors, so parents should investigate the motives behind a teen suddenly switching to a vegetarian diet. While not all vegetarians have an eating disorder—and not all those suffering from an eating disorder utilize a vegetarian diet to mask their symptoms—those who do use it as an excuse should receive treatment. “Eating disorders have the highest mortality rate of all the psychiatric disorders, even depression,” Dr. Bellace explains, stressing the importance of “getting someone into treatment with someone who is legitimately an eating disorder specialist… to really intervene early enough in the eating disorder to really improve the prognosis down the road.”

In my experience, my three years as a vegetarian forced my chicken-soup-andbrisket family to consider the wide world of vegetables, and ultimately had us all addicted to make-your-own salad meals. While I did spend inordinate amounts of time figuring out what I could eat at my next meal, my thoughts never strayed to how I could further control or limit my diet. But my story could have easily ended differently. If I was less emotionally stable, less self-confident or less supported by friends and family, my black-and-white thought process around “good and bad” food could have easily slipped into the realm of an eating disorder. The line is much too thin between obsessing over the next meal being vegetarian and obsessing over the next meal in general.