Prevalence of disordered eating behaviors varies at the intersection of gender identity and sexual orientation among sexual and gender minority youth.

Abstract

Engaging in disordered eating behaviors (DEBs) to attempt to control weight is a well-documented precursor to the development of an eating disorder. Both gender identity and sexual orientation have been identified as relevant social positions in the development of DEBs. Most existing studies have been unable to examine the intersection of these identities due to limitations in sample size. The present study assessed DEB disparities at the intersection of gender identity and sexual orientation among a large sample of sexual and gender minority adolescents. The sample included n = 9,876 adolescents. Past-year prevalence of dietary restriction, self-induced vomiting, binge eating, and diet pill use was assessed. Data were analyzed with multilevel analysis of individual heterogeneity and discriminatory accuracy, which assumes individuals within a given subgroup are exposed to similar structural processes like heterosexism that lead to disparities. Pansexual transgender boys were among the three highest prevalence groups for multiple DEBs: Restricting prevalence was 67.1%, vomiting prevalence was 29.1%, and binge eating prevalence was 45.5%. For all outcomes, at least one subgroup had unexpectedly high prevalence; for all outcomes except use of diet pills, at least one subgroup had unexpectedly low prevalence, indicative of interactive intersectional effects. Overall, results demonstrate that DEBs do not universally vary across either gender identity or sexual orientation. Instead, patterns are more complex as marginalized and privileged identities are not associated with only risk or only resiliency. More research is needed on the factors that drive the development of DEBs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).