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Symposium Speakers Series: Eating Disorders in Gender Diverse Youth

The 9th Annual Veritas Collaborative Symposium on Eating Disorders unites our community of experts and other leaders in the field under a shared mission to advance our understanding of what it means to deliver best-practice eating disorders care to diverse populations. Our Symposium Speaker Series offers a chance to meet our keynote speakers and begin exploring the topics that will be discussed in greater detail at the virtual Symposium.

Veenod L. Chulani MD, MSED, FSAHM, CEDS is the Section Chief of Adolescent Medicine at Phoenix Children’s Hospital and Medical Director of the Gender Support Program. His clinical areas of expertise include trauma and adverse childhood experiences as well as the care of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. We recently sat down with Dr. Chulani to discuss the connection between vulnerability and visibility in this population and his upcoming keynote presentation at the 9th Annual Veritas Collaborative Symposium on Eating Disorders, “Eating Disorders in Gender Diverse Youth.”

Veritas Collaborative: The term “gender diversity” is fairly new to the clinical—and cultural—vocabulary. Can you explain what it means?

Dr. Chulani: We use the term “gender diverse” to describe individuals whose gender identity, role, or expression, don’t necessarily conform to social expectations and norms based on their sex assigned at birth.

Ultimately, gender diversity is really about creating space to acknowledge non-binary experiences of gender and recognize the diverse range of experiences people have with respect to gender, independent of the sex that was assigned at birth.

Veritas Collaborative: Do eating disorders present differently in this population?

Dr. Chulani: The answer is complicated. Although cisgender and gender diverse individuals affected by eating disorders similarly present with body dissatisfaction and share the same set of disordered eating behaviors, there are notable differences in their underlying drivers, motivators, and experience of gender dysphoria.  A common theme among gender diverse individuals is an effort to suppress their gender and/or gender characteristics. This is especially true of female-identified, male-identified, and nonbinary-identified youths around the onset of puberty.

Young people quickly learn that one way to suppress the gender characteristics that begin to emerge around adolescence is to keep their bodies from getting the nutrition needed to properly develop. It is critical that we recognize puberty as a period of particular vulnerability for this population as a whole. Attaining or accentuating characteristics of their identified gender is also an underlying theme, especially as gender diverse youth internalize body image pressures and ideals. This includes trans males wanting to appear less curvy and more muscular and trans females seeking a smaller and thinner appearance. Eating disorders in gender diverse individuals, however, must also be viewed in the context of minority stress, anti-transgender stigma, and discrimination which research suggests are associated with higher rates of eating disorders in the population.

Veritas Collaborative: The very recent emergence of the term, ‘gender diversity,’ hints at the lack of visibility for this population. How has a lack of recognition impacted gender diverse people coping with eating disorders?

Dr. Chulani: Historically, we have not done a good enough job of carving out spaces for gender diverse individuals in healthcare—and it shows. One national survey found that half of transgender people went without the care they needed because they didn’t feel like healthcare spaces were safe or affirming for them. We also have not routinely collected information about sexual orientation and gender identity in our national surveys. Here, we’re talking about a real visibility problem—when it comes to healthcare policy and planning, you only count if you’ve been counted.

With the development of clinical programs serving gender diverse populations and the routine collection of information about sexual orientation and gender identity patient/client registration and in our national surveys, we are now only realizing the burden of eating disorders on this population. The social marginalization behind their lack of visibility has also impacted their financial resources, insurance status, and access to eating disorder treatment. Even when they do seek out treatment, research and personal accounts suggest that their experiences can often be negative and lacking gender competence, It is vital that we continue to carve out safe, affirming spaces for gender diverse individuals to access the care they need. We also need to make sure that gender diverse people are included in the surveys and studies that inform social and healthcare policies.

Veritas Collaborative: Gender diverse youth – children and adolescents – are clearly made even more vulnerable by structural barriers, but what do we know about the social barriers encountered by this group?

Dr. Chulani: There is a growing body of literature that speaks to unique patterns of vulnerability among gender diverse individuals affected by eating disorders. Family acceptance,  peer connections, and social support can have a protective effect on those patterns of vulnerability, but the unfortunate fact remains that social stigma can undermine those supportive structures for gender diverse individuals and put them at a significantly greater risk of developing eating disorders and experiencing other health disparities. One study found this population to be five times more likely to report an eating disorder than their cis-gender counterparts.

Veritas Collaborative: How can communities of support be there for their gender-diverse loved ones with eating disorders?

Dr. Chulani: Affirmation is key. Affirm your loved one’s gender identity and advocate for their access to transition-related care especially if gender dysphoria is central to their eating disorder — it will be a necessary part of their recovery. Be the safe, affirming support system they need — allowing your loved one to feel supported in their gender identity and their recovery from an eating disorder.

As healthcare providers, we can strive to create safe and affirming spaces within our practices that better respond to the needs of this underserved group. We should center their voices and partner with the community to build the kind of treatments that reflect their unique needs.

Veritas Collaborative: What is the one thing you hope attendees take away from your keynote presentation?

Dr. Chulani: The importance of allyship. This is a social justice issue. Being a strong ally and advocating for this community is critical to not only address eating disorders—because eating disorders are just one of the many disparities and inequities impacting this community—but to influence more positive outcomes for gender diverse individuals, overall.

When we come together to tap into our collective professional knowledge and learn more about providing best-practice eating disorder care to diverse populations from leading experts, we move our field forward. Join us for Veritas Collaborative’s completely virtual 9th Annual Symposium on Eating Disorders and earn up to 26.0 continuing education credits. Register today.