Emerging trends in eating disorders among sexual and gender minorities

Abstract

Purpose of review-To review the recent literature on eating disorders, disordered eating behaviors, and body image dissatisfaction among sexual and gender minority populations, including, but not limited to, gay, lesbian, bisexual, and transgender people.Recent findings-Overall, eating disorders, disordered eating behaviors, and body dissatisfaction are common among sexual and gender minority populations. Lifetime prevalence for anorexia nervosa (1.7%), bulimia nervosa (1.3%), and binge-eating disorder (2.2%) diagnoses are higher among sexual minority adults compared to cisgender heterosexual adults in the US. Lifetime prevalence of eating disorders by self-report of a health care provider's diagnosis are 10.5% for transgender men and 8.1% for transgender women in the US, including anorexia nervosa (4.2% and 4.1%) and bulimia nervosa (3.2% and 2.9%), respectively. Disordered eating behaviors may be perpetuated by minority stress and discrimination experienced by these individuals. Body dissatisfaction may be a core stressor experienced by transgender people; gender dysphoria treatment has been shown to increase body satisfaction. A particular clinical challenge in caring for transgender youth with eating disorders is the standard use of growth charts based on sex.Summary-Novel research demonstrates that sexual and gender minorities with eating disorders have unique concerns with regards to disordered eating and body image.

Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations

“…Similarly, transgender women previously reported higher scores on the Shape Concern subscale than presumed cisgender women [20]. Shape concerns in genderexpansive individuals may be linked to gender dysphoria and body dissatisfaction when one's body shape is discrepant from one's gender identity [18,37,38]. It may be especially challenging for gender-expansive individuals to attain certain shape ideals when certain anatomic structures cannot be altered medically or surgically [38,39].…”

Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students

“…Additional supplemental analyses (results stratified by year and BMI) are displayed in the online supplement. All analyses were conducted in 2021 using Stata 15.1 [53].…”

Health inequalities among LGBTQ+ communities

“…A recent review of eating disorders and disordered eating amongst LGBT adults and adolescents found these groups were at greater risk than the general population, identifying a heightened risk among gay men, bisexuals and trans people, with mixed results for lesbian adults and adolescents. (7) Although a previous study comparing lesbian adolescents to their heterosexual peers identified a greater prevalence of purging behaviours and focus on reducing weight among the lesbian cohort (8). Eating disorders and disordered eating can be prominent among gay males due to the cultural pressures within the community to fit certain body type categories.…”

“…(8) Factors suggested to contribute to the development of eating disorders for LGBT people include increased stress through experiences of stigma and violence but also cultural ideals within the LGBTQ+ community, such as the need to be 'thin' and 'fit' to be viewed as attractive. (7,8) For substance use disorders, evidence is limited. While many studies have identified heightened levels of substance use/abuse among LGBT groups along with high risk factors for developing a disorder, very few have examined substance disorders specifically.…”

“…Particular communities are reported to be at heightened risk -specifically, Black, Asian and minority ethnic LGBT people, disabled LGBT people, and those from lower income households. (3,7) Trans and non-binary groups experience higher rates of multiple mental health disorders (3,8,10) and within LGB, bisexuals tend to report higher levels of anxiety, depression and suicidality. (2,3,10) It is vital to understand that the difficulties an individual experiences being LGBTQ+ are in addition to everyday stresses such as finances, employment, and relationships.…”