Sexual orientation, gender identity linked to eating disorders

Study shows elevated risk for transgender, lesbian, gay and bisexual students

Transgender and non-transgender lesbian, gay and bisexual students are at greater risk for eating disorders, finds a new study from the Brown School at Washington University in St. Louis and Washington University School of Medicine in St. Louis.


The study used data from the American College Health Association–National College Health Assessment (ACHA-NCHA), a survey of 289,024 students from 223 U.S. universities. Researchers found that the rates of self-reported eating disorders were highest in transgender people. Heterosexual men had the lowest rates.

“Transgender people were more likely to report a diagnosis of an eating disorder — bulimia nervosa or anorexia nervosa — in the past year,” said senior author Alexis Duncan, PhD, assistant professor at the Brown School. “They also reported using vomiting, laxatives or diet pills more for weight control in the past 30 days than cisgender men and women, regardless of their sexual orientation.”

The ACHA-NCHA survey, the authors wrote in the study, “includes the largest number of transgender participants ever to be surveyed about eating disorders and compensatory behaviors, thus enabling us to conduct statistically powerful analyses of the relationship between gender identity, sexual orientation and eating-related pathology.”

The results were published in the Journal of Adolescent Health in April. Elizabeth W. Diemer, who graduated in 2014 with a bachelor’s degree in psychology in Arts & Sciences, was first author on the study.

The students self-reported their mental health, substance use, sexual behavior and nutrition history on questionnaires distributed between 2008-2011.

Of the ACHA-NCHA survey data, 268,066 students self identified as heterosexual, 5,057 as unsure, 15,422 as bisexual, lesbian or gay, and 479 as transgender.

Transgender students were found to have significantly greater odds of past-year eating disorder diagnosis, past-month diet pill use and past-month vomiting or laxative use compared to cisgender heterosexual women.

Transgender participants also were significantly more likely than members of any other group, including cisgender sexual minorities, to report past-year eating disorder diagnosis and past-month compensatory behaviors.

“I don’t think that this is particularly surprising to the LGBTQ community and/or to clinicians that work with members of this community,” Duncan said. “There is a lot of anecdotal evidence of eating disorders among transgender people; however, there have been few previous studies that have compared transgender people to cisgender people, and to our knowledge, no single previous study has compared transgender people to both cisgender heterosexual and sexual minority individuals.”

In addition to Duncan and Diemer, co-authors on the study are Julia Grant, PhD, associate professor of psychiatry at the School of Medicine; Melissa Munn-Chernoff, PhD, assistant professor of psychiatry at University of North Carolina at Chapel Hill; and David Patterson, PhD, assistant professor at the Brown School.