Disordered Eating, Food Insecurity, and Weight Status Among Transgender and Gender Nonbinary Youth and Young Adults: A Cross-Sectional Study Using a Nutrition Screening Protocol

Abstract

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.

Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals

“…Consistent with this, Watson and colleagues found higher rates of eating disordered behaviors among transgender youth who had experienced higher rates of harassment and discrimination (Watson et al, 2017). In addition, it has been reported that TNB individuals also have increased rates of food insecurity, which may contribute to disordered eating (Arikawa et al, 2021; Linsenmeyer et al, 2021). However, little research on eating disorders has been conducted with clinical TNB samples compared to their cisgender peers (Reisner et al, 2015), and there is a tendency to combine TNB individuals with lesbian, gay, and bisexual (LGB) individuals in comparisons with cisgender individuals rather than studying TNB individuals separately (Brewerton et al, 2021).…”

An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients

“…8 Nutrition-related health disparities include elevated rates of disordered eating and body dysmorphia, food insecurity, and overweight and obesity compared with cisgender populations. [9][10][11][12][13][14] Disordered eating may be https://doi.org/10.1016/j.jand.2022.02.014…”

“…11,13 Beyond the intersection with poverty and homelessness, food insecurity may be elevated among TGGD youth and adults due to fear of discrimination at faith-based food pantries, the need to provide identification that may include a photograph or gender marker inconsistent with gender identity, the competing financial burden of food and medical care, and familial rejection. 9,[12][13][14] TGGD individuals may transition in different ways to align with their gender identity, such as socially, legally, or medically, although the types of therapeutic options, timing, and duration are variable and individualized. 5 Medical interventions are medically necessary for many transgender individuals to alleviate the psychological distress caused by gender dysphoria.…”

“…This approach has been utilized in clinical practice by health care teams caring for TGGD clients. 13,32 An estimated 62% of TGGD adults in the United States have medically transitioned with HT and an additional 23% plan to do so in the future. A smaller proportion have had gender-affirming surgeries (4% to 43% depending on surgery type), with orchiectomy as the most common transfeminine surgery and chest surgery as the most common transmasculine surgery.…”

“…4,5 Existing research has reported the strategy of assessing growth using both the boy and girl charts for TGGD patients who are medically transitioning and has underpinned the need for further research in this area. 13,32,36 JY is a 50-year old, African American trans man who was referred to nutrition services for nutrition assessment and suspected iron deficiency. JY was assigned female at birth, identifies as a trans man, and uses he/his or they/their pronouns.…”