Lets think about Veganism . . .
Veganism is defined by The Vegan Society as ‘a way of living which seeks to exclude, as far as is possible and practical, all forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose’. The choice to adopt a Vegan lifestyle may be down to concerns about the environment (Feiel et al 2009), sustainability (Austgulen 2018, Sabate et al 2014, Hoffman 2013) or to improve overall health (Dinu et al 2017, Federal Commission for Nutrition 2018).
So is plant based and Veganism the same thing? Plant based diets are different to following a Vegan diet. Plant based diet are when individuals choose to reduce their intake of animal products but don’t exclude all animal products from their lifestyle. Diet may include some animal-based products such as eggs or fish (British Dietetic Association 2020 and Lea 2006).
Can veganism develop into an eating disorder? Eating Disorders are a serious mental health illness. They can develop due to social, environmental, psychological factors. Anyone can develop at eating disorder regardless of age, gender, ethnicity and background. Choosing a vegan lifestyle does not mean you will develop an eating disorder or mean you have disordered eating. The concern is that vegan diet could allow food restriction to develop and disguise pathological eating behaviours (Mclean 2022) which could results in people not being able to access the support they need.
Research shows that there is a link between patients adopting a vegetarian diet and disordered eating (Zuromsk et al, 2015 Bardone-cone et al 2012, Bas et al 2005). There is a higher prevalence of people who have an eating disorder that are lifetime vegetarians compared to those without an eating disorder. 61% of people believed there was a relationship between their eating disorder and choosing to become a vegetarian (Bardone-Cone 2012). However, no such research has been conducted to look at the link between veganism and eating disorders.
Could following a Vegan diet support recovery? A very small study in 2019 found that those who have struggled with disordered eating found following a vegan diet reduced their focus on body image and helped them to develop new connections within vegan culture (Costa et al 2019 and McLean 2022) and had lower eating disorders behaviours compared to omnivores (Heiss 2017).
What if my patient would like to follow a vegan diet?
The Vegan society is clear that we must not discriminate against someone who is vegan. Veganism has been confirmed within the protected characteristics of ‘religion or belief’ under The Equality Act 2010 in England, Wales, and Scotland (Legislation.org.uk). As health professionals we have a duty to ensure that we are not discriminating against the people we are supporting. There had been concerns raised anecdotally by patients follow a vegan diet that their views and beliefs were ignored in treatment. However, it has been found that eating disorders and mental health professionals hold positive attitudes towards veganism (Fuller and Hill et al 2020), but we must still ensure that we don't allow our own internal bias ( if this exists) effect treatment options.
Everyone is unique and we need to ensure we are supporting them as such. This means as health professionals we need to be including vegan options on individual meals plans, information leaflets, catering options in our hospitals and also ensuring we are up to date with what nutritional supplements and oral nutritional supplements are available for our patients.
For some people they may be lifelong vegans, others may have adopted a vegan lifestyle recently but find it helpful in recovery and some might find it a barrier to meeting their nutritional needs or recovering from their eating disorder. The British Dietetic Association Mental Health Specialist Group has developed some key considerations to help you gently navigate with your patients how veganism is impacting or not impacting on their recovery from an eating disorder. If your patient feels they need to move away from adopting a vegan diet as they are undergoing treatment for their eating disorder, we can support them in other areas of their life to choose vegan products such as clothing, toiletries, banks and energy providers.
So what are our take homes as health professionals?
It is possible to meet someone’s nutritional needs if they are following a vegan diet. It is important to understand if veganism was present before the eating disorder, before developing a plan as a team. It may be that we need to gently challenge any links to dietary restraint so that we understand the patient’s needs. We can do this by having a discussion with the patient and ensuring they are involved in developing their care plan. As health professional it is important that we are not biased and we upskill ourselves in veganism so that we can provide the best quality care for our patients.
References:
Austgulen MH, Skuland SE, Schjoll A, Aldnes F. Consumer Readiness to Reduce Meat Consumption for the Purpose of Environmental Sustainability: Insights from Norway. Sustainability. 2018; 10(9): p. 3058.
Bardone-Cone, A.M., Fitzsimmons-Craft, E.E., Harney, M.B., Maldonado, C.R., Lawson, M.A., Smith, R. and Robinson, D.P., 2012. The inter-relationships between vegetarianism and eating disorders among females. Journal of the Academy of Nutrition and Dietetics, 112(8), pp.1247-1252.
British Dietetic Association 2020. Eating patterns for healthy and environmental sustainability. Available from : https://www.bda.uk.com/uploads/assets/539e2268-7991-4d24-b9ee867c1b2808fc/a1283104-a0dd-476b-bda723452ae93870/one%20blue%20dot%20reference%20guide.pdf
Costa I, Gill PR, Morda R, Ali L. ''More than a diet'': A qualitative investigation of young vegan Women’s relationship with food. Appetite. 2019; 143: p. 104418.
Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Reviews in Food Science and Nutrition. 2017; 57(17): p. 3640-3649.
Federal Commission for Nutrition (FCN). Vegan diets: review of nutritional benefits and risks. Expert report of the FCN. 2018;: p. 1-83.
Feiel S, Dangour AD, Garnett T, K.Lock , Chalabi Z, Roberts I, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture. The Lancet. 2009; 374: p. 2016-2025.
Fuller, S.J. and Hill, K.M., 2022. Attitudes toward veganism in eating disorder professionals. BJPsych Bulletin, 46(2), pp.95-99.
Heiss S, Coffino JA, Hormes JM. Eating and health behaviours in vegans compared to omnivores: Dispelling common myths. Appetite. 2017; 118: p. 129-135.
Hoffman SR, Stallings AF, Bessinger RC, Brooks GT. Differences between health and ethical vegetarians. Strength of conviction, nutrition knowledge, dietary restriction, and duration of adherance. Appetite. 2013; 65: p. 139-144.
Lea E, Crawford D, Worsley A. Public views of the benefits and barriers to the consumption of a plant-based diet. European Journal of Clinical Nutrition. 2006; 60: p. 828.
Legislation.gov.uk. www.legislation.gov.uk. [Online].; 2010. Available from: http://www.legislation.gov.uk/ukpga/2010/15/contents.
Sabate J, Soret S. Sustainability of plant-based diets: Back to the future. American Journal of Clinical Nutrition. 2014; 100(suppl_1): p. 476S-482S.
The Vegan Society. What rights do vegans have. [Online].; 2020 [cited 2020 July 24th. Available from: https://www.vegansociety.com/get-involved/international-rights-network/what-rights-do-vegans-have.
Zuromski KL, Witte TK, Smith AR, Goodwin N, Bodell LP, Bartlett M, et al. Increased prevalence of vegetarianism among women with eating pathology. Eating Behaviours. 2015; 19: p. 24-27.