Trans-Affirming Care and Eating Disorders: Lived Experience of Tgd Adults

Background and Purpose: Transgender and gender diverse (TGD) populations experience eating disorders (ED) at high rates. EDs are associated with high rates of mortality, significant long term health impacts, and lower quality of life. Despite the prevalence and consequences of EDs, TGD people face numerous barriers in accessing traditional ED treatment. Trans-affirming primary care, in which TGD people receive culturally aware, up to date, clinical support for gender affirmation in the context of general primary care services is well positioned as a site for intervention to improve prevention, screening, treatment, and management of EDs in TGD populations. However, LGBT health settings in the United States have been understudied, and it is not known how trans-affirming healthcare practices are addressing EDs.

This study addresses this gap through centering the perspectives of trans-affirming primary care patients with EDs to understand how trans-affirming care is currently addressing EDs and to offer recommendations for improved care for this population.

Methods: Five focus groups were conducted with TGD adults (ages 18-30+) with current or past EDs or disordered eating patterns (n=22). The sample is predominantly white (68%), nonbinary (59%), and sexually diverse (50% queer, 14% bisexual, 5% lesbian, 23% gay, and 9% asexual). Participants were recruited through the social media platforms of a large trans and intersex collective of ED care workers, advocates, educators, and researchers with lived experience of EDs. Interviews were transcribed verbatim and were coded and analyzed via thematic analysis as proposed by Braun and Clarke (2006; 2014; 2022).

Findings: Data analysis revealed major themes including: the impact of “medicalized fat phobia” or weight stigma on care, a perception that primary care providers lack training in EDs, and a sense that ED care exists in a separate “silo” than medical care due to a perception that EDs are seen as a mental health issue rather than a medical concern. Subthemes included: patients’ need to advocate for their own access to care, the consequences of being labeled “high risk” due to an ED, and gatekeeping.

Conclusions and Implications: Findings highlight how intersecting marginalized identities impact patients’ primary care experiences, even in environments that are supportive of their gender identity. For example, weight-based measures of health in medicine contribute to unequal treatment of TGD patients with EDs and discourage patient disclosure of disordered eating symptoms. In addition to provider education, interventions to improve care for TGD patients with EDs must also include systemic measures to advocate for size inclusive medical care and improved screening for EDs as well as increased integration between mental health providers, ED treatment providers, and primary care practices. Social workers have the potential to improve care for TGD patients through care coordination and advocacy, however social workers must be cognizant of the barriers TGD people face in accessing treatment and the TGD community’s unique history with social work and medicine.