Exploring the Link between Gender, Sexual Identity and Disordered Eating

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This article was written by Jen Connolly, Nutrition Coach & Student Nutritionist, and Maeve Hanan, Disordered Eating Specialist Dietitian and founder of Dietetically Speaking.


The relationship between gender, sexual identity, and disordered eating is a nuanced area in need of more research. However, understanding how these factors interconnect is important for addressing the unique challenges that can be faced by members of the LGBTQIA+ and gender-diverse communities. So this article will delve into this important topic.

Exploring Gender and Sexual Identity

Gender identity can be defined as one’s sense of self as male, female, a blend of both or neither. Our gender identity can be the same or different from the sex assigned to us at birth (1). Many people view gender identity as a spectrum, rather than a binary. 

Gender includes a diverse range of identities. Some common terms include:

  • Trans or transgender – when someone’s gender is different from the sex they were assigned at birth. 
  • Non-binary, gender nonconforming, gender diverse and genderqueer – umbrella terms for people whose gender identity doesn’t align with the binary terms of male or female. Some people identify with some aspects of one or both of these identities, or identify with neither. Some people identify as genderfluid and see their gender as flexible, rather than a fixed identity.
  • Cisgender – when someone’s gender identity is the same as the sex they were assigned at birth (2). 

Sexual orientation refers to an individual’s inherent emotional, romantic or sexual attraction to other people, based on the other persons’ gender and sex characteristics (3).

The LGBTQIA+ community includes those who identify as lesbian, gay, bisexual, transgender and non-binary, queer and questioning, intersex and ace (asexual). The ‘plus’ represents other sexual identities such as pansexual. Some people may use one or more of these terms or many other people don’t define themselves with any terms (4).

A person’s sexual orientation is independent of gender identity.

Understanding Disordered Eating

Our relationship with food lives on a spectrum, which can vary, starting with intuitive eating on one end, moving to ‘normal eating’, to dieting, to disordered eating and then to a clinical eating disorder on the other end. It is common to move between different areas on this spectrum if you struggle with your relationship with food.

Disordered eating refers to a spectrum of problematic eating behaviours and distorted attitudes towards food, weight, shape, and appearance (5).

The following are some common behaviours associated with disordered eating (this is not an exhaustive list)

  • Eating very little
  • Vomiting after eating
  • Cutting out food groups 
  • Obsessive food tracking 
  • Compensating for food with exercise
  • Fasting or skipping meals
  • Binge eating
  • Food fears
  • Using diet pills

Disordered Eating behaviours do not meet the diagnostic criteria of an Eating Disorder.

Nonetheless, disordered eating can still have a significant negative impact on physical, mental or emotional health.  

Disordered Eating has been associated with fatigue, hair loss, digestive issues, loss of periods and hormonal issues and decreased bone density (5,6). In terms of mental and emotional health, disordered eating has been associated with depression, anxiety, reduced quality of life, low self-esteem, poor body image (7,8).

Additionally, people who engage in disordered eating behaviours are at an increased risk of developing an eating disorder in the future (9).

There’s less research related to disordered eating as compared with clinical eating disorders, even though disordered eating is more common. This article will cover both disordered eating and eating disorders in terms of how this impacts LGBTQIA+ and gender diverse communities.

Disordered Eating Among the LGBTQIA+ and Gender Diverse Community

In the UK, 1.25 million people are estimated to have an eating disorder (10). 

However, a systematic review (a detailed summary of all the scientific research) in 2020, found that, LGBTQIA+ adults and adolescents experience disordered eating more than their heterosexual and cisgender counterparts (11).

In fact, young LGBTQIA+ people are three times more likely to experience an eating disorder (12).

Furthermore, there are varying levels of disordered eating within the LGBTQIA+ and gender diverse communities. A study of U.S. students in 2022 found that certain gender identities and sexual orientations have a higher risk of eating disorders. Genderqueer and gender non-conforming students were at the highest risk, followed by trans women, gender expansive students, and trans men.

The risk also varied based on sexual orientation. Trans men who identified as gay, bisexual, or queer were more likely to be at risk than straight trans men. Similarly, LGBQ gender non-conforming people were nearly five times more likely to be at risk than their heterosexual counterparts. Bisexual and queer trans women were at higher risk compared to straight or lesbian trans women (13).

Another scientific review, found that sexual minority males reported higher rates of restrictive eating, purging, diet pill use and bingeing, during their adolescent years and into young adulthood, compared to heterosexual males (14)

Risk Factors for Disordered Eating in the LGBTQIA+ and Gender Diverse Community

So why is disordered eating more prevalent among the LGBTQIA+ and gender diverse communities? 

There’s no one single reason for this, as it relates to a complex mix of factors that centre around the discrimination that members of these communities often face.

For example, being stigmatised for your gender and/or sexual identity can lead to internal shame and rejection issues as well as worsened body image (11).

Gender norms and gender stereotypes can also heighten body image issues; which can become even more challenging for those struggling with gender dysphoria (feeling distress when gender identity differs from sex assigned at birth or related physical traits).

Of course risk factors will also vary between different people and their individual circumstances and experiences.

Getting the Right Support

It is important to acknowledge the larger societal issues at play and that everything is not within individual control. There is also a need for more inclusive environments and health care practitioners who are skilled in addressing the unique needs of LGBTQIA+ and gender diverse individuals. 

