As a culture, we tend to associate eating disorders with privileged young women. Even though research shows that the demographics are far more varied, that eating disorders strike people of all gender and sexual identities, races, and socioeconomic classes, the specter of a limp and faceless Mary-Kate Olsen-like figure, bones jutting out of a Balenciaga dress, fervently clutching a green juice and a Marlboro light still hovers in the popular imagination of what the words "eating disorder" have come to mean.
The image is reinforced throughout the eating disorder community itself, making it almost impossible to eradicate. On nationaleatingdisorders.org, two thin women are pictured smiling longingly at the camera. On eatingdisorderhope.com, a website designed to connect people with treatment facilities, countless other thin, young, mostly white women peer out from banners ads for eating disorder treatment facilities. It's only natural to assume the faceless, thin female figure has become the unofficial spokesperson for those dealing with eating disorders because she is the type of person these diseases mainly affect. However, this misinformation is far from the truth.
It turns out eating disorders are most common among those who we have selectively ignored: A study published in the Journal of Adolescent Health earlier this year found that transgender youth were four times more likely to report an eating disorder diagnosis than their cisgender heterosexual female peers—the next leading eating disorder group. The study involved over 200,000 heterosexual students, 5,000 who are "unsure," 15,000 who are gay, lesbian, or bisexual, and 479 who are transgender.
The researchers compared various gender identity and sexual orientation groups with cisgender heterosexual women, who are usually the focus of eating disorder literature. Not only were transgender students four times more likely to report an eating disorder diagnosis than their cisgender heterosexual female peers, they were also twice as likely to report using diet pills and more than twice as likely to report vomiting or laxative use during the previous month.
Transgender students were four times more likely to report an eating disorder diagnosis than their cisgender heterosexual female peers.
"Some of the qualitative studies in the past have suggested that because trans people are actively trying to change their bodies, they might be using disordered eating behaviors to suppress secondary sexual characteristics," Elizabeth Diemer, first author on the study in the Journal of Adolescent Health, tells Broadly—meaning that trans people are developing eating disorders at such high rates because they are trying to either gain or lose weight to accentuate or suppress parts of their bodies as they transition, and they are using food to help them achieve these goals.
However, Dan Maldonaldo—a genderqueer and transgender logistics coordinator at T-FFED, a Los Angeles-based collective working to bring awareness and treatment options to eating disorders in the trans community—is quick to caution against this theory. "I think when we report eating disorders in our community to medical professionals, a lot of times there's this arrogance or conflation of gender dysphoria with body dysmorphia," they say. "People think that once you're able to transition that your eating disorder will disappear. This is not the case. There's a lot of reasons why eating disorders are prevalent in the transgender community, but it doesn't necessarily have to do with the fact that we are trans and we have bodily issues that have to do with our gender."
It turns out that asking why trans youth are at such a higher risk for developing eating disorders might be beside the point. Trans patients still often struggle with medical professionals who don't know how to address them, never mind to understand their condition and offer appropriate treatment. "A lot of times, whenever I go to the doctor's office—and this is often true in ED treatment facilities—there's a lot of misgendering," Maldonaldo tells Broadly. "People are not really aware of how to speak with, interact with, and speak about my community. I think that's something that really needs to change."
People think that once you're able to transition that your eating disorder will disappear. This is not the case.
It's an understatement to say a lot of work needs to be done before trans youths with eating disorders receive as much attention as their cisgender peers. Of course, it can be all too easy to overlook eating disorders in trans youth when there are countless other serious issues happening simultaneously. "There's a much higher proportion of trans youth who are homeless or not with their families, or going through other economic issues that might make it harder for them to even get to treatment or get to a stage where the eating disorder would be the first thing on their plate," Diemer tells Broadly. "If they're looking for housing, obviously that needs to come first."
In order to seriously address the issue of eating disorders among trans youth, it seems, the simplest way is to shift our understanding of what eating disorders look like and whom they affect. "In the field we're concerned with busting the myth," Dr. Alexis Duncan, senior author of the study in the Journal of Adolescent Health, tells Broadly. "People tend to think about eating disorders as being people with anorexia, but most people with eating disorders are not too thin, so they by definition do not have anorexia. It's much more likely that someone will have binge eating disorder or bulimia, and be of normal weight or even overweight. So the question is: how do we bust the myth?"
I'll see ads for a recovery facility and it will have all thin white women on it. That's often very harmful.
The only answer, it seems, is to continue raising awareness about the fact that eating disorders don't affect only a specific, stereotypical demographic. "Most eating disorder treatment facilities have very little visibility for people outside of the existing stereotypes," Dan Maldonaldo explains. "Sometimes I'll see ads for a recovery facility and it will have all thin white women on it. That's often very harmful. We can start a conversation by asking about it and showing ads of different types of people—people of different sizes and different racial backgrounds and genders. That would be really helpful."
In the meantime, there is some help available to transgender people suffering from EDs: T-FFED holds a bi-weekly in-person eating disorder support group for transgender and genderqueer people in the Los Angeles area, as well as an active online support group for anyone who can't make it in person. "Anyone who has access to the Internet has access to our online support group," Maldonaldo says. "We have folks from around the country. There's people from all over the US and Canada, and even Thailand. It's great to see a community of people who are healing on their own—and to provide support for people who are not able to access it regularly."