The way you treat yourself sets the standard for others.
Although vegans are generally leaner than their nonvegan counterparts, becoming vegan doesn’t guarantee thinness—vegans come in all shapes and sizes. As a result, for an overweight individual, it can be frustrating to adopt a vegan diet and not lose an ounce. For people who struggle with being too thin, it can be even more challenging to gain weight on a vegan diet. However, well-planned vegan diets are powerfully effective in helping to support and promote healthy body weights, regardless of a person’s starting point.
Americans certainly need help in the weight-control realm; they’re among the fattest people in the world. Nearly 70 percent of American adults who are 20 or older are overweight or obese. More than one-third of American adults are obese, and less than one-third are at a normal weight.1,2 In contrast, approximately 1.6 percent of the US population is underweight,3 a steady decline from about 4 percent in the early 1960s.
Eating disorders also are a growing concern. An estimated 0.5 to 1 percent of American women suffer from anorexia nervosa,4 and roughly 3 percent will suffer from bulimia during their lifetime. Rates of eating disorders are higher among young women; about 6 percent of teen girls and 5 percent of college-age women are affected.5 Many people believe that being vegan can trigger eating disorders. However, anorexia nervosa, bulimia, and other compulsive eating behaviors are the result of a state of mind rather than of a particular diet.
The following discussion addresses the causes and consequences of weight problems, provides a guide for helpful and healthful eating behaviors, and offers practical advice for overcoming specific weight issues.
There’s no one “ideal” weight for individuals who are the same height, because healthy weight depends on a combination of factors besides height: bone structure, muscle mass, body fat, and body build. However, general guidelines—along with additional indicators, such as body mass index (BMI) and percentage of body fat—can be helpful in determining if a person is overweight, obese, or underweight:
• Overweight. At least 10 percent above healthy body weight (for most people, about 10 to 30 pounds above healthy body weight).
• Obese. At least 20 percent above healthy body weight (for most people, 30 pounds or more above healthy body weight).
• Underweight. At least 15 to 20 percent below healthy body weight (for most people, 20 to 30 pounds under healthy body weight).
The percentage of body weight composed of fat can indicate whether a person’s weight is within a healthy range. Body fat of more than 17 percent in men and 27 percent in women indicates overweight; body fat of greater than 25 percent in men and 31 percent in women indicates obesity. Low body fat doesn’t necessarily predict underweight in men, because male athletes can achieve body fat under 8 percent and still be healthy. However, low body fat can induce amenorrhea (cessation of menstruation) in women at levels below 13 to 17 percent (the exact percentage varies among individuals).
Getting accurate body fat measurements can be difficult and costly. Instead, BMI is commonly used as a simple, noninvasive way to estimate total body fatness. This is generally done using a chart or BMI calculator (both widely available online). BMI is determined by dividing a person’s mass (weight in kilograms) by the square of their height in meters (kg/m2).
A BMI of 18.5 to 24.9 is in the healthy weight range. A BMI of 25 to 29.9 is considered overweight. Obesity is defined as a BMI of greater than or equal to 30, with further designations made according to degree of obesity (class 1 obesity: BMI 30 to 34.9; class 2/severe obesity: BMI 35 to 39.9; class 3/extreme obesity: BMI ≥ 40). A BMI below 18.5 is deemed underweight; mild underweight ranges from 17 to 18.49, moderate underweight from 16 to 16.99, and severe underweight is any BMI under 16. (Table 12.1 charts the BMI for a range of heights and weights.)
While useful for most people, BMI has several significant limitations. Foremost, it doesn’t take into account differences in body composition due to age, gender, race, or ethnicity.6 BMI may be most accurate for Caucasian women and small-boned men. For men with more muscle mass or larger bone structure, it’s less reliable. For example, a man might register a BMI of 25 or more (considered overweight), but if he has a large frame and muscular build, he could actually be very lean. For many men and some large-boned muscular women, BMI might be more accurate if the cutoffs for overweight were shifted up by about 2 points to 27. BMI is also less accurate for some black people, who have denser, more muscular builds, and for whom a high BMI also wouldn’t indicate overweight. However, genetic diversity is even more pronounced in blacks than Caucasians, so this assumption wouldn’t apply to all black people.
TABLE 12.1. Body mass index (BMI)
Likewise, individuals with smaller bone structure and lower muscle mass may not be underweight, even if their BMI dips below 18.5. For such individuals, the cutoffs for overweight also may need to be dropped a couple of points. This is especially true for Asians, who commonly experience the adverse consequences of overweight—such as high blood pressure and insulin resistance—when their BMI is only 23.7 In both Japan and Singapore, BMI tables show cutoffs for overweight at 22.9 instead of 24.9.8,9
In addition, BMI is only considered valid for those between 20 and 65 years old, is less precise for very short people (less than 5 feet/1.5 meters), and is of little value to body builders or other individuals with extremely large muscles. Pregnant women shouldn’t use BMI tables but should follow their physician’s advice on healthy weight during pregnancy.
Factoring in body shape can help to eliminate some of the inconsistencies associated with BMI. The most common descriptors of body shape are “apple” and “pear.” People who carry the bulk of their weight above the hips (mainly in the abdomen) have an apple shape. This body shape is more prevalent in men. Apple-shaped people sometimes have a larger waist than hip measurement and tend to gain weight in the abdomen first. People with apple-shaped bodies are more likely to accumulate visceral fat, a dangerous type of fat that accumulates in and around body organs. Conversely, people who carry excess weight below the waist (on hips, thighs, and buttocks) have a pear shape. This body shape is more common in women. Pear-shaped people generally have larger hips than waists and tend to have more subcutaneous fat. While not without health risk, subcutaneous fat isn’t as harmful as visceral fat.
Measuring and calculating the waist-to-hip ratio confirms an apple or pear shape. To arrive at the ratio, divide the waist measurement by the hip measurement. A ratio of 0.8 or less for women and 0.9 or less for men is considered a pear shape. Higher ratios indicate an apple shape.
Having an apple or pear shape isn’t a concern unless a person is carrying excess weight. In the overweight or obese, having an apple shape results in a much higher risk for heart disease, type 2 diabetes, hypertension, and several types of cancer. For those who naturally become apple shaped with weight gain, it’s particularly important to maintain a healthy body weight.
Using the waist measurement alone can determine whether a person is carrying excess baggage. Waist measurements of more than 32 inches in women and 37 inches in men are commonly used as upper limits, over which further weight gain is ill advised. A measurement of 35 inches for women and 40 inches for men indicates a likelihood of overweight, and that health improvements could be expected with weight loss. Once again, these numbers would need to be adjusted for those with very large or very small frames.
Today, a majority of Americans are actively attempting to change their body weight. Most are consumed with losing weight, while a handful want to gain a few pounds. For most people, “diets” are a lesson in frustration because they eventually end, and the same weight problem seems to return.
There are more-effective, permanent solutions. Whether a person is overweight, underweight, or struggling with an eating disorder, three simple steps can set the course to a healthy body weight for life:
1. Make great health the #1 goal. To permanently overcome an unhealthy body weight, the first and most critical step is to redirect focus from weight to health. When health and wellness become the top priority in food selection, overall body weight responds predictably in a positive direction. Foods shouldn’t be chosen on the basis of calories or their perceived effectiveness as weight-change aids. Instead, nourishing foods should be selected to help and protect the body, and offer enjoyment and satisfaction while maintaining a healthy weight.
2. Build healthy habits. Habits are simply behaviors repeated so often that little conscious thought is required. Habits that erode health can be replaced with those that restore health. To create a habit, choose a new routine and follow it diligently for at least a month. After a behavior is repeated for a month, it’s well on the way to becoming a good habit.
3. Think positive. In the journey toward a healthy weight, there are no interviews, no exams, and no reprisals. Slips should be met with a review of, and appreciation for, all the constructive changes already made, and a renewed commitment to press on. Positive affirmations can push out negative thoughts. Consider every constructive step taken as cause for celebration.
Before significant diet and lifestyle changes are undertaken, make the appropriate mental and physical preparations:
• Have a physical examination. Check blood cholesterol, triglyceride, blood glucose, and CRP (measure of inflammation) levels. Get vitamin B12, vitamin D, and iron levels tested. Check blood pressure and body weight. Review any prescription medications with health care providers; medications may need to be adjusted or eliminated once a healthy diet supports the body, so close monitoring may be necessary.
• Record diet and lifestyle for three days. Track food and beverage intakes for three full days (including one weekend day); be specific about preparation methods and amounts. Note the time of day a food was eaten, where it was eaten, and hunger level at the time.
Record all activities, from gardening and grocery shopping to exercise and answering e-mails, and document sleeping patterns. Also note other positive activities, including massages, pedicures, prayer time, meditation, and enjoyable social activities. Finally, record all addictive substances used (cigarettes, alcohol, and recreational drugs). Such a record provides a powerful reality check, as well as a valuable baseline.
• Set realistic health goals. Set short- and long-term goals that are specific, measureable, and attainable. Goals can include weight loss or gain, but this shouldn’t be the primary focus. Instead, select goals that encourage health gains, such as improving fitness; increasing fiber intake; eating more leafy greens and beans; improving blood cholesterol, triglyceride, or blood glucose levels; more effectively managing stress; improving energy and mental alertness; curtailing mood swings; stopping smoking or reducing alcohol consumption; getting better at time management; sleeping at least seven hours a night; or being more patient and kind. Tackle goals one at a time, so the tasks don’t become too overwhelming. Even small changes can produce big health rewards.
• Restock the pantry. Get rid of foods and other items that don’t promote health; ultraprocessed fat-, sugar-, and salt-laden foods are analogous to addictive drugs. Instead, shop for healthy and tasty items. Select health-promoting recipes that sound appealing and gather the ingredients required. Consider investing in high-quality food preparation equipment, if possible.
Dietary guidelines specific to individual weight challenges have been provided in the following sections on overweight, underweight, and eating disorders. However, lifestyle factors beyond food can undermine dietary efforts if neglected. Although there are additional considerations for those with eating disorders, the following issues pertain to everyone who struggles with body weight.
One of the great attractions of a vegan diet is the promise of slimness. This is an established part of the vegan stereotype. However, being vegan doesn’t preclude overweight or obesity, and becoming vegan doesn’t guarantee weight loss or even weight maintenance.
For many overweight vegans, the stereotype only adds stress to an already demanding lifestyle, because some may feel embarrassed not to be living up to expectations. However, the only prerequisite for being vegan is a compassionate heart.
Still, do vegans really have an advantage in regard to ideal body weight? Do plant-based diets offer a solid solution to the current weight crisis? In general, the answer is “yes.”
Being vegan provides remarkable protection against overweight and obesity. In a Swedish study of more than 55,000 women, self-identified vegans had about one-third the risk of overweight or obesity compared to omnivores, while vegetarians and semivegetarians had close to half the risk.10 More than twenty studies have reported that vegans are leaner than other dietary groups, have lower BMIs, and have lower percentages of body fat.11 Two large studies—EPIC-Oxford in the United Kingdom and the Adventist Health Study-2 (AHS-2) in the United States—compared the BMIs and obesity rates of vegans with other dietary groups, including health-conscious meat eaters, fish eaters, and lacto-ovo vegetarians. In these studies, vegans had the lowest BMIs (page 39). Vegan BMIs ranged from 21.98 to 23.6, compared to 23.49 to 28.8 for health-conscious meat eaters.12,13 In the EPIC-Oxford study, vegan obesity rates were under 2 percent compared to more than 5 percent in health-conscious meat eaters.12
What gives vegans the advantage? Vegans tend to eat more fiber; more vegetables, fruits, and legumes; and more whole foods in general. They also tend to eat fewer highly processed and fast foods, and they eat no meat or dairy products, factors that have been associated with better weight management.14,15 While the science is reassuring, it may offer little consolation to vegans who are overweight or obese. So, why aren’t kale-munching vegans entirely protected?
