What do Adolescent Vegetarians Really Eat?
ABSTRACT & COMMENTARY
Synopsis: Adolescents who consider themselves to be vegetarians consume more fruits and vegetables and eat fewer sweet and salty foods than non-vegetarians. However, they more frequently self-induce vomiting and use more laxatives.
Source: Neumark-Sztainer D, et al. Arch Pediatr Adolesc Med 1997;151:833-838.
One hundred seven adolescents from non-urban public schools in Northern Minnesota who identified themselves as vegetarians in the Minnesota Adolescent Health Survey (MAHS) conducted in secondary schools throughout the state were asked to complete a detailed dietary intake survey and also to report whether they had disordered eating behaviors. The 107 vegetarians were compared to a matched group of non-vegetarian adolescents also from the MAHS. The reported intakes of 11 types of food of the two groups were compared. Vegetarian adolescents were twice more likely to consume fruits or vegetables, one-third as likely to consume sweets, and one-fourth as likely to eat salty foods more than once a day. Disordered eating behaviors were more common in the vegetarians than in the controls. Frequent dieting was reported by 38% of the vegetarians compared to 21% of the non-vegetarians. Induced vomiting was four times more frequent in the vegetarians (15% vs 4%). Laxative use for weight control was eight times more frequent among the vegetarians (8% vs 1%).
COMMENT BY WALTER ANYAN, MD, FAAP
The data in this report include nutritional practices as well as eating behaviors suggestive of bulimia nervosa among adolescents who took part in a huge survey during 1986 and 1987 in Minnesota. At the time of the survey, one out of every 166 adolescents who participated was currently on a special diet because of "being a vegetarian." The food groups used by the vegetarians were diverse: only 5% never used diary foods, while 42% never ate eggs. More vegetarians (40%) than nonvegetarians (15%) never ate fish or poultry, but 15% ate fish or poultry at least once a day, compared with 12% of nonvegetarians. Both groups made surprisingly similar use of beans, peas, peanut butter, and grains-basic elements of vegetarian diets. Beyond reporting dietary practices, the article also presents the adolescents' experience with frequent dieting to lose weight during the past year and with binge eating, induced vomiting, or using laxatives. The prevalence of each behavior, while great among vegetarians, was also substantial among nonvegetarians. The clearest implication of the study for clinical practice appears to be that a clinician should discuss the sort of diet that an adolescent uses and should ask whether some foods are not eaten at all.
When the diet is noted to be unusual or restrictive, additional information can be pursued to determine nutritional adequacy. One can explore the knowledge and beliefs that have been used to structure the diet, and one can also identify discrepancies that an adolescent perceives between actual and idealized weight and shape, as well as the measures that might be taken to narrow them. (Dr. Anyan is Professor of Pediatrics and Adolescent Medicine, Children's Hospital at Yale-New Haven, Connecticut)
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