Eating disorder symptomatology among transgender and gender-diverse individuals: a cross-sectional study

Transgender and gender-diverse individuals tend to be at increased risk of experiencing eating disorders compared to cisgender individuals. Gender-affirming treatment seems to have a significant impact on eating disorder symptomatology; however, there is limited knowledge of gender transition and gender congruence in relation to eating disorder symptomatology. The study aimed to both estimate the prevalence of eating disorders and eating disorder symptomatology among transgender and gender-diverse individuals and assess the motivation behind engaging in eating and diet habits. Furthermore, the association between the degree of transition, gender congruence, and eating disorder symptomatology was explored, and the level of body dissatisfaction and quality of life was examined.

Transgender and gender-diverse individuals were compared to a matched non-clinical comparison group. A national cross-sectional survey, including the Eating Disorder Examination Questionnaire, and assessments of gender transition, gender congruence, body dissatisfaction, and quality of life were forwarded to all individuals who had active contact with one of three centres for gender identity and a non-clinical comparison group. Fisher's exact test, two-sample t-test, and linear regression model were conducted for analyses.

In total, 1,132 transgender and gender-diverse individuals and 688 individuals from the non-clinical comparison group were included. The prevalence of eating disorders was 19.25% (n = 119) among transgender and gender-diverse individuals compared to 14.02% (n = 75) in the non-clinical comparison group (p-value = 0.010); 80.6% of the transgender and gender-diverse individuals reported using eating and diet habits to modify sex characteristics and/or gender expression. Gender congruence and gender transition were negatively associated with ED symptomatology. Transgender and gender-diverse individuals had significantly lower gender congruence and quality of life and higher body dissatisfaction than the non-clinical comparison group.

Transgender and gender-diverse individuals seemed to experience disproportionately high levels of eating disorder symptomatology and engaged in eating and diet habits primarily for gender-affirming purposes, potentially increasing the risk of developing eating disorders. Gender transition and gender congruence seem to be important factors to consider in relation to eating disorder symptomatology. Thus, gender-affirming health care for transgender and diverse individuals seems essential to reduce or prevent the development of eating disorders.