Eating Disorders in the LGBTQ+ Community

LGBTQ+ Identity as a Risk Factor for Eating Disorders 

Compared to their non-LGBTQ+ peers, members of the LGBTQ+ community often experience health disparities medically, psychiatrically and socially. A larger share of LGBTQ+ individuals have an ongoing health condition, a chronic condition or disability. LGBTQ+ individuals are also more likely to report needing mental health services. Additionally, LGBTQ+ people were twice as likely as non-LGBTQ+ people to report that they had been discriminated against during a health care visit over the past two years. 

Unfortunately, these disparities continue when looking at eating disorders in LGBTQ+ individuals. Members of the LGBTQ+ community have an increased risk of developing an eating disorder compared to their non-LGBTQ+ peers. Unfortunately, members of the community are also more likely to experience barriers to care than the general population. Without treatment eating disorders can have serious psychiatric consequences and lead to severe medical complications, highlighting the importance of effective, accessible and affirming eating disorder care in this population. 

Eating Disorder Prevalence by Identity 

The prevalence of eating disorders and eating disorder diagnoses differ across LGBTQ+ identities, including sexual orientation and gender identity.   

Sexual Orientation & Eating Disorders 

Gay and bisexual men and lesbian and bisexual women have different experiences of eating disorders. The research for gay and bisexual men is more consistent compared to that of lesbian and bisexual women.  

Gay & Bisexual Men 

Men make up 15% of cases of anorexia nervosa, bulimia and binge-eating disorder, and up to 22% of young men turn to dangerous means to bulk up muscle with disordered eating behaviors. While men can suffer from an eating disorder, there still exists stigma and shame exist surrounding seeking treatment for an eating disorder. When men do seek care, clinicians aren’t as quick to screen for or identify an eating disorder. Additionally, parents of teenage boys might not recognize eating disorder symptoms in boys, attributing significant weight loss or excessive exercise to puberty. 

On top of being male, gay and bisexual men also face additional pressures both within and outside of the community to conform to certain body standards. Despite gay men only representing 5% of the total male population, of the men who have an eating disorder 42% identify as gay.  

Gay men are seven times more likely to report bingeing and 12 times more likely to report bingeing than heterosexual men. Additionally, gay and bisexual boys report being significantly more likely to have fasted, vomited or taken laxatives or diet pills to control their weight in the last thirty days.  

The gay community has its own ideas of attractiveness and how that attractiveness is valued. The prevalence of idealized body types (typically thin and/or muscular) in dating preferences and gay media can lead to eating disordered behaviors to achieve these ideals. Men with a desire for thinness may engage in restriction or bingeing and purging, while men with a desire for muscularity may excessively or compulsively exercise to boost their feelings of attractiveness or to receive validation from their community. 

Lesbian & Bisexual Women 

Research is limited and conflicting on eating disorders among lesbian and bisexual women. While research indicates lesbian women experience less body dissatisfaction overall, research has also shown that there are no significant differences between heterosexual women and lesbians in the prevalence of any eating disorders.  

Other studies have found that lesbian, bisexual and mostly heterosexual females were about twice as likely to report binge eating at least once per month in the last year. Bisexual and questioning women been found to have particularly higher rates of disordered eating compared to their lesbian and straight peers. 

Because of conflicting research, it is hard to determine whether lesbian culture is a protective factor against negative body image or whether the lesbian community is more likely to reject heteronormative beauty ideals or accept diverse body types. 

Transgender and Non-Binary Identity & Eating Disorders 

Transgender and non-binary individuals may take on disordered eating patterns or develop an eating disorder to create an “acceptable” or “passing” appearance. They may see eating disorders as one of the only ways to achieve their desired body weight or shape. 

Transgender Men & Women 

Transgender men and women may feel serious social pressure from their family, friends and peers to “pass” (being perceived as the gender you identify as). Additionally, passing may also be necessary to maintain their safety. Transgender individuals who do not “pass” or who are gender non-confirming may be identified as transgender and subsequently become a target for bullying or discrimination, be forcefully outed or become a victim of anti-trans violence. 

