Medical considerations in the care of transgender and gender diverse patients with eating disorders

Why is this research important? 

There is a paucity of research exploring eating disorders in transgender and gender diverse people. However, existing and emerging research suggests that eating disorders, disordered eating and body dissatisfaction are highly prevalent in transgender and gender diverse individuals [1-6]. Additionally, evidence has highlighted an increased risk of eating disorder behaviours in transgender and gender diverse people compared to cisgendered individuals [6].  

Numerous factors have been proposed for this increased risk. For instance, behaviours related to eating disorders may be used to alter an individual’s physical characteristics in a way that aligns with their gender identity [5,7,8]. Stress associated with being a member of a historically excluded group, as well as increased rates of harassment and discrimination, has also been postulated to increase physical and mental health issues in transgender and gender diverse people, including an increase in eating disorders [9]. Transgender and gender diverse people also face an increased risk of food insecurity, which may contribute to increased levels of disordered eating [10,11].  

Despite the emerging evidence and increased awareness of the risk of eating disorders in transgender and gender diverse people, there is still a lack of gender-affirming eating disorder health care being delivered. According to the United States National Transgender Discrimination Survey, 50% of respondents needed to teach their health providers about trans health [12]. Similarly, previous research has found that transgender patients feel that primary care providers ignore their gender identity or misgender them [13]. These issues create additional barriers for transgender and gender diverse patients when accessing care, including eating disorder treatment [13].  

In their 2022 review, Riddle and Safer synthesise the available literature exploring the medical care of transgender and gender diverse patients and integrate this with existing eating disorder literature. The authors conclude that the available research on this topic is significantly lacking and requires future collaborative efforts to increase understandings of eating disorder treatment for transgender and gender diverse people. Despite the paucity of data, the authors urge health professionals to identify and follow best practice based on the existing knowledge in both transgender medical care and eating disorder treatment. This includes: a) building inclusive environments in treatment facilities for staff and patients by using correct pronouns and providing gender-inclusive and trauma-informed eating disorder care, b) incorporating support for patients seeking out gender-affirming medical interventions into eating disorder treatment processes and working with individuals to reduce barriers to care created by their eating disorder, c) providing additional eating disorder care that takes into account the impact of gender-affirming hormonal therapy and other related treatments on medical markers related to the eating disorder, and d) considering the patient’s gender identity as well as their hormonal status in treatment-related goals. Additionally, the authors state that it would be beneficial for all professionals providing eating disorder treatment to attend training in gender affirming care to provide inclusive and holistic eating disorder care.  

Moreover, there is a small but growing evidence base that draws upon the knowledge, expertise and lived experience of transgender and gender diverse people to highlight challenges and propose solutions to improve eating disorder care. Further research and work in this space is warranted to ensure eating disorder treatment for transgender and gender diverse patients is safe, accessible, effective, evidence-informed and gender-affirming.  

Authors: Megan C. Riddle and Joshua D. Safer   

Abstract/Summary: 

Background: Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. 

Methods: This review examines the existing literature on TGD medical care and integrates this with the eating disorder literature. Improved knowledge of the medical needs to TGD individuals can help decrease barriers to care. This review aims to better understand the medical needs of TGD individuals in eating disorder treatment and highlights areas for further research. 

Results: The review found that research in this area is severely lacking and the field would benefit from a concerted efforts to increase our understanding of the unique aspects of eating disorder treatment for TGD individuals.  

Conclusion: Current evidence points to the necessity of providing gender affirming care within the context of eating disorder treatment.  

Access: Open 

Link: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00699-3  

Citation: Riddle, M.C., Safer, J.D. Medical considerations in the care of transgender and gender diverse patients with eating disorders. J Eat Disord 10, 178 (2022). https://doi.org/10.1186/s40337-022-00699-3  

References:  

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