Everyone knows that overeating and underactivity are at the root of the global overweight and obesity epidemic. The solution is clearly a matter of energy balance. Although it’s true that overweight and obesity are the result of energy imbalances, these imbalances are the product of a complex interplay of physical, environmental, and emotional factors.
Although the statement “if you eat more than you need, you gain weight; if you eat less than you need, you lose weight” sounds simple, a number of things can throw a monkey wrench into this “energy in, energy out” theory. For example, cutting 500 calories per day can cause a weight loss of 1 pound per week for a few weeks, but the body quickly adjusts to the new normal, and weight loss slows or stops. As it turns out, adults with greater fat reserves can expect to lose more weight by reducing calorie consumption than people with fewer fat reserves. However, small changes in energy intake can still result in significant weight loss over time.
The standard view that “a calorie is a calorie” has also come under fire. Accumulating evidence suggests that not all calories behave the same way in the body.16 For example, some foods and food combinations promote calorie-burning more effectively than others. In addition, sleep, stress, and exposure to environmental toxins can disturb hormones that influence fat storage, fat breakdown, calorie-burning, and body weight. These factors can weigh as heavily on vegans as on nonvegans.
Some people are metabolically efficient. The good news for such individuals is this: if they were dropped on a desert island with no food, their metabolism would slow, preserving every ounce of fat and releasing stored energy gradually to prolong survival. The bad news is that they’re more likely to live in places with endless supplies of tempting, energy-dense food. Those who are best able to survive famine are the least able to survive excess. For metabolically efficient people, moderate food intake and vigorous physical activity are necessary.
Not surprisingly, risk for weight gain can be affected by genes, age, and gender. Men tend to burn more calories than women and, for most people, metabolism gradually declines after age 40. Very low-calorie diets and yo-yo dieting only make matters worse, because they signal the body to put on the metabolic brakes and conserve precious energy stores.
Less commonly, overweight and obesity are triggered by hypothyroidism. This condition reduces metabolic rate, triggers weight gain, and often makes its sufferers feel cold, tired, weak, and depressed. Hypothyroidism can be triggered or worsened by chronic iodine deficiency, which is rare in North American omnivores due to the addition of iodine to table salt. However, risk may be increased among vegans who avoid iodized salt (perhaps choosing sea salt, tamari, or Bragg Liquid Aminos instead) and who fail to ensure a reliable source of iodine in the diet (for more information on iodine, see pages 191 to 194).
Medications, such as corticosteroids, antidepressants, and seizure medicines can also slow metabolism, increase appetite, or cause water retention, all of which can lead to weight gain.
Humans are hardwired to like the taste of fat, sugar, and salt. Highly dilute in nature, these flavors once assured people that a food was safe and nourishing to consume, and that it would sustain them through lean times, give them energy, or replenish losses. However, when the sources of these flavors are concentrated and used as the principal ingredients in processed foods, the body’s innate ability to control appetite becomes unhinged. Vegan versions of such foods can be just as problematic. This is no mere coincidence. These foods are all physically addictive. Foods that contain hyperconcentrations of sugar, fat, and salt (all of which are vegan ingredients) stimulate the same pleasure centers in the brain as heroin, nicotine, and alcohol. Essentially, they provide such pleasure that they trigger cravings.17–19
To further challenge self-control, portion sizes keep expanding. According to the Centers for Disease Control and Prevention (CDC), the average restaurant meal today is four times larger than it was in the 1950s. Not surprisingly, evidence confirms that as portion sizes increase, people eat more.20 Also, it doesn’t seem to matter if the dietary choices are vegan. Vegan versions of almost every convenience food, snack food, and fast food are now available, and the word vegan is used to provide products with a “health halo” regardless of portion size.
On the other hand, physical demands have dwindled dramatically since the 1950s. Every possible convenience has been developed to help reduce the need for physical activity. Even if people wanted to increase activity, many neighborhoods lack sidewalks and safe places for exercise. In these environments, staying slim is an ever-greater challenge.
Another less well-recognized potential trigger for weight gain is lack of sleep.21 Although less sleep would seem to imply greater caloric expenditure, evidence suggests that lack of sleep promotes weight gain. Sleep-deprived people seem to crave more energy-dense foods. In addition, there’s some evidence that lack of sleep reduces insulin sensitivity, increases levels of ghrelin (a hormone that promotes hunger), and reduces levels of leptin (a hormone that curbs hunger).
For many people, weight gain has as much to do with self-preservation and social pressure as it does with overeating and underactivity. Difficult interactions, disappointment, embarrassment, stress, overwork, or hardship all seem to be eased by food, even in the complete absence of physical hunger. Of course, social events and festive experiences are often celebrated with favorite foods and beverages too. Eating in response to feelings rather than physical hunger is known as “emotional eating,” and it’s a well-recognized factor in overweight and obesity. In its most severe form, emotional eating can lead to eating disorders, such as compulsive overeating or binge eating disorder (see page 392 for more information).
The economic and health burdens associated with overweight and obesity are immense. In 2008, medical costs associated with obesity in the United States were estimated at $147 billion.22 Contrary to popular opinion, “healthy obesity” is not a benign condition. Compared to healthy normal-weight individuals, obese people are at increased risk for long-term adverse health outcomes, even when they appear metabolically healthy.23 Excess body fat causes unwanted changes to the body’s basic physiology, adversely affecting blood pressure, cholesterol, triglycerides, respiration, fertility, skin and joint health, hormones, and insulin action. Gaining excess fat significantly increases risks for many debilitating and often fatal conditions:24–26
• Type 2 diabetes. The risk of type 2 diabetes is directly linked to degree of body fat, particularly for people with an apple shape. As body fat increases, insulin sensitivity declines, and insulin resistance increases.
• Coronary artery disease, congestive heart failure, and stroke. Being overweight contributes to high blood pressure, high cholesterol, high triglycerides, and angina (chest pain), and can markedly increase the chances of sudden heart attack, stroke, or congestive heart failure.
• Cancer. Overweight women suffer more breast, uterine, cervical, ovarian, gallbladder, and colon cancers, while overweight men are at elevated risk for cancers of the colon, rectum, and prostate.
• Osteoarthritis. Excess body weight increases the risk of osteoarthritis, probably by placing extra pressure on joints and eroding the cartilage tissue that cushions and protects the joints.
• Sleep apnea. Sleep apnea triggers pauses in breathing during sleep and is often marked by heavy snoring and snorting breaths that follow sometimes fairly prolonged lapses in breathing. Risk for sleep apnea is significantly higher in overweight individuals.
• Gout. The product of high levels of uric acid in the blood, gout causes painful swelling in the joints, usually affecting one joint at a time. The most common site affected is the big toe, but it’s also seen in the ankle, knee, elbow, wrist, and finger joints. The risk for gout increases progressively with excess body weight.
• Gallbladder disease. Being overweight significantly increases the risk of both gallbladder disease and gallstones. However, rapid, significant weight loss can also increase the chance of developing gallstones.
• Polycystic ovarian syndrome. This painful disorder is marked by small cysts on the ovaries, menstrual irregularities, facial hair, acne, patches of dark skin on the neck, and weight gain in women of reproductive age. It’s associated with insulin resistance and abdominal obesity and strongly increases the risk of type 2 diabetes, heart disease, and stroke.
Although published research doesn’t exist to answer whether being vegan protects against the adverse consequences of overweight and obesity, evidence suggests that healthy lifestyle habits are associated with a significant reduction in mortality in normal-weight, overweight, and obese individuals, with the greatest benefits being observed in obese individuals.27 Because vegan diets are generally associated with reduced risk of chronic disease, one may expect that overweight and obese vegans would enjoy some advantages over overweight and obese omnivores. However, vegans who consume unhealthful diets could certainly fare worse than health-conscious omnivores.
It’s common knowledge that dietary modifications are an essential component of weight management, but the extent of the modifications necessary for long-term success are often underestimated. While caloric restriction is generally necessary, many other dietary factors must interact to produce the desired results. Some dietary choices essentially set up a chain reaction of metabolic dysfunction that compromises all body systems. Consuming a rich variety of healthful foods builds a powerful defense against this type of assault. Six health goals are fundamental to achieving and maintaining healthy body weight for life:
1. Overcome food addictions and cravings. Where food addiction is concerned, ultraprocessed and fat-, sugar-, and salt-laden foods are essentially equivalent to drugs. To break the cycle, the addictive foods must be eliminated. When these foods are replaced with foods of real value to health, the body restores its balance and frees itself from the addiction. At this point, the body can better handle the occasional “addictive food” and is less likely to crave it.
For success in overcoming a food addiction, blood sugar levels must be stable. Eating meals with a good balance of protein, carbohydrate, and fat helps. For example, breakfast cereal should be topped with nuts, seeds, and unsweetened nondairy milk. Beans at breakfast yield staying power through the morning. Eat legumes, tofu, or tempeh at lunch and dinner. Avoid caloric beverages, sugar, and artificial sweeteners. Eliminate deep-fried foods.
One less well-recognized cause of cravings is allergies or sensitivities; for a number of people, gluten is an issue. Ironically, people often crave the very foods to which they’re sensitive. Consider eliminating suspect foods for two to four weeks, then gradually adding them back, one at a time, at two- to four-day intervals.
2. Control inflammation. Inflammation is one of the key driving forces behind overweight and obesity, as well as many other chronic diseases. Dietary factors, including overeating itself, can generate inflammation in many ways. When fat cells become bloated, production of proinflammatory hormones increases and production of anti-inflammatory hormones decreases. This imbalance promotes insulin resistance.28
Other common contributors to inflammation are foods to which individuals are sensitive or allergic. Environmental contaminants, chronic stress, and deficiencies of certain nutrients, such as vitamin D and omega-3 fatty acids, can also promote inflammation. Fortunately, the vegetables, fruits, legumes, whole grains, nuts, seeds, herbs, and spices in a whole-foods plant-based diet provide an array of anti-inflammatory compounds that help to keep inflammation at bay.
3. Improve digestion. An inflamed gut—which can result from allergies or sensitivities, intestinal diseases, parasites, chronic or acute diarrhea, and other factors—may contribute to obesity and disease. “Leaky gut,” a popular term that describes increased intestinal permeability, allows fragments of food proteins to penetrate the intestinal lining and enter the bloodstream. When proteins circulate in the bloodstream, they can accumulate almost anywhere in the body, potentially leading to insulin resistance or other adverse conditions. The foods most commonly associated with leaky gut are ultraprocessed packaged convenience items, including products with refined sugar or flour, and those linked to hypersensitivities, such as gluten-containing grains and dairy products.29–34
Unhealthy intestinal flora also adversely affect digestion, metabolism, and immune function. Evidence suggests that these bacteria produce toxins with the potential to injure the gut lining and contribute to leaky gut.35–37 Conversely, beneficial bacteria may help to promote leanness by manufacturing short-chain fatty acids that reduce fat accumulation in cells, boost metabolism, and promote the production of satiety hormones.38 Low-fat, high-fiber, vegetable-rich diets encourage good bacteria to flourish. In addition, high-quality probiotics will support the reestablishment of healthy gut flora.
4. Reinforce detoxification systems. Scientists are just beginning to recognize a connection between body fat accumulation and environmental contaminants, such as bisphenol A (BPA), heavy metals, persistent organic pollutants, and pesticides. Consumers can’t completely eliminate exposure to these compounds, but they may take steps to minimize it. In addition, body systems that help to excrete these compounds can be reinforced.
Fortunately, vegans may be at an advantage on both counts. First, because they’re high on the food chain, animal products (including fish) are significant sources of environmental toxins. Not surprisingly, preliminary evidence suggests that exposure to such toxins may be reduced in vegetarian and vegan populations.39,40 Second, cruciferous vegetables, which tend to be heavily consumed by vegans, are rich in phytochemicals that support the body’s detoxification processes. Numerous vitamins, minerals, amino acids, phytochemicals, and antioxidants play a role in this process, so good nutritional status is important. Finally, eating organic foods, when possible, reduces exposure to pesticides.
