Prisoners of the plate: can a meatless diet mask an eating disorder?

Vegetarian Times, April, 1995 by Judy Krizmanic

WHEN 15-YEAR-OLD Cari became a vegetarian a few years ago, her parents weren't pleased. She remembers them rattling off the typical concerns: Did she know anything about nutrition? Was she just going through a phase? But one of their worries was especially pointed. "They were paranoid that I might develop an eating disorder," she says.

To most vegetarians, such a concern sounds misplaced. After all, most of us equate being a vegetarian with being healthy: Mountains of scientific evidence show that vegetarians enjoy better health and suffer fewer chronic illnesses than non-vegetarians. And as it turns out, Cari's parents' fears were unfounded. Their daughter became a vegetarian not to lose weight; she did it out of a love for animals. But in some cases, it's not out of line to suspect that a vegetarian diet might be masking a real problem with food. If you're concerned about yourself or someone you know, take note of a few signs that can help you detect an eating disorder that may be hiding under the guise of a vegetarian diet.

EATING TO LOSE

A GROWING NUMBER of Americans report eating more healthfully than in recent years, but that doesn't translate into a lower rate of eating disorders--some researchers estimate that the number of eating disorder cases has increased by 50 percent in the past decade. Approximately 7 million Americans suffer from an eating disorder, a term that usually refers to anorexia nervosa (marked by severely restricted eating to the point of self-starvation) or bulimia nervosa (marked by cycles of binging on food and then purging by vomiting or using laxatives). People with eating disorders don't always fit into one category or the other; it's more common to see a combination of behavior. And they don't always look the part; a bulimic, for example, may be of normal weight.

Anorexia and bulimia are typically thought of as women's problems, but a growing number of men have begun seeking treatment for the disorders as well. And eating disorder experts have noticed another disturbing trend: the age of onset has plummeted; statistics now reveal girls as young as 10 or 11 with the disorders. At any age, unchecked eating disorders pose great health risks, including dehydration, anemia, liver and kidney damage, irregular heartbeat, heart attack and even death. Up to 20 percent of people with anorexia die, according to the statistics from Anorexia Nervosa and Related Eating Disorders Inc., (ANRED) a Eugene, Ore.-based non-profit educational organization.

In recent years, some eating disorder therapists have noticed something else about their patients: A number of them are calling themselves vegetarians. In some ways, the odds explain it. As more Americans become vegetarian, the number of vegetarians in various subgroups--including the subgroup of anorexics and bulimics--will increase. But sometimes, the link between a vegetarian diet and an eating disorder is more than coincidence. "Some of them truly are vegetarian, and have been for a long time," says Ron Thompson, Ph.D., co-director of the eating disorder program at Bloomington Hospital in Bloomington, Ind., and author of Helping Athletes with Eating Disorders (Human Kinetics Publications, 1992). "But for some, it's just another way of rationalizing their diets."

There are no hard numbers on just how many people with eating disorders call themselves vegetarian, but many practitioners say they see it happening. Thompson says the number of his patients claiming to be vegetarian has increased from one-quarter of his clientele to about one-third in the past two years. At the Harvard Eating Disorder Center at Massachusetts General Hospital in Boston, Director David Herzog, M.D., also says that about one-third of the patients say they are vegetarian. Sheri Weitz, R.D., a nutrition therapist for the Rader Institute, a nationwide eating disorder center, says that about half of the people she sees at her Los Angeles location call themselves vegetarian.

A VEIL OF VEGETARIANISM

THERE HAVEN'T BEEN any major studies published to explain the vegetarian-eating disorder connection, but it's pretty clear why a vegetarian diet appeals to the disordered eater. Most people with eating disorders avoid high-fat meat and dairy products anyway. "People with eating disorders, especially anorexic folks, have a tremendous amount of angst about anything with a good amount of fat in it," says Herzog, who is also an associate professor of psychiatry at Harvard Medical School, Boston. They categorize foods as "safe" and "unsafe." A vegetarian diet feels safer to some of them, because it automatically omits many of the high-fat, high-calorie items that can make them feel heavy or polluted.

To a person with an eating disorder, a vegetarian diet also provides an appealing framework: a set of rules governing what is allowed. "The person with an eating disorder is very fond of structure and rules because they give her a sense of control," says ANRED Director Jean Rubel.

SPOTTING A PROBLEM