Sam Sharpe, ORISE Fellow
Office of the Assistant Secretary for Health

Eating disorders are complex, multifaceted conditions which can substantially impact mental health, physical health, and quality of life for individuals experiencing them. This year, National Eating Disorders Awareness Week (NEDAW) takes place February 26th to March 1st. The Office on Women’s Health’s theme for NEDAW 2024 is “Let’s Talk about It: Eating Disorders, Stigma, and Empowered Recovery.” One of the main goals of NEDAW is to reduce the stigma around eating disorders in all populations by providing accurate education, dismantling stereotypes, and improving the quality of care available to all people with eating disorders.

Eating Disorder Stigma and Stereotypes

As with many other types of health challenges, awareness about eating disorders can be important for helping affected individuals and those around them better understand what is going on and find help and support. However, general awareness about a topic, especially a complex and variable type of illness, does not always translate to accurate and comprehensive knowledge. Eating disorders affect millions of people in the US, and both fictional and non-fictional accounts of eating disorders have been featured in popular media for decades. As a result, many people have some level of awareness about eating disorders, but unfortunately, most people have an incomplete picture of what eating disorders are, who they impact, and how to provide effective support for people who are struggling with them.

A common stereotype persists that eating disorders only or primarily impact thin, white, cisgender young women and girls. Although widespread, this stereotype is not borne out in reality. The Office on Women’s Health recognizes that both women and people of all genders deal with eating disorders. These illnesses also impact individuals of all body sizes, ages, and racial and ethnic backgrounds. However, due to both these stereotypes and the differences in eating disorder presentation across different demographics, it can be difficult for many people to get an accurate diagnosis and appropriate treatment for their eating disorder. Individuals who do not match assumptions about what a person with an eating disorder looks like also face increased levels of stigma because their struggles may not be taken seriously, and other people may not believe that someone like them can have an eating disorder.

The LGBTQIA+ Community

One group that experiences significant stigma and misconceptions related to eating disorders is the lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) community. Overall, rates of eating disorders are disproportionately high in LGBTQIA+ communities compared to general populations, awareness about eating disorders in these communities is low, and the way that eating disorders present in these communities may differ from common eating disorder stereotypes. Stigma and discrimination against LGBTQIA+ identities are widespread, and many individuals within this community experience a constant, ongoing level of increased stress related to discrimination, exclusion, and mistreatment (known as minority stress) that negatively impacts their mental health and increases their risk of developing conditions such as eating disorders. Experiences of minority stress can be compounded for individuals experiencing intersectional forms of oppression, such as both homophobia and racism.

The LGBTQIA+ community is itself very diverse, including individuals of different ages, racial and ethnic backgrounds, disability statuses, religions, and more; multiple different factors can impact the development of eating disorders within this community. Below are examples of unique considerations and challenges within LGBTQIA+ populations.

• Lesbian Populations: Existing research on eating disorders in lesbian populations has shown inconsistent results, with some studies suggesting that adult and adolescent lesbians are at increased risk for eating disorders and others showing no statistical differences in eating disorders between lesbians and straight women. There is some evidence that lesbians may feel pressure to achieve gendered appearance ideals regardless of their sexual orientation and, in some cases, may face expectations to conform to specific appearance ideals within their communities, as well as the impacts of minority stress.
• Gay Populations: There is a common stereotype that eating disorders primarily affect women and girls, but many boys and men also struggle with eating disorders. There are higher rates of eating disorders among gay men and adolescents than among those who are straight. One contributor to the elevated incidence of eating disorders among gay men is the increased pressure many feel to conform to specific body ideals that are prominent in gay subcultures to be considered desirable, attractive, and accepted by others within the subculture. Compared to the experiences of straight men, gay men may be trying to achieve narrower and less accessible appearance ideals, may feel that their desirability within social communities is more dependent on their appearance, and may experience additional pressure to avoid rejection based on their appearance as members of an oppressed group.
• Bisexual Populations: There is limited existing research on eating disorders in bisexual populations; however, these individuals are likely also at increased risk. Some research on eating disorders among bisexual individuals has found increased rates of incidence compared to their heterosexual counterparts. While researchers sometimes group bisexual individuals with gay or lesbian populations, some studies that have considered these populations separately have found that bisexual individuals are more likely to have an eating disorder than either gay or straight individuals of the same gender.
• Transgender and Non-Binary Populations: Compared to cisgender individuals, those who are transgender or nonbinary are known to experience higher rates of eating disorders and additional complicating factors in the development and treatment of eating disorders. Some transgender and nonbinary people experience gender dysphoria related to their physical appearance or gendered social expectations. This may lead individuals to engage in eating disorder behaviors in an attempt to alter their body shape or size, reduce dysphoric physical features, decrease the incidence of other people incorrectly assessing their gender, or increase conformity to gendered body ideals. Because of the unique forms of discrimination and increased levels of violence that transgender and nonbinary people face, especially when they have a gender-nonconforming presentation, there can be elevated levels of pressure to fulfill these appearance ideals, including specific aspects of body shape and size.
• Intersex Populations: There is little to no research on eating disorders within intersex populations, as overall public health research on intersex populations is lacking. However, this population is often subjected to unique forms of trauma, oppression, and erasure. Existing research has found high overall rates of mental health challenges in intersex populations, suggesting that the same may be true for eating disorders.

Eating Disorder Risk Factors

While the prominence of community-specific appearance ideals and pressures to achieve them can undoubtedly play a role in the development of eating disorders, this is not the only causative factor for eating disorder development in both general and LGBTQIA+ populations. Some people attribute their eating disorders primarily to these pressures, while others consider them to be partially related, or others develop eating disorders for completely unrelated reasons. Other factors that can impact eating disorder development include:

• Negative family dynamics around food
• Trauma
• Physical health problems resulting in mouth or gastrointestinal (GI) pain
• Disordered eating and exercise behaviors encouraged in sports, such as under-eating and over-exercising
• Food insecurity
• Genetic predispositions
• Sensory sensitivity to the smell, taste, and texture of food

It is important to understand that people have unique experiences and recognize that a single cause or narrative cannot be applied to everyone. It is critical that blanket assumptions are not made as to why LGBTQIA+ people develop eating disorders, as this can interfere with proper diagnosis and treatment as well as perpetuate false stereotypes.

To learn more, check out the resources below and follow along in reading part 2 of this blog titled “Eating Disorder Treatment Considerations for the LGBTQIA+ Community.”

Resources to Learn More

• Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature | Journal of Eating Disorders | Full Text (biomedcentral.com)
• Transgender Clients’ Experiences of Eating Disorder Treatment - PMC (nih.gov)
• How Eating Disorder Treatment Can Be More Trans-Inclusive (healthline.com)