5. Balance hormones, boost metabolism. Optimal health and metabolism depend on the proper functioning of the body’s many systems that produce and release hormones, including thyroid, stress, and sex hormones. Thyroid hormones control metabolism and can have a significant impact on body weight. Vegans—especially those who avoid iodized salt and sea vegetables—may be low in iodine, which is needed in the production of thyroid hormones. Insufficient selenium and vitamin D can also adversely affect thyroid function.41,42
The stress hormone cortisol helps to deliver the appropriate type and quantity of carbohydrate, fat, or protein to body tissues. Under conditions of chronic stress or calorie deprivation, cortisol levels rise. Elevated cortisol levels are associated with increased appetite and cravings for foods rich in fat and sugar.43–45 In addition, fat is shuttled into visceral fat deposits in the abdomen, which promotes cardiovascular disease and insulin resistance.
Insulin resistance impacts sex hormones. In women, insulin resistance can trigger polycystic ovarian syndrome, causing masculinizing symptoms, such as unwanted hair growth and infertility. In men, elevated insulin levels can depress testosterone levels and sex drive.46,47
A whole-foods, low glycemic-load, nutrient-dense, plant-based diet (with appropriate supplements) plays a critical role in balancing hormones and boosting metabolism. Stress management and physical activity also are vital.
6. Enhance nutritional status. Much of the developed world is overfed and undernourished. People consume too many calories and environmental contaminants; too much fat, salt, and sugar; and not enough of the elements necessary for optimal health. Vegans tend to have higher intakes of vegetables and fruits, fiber, and a number of nutrients, phytochemicals, and antioxidants. But, even so, nutrient shortfalls aren’t uncommon among vegans.
When curtailing calories for weight control, foods with high energy density (many calories per gram) should be deemphasized. More important are foods with high nutrient density (many nutrients per calorie). Fueling the body with high-quality organic whole plant foods shifts gene expression, reducing the risks for overweight, obesity, and chronic disease. The best choices are vegetables (especially leafy greens), legumes, fruits, nuts, seeds, and intact whole grains (rather than grains ground into flour).
1. Eat at least five servings of nonstarchy vegetables per day. In their natural state, vegetables are the most nutrient-dense foods on the planet. One serving equals 1 cup (250 ml) raw or ½ cup (125 ml) cooked. Aim for color and variety: at least one serving each of green (including dark leafy greens), red, orange-yellow, purple-blue, and white-beige vegetables; include raw vegetables daily. Cooked vegetables are most nutritious when lightly steamed. Limit the serving sizes of starchy vegetables, such as sweet potatoes and corn, to no more than ½ cup (125 ml) once or twice a day. Include sprouts, which are highly nutritious and inexpensive to grow.
TOP TEN HEALTHY-WEIGHT ALLIES |
TOP TEN HEALTHY-WEIGHT ENEMIES |
Leafy greens |
Overeating |
Nonstarchy vegetables; sea vegetables |
Sugary beverages |
Sprouts |
Sugar-laden treats (e.g., frozen desserts, candy, pastries) |
Legumes of all kinds |
Refined starches (e.g., white-flour breads, bagels, crackers, cookies) |
Fresh fruits |
Ultraprocessed convenience foods |
Nuts and seeds |
Fast and/or fried foods |
Herbs and spices |
Salty snack foods |
Unrefined starchy foods—intact whole grains, starchy vegetables |
Concentrated fats and oils |
Herbal teas (e.g., green tea) |
Environmental contaminants |
Water |
Alcohol |
2. Learn to love legumes. Eat at least three ½ cup (125 ml) servings of legumes per day. (New consumers should begin with smaller servings to allow the gut bacteria to adjust to the increased fiber intake.) Beans, lentils, and peas are among the richest fiber sources, providing satiety and staying power between meals. Lentils and split peas or fresh peas (in or out of the pod) are extremely low in fat but high in nutrients. Lentils, mung beans, and whole peas are excellent candidates for sprouting. Other nutrient-rich legume-based products include tofu and tempeh, unsweetened soy milk, protein powders, and vegan meat substitutes (check the labels, though). Add beans to stews, soups, and salads or use them to make patties, loaves, or spreads. If using canned beans, opt for those in BPA-free cans.
3. Go easy on grains. As calorie needs decrease (e.g., with age, menopause, reduced physical activity, and so forth), intake of all grains should be reduced as well. Especially avoid refined grains, such as white rice and products made from white flour and white rice, as well as processed cereals with added sugar and salt. Minimize the use of ground grains (e.g., flour) of all types, even whole-grain flours. (This includes whole-grain breads, crackers, cookies, pretzels, and other flour-based baked goods.)
Choose intact whole grains, such as quinoa, wild rice, buckwheat, oat groats, and barley, and, for most people, limit portion sizes to ½ cup (125 ml). One of the most healthful ways to use grains is to sprout them. Add the sprouts to salads or enjoy as a breakfast cereal (add fruit, nuts, seeds, and nondairy yogurt or milk). Although less desirable than intact whole grains, cut grains (e.g., bulgur) and rolled grains (e.g., rolled oats) also can be part of the diet.
4. Satisfy a sweet tooth with fresh fruit. Although the thought of an apple for dessert may seem boring, there are many ways to turn fruit into a tantalizing after-dinner treat. Simply slicing fruit and creatively arranging the pieces on a plate makes it seem special. Topped with a little cinnamon and plain nondairy yogurt or nut cream, chopped fruit or berries turn into a delightful parfait. Fruits can be poached, baked, or grilled for fabulous flavor. And, who wouldn’t appreciate the taste of ice cream—minus the fat and sugar? Freeze peeled bananas, berries, pineapple, mango, and other fruit; process these through a juicer to make a soft-serve ice cream for instant consumption. Alternatively, blend together frozen fruit with just enough nondairy milk or yogurt to make a smooth ice cream.
Because fruit skins and seeds are especially rich sources of fiber and phytochemicals, edible varieties should be consumed. Limit use of dried fruits to ¼ cup (60 ml) or less per day; these foods are more concentrated in naturally occurring sugars, and are higher in calories. People with elevated blood glucose levels are well-advised to limit fruit to not more than four servings a day (see page 335 for recommended serving sizes).
5. Select nuts, seeds, and avocados as primary fat sources. Although high-fat plant foods are calorie packed, in both population studies and clinical trials, they’re inversely associated with weight gain.48 Loaded with protective compounds, including essential fatty acids, these higher-fat plant foods are vital health allies. Eat about 1 to 2 ounces (30 to 60 g) of nuts and seeds a day. Select a mix of nuts and seeds that provides a good balance of essential fatty acids, such as chia seeds, flaxseeds, hempseeds, and walnuts. Include a Brazil nut for selenium.
One of the best ways to eat nuts is straight from the shell, because the effort required to retrieve the nut discourages overconsumption. In addition, soaking nuts and seeds reduces antinutrients and increases their nutritional value. Soaked nuts can then be dehydrated to add crunchiness without adding the harmful products of oxidation formed during roasting.
Minimize the use of fats and oils. They provide about 120 calories per tablespoon (15 ml) but very few nutrients, because minerals, phytochemicals, fiber, and most fat-soluble vitamins are left behind during processing. Partially hydrogenated oils contain harmful trans-fatty acids—read labels, and avoid them completely.
6. Make the most of herbs and spices. Herbs and spices are the most recently hailed health heroes. They enhance food flavor without increasing sodium or fat intake. Several herbs and spices also may boost metabolism, calm inflammation, or balance blood glucose levels. Among the spicy superstars are black pepper, cardamom, cayenne, cinnamon, cumin, cloves, ginger, ginseng, mustard seeds, oregano, rosemary, and turmeric. Freshly grown herbs can be frozen or dehydrated for later use.
7. Keep a lid on ultraprocessed and convenience foods. Such foods are generally the result of many stages of processing, such as grinding, refining, and/or partial hydrogenation. To enhance the final products, food manufacturers also may add sugar, salt, additives, colors, or preservatives. Because of the body’s natural affinity for these flavors, individuals overconsume calorie-dense foods. Good examples include chips and other salty snacks, sugar-laden breakfast cereals, and salt- and fat-rich frozen dinners.
Not all processed foods are harmful. To meet consumer demands for healthful options, food manufacturers have responded with better choices. For example, some foods may be partially prepared to help reduce cooking time, but their processing is kept to a minimum and few ingredients are added. Good examples include frozen herbs, beans canned with little salt in BPA-free cans, shelled frozen edamame, some sprouted breads, organic sugar-free fruit-and-nut bars, and some jarred tomato sauces. To find such minimally processed foods, read the ingredient list.
8. Minimize the use of sugar and avoid artificial sweeteners. Whether sugar comes from high-fructose corn syrup or organic dehydrated cane juice, the type of sugar matters less than the amount ingested. Besides being a source of empty calories, sugar offers few or no nutrients. Be aware of added sugars in foods; read the labels on packaged foods to find and avoid them. In most cases, if a commercial vegan product contains no fruit (fresh or dried), it’s likely that any sugar listed on the label is added sugar.
Avoid artificial sweeteners; they provide no real assistance in a quest for health and may negatively affect metabolism and appetite control, undermining efforts to achieve a healthy body weight.
9. Choose the right beverages. Water is the best thirst quencher—and it’s calorie-free. If possible, dispense the water through a filter that eliminates chlorine, lead, nitrates, microorganisms, and other environmental contaminants without removing minerals, such as calcium and magnesium.
Herbal teas can be healthful beverage choices. Green tea has been shown to boost metabolism and may aid in weight loss.49 For added nutrition with minimal calories, vegetable juice (especially green juices or tomato juice) or wheatgrass juice are good options. Nutritious but higher-calorie beverages (fresh fruit juices and fortified soy, rice, or other nondairy milks) provide 100 to 150 calories per cup. Homemade smoothies made from some combination of fruit, greens, and seeds can make healthful meal replacements providing 400 to 500 calories per 24-ounce (750 ml) serving. They should be looked upon as meal replacements and limited to not more than one per day. Commercial smoothies often are loaded with concentrated juices and can contain up to 800 calories in a 24-ounce (750 ml) serving and 75 grams (18 teaspoons) of sugar—unless you can control the ingredients, avoid them.
Although some beverages add nutritional value to the diet, in general, whole foods provide greater satiety value for weight management. Fluids don’t fill the stomach the way solid food does, so it’s easy to underestimate a beverage’s contribution to calorie intakes. A 12-ounce serving of lemonade, fruit punch, or soda pop contains 120 to 150 calories but provides little, if any, nutritional value. Alcoholic beverages can also send calorie intakes soaring.
• Eat at least five servings of nonstarchy vegetables a day.
• Eat at least three servings of legumes daily.
• Limit grains to not more than three servings a day—eat only intact whole grains.
• Eat four servings of fresh fruit per day.
• Eat 1 to 2 ounces of nuts and seeds per day. Include at least one serving of omega-3 rich walnuts, flaxseeds, chia seeds, or hempseeds. Limit added fats and oils.
• Spice it up—use herbs and spices liberally.
• Steer clear of ultraprocessed foods.
• Skip added sugars.
• Drink water. Minimize consumption of caloric beverages.
• Take supplements, as needed.
Artificially sweetened calorie-free beverages aren’t the answer, nor are the sweeteners themselves. Stevia is a reasonable option to sweeten coffee or tea, if necessary. (For more information, see page 167.)
Adequate hydration is vital to healthy body functioning and peak performance. Dehydration can be mistaken for hunger and can trigger overeating. Water is generally the best beverage choice, so having a water bottle handy is a good habit to develop.
10. Consider nutritional supplements. Whole-foods vegan diets can be low in vitamin B12, iodine, and vitamin D (depending on exposure to sunshine). Unless reliable sources of these nutrients are obtained from fortified foods, it’s wise to take supplements. Targets for these nutrients are about 1,000 mcg of vitamin B12 two or three times per week (see pages 214 to 222 for more options), 150 mcg of iodine per day, and 1,000 mcg of vitamin D per day (see pages 222 to 230 for more options). A multivitamin-mineral supplement is also an option, although unnecessary if reliable sources of iodine and vitamins B12 and D are ensured.
