Eating Disorders Create Unique Challenges in the LGBTQIA+ Community

Pride Month reminds us to promote awareness and education around the spectrum of unique challenges that the LGBTQIA+ 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 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 variety of challenges, recent research also highlights opportunities to reduce eating disorder risk in the LGBTQIA+ 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 said connectedness to the gay community has both a buffering effect and can contribute to the development or maintenance of an eating disorder if the social community holds negative body images or unrealistic expectations.

It’s important that physicians, dietitians, and therapists are aware that LGBTQIA+ 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.

As Senior Director of Clinical Services at Veritas Collaborative and The Emily Program, I’m passionate about 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. I aim to increase awareness and provide training to health care providers so every person seeking care for an eating disorder feels welcomed, seen, and supported. In honor of Pride Month, I’m exploring some of the unique challenges that the LGBTQIA+ community faces with eating disorders and how we can all be better advocates.

Unique Challenges Facing the LGBTQIA+ Community

People with marginalized identities are at an increased risk for the development of mental health issues, including eating disorders, because they experience unique stressors such as prejudice and discrimination. Internalized homophobia or heterosexism, as well as other structural and social barriers, can exacerbate these challenges and risks within the LGBTQIA+ community.

There are also a variety of unique eating disorder considerations for certain subsections of the LGBTQIA+ 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 LGBTQIA+ community that isn’t very well understood from a medical provider perspective. Side effects associated with HRT can mask or magnify eating disorder symptoms. It’s essential that the professional care community be aware of this issue when treating trans patients — especially since there isn’t much related data and research yet.

These examples highlight the need for health care providers to complete a comprehensive assessment of potential eating disorders within the LGBTQIA+ community. As a culture, we still buy into this 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 in 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 LGBTQIA+ 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 LGBTQIA+ individuals, and 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 LGBTQIA+ patients.

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

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

• Provide a safe environment: When we support people who identify as LGBTQIA+, we want them to feel safe and accepted. It’s important to provide an environment where your friend or loved one feels 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 treatment providers where they will feel comfortable.
• Identify support sources specific to their community: Offer support by searching for a specific LGBTQIA+ 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 important to never shame or blame any aspect of someone’s identity for the development of their eating disorder. Complex biopsychosocial disorders, eating disorders are mental illnesses that are never chosen.

Celebrating Pride Month at Veritas

Veritas Collaborative is dedicated to involving patients in a variety of activities and celebrations throughout Pride Month — from rainbow cupcake decorating contests to freeform art projects related to gender and sexual identity and expression. We also participate in National Coming Out Day to exhibit solidarity and unification in terms of increasing access to care and advocacy for the LGBTQIA+ community.

Participating in heritage month celebrations is another way we aim to show up throughout the year as an affirming care provider at Veritas. Each month, we honor a different culture, ethnicity, or group of people through art and culinary projects and educational programming, providing historical and educational information to promote awareness. Pride Month is an opportunity for the entire Veritas community to recognize the unique challenges that LGBTQIA+ individuals face and to become better advocates for community members with eating disorders.

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’s passion is providing best-practice, research-informed, and multiculturally competent treatment to patients and their families suffering from eating disorders. She 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.