Disparities in self‐reported eating disorders and academic impairment in sexual and gender minority college students relative to their heterosexual and cisgender peers

Abstract

Objective:The purpose of the current study was threefold: (a) compare rates of selfreported anorexia nervosa (AN), self-reported bulimia nervosa (BN), and eating pathologyspecific academic impairment (EAI) by gender identity (cisgender men, cisgender women, transgender or genderqueer) and sexual orientation (gay or lesbian, bisexual, unsure, other), (b) examine associations between gender identity, sexual orientation, and eating outcomes, and (c) identify for whom rates of eating disorder diagnosis and impairment is greatest. Method:The study includes a sample of Minnesota students (n = 13,906) who participated in the College Student Health Survey from 2015 to 2018. Chi-square tests with bootstrapping examined differences in eating pathology rates between groups.Adjusted logistic regressions tested the association between gender identity, sexual orientation, and self-reported eating outcomes.Results: Chi-square results revealed heightened rates of self-reported AN, self-reported BN, and EAI in cisgender women, transgender or genderqueer, and sexual minority (e.g., lesbian or bisexual) students. Logistic regression analyses in cisgender men and cisgender women revealed higher odds of self-reported AN, self-reported BN, and EAI in sexual minority students relative their heterosexual peers. Chi-square analyses indicated that bisexual cisgender women reported heightened rates of all three eating pathology measures relative to other sexual and/or gender (e.g., transgender) minority students.Discussion: Individuals with marginalized gender and/or sexual orientation identities report heightened rates of eating pathology, with cisgender bisexual women reporting the poorest outcomes relative to individuals from other marginalized identities. Preventive efforts and more research are needed to understand the mechanisms driving this disparity and to reduce prevalence among marginalized groups. K E Y W O R D S anorexia nervosa, bulimia nervosa, disparities, gender identity, sexual and gender minorities 1 | INTRODUCTION Eating disorders (EDs) and eating disorder behaviors (e.g., purging) affect people of all social identities. Yet, recent research has

Disparities in eating disorder risk and diagnosis among sexual minority college students: Findings from the national Healthy Minds Study

“…Our results indicating greater likelihood of ED diagnosis among sexual minorities with elevated ED risk compared with their heterosexual peers aligns with prior evidence showing that sexual minorities, particularly those who identify as gay or lesbian, are more likely to utilize mental health services than their heterosexual peers (Eisenberg, Hunt, Speer, & Zivin, 2011). Our findings with regard to ED risk and diagnosis complement recent findings indicating elevated rates of ED diagnoses among bisexual and lesbian women (Simone, Askew, Lust, Eisenberg, & Pisetsky, 2020); our results suggest elevated ED diagnosis rates in lesbian women may reflect differences in mental health service utilization rather than differences in ED risk.…”

Food Insecurity and Eating Disorders: a Review of Emerging Evidence

“…Along with emerging research in other marginalized populations indicating that EDs do in fact affect racial/ethnic minorities [ 64 ], sexual minorities [ 65 ], gender minorities [ 66 , 67 ], and individuals of higher weight status [ 25 , 68 ], the findings reviewed above provide further evidence against the historical ED stereotype. However, because many existing theoretical models used to explain the onset and maintenance of EDs were developed largely in accordance with the SWAG stereotype, these models may need to be reworked to be more relevant for individuals who do not fit that stereotype.…”

Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature

“…Adult sexual minorities have been found to have experienced significant disordered eating symptomology, including desire to be thin, bingeing, purging, and body dissatisfaction, which correlated with being overly concerned about body shape and size and level of femininity (regardless of sex assigned at birth). These behaviors occurred at higher rates than within the heterosexual and cisgender male population, but did not appear to be significantly different from heterosexual and cisgender females [ 37 , 44 , 120 , 145 , 151 ]. Adult sexual minorities also were almost twice as likely to experience food addiction (defined as the application of the criteria of substance use disorder to highly rewarding foods) compared to heterosexuals, which was aggravated by heterosexist harassment [ 135 ], and sexual minorities have reported higher rates of weight discrimination than heterosexual peers, even after controlling for body mass index (BMI) and race [ 145 ].…”

“…While eating disorders and disordered eating behaviors can affect individuals with various identities, it has been found that disparities exist in certain marginalized groups, such as sexual and gender minorities [ 145 ]. The purpose of this research is to review the literature regarding eating disorders and disordered eating behaviors within lesbian, gay, bisexual, and transgender (LGBT) adults and adolescents in comparison to their heterosexual and cisgender counterparts.…”

“…Indeed, it has been reported that both clinical eating disorders and eating disorder behaviors occur more frequently in LGBT individuals compared to their heterosexual and cisgender counterparts [ 10 , 32 , 44 , 73 , 145 , 160 ]. Further research has indicated that approximately 54% of LGBT adolescents have been diagnosed with a full-syndrome eating disorder during their lifetime, with an additional 21% suspecting that they had an eating disorder at some point during their life [ 157 ].…”