Even when consumers are acutely aware of which foods are nutritious, today’s obesogenic environment can lead to less-healthful choices. Strengthening the resolve against this constant temptation requires a heightened awareness of the body’s needs, and consciousness of the enticing environment that can weaken judgment. Consider these proven strategies:
• Listen to body signals. Learn the body’s natural hunger signals to reclaim the lost skill of intuitive eating. Avoid these twin temptations: eating when not hungry or fasting when famished. Sometimes thirst is mistaken for hunger. When hunger strikes, first drink a glass of water and wait fifteen minutes. If hunger is still present, then eat. Plan for regular mealtimes, but be flexible. In the absence of hunger, skip a meal or eat very lightly. Eat slowly and stop when comfortable, but not full.
Recognize when nonphysical “hunger” is triggered by emotions or environment. Fill that “hunger” with an appropriate nonfood option. For example, if you recognize a temptation to indulge in emotional eating, go for a walk, call a friend, or take a bubble bath instead. If a strong emotion, such as anger, triggers hunger, take it out on a punching bag or stomp around the block.
• Eat mindfully. Build healthful habits that make mindless eating less harmful (such as mindlessly eating greens instead of candy). Create a relaxing atmosphere to make meal times special. Eat slowly and chew food well to aid digestion, enhance appreciation of the foods’ flavors, and reduce total food intake. Be conscious of everyone involved in getting food to the table and consume the meal with a grateful heart. Buy from local farmers and local producers and avoid foods that support practices inconsistent with your values.
• Build healthful habits. Keep mealtimes regular; skipping meals can lead to overeating at the next meal. Avoid eating within two to three hours of bedtime; eating drives up insulin levels, triggering fat storage. The body doesn’t need much fuel to sleep, so satisfy true hunger with vegetables or a piece of fruit.
Portion control can be a challenge. Placing serving bowls or platters of food on the table at mealtimes often results in larger servings than those portioned onto plates or into bowls. Begin by using smaller cups, plates, and bowls. Always serve recommended portions on a plate or in a bowl, and sit down to eat. Put the salad and vegetables on the table and leave other foods on the counter or stove after preparing plates or bowls. Because it’s easy to overeat while standing, especially during food preparation, suck on a cinnamon stick or chew some mint to avoid excessive “tasting.”
Be careful not to fall into the “health halo” trap by eating larger servings of foods labeled low-calorie, low-fat, natural, or organic. While such replacements may contain 10 or 15 percent fewer calories, eating larger quantities easily eliminates that advantage.
Finally, keep food out of sight, unless it’s superhealthy and increased intake is desired. Ditto for eating while watching TV. To keep hands occupied, do a craft, catch up on ironing, or do some stretching exercises during viewing.
While being underweight affects people of both genders, it’s less often recognized as a serious problem for women, in whom thinness is prized. Men feel a different sort of pressure when it comes to body shape. For them, low body fat is desirable, but being skinny isn’t. Their goal is usually a buff body, so their quest involves accumulating sufficient muscle mass.
Fortunately, a well-planned vegan diet can support weight-gain goals for both men and women. While modern culture tends to promote the consumption of meat for increasing muscle mass, similar rewards can be reaped by consuming protein-rich plants foods.
Vegans typically have lower BMIs and less body fat than lacto-ovo vegetarians or the general population; most vegans fall within the healthy weight range.12,13,50–53 However, vegans do seem to experience higher rates of underweight compared to the general population, although data is currently very limited.
One German study reported high rates of underweight in raw vegans: 25 percent of raw vegan women and 14.7 percent of raw vegan men who participated in the study were underweight, and the diets of these participants tended to be high in fruits and low in protein.54 This research group also noted very low rates of overweight and obesity in the study’s participants, with only 5 percent of women and 6 percent of men being overweight or obese. A small American study reported that 36 percent of its vegan participants (9 of 25) had BMIs of less than 19. In this report, a significantly greater proportion of vegans fell near or below the BMI cutoff for underweight than expected. Finally, the Oxford Vegetarian Study found that among approximately 11,000 vegetarians and vegans, more than 20 percent had BMIs of 18 to 20. In fact, more of these participants had BMIs under 18 (underweight) than BMIs over 28 (overweight).55 Further research on the rates of underweight in vegan populations and the resulting health consequences is warranted.
While the BMI chart on page 363 provides useful guidelines, its cutoffs aren’t accurate for everyone. Careful consideration of the following factors will help determine whether or not low body weight poses a health risk and warrants treatment:
• State of health. After ruling out an underlying disease (such as cancer) in someone who lacks energy or is weak, often sick, and requires long recovery periods, chances are good that body weight is too low. On the other hand, an individual who is generally in good health, is energetic and seldom sick, and quickly recovers from illness may be at a healthy body weight even if BMI is low.
• Body frame. In people with small frames, BMI sometimes suggests underweight, even when the person is at a healthy weight for his or her size. For example, a healthy, small-boned Asian woman who is 5 feet 4 inches (1.63 m) and weighs 107 pounds (52 kg) has a BMI of 18.4, which is technically underweight. However, considering her bone structure and health status, this woman is likely at a healthy weight. On the other hand, a 5 foot 4 inch (1.63 m) woman with a large bone structure may be underweight at 116 pounds (56.4 kg), despite a BMI well within the healthy range at nearly 20.
If underweight is associated with increased mortality, why do studies on calorie restriction (CR) suggest increased longevity? While it’s not certain, one explanation is that the adverse health outcomes associated with underweight populations are actually a consequence of poverty, malnutrition, poor lifestyle habits, and illness. In contrast, participants in CR studies are generally healthy and reasonably well nourished. Not surprisingly, these associated benefits are lost if the study subjects become malnourished.70
CR is a long-term dietary intervention in which energy intake is reduced by 10 to 30 percent but adequate nutrients are provided. Most epidemiological studies of calorie-deprived human populations are associated with malnutrition and aren’t useful for CR research. The most notable exception is in Okinawa, Japan, where traditionalist Okinawans purposefully restrict their caloric intake by eating until they’re only 80 percent full. Yet, they maintain good nutritional health. In fact, they’re known to live extraordinarily healthy lives and boast one of the largest populations of vigorous centenarians in the world. The Okinawan experience suggests considerable potential for CR diets in maintaining human health.
In clinical studies of animals and organisms, CR has been shown to delay the onset of aging and to increase longevity. CR effectively reduces age-related changes in subject’s energy metabolism, inflammation, and subjects’ many other mediators of health. Two research groups are currently conducting investigations in humans: the National Institute on Aging (NIA) and the Calorie Restriction Society (CR Society). The NIA is performing short-term CR studies in humans. Preliminary evidence suggests that during periods of CR, people exhibit similar adaptive responses as other calorie-restricted species. The CR Society is carrying out long-term studies of adherents who maintain a strict CR-lifestyle regimen. These individuals have been reported to have had favorable changes in metabolic markers for disease.71,72
Although the data on disease-risk indicators have proven favorable, experts are not yet recommending CR as a long-term therapeutic diet for humans. Concerns remain about variability among individuals and safety at their various life-cycle stages (e.g., children, adolescents, pregnant and lactating women, and seniors who are at greater risk for malnutrition). While common sense would suggest avoiding CR during stages of growth and development (e.g., infancy, childhood, adolescence, pregnancy, and lactation) and for those at increased risk for malnutrition, it’s possible that moderate CR will prove useful for some individuals. It’s not easy to meet the needs for all nutrients on low-calorie diets, thus caution is warranted.
• Gender. Men tend to have larger bones and muscles than women, so at any given height, lean men generally weigh more than lean women, even when their body fat percentage is lower. Although the BMI cutoffs are the same for men and women, it’s relatively common for men to be underweight when their BMI is at the lower end of the normal range (i.e., between 18.5 and 20).
• Lifestyle. Underweight is more of a concern in those whose low body weight is due to unhealthy lifestyle practices, such as substance abuse or a poor diet. However, underweight people who eat nutritious plant-based diets, avoid addictive substances, and engage in regular physical activity have low risks for illness.
Underweight is relatively rare in populations with abundant food supplies. Still, hunger due to food scarcity, the most common cause of underweight worldwide, is more prevalent in affluent countries than many realize.
Technically, underweight is the result of insufficient energy intake relative to energy output. However, the causes of weight imbalances are far more complex than textbook calculations might suggest. Physical factors, such as genetics, illness, and chemical dependency, can all play a role. In addition, some individuals are born with lean genes.56 If their metabolic rate is naturally high, these people require more calories than others of similar height and weight to avoid underweight. Psychological factors—depression, eating disorders, stress, abuse, and cultural pressure—also can undermine healthy eating patterns, reduce energy intake, and result in significant, sustained weight loss. Other environmental factors, such as overactivity, social isolation, and poor eating habits (such as restrictive eating or skipping meals), can also lead to underweight.
A vegan diet makes weight maintenance even more challenging because plant foods, which are high in fiber and generally low in fat, cause feelings of fullness with fewer calories. Fortunately, simple steps can ensure healthy weight maintenance after animal products are removed from the menu (see pages 381 to 390).
While most people would rather be underweight than overweight, being underweight is associated with increased mortality. Underweight individuals are generally at greater risk than people who are normal weight or overweight, although they’re at lower risk than the obese.57 In the Oxford Vegetarian Study, the death rate of participants with BMIs below 18 was more than double the death rate of those with BMIs between 20 and 22.55 Research suggests that the association between underweight and mortality is most pronounced in people with poor lifestyle habits, such as smoking, inactivity, and poor vegetable and fruit intake.58,59 Deaths from respiratory diseases and illnesses (apart from cancer and circulatory diseases) are increased in the underweight compared to people in other weight categories. In contrast, mortality from cardiovascular diseases, diabetes, kidney diseases, and some cancers is increased in those who are obese.60
Underweight can also negatively affect immune response and resistance to infection. Poor intakes of protein and calories can compromise the production of antibodies, cytokines, and other compounds necessary for optimal immune function. Even mild single-nutrient deficiencies can threaten immune response. A lack of zinc, selenium, iron, copper, essential fatty acids, and vitamins A, C, D, E, B6, and folic acid can have significant negative impact on the immune system.61–64
Being underweight can also compromise hormone production and action in both males and females. In females, low body fat can prevent ovulation, induce amenorrhea, and reduce fertility.65,66 If conception does occur and weight gain during pregnancy is insufficient, the baby’s development is put at risk, and it’s more likely to be small for its gestational age. In underweight men, sperm count and semen quality can be significantly reduced.67
For nutritious menus and delicious high-protein recipes, all with nutritional analysis, see Cooking Vegan by Vesanto Melina and Joseph Forest (Book Publishing Company, 2012).
Underweight is often associated with multiple nutritional deficiencies. For example, underweight individuals—particularly women of child-bearing age—are at increased risk for iron deficiency, resulting in weakness, fatigue, irritability, and paleness. In some individuals, iron deficiency leads to hair loss and intolerance to cold.
When the body doesn’t receive sufficient calories, it mobilizes energy from glycogen stores (carbohydrates); when these are exhausted, fat is used. Then, the body relies upon stored protein for amino acids and energy, resulting in decreased muscle mass, leading to weakness and fatigue. Underweight can also trigger bone breakdown and decreases in bone density, elevating the risk for osteoporosis.68,69
Deciding to actively pursue weight gain depends on personal body perception. For the most part, men are more inclined to correct an underweight problem than are women because of cultural preferences for muscular men and thin women. The most effective approach to weight gain isn’t so different than it is for weight loss: permanent lifestyle changes that promote and sustain health and wellness.
Underweight vegans also should consider the ultimate goals of a vegan lifestyle. A positive personal example is a powerful tool to motivate others toward adopting a more compassionate and sustainable lifestyle. However, underweight and generally unhealthy vegans fail to provide the kind of inspiration for dietary change that is often hoped for.
