Though eating disorders can affect anyone regardless of gender identity, data shows that transgender individuals, or people who identify with a different gender than the one assigned at birth, are at higher risk for eating disorders.1 Gender dysphoria, or the sense of distress that occurs when one’s body feels mismatched with one’s gender identity, can contribute to body image distress.
Transgender folx are also more likely to experience food insecurity and discrimination, which are linked to higher rates of eating disorders.1, 2, 3 Due to lack of educated providers and bias, transgender individuals often have difficulty navigating the healthcare system, which may lead to treatment avoidance. As a Registered Dietitian Nutritionist, I have seen many of my transgender clients present with eating disorders and disordered eating. This lead me to ask: What is gender-affirming nutrition care?
Here are four components necessary for gender-affirming nutrition care:
1. Affirming clients’ identities from the beginning
Before I meet with a client for their initial nutrition session, I take time to review my client’s gender identity, sex assigned at birth, preferred name, and pronouns as collected by our intake coordinators. This helps ensure that I am addressing the person correctly, while understanding any differences that may affect nutritional needs. It’s important that I review this background information so that my client doesn’t have to spend time explaining the basics of their identity.
2. Body image care that acknowledges gender dysphoria
We know that eating disorders can cause body dysmorphia, or distorted, obsessive thinking about one’s body. When working with eating disorders, we aim to separate which thoughts about the body come from the true self or the internal bully: the eating disorder.
This becomes more complicated for folx experiencing gender dysphoria. As providers, we need to validate the very real distress that our transgender clients face as they navigate body image. In our Rainbow Road eating disorder treatment program, we support this through our Body Image, Gender Dysphoria and Dysmorphia group where clients work to untangle struggles along with peers who have similar experiences. We can also help by providing referrals in the community for gender-affirming care.
3. Nutrition counseling to support gender-affirming medical interventions
When starting gender-affirming hormone replacement therapy (HRT), the body undergoes metabolic changes that allow it to appear more feminine or masculine. Many transgender folx with eating disorders struggle with changes in appetite that occur with starting HRT. Gender-affirming nutrition work can help people re-establish trust in their bodies and their abilities to nourish themselves. Nutrition is also crucial around gender-affirming surgical interventions to give our bodies the “building blocks” needed to heal. We help our clients to nourish themselves before and after these interventions, while recognizing how crucial it is for folx to be able to access these services.
4. Care that affirms the whole person
It is not only transgender identities that can present barriers to treatment. Folx may also have trouble finding care that is neurodivergent-friendly, anti-ableist, fat positive, and acknowledges the harms of racism and homophobia. In nutrition work, we acknowledge the factors beyond the person’s control that make it difficult to heal from an eating disorder. We also acknowledge that neurodivergence may affect a person’s food preferences and how they choose to nourish themselves. It is important that nutrition work recognizes that people of all sizes can be affected by eating disorders, and all bodies deserve healing.
We’re here to help.
We know finding care can be tough. That’s why Walden is here for you. If you are concerned that you, or a loved one, may have an eating disorder, please reach out by completing the form on this page or email us at firstname.lastname@example.org.
Emily Taylor, RD, LDN, CDN (she/her) is the Lead Registered Dietitian for Walden Behavioral Care’s Rainbow Road virtual PHP/IOP. She is passionate about providing care to the LGBTQ+ community and believes in the power of team-based, collaborative eating disorder care. She also has experience in private practice, community health, and research settings. She is a graduate of the University of Connecticut Coordinated Program in Dietetics.
1 Parker, L. L., & Harriger, J. A. (2020). Eating disorders and disordered eating behaviors in the LGBT population: A review of the literature. Journal of Eating Disorders, 8(1). https://doi.org/10.1186/s40337-020-00327-y
2 Conron, K. J., & O’Neill, K. K. (2022, April 14). Food insufficiency among transgender adults during the COVID-19 pandemic. Williams Institute. Retrieved March 27, 2023, from https://williamsinstitute.law.ucla.edu/publications/trans-food-insufficiency-covid/
3 Hazzard, V. M., Loth, K. A., Hooper, L., & Becker, C. B. (2020). Food insecurity and eating disorders: A review of emerging evidence. Current Psychiatry Reports, 22(12). https://doi.org/10.1007/s11920-020-01200-0