As transgender people come out or begin to transition, they may begin to internalize diet culture messaging about the idealize male or female body. This may also be a source of gender dysphoria, as they compare their body to the ideal. Transgender men may seek to have a more muscular build to conform to society’s expectation for men and masculinity, while transgender women might desire a thin and delicate frame to conform to society’s expectation for women and femininity. 

Together, these factors can increase a trans person’s risk of developing an eating disorder. About 16% of transgender individuals suffer from an eating disorder. Transgender individuals are also at a higher risk of suicidality, with 40% of transgender adults attempting suicide in their lifetime, compared to less than 5% of the general population. With suicide being a major cause of death for those with eating disorders, transgender individuals with eating disorders are particularly at-risk.  

Non-Binary & Gender-Expansive Individuals 

Non-binary and gender-expansive gender identities are genders that do not fit within the gender binary (man and woman). Some gender-expansive identities include non-binary, genderqueer, gender-fluid, bigender and pangender. 

Non-binary individuals often fear their gender identity will not be accepted, and experience identity invalidation, a lack of social support and increased discrimination. There is also the additional stressor of the invalidation of gender-expansive identities being described by society as “fake” or “nonsensical.” 

While there is not a lot of research specifically focusing on non-binary individuals, a recent study reported that nearly 25% of gender-expansive individuals reported recently engaging in dietary restraint, and 12.9% reported engaging in objective binge episodes. Another study showed non-binary participants were significantly more likely to report an eating disorder diagnosis compared to their binary gender peers. 

Risk Factors & Protective Factors for Eating Disorders in the LGBTQ+ Community 

LGBTQ individuals experience greater levels of stress, discrimination, violence, bulling, social pressure to conform and higher levels of isolation compared to their straight and cisgender peers. These challenges – collectively considered the Minority Stress Theory – make LGBTQ individuals more likely to experience mental health struggles, especially if their identity isn’t affirmed by their loved ones or they have experienced trauma.   

Ongoing support from peers, strong family relationships and friendships, along with a sense of self-compassion can help protect against the development of eating disorders.  

LGBTQ+ individuals are at an increased risk of developing eating disorders along with other psychiatric illnesses. It is vital providers understand the unique way eating disorders present and develop in the LGBTQ+ community to provide high-quality, evidence-based LGBTQ-competent care.

References 

1. Dawson, L., Long, M., & Frederiksen, B. (2021). LGBT+ People’s Health status and Access to Care. KFF. Retrieved February 25, 2024, from https://www.kff.org/report-section/lgbt-peoples-health-status-and-access-to-care-methods/ 
2. Burnette, C. B., Kwitowski, M. A., Trujillo, M. A., & Perrin, P. B. (2019). Body Appreciation in Lesbian, Bisexual, and Queer Women: Examining a Model of Social Support, Resilience, and Self-Esteem. Health Equity, 3(1), 238–245.  
3. FAQ: What is Passing? (2020, December 17). Teen Health Source. 
4. National Eating Disorders Association. (2012). Eating Disorders in LGBT (Gay/Lesbian/Bisexual/Transgender) Populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdf 
5. New survey on LGBTQ youth finds “concerning” disparities in suicide risk | NAMI: National Alliance on Mental Illness. (2021, May 19). National Alliance on Mental Illness. 
6. Young, R., & Paris, F. (2020, February 25). Gay Men More At Risk Of Eating Disorders, But Finding Community Can Be Hard | Here & Now. WBUR. 
7. Watson, R.J., Veale, J.F., Saewyc, E.M. (2017). Disordered Eating Behaviors Among Transgender Youth: Probability Profiles from Risk and Protective Factors. International Journal of Eating Disorders, 50(5), 515-522. 
8. Diemer, E. W., White Hughto, J. M., Gordon, A. R., Guss, C., Austin, S. B., & Reisner, S. L. (2018). Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample. Transgender Health, 3(1), 17–23. https://doi.org/10.1089/trgh.2017.0043 
9. Nagata, J. M., Compte, E. J., Cattle, C. J., Flentje, A., Capriotti, M. R., Lubensky, M. E., Murray, S. B., Obedin-Maliver, J., & Lunn, M. R. (2020). Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations. Journal of Eating Disorders, 8(1). https://doi.org/10.1186/s40337-020-00352-x 

Last Reviewed: March 2024 by Casey Shamy, LSW