1. Increase food intake. In theory, adding 500 calories per day results in a gain of 1 pound per week, but in reality, caloric needs for weight gain can vary considerably from person to person. Most underweight adults require between 2,500 and 4,000 calories per day to gain weight, and competitive athletes need more. To reach this goal, select energy-dense vegan foods and increase serving sizes. Begin by following The Vegan Plate (see pages 434 to 435); include extra servings from each group, as needed. This will not only increase calorie intakes to recommended levels but also will ensure that nutrient needs are being met. A 2,500- to 2,800-calorie menu is provided on page 441, and a 4,000-calorie menu is provided on page 442. Table 12.2 (page 382) presents general guidelines on the daily number of servings from each food group needed to achieve 2,500- and 4,000-calorie diets. Ideally, these foods should be consumed throughout the day, including a bedtime snack (with other snacks as desired).
TABLE 12.2. Suggested servings for weight gain
Source:73
*Serving sizes provided in The Vegan Plate (pages 434 to 435)
**1 serving = 1 tsp.
2. Eat more often. Snacking between meals and before bedtime plays an important role in weight gain. It’s difficult to consume sufficient calories when eating only one or two meals a day. Aim for three meals a day, plus two or three hearty snacks. Avoid skipping meals or going to bed on an empty stomach. A timer can be used to remind those who are likely to forget to eat. If mornings are rushed, a lunch and snacks can be made the night before.
Add at least 500 calories more per day to the current diet. These snack options provide approximately 500 calories each:
• ¾ cup (185 ml) of trail mix (nuts, seeds, and dried fruits)
• ⅓ cup (165 ml) of nuts
• a smoothie (see recipe on page 387)
• a smoothie (see recipe on page 387)
• 1 almond butter and banana sandwich plus 1 cup (250 ml) of fortified soy milk (or hot chocolate made with soy milk)
• ¾ cup (185 ml) of granola, 1 banana, and 1½ cups (375 ml) of fortified soy milk
• 20 crackers, 2 ounces (60 g) of vegan cheese, 4 veggie meat slices, and 10 olives
• 1 vegan muffin or energy bar, 1 cup (250 ml) of coconut yogurt, and an apple
• 2 ounces (60 g) of baked pita chips and ½ cup (125 ml) each of salsa, refried beans, and guacamole
3. Sneak in extra calories. Whole plant foods, especially fruits and vegetables, can be high in fiber, low in fat, and relatively low in calories. When such foods predominate in the diet, they can be filling without providing sufficient calories for weight gain. When more high-calorie foods are consumed, not only does energy intake improve, but favorite dishes also become more appealing. The following suggestions will add calories, nutrients, and flavor:
• Garnish a salad with beans, nuts, seeds, tofu, and avocado. Prepare a dressing using nut or seed butters, avocado, or high-quality oils.
• Add a creamy sauce to steamed vegetables.
• Include tofu, nuts, or seeds in stir-fries, casseroles, and pasta dishes.
• Top diced fruits with soy yogurt, granola, and cinnamon.
• Cook breakfast cereal (e.g., whole grains or oats) in nondairy milk. Add chopped nuts, seeds, and dried fruits.
• Spread nut butter on muffins or toast.
• Use full-fat nondairy milk (such as soy milk) instead of lighter varieties.
• Top vegan ice cream with nuts, dark chocolate pieces, and berries.
• Dip cut-up fruit in a vegan avocado/chocolate mousse.
• Add cashew cream (purée ½ cup/125 ml cashews with 1 cup/250 ml water) or coconut milk to soups and sauces.
4. Use beverages to boost calories. Including nutritious calorie-rich fluids increases total energy intake with little effort. One cup (250 ml) of fruit juice (fresh-squeezed is best) provides 120 to 180 calories, 1 cup (250 ml) of soy milk about 100 to 120 calories, and a soy/fruit shake about 400 to 500 calories. Limit the amount of other liquids taken with meals, because low-calorie soups or calorie-free coffee and tea take up space in the stomach and can reduce consumption of higher-calorie solid foods. Those who have difficulty eating larger portions at mealtime can try reserving fluids for between meals.
TABLE 12.3. Energy content of selected high-fat foods
Source:73
*Calorie count for commercial products from package labels.
5. Eat higher-fat whole vegan foods. Because vegan diets are generally higher in fiber and lower in fat than nonvegan diets, the easiest way to add energy without adding too much extra food volume is to increase fat intake. Aim for 20 to 35 percent of calories from fat. Among the most energy-dense plant foods are nuts, seeds, soy nuts, tofu, coconut, nondairy products (milks, creams, cheeses, and yogurts), avocados, oils, energy bars, nutritious baked goods, and dark chocolate. Table 12.3 (page 383) provides the approximate calorie content of a variety of high-calorie vegan foods. Specific suggestions on how to add energy-dense foods to meals and snacks are listed below:
Nuts, seeds, and their butters. Nuts and seeds are convenient snacks. Eat ½ to 1 cup (125 to 250 ml) daily.
• Keep a bag of nuts and/or seeds wherever you spend most of your time (work, school, and so forth).
• Use nuts and seeds to make vegan cheeses or sauces.
• Add nuts and seeds to vegetable-based roasts, patties, and stir-fries.
• Sprinkle roasted nuts and seeds on salads.
• Add nuts and seeds to baked goods, pancakes, and waffles.
• Eat nut- and/or seed-based power bars.
• Use nut butters on toast and bread and in dressings.
• Give soy nuts a try.
• Spread nut butter or tahini on apple slices or celery sticks.
Tofu. Tofu is a wonderfully versatile, low-fiber, relatively high-fat vegan food.
• Add soft tofu to shakes and smoothies.
• Enjoy scrambled tofu for breakfast.
• Use flavored tofu or tofu-based eggless salad in sandwiches.
• Sauté chopped or grated tofu with a little oil, tamari, nutritional yeast, and herbs to make a salad topping.
• Add tofu to stir-fries, stews, curries, Asian soups, and lasagne.
• Use tofu to make vegetable-based roasts and patties.
• Enjoy marinated baked or barbecued tofu.
• Make tofu puddings and cheesecake; use tofu in cakes, muffins, and cookies.
Nondairy products. Nondairy foods can significantly increase energy intakes. Vegan replacements for most dairy products—including milk, cream, sour cream, ice cream, hard cheese, cream cheese, yogurt, and butter—are widely available. Some are soy-based, while others are made from almonds, rice, coconut, hempseeds, grains, or root vegetables. These products continue to evolve and are often both tasty and nutritious. Avoid dairy substitutes based on partially hydrogenated oils, sugar, and preservatives; always read the ingredient list before buying. Instead, for example, choose full-fat commercial soy milk made from whole organic soybeans.
It’s not difficult to prepare nondairy foods for complete control over ingredients. Make almond or hempseed milk, fermented cashew cheese, fruit-based ice cream, or soy yogurt.
Work more of these products into a daily menu:
• Choose fortified nondairy milk and/or yogurt for smoothies instead of water.
• Use nondairy milk and yogurt in cereals, puddings, soups, pancakes, and baked goods.
• Enjoy nondairy yogurt as a base for desserts; add berries and granola or nuts.
• Add vegan mayonnaise to sandwiches and salads, and use vegan sour cream as a base for dips or a topping for soups (make versions that use cashews or tofu).
• Experiment with nut-based cheeses; both hard cheeses and cream cheese can be prepared from scratch.
Avocados. Avocados pack a lot of calories into a small package and provide exceptional flavor and incredible versatility:
• Dress up a salad with wedges of avocado.
• Mash with lemon or lime juice for dips, sandwich spreads, and toppings.
• Add avocado chunks to salsa.
• Use avocado pieces in vegetable pita sandwiches.
• Add diced avocado to pasta or quinoa salads.
• Use blended avocado to add richness to chocolate pudding.
• Add to mashed potatoes.
Sweet treats. With the right ingredients, sweet treats can make a valuable contribution to a daily calorie count:
• Raw versions of cheesecakes, pies, cookies, and brownies are based on nuts, coconut, and dried and fresh fruits, so they generally provide nutrient-dense calories. See recipes in Becoming Raw by Brenda Davis and Vesanto Melina (Book Publishing Company, 2010.)
• Include nuts, seeds, coconut, and their butters as some or all of the fat in baked goods.
• Use ground flaxseeds as an egg replacer.
• Select recipes that use dates and other dried fruits for a sweetener instead of sugar.
• Use high-quality oils instead of hydrogenated fats in baking.
6. Be generous with carbohydrates. Aim for about 55 to 65 percent of calories from carbohydrates. The most concentrated sources are grains and starchy vegetables. Excellent choices are high-protein pseudograins (such as amaranth, buckwheat, and quinoa) and nutrient-dense, colorful, starchy vegetables (such as corn, squash, yams, and purple potatoes).
• Soak and sprout grains to use in cereals and salads, breads, and raw or baked treats.
• Cook intact grains and use in salads, stews, pilafs, and cereals.
• Top baked yams or sweet potatoes with spicy black-bean peanut sauce.
• Add cooked yams or sweet potatoes to salads.
• Enjoy breads with hummus or other legume-based spreads.
• Add potatoes to curries, stews, and scrambled tofu.
• Use whole-grain flours with added wheat germ to make breads, muffins, pancakes, and waffles.
• Add corn to marinated salads, soups, and stews.
7. Push plant protein. For the underweight who have lost muscle, an intake of approximately 1.2 to 1.7 grams of protein per kilogram of body weight per day is recommended to regain muscle mass. For a person who isn’t aiming for big muscle gains, an intake of 1.2 g/kg/day is usually sufficient.
TABLE 12.4. Protein-rich food replacements
Source:73
MAKES 1 SERVING
Smoothies are an exceptional vehicle for adding protein, calories, and nutrients to a vegan diet. Blending foods breaks down plant cell walls, making the nutrients highly available for absorption. For ice-cold smoothies, use frozen fruit (peel bananas before freezing) or add a few ice cubes before blending.
1 scoop protein powder
1 banana
1 cup (250 ml) berries, peaches, or other fruit
1½ cups (375 ml) fortified soy milk or other nondairy fortified milk
Put all the ingredients in a blender and process until smooth. Drink immediately.
Provides approximately 400 to 500 calories and about 30 to 40 grams of protein, depending on milk selected.
Superb Smoothie Boosters
Smoothie boosters and variations can add significant fat and calories (e.g., seeds, nuts, seed or nut butters, avocado, tofu, or oils); some add phytochemicals and antioxidants (e.g., kale, cocoa or carob powder, herbs, spices, or goji berries); others add beneficial bacteria (e.g., probiotic powder or nondairy yogurt). Add any one or more of the following items to the basic recipe above:
• 2 cups (500 ml) chopped kale for a green smoothie
• ½ small avocado (best in a green smoothie)
• Fresh herbs, such as mint, oregano, and basil (in green smoothies)
• ½ cup (125 ml) soy yogurt or other nondairy yogurt; reduce soy milk in the basic recipe to 1 cup (250 ml), if desired
• ¼ to ½ cup (60 to 125 ml) soft tofu
• 2 tablespoons (30 ml) goji berries (soak dried berries at least 4 hours or overnight)
• Cinnamon, nutmeg, ginger, and/or cloves (in fruit smoothies)
• 2 tablespoons (30 ml) hempseeds, flaxseeds, or chia seeds
• 1 to 1½ tablespoons (15 to 22 ml) cocoa or carob powder
• 1 tablespoon (15 ml) cold-pressed EFA oil (try one with added DHA)
• 1 tablespoon (15 ml) almond or other nut butter
• ¼ teaspoon powdered probiotics
Calculate protein needs based on ideal body weight, not actual body weight. For example, a person who weighs 120 pounds (55 kg), whose healthy weight is 145 pounds (66 kg), should aim to eat at least 80 grams of protein per day (66 kg × 1.2 g/kg = 79.2 g). This intake level isn’t difficult to achieve on a weight-gain diet. If 2,500 calories and 80 grams of protein are consumed daily, approximately 13 percent of calories are provided by the protein (80 grams of protein × 4 calories per gram = 320 calories; 320/2,500 = 12.8 percent). This target puts protein intake in the recommended range of 10 to 15 percent of calories from protein, which is sufficient for good health. (See protein contents of menus on pages 439 to 442.)
