Abstract
Objectives: Plant-based/vegan diets are growing in popularity. There are growing numbers of individuals adopting plant-based diets and there are legitimate concerns from professionals that this can enable food restriction or mask disordered eating. The aim of this study was to examine the role a plant-based diet can play for those in recovery from restrictive eating disorders (anorexia and bulimia nervosa). Methods: Interviews conducted with fourteen individuals who identified as having a restrictive eating disorder for which a plant-based diet played/plays an important part in their recovery. Semi-structured interviews explored the individual's lived experiences and motivations of adopting a plant-based diet, and perceptions of the role it played in recovery. Data was transcribed verbatim and analyzed using thematic analysis (Braun & Clarke, 2006). Results: Three key themes with six contributory subthemes were identified. Key themes were plant-based as a gateway to recovery, the changing value of food, and the function of control. Theme content highlighted an evolving role of identity and community, with a shift in meaning and value of food described, and for some, the development of a new relationship with their body. This facilitated a de-coupling of anxieties about food and promoted positive experiences of eating, esteem and empowerment. Conclusions: These findings present a unique insight into the role that plant-based eating may play in recovery for some restrictive eating disorders. The data demonstrated that motivations to control food intake may contribute to the decision to eat plant-based. However, for these individuals it provided a “gateway” to a new more meaningful relationship with food. These findings highlight some of the risks and benefits of eating plant-based in recovery and an important role for health professionals in understanding/supporting individuals during recovery.
| Original language | English |
|---|---|
| Article number | 107137 |
| Journal | Appetite |
| Volume | 194 |
| Early online date | 28 Nov 2023 |
| DOIs | |
| Publication status | Published - 1 Mar 2024 |
Funding
Despite the reported beneficial effects of plant-based diets, potential adverse effects of vegetarianism and veganism on wellbeing have attracted attention. It has been postulated that vegetarianism and eating disorders (ED) can be intertwined phenomena, with eating-disordered groups reporting higher rates of vegetarianism (Baş, Karabudak, & Kiziltan, 2005; Lindeman, Stark, & Latvala, 2000) and vegetarian adolescents at greater risk for ED and extreme weight-control behaviours compared to non-vegetarian controls (Robinson-O'Brien et al., 2009). Furthermore, there is a positive association of vegetarianism with disordered eating behaviours (Klopp, Heiss, & Smith, 2003) such as using laxatives or purging for weight control, especially among adolescents (Neumark-Sztainer, Story, French, & Resnick, 1997; Perry, Mcguire, Neumark-Sztainer, & Story, 2001). Indeed, motivations for vegetarianism cited by adolescents and young adults include weight control and dietary restraint (Klopp et al., 2003). It has also been suggested that the combination of public health and societal messaging about the increasing prevalence and negative sequalae of obesity (Finkelstein et al., 2012) alongside society's well documented ideals of thinness (So & Kwon, 2023) may mediate a potential link between vegetarianism and weight control. However, evidence to support the hypothesis that vegetarianism is a factor in onset of ED has been inconsistent (Timko, Hormes, & Chubski, 2012).The majority of the literature exploring this topic has focused on vegetarianism, and there is a lack of research investigating the experiences of individuals with ED who have adopted a plant-based or vegan diet (Dyett, Sabaté, Haddad, Rajaram, & Shavlik, 2013; Radnitz et al., 2015) despite the rapid increase in uptake (Allès et al., 2017; Galmiche, Déchelotte, Lambert, & Tavolacci, 2019). Even with the concerns of professionals there has been limited study or evidence to suggest that veganism or plant-based eating is associated with a higher risk of disordered eating behaviours (Robinson-O'Brien, Story, & Heim, 2009). While the transition to plant-based eating in ED is most commonly attributed to ethical and moral reasons there has been a reported increase in the number of individuals seeking treatment for ED who are following a plant-based or vegan diet (O'Connor, 2019). It is unclear whether this in part reflects the more global increase in popularity of plant-based diets (Allès et al., 2017; Bryant, 2019) or may in some way serve as a function of ED pathology. Given the complexity and risks of ED there is a need to better understand the role that plant-based diets play for those living with ED and for those providing clinical support and in-patient services (Brown, Fuller, & Simic, 2019). In particular, there is a pressing need to better examine and explore the mechanisms through which adopting a plant-based diet serves to perpetuate, mask or challenge eating disorder pathology and behaviour.Further study is needed to understand the potential role of plant-based diets in ED. As those with an ED are a group at high-risk of chronic psychological and physical morbidity (Wolff & Treasure, 2008), any masking and maintenance of disordered eating may place individuals at further risk and/or disrupt long term recovery. However, plant-based eating may also provide useful strategies and benefits that could play a potentially useful role in recovery. Evidently understanding more about the motivations and impact of eating plant-based in recovery from ED would be beneficial. In doing so lessons may be learned about what and how best to support individuals with ED in recovery. The current study aimed to examine this novel phenomenon by exploring the experiences and motivations for a plant-based diet in individuals with ED.The participants were informed that they could withdraw or request a break at any time without needing to provide the researcher with a reason, and verbal consent was clarified. Although no significant risks were associated with taking part in this study, the possibility that participants may experience emotional distress during the interview remained and so following interview the participants were provided with a debrief information sheet, which included details about the study and contact details of the principal investigator (an experienced clinical psychologist) and appropriate sources of support specific to ED. It is worth noting however, that no participants took up the option to contact for support.Some participants described being plant-based as a lifestyle choice rather than a food choice - and they felt this lifestyle became part of their identity. For many these values were internalised and beliefs - once dominated by the ED – began to be replaced with related moral and ethical beliefs surrounding animal welfare/environment, which participants felt supported recovery.
Keywords
- Anorexia nervosa
- Bulimia nervosa
- eating disorder
- Plant-based
- Qualitative
- Vegan
ASJC Scopus subject areas
- General Psychology
- Nutrition and Dietetics