Purpose: The purpose of this study was to describe the prevalence of and relationships among disordered eating, food insecurity, and weight status among transgender and gender nonbinary youth and young adults. Methods: This cross-sectional study involved a screening protocol to assess disordered eating and food insecurity risk from September to December of 2019 at a gender clinic using five validated measures: (1) previous eating disorder diagnosis (yes/no); (2) Sick, Control, One Stone, Fat, Food Questionnaire (SCOFF); (3) Adolescent Binge Eating Disorder Questionnaire (ADO-BED); (4) Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS); and (5) Hunger Vital Sign. Age, assigned sex at birth, gender identity, stage of medical transition, and body mass index were collected. Pearson's r correlation coefficients, between-groups t-tests, one-way analysis of variance tests, and Tukey's honest significant difference test were used to characterize the relationships between variables. Results: A total of 164 participants ages 12-23 years completed the screener. Using assigned sex at birth, 1.8% were underweight, 53% were a healthy weight, 17.1% were overweight, and 28.0% were obese. An estimated 8.7% reported a previous eating disorder diagnosis, 28.0% screened positive on the SCOFF, 9.1% on the ADO-BED, 75.0% on the NIAS, and 21.2% on the Hunger Vital Sign. Transgender males scored higher on the NIAS than transgender females ( p = 0.03). Those with a previous eating disorder diagnosis scored significantly higher on the Hunger Vital Sign ( p < 0.05). Conclusion: Gender clinics should routinely screen for disordered eating, food insecurity, overweight, and obesity to identify patients in need of further evaluation and referral.

No guidelines exist regarding nutrition assessment for transgender or gender non-conforming patients. Multiple nutrition assessment methods utilize gender-specific values that provide distinct recommendations for males and females. This clinical case series depicts the food and nutrition considerations of ten adult transgender men using anthropometric, survey, and dietary recall data. Male reference values were used to analyze patient data, though multiple approaches to nutrition assessment in the transgender population are discussed. Major nutrition-related concerns were obesity, low fruit and vegetable intake and high sodium intake; disordered eating was not a prominent concern. Further research is needed to inform nutrition care for the transgender and gender nonconforming populations.

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