Vegan diets can fall short on protein, particularly when legume-based foods, nuts, and seeds are avoided. With a diet of cold cereal and rice milk for breakfast; a tomato sandwich and fries for lunch, and pasta with pesto for dinner, protein intake will be insufficient. Ensure a good source of protein with every meal. Table 12.4 (page 386) provides suggestions for replacing low-protein foods with higher-protein options. For a comprehensive list of the protein content of plant foods, see table 3.5 on pages 97 to 103.
For people who have difficulty meeting protein needs, vegan protein powder is an option. A wide variety of products are available (protein derived from hempseeds, peas, rice, soy, and other plant foods). Adding protein powder to a smoothie is easy and delicious (see recipe on page 387).
8. Make healthy eating a priority. For those who often find their cupboards bare, and who eat mainly out of boxes and bags, significant lifestyle adjustments may be necessary to achieve weight-gain goals. To succeed, begin with a plan:
• Make a weekly menu, prepare a shopping list, and select a weekly shopping day.
• Order in bulk, if possible. Look into co-ops, buying clubs, and organic delivery services.
• Learn to cook. Take lessons; go with a friend to make it fun.
• Make eating a social event. Eat with friends and family more often. Host a potluck, invite someone to dinner, or enjoy a meal at a vegetarian or vegan restaurant. (See links to vegan-friendly restaurants in Resources on page 450.)
• Invest in simple vegan cookbooks and try new recipes periodically to increase variety.
• Buy a slow cooker. Put ingredients in the slow cooker in the morning (following the manufacturer’s recommendations) and come home to a hot meal. Use slow cookers to prepare dishes with grains, beans, vegetables, and/or tofu; try a variety of slow-cooker recipes to make best use of this appliance.
• Cook ahead on weekends to prepare meals that can be easily reheated later. Make one or two main dishes, a soup, and some healthy baked goods and prepare enough to last several days. Freeze the extras for days when there’s no time to cook.
• Keep the pantry, refrigerator, and freezer well stocked with healthy snacks: trail mix, power bars, muffins, healthy cookies, frozen bananas covered in chocolate and rolled in nuts, raw cheesecake, and similar foods. Keep a few goodies in the car, in a purse or backpack, at work, or anywhere you spend a lot of time.
• Keep the blender handy; use it daily to prepare smoothies, sauces, and homemade nut or seed milks and creams.
• Increase food intake.
• Eat more often.
• Sneak in extra calories.
• Use beverages to boost calories.
• Eat higher-fat whole vegan foods.
• Be generous with carbohydrates.
• Push plant protein.
• Make healthy eating a priority.
• Feed hunger; fuel appetite.
• Carefully consider the pros and cons of supplements and weight-gain aids.
9. Feed hunger; fuel appetite. Some people rarely feel hungry; they may have a small appetite or a small stomach. However, hunger and appetite can be affected by moods, stress levels, and physical activity. Try these strategies to improve appetite:
• Increase food intake gradually, allowing the stomach to expand slowly over time.
• Focus on energy-dense foods that take up less space in the stomach per calorie. Good examples are nuts, seeds, dried fruits, beans, avocado, and tofu. Mashing and puréeing foods can also help reduce their volume.
• Stimulate hunger with tempting aromas. Make bread or buy frozen dough and bake it. Put a few cinnamon sticks and cloves in water and simmer on the stove. Inhale enticing aromas at fresh food stands, bakeries, and restaurants.
• Peruse magazines and cookbooks with beautiful photographs of food and try the recipes.
• Choose larger bowls, plates, cups, and cutlery. Using bigger dishes, forks, and spoons has been shown to increase total food intake.
• Eat several courses; instead of one big plate of food, have four courses at the main meal. A variety of different aromas and tastes is more appetizing.
• Honor hunger. At the first signs of hunger, eat as soon as possible. If hunger doesn’t strike by mealtime and a full meal is unappealing, consider having a nutritious beverage (such as a smoothie) or a substantial snack instead.
• Notice if certain foods cause gastrointestinal distress (gas, bloating, or stomach upset), which can reduce appetite and food intake. Some people discover that their body can handle these foods when it’s functioning at its best (for some, that’s in the morning, for others, it’s at night). Some foods, such as beans, are naturally gas-forming, and it can take the body time to adjust to increased consumption. If this is an issue, eat small servings and gradually increase portion sizes. See pages 157 to 160 for tips on reducing gas production from beans.
10. Carefully consider the pros and cons of supplements and weight-gainaids. Dozens of weight-gain aids are available, though most are designed for body builders who aren’t underweight. Investigate the risks and benefits before trying a new supplement. Although some may prove helpful, others are a waste of money or are potentially harmful. The US Food and Drug Administration provides information online regarding bodybuilding products that contain hidden ingredients considered unsafe. Supplements intended for bodybuilding athletes are reviewed on pages 422 to 425.
Health care providers may suggest appetite stimulants to support weight-gain efforts. Although these can be effective, some have undesirable side effects. It’s best to use other strategies to increase food intake.
A multivitamin-mineral supplement may be helpful, especially for individuals struggling to improve the quality and consistency of their diet. Select a supplement that provides zinc, magnesium, chromium, selenium, and possibly iron (have iron levels tested to see if additional iron would be beneficial). Vegans require supplements of vitamin B12 (if insufficient fortified foods are selected), vitamin D (if sunshine exposure is limited), and iodine (if iodized salt isn’t used).
When constant thoughts of food and eating, and unnatural concerns about weight and body shape, negatively affect a person’s physical or emotional health and day-to-day functioning, the possibility of an eating disorder must be considered.
The image that most often springs to mind when people think of eating disorders is that of a young, emaciated woman with anorexia nervosa. Unfortunately, it’s been rumored that being vegan is a trigger for eating disorders. However, whether an individual has an eating disorder isn’t determined by body weight, gender, or dietary pattern, but rather by state of mind. Eating disorders are characterized by extreme emotions, attitudes, and behaviors toward food, eating, and body weight and shape. They’re serious psychological conditions, and their presence can result in life-threatening physical consequences. In fact, eating disorders have the highest death rates of all mental illnesses.73
The good news: eating disorders are highly treatable and completely curable. For someone at risk, this section provides the information, support, and reassurance needed to start down the road to recovery.
The American Psychiatric Association recognizes eight distinct eating and feeding disorders—the three most widely recognized are anorexia nervosa, bulimia nervosa, and binge-eating disorder (BED).75
Anorexia nervosa is characterized by self-starvation that results in extreme thinness. There are two distinct subtypes of anorexia nervosa: the restricting type (weight loss is achieved by restricting food intake) and the bingeing/purging type (weight loss is achieved through bingeing and purging or a combination of restricting and bingeing/purging). Of those suffering from anorexia nervosa, 90 to 95 percent are female. The disorder generally appears in adolescence, with 40 percent of newly identified cases being 15- to 19-year-old girls.76 Death rates are as high as 5 to 20 percent, although one recent report estimated the death rate at 4 percent.77
Affected individuals go to great lengths to achieve weight loss, often building elaborate rituals around food, eating, and exercise. Food is generally viewed as the enemy, and the ultimate goal is to achieve complete control over eating, calories, and body weight. Cessation of menstruation is a common feature in females but was removed as a diagnosis criteria in 2013, because it can’t be applied to males or to females who are premenarchal, postmenopausal, or taking oral contraceptives. Three primary criteria are used for diagnosis:75
1. Weight loss. Persistent restriction of energy intake leading to significantly low body weight (in the context of what’s minimally expected for age, sex, developmental trajectory, and physical health).
2. Fear of weight gain. Either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight).
3. Distorted body image. Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Bulimia nervosa or bulimia is typified by recurrent cycles of binge eating and behaviors that attempt to compensate for calories consumed. There are two primary methods of compensation: purging (which includes vomiting or taking laxatives, diuretics, or enemas) and nonpurging (which generally involves fasting or exercise). The primary feature that distinguishes bulimia nervosa from anorexia nervosa is body weight. Although people with bulimia experience considerable weight fluctuations, their weight is generally within a normal weight range and they aren’t underweight. While bulimia affects a disproportionate number of females, as many as 20 percent of sufferers are male.78 Some evidence suggests that those with a history of addictions, compulsive disorders, or affective conditions may be at increased risk. Diagnosis of bulimia nervosa is dependent on five criteria:75
1. Binge eating. Recurrent episodes of binge eating (eating an unusually large amount of food; a lack of control over eating during the episode).
2. Compensatory behaviors. Recurrent, inappropriate compensatory behavior to prevent weight gain (e.g., self-induced vomiting; excessive exercise; fasting; and misuse of laxative, diuretics, enemas, or medications).
3. Frequent binge/purge episodes. Episodes occur at least once a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. Absence of anorexia nervosa.
Binge-eating disorder (BED) is characterized by periods of obsessive, uncontrolled consumption of large amounts of food. Eating often takes place quickly and in isolation and is frequently followed by feelings of guilt, disgust, and/or shame. While people with BED don’t purge, many do attempt to periodically restrict food intake through dieting or fasting. BED is much more severe than overeating and is associated with distress regarding the eating behavior and co-occurring psychological issues. It’s more common in men than other eating disorders, with about 35 percent of those affected being male.79 Approximately two-thirds of sufferers are obese, although some are just overweight or even normal weight.80 While BED is even more common than anorexia nervosa or bulimia nervosa, it was only in 2013 that it was acknowledged as a diagnosis in its own right (it had previously been considered an eating disorder not otherwise specified (EDNOS). Diagnosis of BED is dependent on five criteria:75
1. Binge eating. Recurrent episodes of binge eating (eating an unusually large amount of food; a lack of control over eating during the episode).
2. Unusual eating behaviors and feelings associated with behaviors. Binge-eating episodes are associated with at least three of the following:
• eating much more rapidly than normal
• eating until feeling uncomfortably full
• eating large amounts of food when not feeling physically hungry
• eating alone because of feeling embarrassed by how much one is eating
• feeling disgusted with oneself, depressed, or very guilty afterward
3. Marked distress regarding eating is present.
4. Frequent binge episodes. Binge eating occurs, on average, at least once a week for three months.
5. Lack of compensatory behaviors. Not associated with compensatory behaviors, as in bulimia nervosa or anorexia nervosa.
Eating disorders that don’t meet the diagnostic criteria for anorexia nervosa, bulimia nervosa, or BED generally fall into “other” categories, such as Other Specified Feeding or Eating Disorder (OSFED) or Avoidant/Restrictive Food Intake Disorder (ARFID). The body weights of people suffering from these less well-recognized eating disorders can range from seriously underweight to morbidly obese. It’s important to note that just because these eating disorders categories are less well-known, it doesn’t mean that they’re less severe. A recent study reported death rates of 5.2 percent among those suffering from these “other” eating disorders, compared to about 4 percent for those with anorexia nervosa or bulimia.77
An eating aberration that doesn’t fit into any of the recognized eating-disorder categories is called Unspecified Feeding or Eating Disorder (UFED). Examples may include orthorexia and diabulimia. Orthorexia describes an extreme obsession with eating a perfect diet, often leading to instability and social isolation. The obsession is with health and purity rather than body weight. Only foods viewed as clean or health supportive are consumed. Food preparation techniques are selective and often exclude the use of frying and barbecuing. While these are wise choices, the person with orthorexia takes the pursuit of a healthful diet to a pathological level, harming emotional—and possibly physical—well-being. Diabulimia refers to a condition in which people with type 1 diabetes minimize insulin doses in an effort to reduce fat storage (insulin encourages fat storage). This action can cause chronically elevated blood sugars, increasing the risk of ketoacidosis and other complications of diabetes.
Eating disorders are the product of a complex interplay of biological, psychological, family, social, and cultural factors, as well as a manifestation of unresolved emotional challenges. The complexity is compounded by the fact that eating disorders involve an obsession with or an addiction to food—a substance absolutely essential to life.
