Eating Disorders in LGBTQ+ Populations: Findings from The Pride Study
By Jason Nagata, MD, MSc
I first became aware of the under-recognition of eating disorders in diverse populations when I was a medical student caring for a gay teenage boy. He had lost over 50 pounds in only three months through extreme and unhealthy weight control behaviors after being teased as “fat”, by high school classmates. When he became interested in dating, he automatically felt dismissed due to his weight. He became obsessed with the pursuit of leanness and muscularity, restricting his food intake to one meal per day and compulsively running on the treadmill for four hours per day. He initially received compliments and praise from family, friends, dates, and social media. Encouraged, he stopped eating out with friends and family because he was concerned about the inadequate protein and high fat and carbohydrate content of food at restaurants. It took over a year for anyone to notice that he had developed an eating disorder. His primary care physician noted a dangerously low heart rate at his annual checkup and referred him to our eating disorders clinic. As I supported him over the course of a year, I learned that most eating disorder research to date had focused on cisgender heterosexual women, and there was limited guidance for LGBTQ+ people and cisgender men.
As I furthered my medical training, I focused on adolescent medicine as my specialty and focused my research on better understanding eating disorders in diverse populations. I read about the launch of The PRIDE Study and its concentration on health research in sexual and gender minority populations. I took the opportunity to use their data to better understand eating disorders in LGBTQ+ people. I worked with The PRIDE Study’s Research Advisory Committee and Participant Advisory Committee to launch an eating disorder and body image-focused ancillary study. Study participants were asked to complete the most commonly used assessment tool for eating disorders, the Eating Disorder Examination Questionnaire.
I analyzed the data in several sexual minority populations. My first published study focused on eating disorders and related behaviors in gay men. Overall, we found that 20% of gay men reported dietary restraint, while 11% reported binge eating, and 10% reported excessive exercise in the past month. My next study focused on eating disorders in lesbian women, finding that 14% reported dietary restraint, 9% reported binge eating, and 5% reported excessive exercise in the past month. Another study focused on bisexual plus (including bisexual, pansexual, polysexual, and other sexual orientations) men and women, finding 24% and 19% of dietary restraint, 11% and 11% of binge eating, and 5% and 4% of excessive exercise among bisexual plus men and women, respectively, in the past month. My next set of analyses focused on gender minority populations, including transgender men, transgender women, and gender-expansive (including non-binary and genderqueer) people. Among transgender men, 25% reported dietary restraint, 11% reported binge eating, and 8% reported excessive exercise. Among transgender women, 28% reported dietary restraint, 13% reported binge eating, and 8% reported excessive exercise. Among gender-expansive people, 23% reported dietary restraint, 13% reported binge eating, and 7% reported excessive exercise.
These findings are especially important during the COVID-19 pandemic, as we have seen an increase in eating disorder symptoms among LGBTQ+ people. Disruptions in daily routines and constraints on physical activity may increase body image concerns and negatively impact eating and exercise patterns. Stressors related to the COVID-19 pandemic, social isolation from sheltering in place, and food or job insecurity may disproportionately affect LGBTQ+ people and can worsen eating disorder symptoms. Eating disorders can affect people of all sexual orientations, gender identities, races, ethnicities, ages, and socio-economic strata. We hope that these studies will help health care providers and researchers to better understand eating disorders in LGBTQ+ populations. We hope that the findings will enhance our understanding of risk factors, inform screening approaches, and improve prevention and treatment programs to provide individualized care for LGBTQ+ people with eating disorders.
If you would like help or additional information about eating disorders, the National Eating Disorders Association Helpline has limited hours on weekdays to take calls and answer questions at (800) 931–2237. More information can be found about this helpline at their website:
General information on eating disorders from the National Eating Disorders Association can be found here: https://www.nationaleatingdisorders.org/
To learn more about eating disorders in LGBTQ+ populations from the National Eating Disorders Association, please visit: https://www.nationaleatingdisorders.org/learn/general-information/lgbtq
If you are in distress, please consider reaching out for services in your area which include calling 911 or going to your nearest emergency room. Please also consider calling 1–888–843–4564 (LGBT National Hotline) to talk with someone.