Eating Disorders Create Unique Challenges in the LGBTQ+ Community

Pride Month reminds us to promote awareness and education around the spectrum of unique challenges that the LGBTQ+ community faces, including a greater risk of developing an eating disorder. Existing research shows that beginning as early as age 12, gay, lesbian, and bisexual teens may be at higher risk of binge eating and purging than their heterosexual peers. For example, gay males are thought to only represent 5% of the total male population, but among males who have eating disorders, 42% identify as gay. And, according to one study, females who identify as lesbian, bisexual, or mostly heterosexual were about twice as likely to report binge eating at least once a month in the past month.

Despite the prevalence of eating disorders and disordered eating behaviors in this vulnerable community, recent research also highlights opportunities to reduce eating disorder risk in the LGBTQ+ community. One study concluded that a sense of connectedness to the gay community related to fewer eating disorders, suggesting that feeling connected to the gay community may have a protective effect against eating disorders. Other studies, however, have suggested that connectedness to the gay community can have both a buffering effect and be a potential contributor to the development or maintenance of an eating disorder, if the social community holds negative body images or unrealistic appearance expectations.

It’s important that physicians, dietitians, and therapists are aware that LGBTQ+ individuals are at greater risk for developing eating disorders so they can conduct a thorough assessment of each patient’s relationship with food and their bodies. Early detection and intervention are key to treatment and recovery.

In honor of Pride Month, let’s explore some of the unique eating disorder challenges the LGBTQ+ community faces and how we can all be better advocates.

Unique Challenges Facing the LGBTQ+ Community

People with marginalized identities are at an increased risk for developing mental health issues, including eating disorders, because they experience unique stressors such as prejudice and discrimination. In recent years, states nationwide have advanced a record number of bills that single out LGBTQ+ individuals for exclusion or differential treatment. Transgender youth bear the brunt of these cruel attacks, threatening their safety, freedom of expression, and right to receive informed, gender-affirming care. Internalized homophobia or heterosexism, as well as other structural and social barriers, can further exacerbate these challenges and risks within the LGBTQ+ community.

There are also a variety of unique eating disorder considerations for certain subsections of the LGBTQ+ community. Transgender people may develop eating disorder symptoms related to gender dysphoria and body dissatisfaction. In this case, disordered eating may be triggered, in part, by a desire to change their body to affirm their gender identity. Trans men, for example, may engage in restriction in an attempt to change the size of their breasts or hips or to suppress menses. Another example can be seen in gay men who have the desire to look both lean and muscular, which may lead to steroid use or restriction, or compulsive exercise.

The side effects of hormone replacement therapy (HRT) for gender transition are another important area of consideration for members of the LGBTQ+ community that isn’t very well understood from a medical provider perspective. Side effects associated with HRT can mask or magnify eating disorder symptoms. The professional care community must be aware of this potential issue when treating trans patients — especially since we still lack comprehensive related data and research.

These examples highlight the need for healthcare providers to complete a thorough assessment of potential eating disorders within the LGBTQ+ community. As a culture, we still buy into the myth that all people with eating disorders are thin, young, white women — and that’s just not true. This myth contributes to eating disorders being overlooked or dismissed by anyone who doesn’t fit into that narrow category.

The Importance of Finding an Affirming Treatment Environment

Unless a treatment facility explicitly states that they provide affirmative care, it can be difficult for someone in the LGBTQ+ community to find a provider that will make them feel safe and seen. At Veritas, we aim to be a leader in providing affirmative and competent care to LGBTQ+ individuals, and we support and follow best practices at every stage of the treatment process.

For instance, we take gender identity into account when making room assignments. When determining expected body weight (EDW) for trans patients, we look at both sex assigned at birth and gender identity growth charts and whether they have received HRT. Our dietitians are also highly skilled and trained at providing treatment for transgender individuals in the process of transitioning.

Another best practice in creating an affirming treatment environment is using respectful and inclusive language. At Veritas, we are incredibly mindful about using the names and pronouns that reflect each person’s identity. Accomplishing this involves comprehensive training for our staff, from the front line to the executive team, in providing affirming care to LGBTQ+ patients.

How to Support Someone in the LGBTQ+ Community with an Eating Disorder

If you’re looking for ways to be there for a friend or loved one in the LGBTQ+ community who has an eating disorder, it’s important that the individual struggling feels fully seen and embraced. Here are some tips to provide support:

• Provide a safe environment: When we support people who identify as LGBTQ+, we want them to feel safe and accepted. It’s essential to provide an environment where your friend or loved one feels fully embraced, no matter their sexual or gender identity or expression.
• Help find treatment providers who will support and affirm their sexual and gender identity and expression: Another active way to show support is to help your friend or loved one identify and vet treatment providers that make them feel comfortable. 
• Identify support sources specific to their community: Offer support by searching for a specific LGBTQ+ support group for eating disorder recovery — whether it’s local or virtual.
• Be mindful of language and understand that eating disorders are complex biopsychosocial disorders: It’s vital never to shame or blame any aspect of someone’s identity for the development of their eating disorder. As complex biopsychosocial disorders, eating disorders are mental illnesses that are never chosen.

Celebrating Pride Month at Veritas

Pride Month is an occasion not only to celebrate diversity, but also to recognize and address the unique challenges faced by members of the LGBTQ+ community. It is a time to rise as stronger advocates for those with eating disorders who have often been overlooked. Their experiences and their needs matter.

Veritas’ commitment to fostering an affirming environment extends beyond Pride Month. Throughout the year, we celebrate heritage months, each honoring a different culture, ethnicity, or group of people through art and culinary projects and educational programming.

If you or a loved one is interested in learning more about eating disorder recovery, explore Veritas’ core program elements.

About the Author

Dr. Sydney Brodeur-Johnson is the Senior Director of Clinical Services and Equity, Diversity, and Inclusion at Accanto Health, the parent company of Veritas Collaborative and The Emily Program.

Dr. Brodeur’s passion is providing best-practice, research-informed, and multiculturally competent treatment to patients and their families suffering with eating disorders. She is committed to increasing access to effective treatment, training professionals to deliver gold-standard care, and empowering them to be the best providers and people they can be.

Dr. Brodeur received her PhD in Counseling Psychology from Virginia Commonwealth University (VCU) in 2005 and completed a postdoctoral fellowship at the University of Alabama at Birmingham with a concentration in the interdisciplinary treatment of adolescents with eating disorders. She assisted with the opening of Carolina House, a residential eating disorder treatment facility in Durham, NC, and was the first Center Director there. From 2008–2019 Sydney served as the eating disorder specialist and Associate Director for Training at University Counseling Services at VCU. In that role, she maintained APA accreditation of the psychology internship program and was the administrator for the training program for students in psychology, social work, and counselor education. She also served as a member of the center’s executive team.

In her free time, Sydney enjoys spending time with her children and partner, being outdoors, listening to music, and traveling.