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Review by Megan Riddle, MD PhD

Avila, J. T., Golden, N. H., & Aye, T. (2019). Eating disorder screening in transgender youth. Journal of Adolescent Health, 65(6), 815–817.

Avila's article, Eating Disorder Screening in Transgender Youth, adds to the nascent field of research regarding eating disordered behaviors in individuals who are transgender or gender non-binary (referred to collectively as transgender in this review).  A search of Pubmed for "eating disorder*" and "transgender" reveals a mere 41 articles, 40 of these published since 2011.  This speaks to both our relatively limited knowledge base and our need to increase awareness in this area.

This article describes survey results from patients ages 13 to 22 at an academic multidisciplinary gender clinic.  Subjects completed the EDE-Q as well as two additional questions assessing the role of weight manipulation for gender-affirming purposes.  In addition, the researchers tracked BMI, calculated based on sex assigned at birth, and whether an individual was taking gender-affirming hormones.  A total of 106 individuals completed the survey, 61% identifying as transmasculine, 28% as transfeminine and 11% as nonbinary.  On average EDE-Q values were within population norms, while 15% had elevated global scores.  A total of 63% of all subjects reported intentional weight manipulation for reasons of gender identity.  Interestingly, they did not find a correlation between intentional weight manipulation and elevated EDE-Q scores.  Also, no significant difference was observed in individuals with elevated EDE-Q scores with regards to gender identity or use of gender-affirming hormones.

Why is this important?

Avila’s work is consistent with existing literature indicating that transgender individuals are at increased risk of developing eating disorders, even when compared to the group typically considered at highest risk, cisgender heterosexual women.  A survey of nearly 300,000 US college students found rates of eating disorders in transgender students to be 15.8%, significantly higher than the 1.85% of cisgender heterosexual women reported an eating disorder diagnosis.  In this study, transgender individuals were also at increased risk relative to cisgender heterosexual women with regards to diet pill use (13.5% vs. 4.29%) and vomiting or laxative use (15.1% vs. 3.71%) in the past month.  Furthermore, research indicates that transgender individuals with eating disorders are at higher risk than their cisgender counterparts with eating disorders (or transgender individuals without eating disorders) for nonsuicidal self-injury, suicidal ideation, and suicide attempts.

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