Health Behaviors of Transgender Youth with and Without Obesity: Establishing an Evidence Base and Prevalence Rates

Background: Transgender youth in the United States are at increased risk for obesity and type 2 diabetes compared with their cisgender peers due to diverse factors including minority stress, stigma, and limited knowledge regarding effective care. Given myriad factors limiting affirming weight-related care, research is needed on health behaviors of transgender youth to provide insight into their experiences and inform novel approaches to care. Methods: Data from the 2017 and 2019 Youth Risk Behavior Surveillance Survey were used to explore the health behaviors of transgender youth with obesity (TYO) and without obesity (TYNO) and cisgender youth with obesity (CYO) and without obesity. Differences by racial and ethnic identity were considered. The study sample included 2561 transgender youths and 21,146 cisgender youths with obesity from 15 US states. Results: Transgender youth had a higher rate of obesity than their cisgender peers. Few significant differences were observed when comparing health behaviors of TYO and TYNO and CYO. Describing self as overweight was the only variable that was consistently significant across comparisons. Transgender youth of all racial/ethnic identities except Other were significantly likely to endorse sleeping <6 hours a night. Health behaviors did not consistently explain obesity status. Race/ethnicity was not significant for any comparison. Conclusions: Results of this study indicated race, ethnicity, and health behaviors did not explain differences in obesity rates for transgender and cisgender youth. Future research is needed to understand factors contributing to the increased risk of obesity in transgender youth.