Biological and genetic factors at least partly determine character and psychological makeup. If a close family member, such as a mother or sister, suffered from an eating disorder, risk is consistently elevated.81
Certain psychological traits also increase risk. People with a natural tendency toward obsessive-compulsive behavior or perfectionism are more susceptible. Affected individuals are often overly concerned about how others perceive them and have difficulty dealing with criticism. In spite of intelligence, work ethic, and notable achievements, they see themselves as inadequate. Many lack self-esteem, personal identity, and independence, and the eating disorder serves as a source of personal control. Often, sufferers see the world as black and white. For example, if being thin is good, being thinner must be better, and being the thinnest is clearly best.
Some families contribute to eating disorders by being overprotective, controlling, rigid, and enmeshed. These tendencies reinforce problems with self-esteem and personal identity. Other families contribute by being emotionally cool or absent, while at the same time having high expectations surrounding physical appearance, achievement, and success. This can leave the affected individual feeling judged, misunderstood, and alone. Difficulty with conflict resolution and failure to share doubts, fears, and anxieties are also commonly reported. Finally, some evidence suggests that parents who set very restrictive rules around food and eating may inadvertently increase risk.82
Socially vulnerable individuals can be pressured into an obsession with weight and food by friends, lovers, or colleagues. Peer pressure can extend into the classroom, the gym, a college dorm, or a dance company. People who feel like outsiders, outcasts, or recluses may lack the kinds of deep social connections needed to allay doubts, fears, and insecurities.
Culture has a profound and powerful influence on the risk of developing an eating disorder. The Western world so highly prizes thinness in women that body weight has a tangible impact on success, employment, power, popularity, and romance. Many women become conditioned to link their self-worth with a number on weight scales. The pressure is further strengthened by the media; the ideal woman is portrayed as young and thin, while the ideal man, regardless of age, is portrayed as strong and fit.
You are not in control of your life when you have an eating disorder; the eating disorder is completely in control of you.
The disorder masquerades as an ally that helps a person reach an ultimate goal. But in reality, it serves only to make sufferers feel like failures, by convincing them that thinness is the only ticket to being beautiful and valued as a human being. The truth is so much sweeter.
“The beauty in your heart is permanent and pure. The exterior is temporary and fleeting. Beauty shines from a light in your heart.”
HEATHER WAXMAN,
NUTRITIONIST, RECOVERED ANOREXIC
These gender differences help to explain why the vast majority of eating disorders occur in women. Although girls and women attempt to emulate popular celebrities, few recognize that about a third of these women are technically underweight. This compares to less than 5 percent of the adult female population.83 Fashion models are even more underweight, with a dangerously low average BMI of about 16.8. The discrepancy between the body weight of models and the general population has widened over the years; models have become thinner and the public has become fatter. The average American woman was at the upper limit of normal weight in the early 1960s with a BMI of 24.9; she’s now overweight with a BMI of 28.4.
The pressure to achieve and maintain a lean physique is magnified in athletes (e.g., dancers, gymnasts, skaters, distance runners, swimmers, and divers). The term “female athlete triad” is commonly used to describe female athletes who exhibit eating disorders, amenorrhea, and eventual osteoporosis. Overzealous coaches and teachers, who encourage dieting and weight loss, often only compound the problem.
A full-blown eating disorder can be initiated by something as trivial as a derogatory comment, as traumatic as a rape, or anything in between. One of the most common triggers is dieting. If weight is lost, the fear of regaining the lost weight can spark an obsession. Often, the disorder begins during a period of increased challenges or responsibilities that the affected individual feels ill-equipped to handle. This may involve a significant life change or loss. Examples include the death of a family member or friend, a move, a change of school, graduation, a divorce, relationship problems, or the onset of puberty. In a fruitless effort, the person attempts to gain control by restricting food intake, bingeing, purging, and exercising or otherwise manipulating food and eating.
How can “normal” concerns about weight and shape be distinguished from those that cross the dangerous line of an eating disorder? In the early stages, it can be challenging for family and friends to know for sure, but the sooner a diagnosis is made, the better the person’s chances of a full recovery.
Many red flags suggest the presence of an eating disorder. Some relate to eating and purging behaviors, others to exercise, attitudes, and social behaviors. For example, an individual might create multiple rituals and rules around food and eating, be obsessive about label reading, or lie about food intake. A sufferer may have a nervous response if “caught” eating or may run water in the bathroom to cover the sounds of vomiting. The person may never be satisfied that her body is thin enough and may compulsively exercise beyond what is necessary or healthy. A vegan with an eating disorder might refuse to consume healthy high-calorie vegan food. When taken together, many such warning signs can point to a serious problem (see Resources on page 450).
Eating disorders can lead to serious physiological changes that signal the need for medical intervention. The physical signs and symptoms of eating disorders can be broadly divided into three categories. Those stemming from starvation (as seen with anorexia nervosa) include swelling of the abdomen, cold hands and feet, and extreme thinness. Purging (as seen with bulimia nervosa and binge/purge anorexics) can result in erosion of the teeth, disorders of the esophagus, and swelling of the hands and face. Binge eating or overconsumption (as seen with BED) can lead to many of the same health concerns as being overweight. For all these disorders, there’s increased risk of heart disease, digestive problems, and liver and kidney damage.
Many experts believe that vegan diets (and other types of vegetarian diets) can increase the risk of eating disorders. Some treatment centers consider the reintroduction of meat a necessary part of recovery.
These beliefs are based on data released between 1997 and 2009 that reported significantly higher rates of disturbed-eating attitudes and behaviors, restrained eating, and disordered eating among vegetarians compared to nonvegetarians.84–88 Currently, approximately 50 percent of adolescents and young women with anorexia nervosa eat some form of vegetarian diet; whereas only 6 to 34 percent of their nonanorexic peers in the general population eat a vegetarian diet.89
Although one might logically conclude that vegetarian diets cause eating disorders, evidence indicates that vegetarian diets are typically adopted after onset and simply mask eating disorders. In other words, vegetarian diets are used as a means to facilitate calorie restriction and legitimize the removal of high-fat, high-calorie animal products, and processed or fast foods made with these products.89,90 One research team quite appropriately labeled this phenomenon “pseudovegetarianism.”91
This isn’t to say that vegetarians can’t develop eating disorders or that individuals with eating disorders won’t decide to become bona fide vegetarians while they’re ill. Both possibilities exist. However, true vegetarians can typically be distinguished by their motivation. A 2013 study of 160 women (93 with eating disorders and 67 controls) examined the motivation for becoming vegetarian in those who were vegetarian or who had ever been vegetarian. Almost half the participants with a history of eating disorders cited weight concerns as a primary motivation for becoming vegetarian; in the control group, none of the participants became vegetarian as a result of concerns about body weight.89
In 2012, two research papers provided valuable insights into the supposed link between vegetarianism and eating disorders. The first paper reported that vegetarians and pescovegetarians weren’t more restrained in their eating patterns than omnivores; however, semivegetarians (no red meat consumption) and flexitarians (occasional red meat consumption) were significantly more restrained than omnivores or vegetarians.92 In addition, the fewer animal products the vegetarians ate (in other words, the more vegan they became), the less likely they were to exhibit signs of disordered eating. The authors noted that while the semivegetarians and flexitarians were motivated by weight concerns, vegetarians and pescovegetarians were motivated by ethical concerns.
The second paper (which included two separate studies) carefully separated true vegetarians and vegans from semivegetarians and omnivores.93 The findings added to the evidence suggesting that semivegetarians are at greater risk for disordered eating than omnivores or vegetarians. The investigators found that vegans had the healthiest scores of all dietary groups and speculated that vegan diets may actually be protective against developing eating disorders.93 Although these are preliminary findings, they do effectively challenge conventional thinking. Furthermore, the conclusion makes sense, given the other-directedness of vegans (their concern for animals and the environment) as opposed to the inner-directed nature of eating disorders.
To provide effective treatment for vegetarians with eating disorders, the first determination must be whether the patient is a true vegetarian or a pseudovegetarian. If the individual is a pseudovegetarian, the reintroduction of animal products can reasonably be considered a valid step in the normalization of eating. On the other hand, the reintroduction of animal products is unnecessary and potentially damaging for true vegetarians or vegans. Individuals who are ethically committed to a vegetarian or vegan lifestyle will resist any attempts to force them to forgo their values. They’ll feel disrespected and disconnected, making it difficult for them to trust their health care providers and work honestly at recovery. For true vegetarians, the addition of higher-fat, higher-calorie vegetarian foods is recommended. For vegans, this includes nuts, seeds, nut butters, avocados, tofu, legumes, starchy vegetables, and whole grains.
Vegans and vegetarians who have eating disorders should ask themselves this question: Was the decision to become vegetarian influenced by a desire to achieve a lower body weight—and is this still true? Some who initially select a vegetarian or vegan diet as a means of eliminating fattening food end up becoming convinced by the ethical, ecological, or health arguments in favor of this eating pattern. Although returning to an omnivorous diet is a part of recovery for some individuals, it’s not necessary for everyone; recovery doesn’t require eating animal foods again. Vegans and vegetarians can achieve complete recovery without forsaking the beliefs and values of this empathetic lifestyle.
The first step to reclaiming a healthy lifestyle is acknowledging the eating disorder. Sufferers may resist taking this first step because they’re terrified that getting help means getting fat or losing what seems like the only part of life under their control.
Recovery requires the acceptance of a simple truth: An eating disorder can result from a quest for perfection in everyday life. However, affected individuals must realize that an eating disorder is not a means of control. If fact, being controlled by an eating disorder results in forgoing opportunities to realize other hopes and dreams. When a quest to be the thinnest of the thin succeeds, the only “reward” may be death. No one will celebrate this as an achievement. Instead, they’ll mourn the tragic loss of a kind, intelligent, and beloved daughter, sister, mother, friend, and colleague.
To overcome an eating disorder, vegans must learn to treat themselves with the sort of compassion that they strive for in their interactions with people and with animals. They need to celebrate each step toward health, even if it’s a single step; to be positive, patient, and gentle with themselves; and to redirect their focus from food to other essential components of a truly meaningful life.
Unfortunately, BED sufferers may have an even harder struggle, because health authorities are just beginning to recognize this condition as a bona fide eating disorder. Health care providers may assume that overweight is the result of overeating and laziness, and instruct sufferers to simply eat less and exercise more.
The various eating disorders are separated by a very fine line. However, the first step in overcoming any eating disorder is to admit there’s a problem and to seek help.
Eating disorders begin as psychological disorders that can produce serious physiological consequences, becoming a disease of both mind and body. Treating only the mind can be a grave error, because malnutrition itself can create alterations in the mind. However, treating only the body is an even more serious error; such treatment neglects the roots of the problem and may mask the symptoms but aggravate the condition.
A complete recovery is possible; however, the healing process may take months or even years. An effective treatment program requires a holistic approach that addresses both causes and consequences. This is best accomplished by a multidisciplinary team that offers consistent, ongoing support.
A trusted family doctor can provide a reference to the appropriate treatment center, where the physiological and psychological consequences of the particular disorder will be medically assessed. For many affected individuals, initiation of appropriate treatment and monitoring by an experienced eating-disorders team is necessary. For those suffering anorexia nervosa, hospitalization is often required for initial treatment, while those with bulimia less often need crisis intervention. For those with BED or an EDNOS that’s less well recognized by health professionals, it’s essential to collect information on these eating disorders to present to the doctor.
Soon after a medical assessment is completed, individual counseling with an experienced therapist should begin. This part of treatment addresses the underlying issues of control, ineffectiveness, and autonomy and explores any traumatic events or abuse that may have contributed to the disorder. Such treatment assists in building self-confidence and independence and in regaining control over daily life. Some individuals also benefit from group therapy, which can help build relationships and break down feelings of isolation and alienation.
Family therapy, while not essential for everyone, is extremely important for younger patients, for whom the family is still a strong influence. Family therapy addresses many of the destructive patterns of interaction that feed the disease, in turn helping to create new and healthier family dynamics.