Nonetheless, for those who are struggling with disordered eating, getting the right support with healing their relationship with food and their body is vital. 

Here are some tips for finding support if you are struggling with your relationship with food:

  • Start by speaking with your GP.
  • It can also help to get support from family members or trusted friends.
  • Eating disorder charities provide information, resources and support services like helplines, support via webchat and online groups e.g. Beat Eating Disorders in the UK and BodyWhys in Ireland.
  • Private services are available if you can’t or don’t want to access public support services (unfortunately these often have long waiting lists and narrow acceptance criteria due to funding).
  • Disordered eating support ideally involves a medical professional (e.g. Psychiatrist or GP), a nutrition professional (e.g. Dietitian) and a mental health professional (e.g. Therapist or Psychologist) who communicate well with each other and have good experience with disordered eating. But, the best support options  for you can vary based on your history and current needs.

Conclusion

The link between gender, sexual identity, and disordered eating highlights the need for an inclusive approach to addressing these issues within the LGBTQIA+ and gender-diverse communities. Adults & adolescents in the LGTBQIA+ community experience eating disorders and disordered eating more frequently than heterosexual and cisgender peers.

The unique challenges these individuals face, ranging from discrimination and body image issues to stigma and societal pressures, underscore the importance of creating supportive environments and tailored healthcare practices. 

Getting the right support is crucial, and it is equally important to advocate for broader societal changes to reduce the systemic barriers these communities encounter. 

If you are interested in support from Disordered Eating Specialist Dietitians, check out our courses and 1:1 support services.

Links For Further Information &  Support:

References

  1. Human Rights Campaign. (n.d.). Sexual orientation and gender identity terminology and definitions. Human Rights Campaign. https://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions
  1. NSPCC. (n.d.). Gender identity. NSPCC. https://www.nspcc.org.uk/keeping-children-safe/sex-relationships/gender-identity/
  1. Dillon, F. R., Worthington, R. L., & Moradi, B. (2011). Sexual identity as a universal process. In S. J. Schwartz, K. Luyckx, & V. L. Vignoles (Eds.), Handbook of identity theory and research (pp. 649-670). Springer. https://link.springer.com/chapter/10.1007/978-1-4419-7988-9_27
  1. Mind. (n.d.). LGBTQIA+ mental health. Mind. https://www.mind.org.uk/information-support/tips-for-everyday-living/lgbtqia-mental-health/
  1. Gordon, C. M., & Nelson, L. M. (2003). Amenorrhea and bone health in adolescents and young women. Current Opinion in Obstetrics and Gynecology, 15(5), 377-384. https://doi.org/10.1097/00001703-200310000-00005 
  1. Neumark-Sztainer, D., Wall, M., Larson, N. I., Eisenberg, M. E., & Loth, K. (2011). Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. Journal of the American Dietetic Association, 111(7), 1004-1011. https://www.sciencedirect.com/science/article/abs/pii/S0002822311004251
  1. National Eating Disorders Association. (n.d.). What is the difference between disordered eating and eating disorders? National Eating Disorders Association. https://www.nationaleatingdisorders.org/what-is-the-difference-between-disordered-eating-and-eating-disorders/
  1. Herpertz-Dahlmann, B., Wille, N., Hölling, H., Vloet, T. D., Ravens-Sieberer, U., & BELLA Study Group. (2008). Disordered eating behaviour and attitudes, associated psychopathology and health-related quality of life: Results of the BELLA study. European Child & Adolescent Psychiatry, 17, 82-91. https://link.springer.com/article/10.1007/s00787-008-1009-9
  1. Boyd, C., Abraham, S., & Kellow, J. (2005). Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders. Scandinavian Journal of Gastroenterology, 40(8), 929-935. https://doi.org/10.1080/00365520510015836 
  2. Beat Eating Disorders UK. (n.d.). Prevalence in the UK. Beat Eating Disorders UK. https://www.beateatingdisorders.org.uk/about-beat/policy-work/policy-and-best-practice-reports/prevalence-in-the-uk/
  1. Parker, L. L., & Harriger, J. A. (2020). Eating disorders and disordered eating behaviors in the LGBT population: A review of the literature. Journal of Eating Disorders, 8, 1-20. https://link.springer.com/article/10.1186/s40337-020-00327-y
  1. Independent. (2021). Eating disorders three times ‘more likely in young LGBT+ people’. Independent. https://www.independent.co.uk/news/uk/home-news/eating-disorders-lgbt-young-people-b1844881.html
  1. Simone, M., Hazzard, V. M., Askew, A. J., Tebbe, E. A., Lipson, S. K., & Pisetsky, E. M. (2022). Variability in eating disorder risk and diagnosis in transgender and gender diverse college students. Annals of Epidemiology, 70, 53-60. https://www.sciencedirect.com/science/article/abs/pii/S1047279722000576
  1. Miller, J. M., & Luk, J. W. (2019). A systematic review of sexual orientation disparities in disordered eating and weight-related behaviors among adolescents and young adults: Toward a developmental model. Adolescent Research Review, 4, 187-208. https://link.springer.com/article/10.1007/s40894-018-0079-2


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Maeve has been consulting on The Food Medic Educational Hub for 12 months now and has been a huge asset to the team. Her ability to translate some very nuanced topics in nutrition into easy-to-follow, informative articles and infographics is really admirable.

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