Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students

Abstract

Purpose This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors (CB) in trans- and cis-gender college students. Methods Data came from 289,024 students from 223 U.S. universities participating in The American College Health Association – National College Health Assessment II (median age 20 years). Rates of self-reported past year SR-ED diagnosis and past month use of diet pills and vomiting or laxatives were compared among transgender students (n=479) and cisgender sexual minority male (n=5,977) and female (n=9,445), unsure male (n=1,662) and female (n=3,395), and heterosexual male (n=91,599) and female (n=176,467) students using chi-squared tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates. Results Rates of past year SR-ED diagnosis and past month use of diet pills and vomiting or laxatives were highest among transgender students and lowest cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past year SR-ED diagnosis (OR: 4.62, 95% CI: 3.41-6.26) and past month use of diet pills (OR: 2.05, 95% CI: 1.48-2.83) and vomiting or laxatives (OR: 2.46, 95% CI: 1.83-3.30). Although cisgender sexual minority men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than for transgender individuals (ORs: 1.40-1.54). Conclusions Transgender and cisgender sexual minority young adults have elevated rates of CB and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.

Lesbian, gay and bisexual college student perspectives on disparities in weight‐related behaviours and body image: a qualitative analysis

“…2009, Centers for Disease Control and Prevention 2011, Austin et al . 2012, Diemer et al . 2015, Laska et al .…”

“I have to constantly prove to myself, to people, that I fit the bill”: Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women

“…Past research on disordered weight control has focused almost exclusively on cisgender women (Smink et al, 2012; Thompson, 1999); only a few recent studies have focused on transgender individuals (Ålgars et al, 2012; Diemer et al, 2015; Witcomb et al, 2015). This study found that 16 of 21 participants reported some level of disordered weight and shape control.…”

“…Indeed, preliminary evidence for eating disorders risk in transgender populations is troubling: in a study of 280,000 U.S. college students, transgender students had two times greater odds of a past-year diagnosis of anorexia nervosa or bulimia nervosa compared to cisgender heterosexual women (Diemer et al, 2015). Very little research has focused on transgender women, who may have distinct risk profiles (Ålgars et al, 2012; Vocks et al, 2009).…”

Fifteen-minute consultation in the normal child: Challenges relating to sexuality and gender identity in children and young people

“…Lesbians are more likely to be overweight than heterosexual teenage girls, with binge eating being a significant risk factor 13. Transgender teenagers are four times more likely than cisgender (non-trans) peers to have an eating disorder,14 and management is complicated as diet can be related to attempts to control development of unwanted secondary sex characteristics (eg, fat deposition patterns and menstruation).…”