Nutrition counseling is an integral part of recovery; the primary goal is the normalization of eating. This part of treatment directly addresses food and eating behaviors. Normal eating helps to restore a healthy nutritional status, emotional state, and overall well-being. This means eating a wide variety of foods in amounts that support appropriate body weight and reintroducing foods that have been eliminated due to their caloric and/or fat content. Vegans with eating disorders will need to incorporate higher-fat, higher-calorie plant foods in their diet.
During treatment, ethically committed vegans may experience some pressure to add meat, eggs, and dairy products to their diets. However, such additions aren’t essential; a person can uphold his or her vegan values and consume a diet that’s balanced and nutritionally adequate. Gather resources for support; this section and the articles referenced in it would be a good starting point. Conversely, for pseudovegetarians, the reintroduction of animal products is generally considered an important step in recovery.
Although the next section is meant as a guide, it isn’t a replacement for proper treatment by a team of experts on eating disorders. Vegans who want to bolster any formal treatment can follow the suggested steps to return to normal eating, and refer to The Vegan Plate on page 434 for further information. In addition, the “Lifelong Solutions for Weighty Matters” section on page 365 offers helpful advice.
1. Eat at least three meals a day, plus one to three snacks. Smaller meals are easier to eat and are less likely to lead to a bloated feeling. Ideally, include breakfast, a small mid-morning snack, lunch, a mid-afternoon snack, dinner, and a small evening snack.
2. Practice mechanical eating until the body heals itself. Normal hunger and satiety signals may be performing poorly. Until normal function of these signals returns, eat set amounts of food at predetermined times. (A registered dietitian can set up an acceptable program that meets nutritional needs.) A sample mechanical program follows:
• Breakfast (7 a.m.): 1 cup (250 ml) of whole-grain cereal, 2 tablespoons (30 ml) of walnuts, 1 cup (250 ml) of fortified soy milk, ½ cup (125 ml) of berries.
• Morning snack (10 a.m.): 1 fresh apple with 1 tablespoon (15 ml) of almond butter
• Lunch (12:30 p.m.): 1 vegetable and hummus wrap or sandwich with tahini dressing
• Afternoon snack (3 p.m.): 6 ounces (180 g) of nondairy yogurt with 2 tablespoons (30 ml) of pumpkin seeds and 1 small sliced banana
• Dinner (5:30 p.m.): 2 to 3 cups (500 to 750 ml) of stir-fry with vegetables and tofu, and ¾ cup (185 ml) of brown rice or quinoa.
• Evening snack (9 p.m.): 12-ounce (375 ml) Protein Power Smoothie (page 387).
3. Reintroduce “unsafe” foods slowly. Foods that were avoided due to their high fat or energy content might be considered “unsafe” by many vegans with eating disorders. This food group includes nuts, seeds, avocados, olives, oils, soy foods and other legumes, and many grain products. Reintroduce these foods slowly and in small portions: slice avocado onto a salad, toss toasted almonds into stir-fries, or add black beans to a soup.
4. Stop counting calories. To end food obsessions, avoid counting calories. During recovery, rely on body signals to guide hunger and satiety. Eat meals and snacks in locations that have no distractions. Enjoy the pleasures of food once more and get reacquainted with foods that provide the greatest satisfaction.
5. Avoid “diet” foods. Buy tasty foods that nourish the body; avoid buying foods solely based on fat or calorie content.
6. Let food be the body’s medicine. Food is the body’s ally, not its enemy. Let it be the fuel that provides nourishment, boundless energy, radiance, and health.
1. Don’t skip meals or otherwise become famished. Hunger is the most powerful binge trigger of all. Skipping breakfast and/or lunch sets the stage for a binge. Eating more frequently will help ensure that hunger doesn’t lead to bingeing. Try eating four to six small meals each day.
2. Practice mechanical eating until comfortable with normal eating. For binge eaters, it’s easy to forget what normal portions look like. A dietitian or nutritionist can develop an eating plan that lists specific foods and quantities for meals and snacks. (It will probably look much like the meal plan described on page 398.) To locate a local vegan-friendly dietitian, see Resources on page 449.
3. Avoid temptation. Don’t keep “trigger” foods in the house. If consumed, such foods should be limited to meals shared with others, for example, at a restaurant. This can help to eliminate feelings of deprivation. Eating reasonable portions can help develop confidence that such foods can still be safe and enjoyable parts of the diet.
4. To subdue overwhelming urges to binge, develop a strategy to avert the unwanted behavior. The most effective plan may require a change of location to escape the trigger food. Take the dog for a walk, go shopping, visit a friend, or make a trip to the library. If a change of location isn’t possible, call a chatty friend, meditate, or read a book. Start a craft project or learn a skill to keep hands busy when the urge to eat strikes. Keep some mints or chewing gum handy to get through difficult moments.
5. Have a plan B: a reasonable, nonbinge snack. Be prepared for real hunger, when the risk for a binge is high. Make a list of five or six reasonable snacks for those occasions and stick to the list. Select foods that take a little effort to consume. Good choices include:
• a handful of nuts in the shell
• a bowl of popcorn
• frozen grapes, apple slices, or a pomegranate
• a slice of toasted pumpernickel bread with almond butter and banana
• sliced strawberries topped with nondairy yogurt and walnuts
• a green smoothie or green juice (drink slowly)
• protein pudding (one scoop of plant-based protein powder stirred into unsweetened almond milk)
6. Break the cycle of eating in secret. Eating alone is an invitation to binge. As much as possible, eat with other people. Bring lunch to the park, plan regular potlucks with friends, and go out to lunch or dinner at a restaurant.
• Get rid of scales. Scales don’t weigh human value; they may reinforce an eating disorder.
• Get involved in nonfood-related activities. Replace eating with pleasurable activities. Rekindle lost enthusiasms and enjoy every accomplishment.
• Monitor exercise activities. For those prone to exercising excessively, routines should be appropriately adjusted, especially if underweight. For example, cut back on disproportionate aerobic activity; don’t exceed thirty to sixty minutes a day. Alternate aerobics with strength-building and stretching activities; weight gain is healthier if it springs from increased lean muscle mass, which results in a fit, healthy look. For overweight individuals who don’t exercise regularly, adding enjoyable activities can reduce bingeing and help to control appetite. Join a hiking club, take up tennis, or find a walking partner. Exercise at least three or four times a week.
• Adopt lifestyle changes that enhance success. Read through the suggestions in the section on “Lifelong Solutions for Weighty Matters” on page 365.
The family and friends of a person with an eating disorder can do a number of things to support recovery and to avoid making things worse, including becoming educated about the disorder. Supporters need to be patient and encourage good habits and personal responsibility, without being judgmental. The required medical assistance should be given to a sufferer younger than 18. Those who are 18 or older can’t be forced to get help, but they can be encouraged, provided with educational information, and offered ongoing support.
Information on eating disorders, organizations, websites, support groups, and recovery centers abound at the local library as well as on the Internet; search on the term “eating disorders.”
To reach exceptional health, everyone—regardless of body size or weight challenges—needs to carefully consider making additional changes beyond dietary alterations.
1. Make exercise a part of daily life. Exercise thirty to sixty minutes daily or at least five to six days a week. Best activity choices depend on age, current fitness level, state of health, and personal preferences. Include a wide variety of exercises—walking, jogging, biking, swimming, hiking, yoga, racket sports, and aerobic classes. To stick with exercise in the long term, choose enjoyable activities.
For people who have been sedentary a long time, walking or another comfortable activity is appropriate. Start with ten or fifteen minutes of walking two or three times a day, increasing the duration of workouts gradually. Include a balance of cardio, strength, and flexibility exercises, as well.
For overall health, moderate aerobic activity (such as brisk walking) combined with moderate resistance training (such as light weight training) is ideal. To get the most from aerobic activity, consider interval training; alternate bursts of intense activity with a less-intense activity. For example, alternate walking with bursts of jogging or running; or alternate slower walking with speed walking.
Include strength training at least two times a week on nonconsecutive days. When choosing training weights, pick up enough weight to challenge muscles; at the end of each set of repetitions, the muscle group should be fatigued. Gradually increase the weights to maintain muscle development. For flexibility, stretch well after workouts and consider adding deeper stretching routines, such as yoga or Pilates.
Beyond exercise, every physical movement the body makes increases its energy expenditure. Such nonexercise activity thermogenesis (NEAT) includes energy burned during physical movements, such as gardening, walking at work or while shopping, cleaning house, and even foot-tapping when seated. NEAT can make an even bigger difference in energy expenditure than planned exercise. People with high NEAT burn as many as 2,000 calories more per day than people with low NEAT. Research shows that lean sedentary controls stand and move their bodies for 2½ hours longer per day than obese individuals.93
For overweight individuals, it’s helpful to be active after eating. Muscles at rest have limited use for sugars that circulate in the bloodstream, but working muscles quickly use them without requiring a huge insulin surge. Being physically active after a meal prevents excess sugar from being stored as fat and keeps sugar from damaging body tissues. Even very light activity can lower blood glucose as effectively as an oral hypoglycemic drug.94,95
Some underweight people may need to cut aerobic activity to thirty to sixty minutes just two or three times a week (at least temporarily). Aerobic activity boosts metabolism and burns calories, which can offset efforts to gain weight, but it shouldn’t be completely avoided because it enhances cardiovascular and respiratory function and keeps body fat low. On the other hand, building and maintaining lean body tissue is critical to successful weight gain. Moderate resistance training is the best way to promote muscle growth and ensure that any weight gained includes a healthy balance of muscle and fat. Resistance training is often performed with free weights or weight machines, but it can also be done using body weight alone (e.g., push-ups or pull-ups) or resistance bands.
To optimize the effectiveness of any weight-training program:
• work with a professional trainer who can tailor a program to meet personal goals and abilities, and track progress
• train two to three times a week on nonconsecutive days to allow muscles sufficient time to recover and grow between workouts
• aim for thirty- to sixty-minute workouts, because short, intense workouts are more effective than long, leisurely sessions
• begin with light weights, gradually increasing them as form is perfected and muscles need new challenges
• change exercise routines every six to eight weeks to prevent plateaus
• warm up for five to ten minutes before strength training and cool down for five to ten minutes afterward
• keep well hydrated by drinking plenty of water
2. Get adequate sleep. Insufficient sleep can compromise physical and mental performance, contribute to death and disease, and undermine efforts to achieve a healthy body weight. For most adults, seven to nine hours a night is reasonable. Choose a regular bedtime and observe it as often as possible. Make the bedroom peaceful and inviting, and plan bedtime activities that calm and soothe, such as taking a warm bath or reading a good book. Waking up spontaneously and feeling refreshed and alert for the whole day indicates a good night’s sleep.
3. Manage stress. Physical and emotional stress can affect metabolism, appetite, and hormones and wreak havoc with the body’s immune system. In some people, stress triggers mindless eating; in others, it leads to missed meals. Incorporating stress management into a daily routine prepares a person to handle challenges as they arise. Of course, a healthy vegan diet, exercise, fresh air, sunshine, and sleep are all important, but attitude trumps these factors when it comes to dealing with stress. Healthy relationships and an appreciation of kind and thoughtful acts by others can help. For many people, a spiritual practice—prayer, meditation, yoga, or tai chi—forms the cornerstone of daily stress management. Learning from mistakes, forgiving mistakes in oneself and others, and moving on can subdue the stresses of daily life.
4. Avoid addictive substances. Addictions to alcohol, cigarettes, or other drugs aren’t only damaging to health, they also alter metabolism and appetite. Alcohol, which provides about 7 calories per gram, or almost twice that of carbohydrate or protein, contributes to excess energy intakes for some, while displacing nutritious foods for others. Although cigarette smoking increases the body’s metabolic rate slightly, it also acts as a developmental obesogen in humans, significantly increasing risk of overweight and obesity in infants of mothers who smoked during pregnancy.96 A struggle with any addiction may contribute to an individual’s challenges. To overcome such addictions, consider all available support systems.