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The International journal of eating disorders
Nov 09, 2024;

Associations Between Gender Diversity and Eating Disorder Symptoms in Early Adolescence.

Jason M Nagata, Karen Li, Angela E Kim, Iris Yuefan Shao, Christopher D Otmar, Kyle T Ganson, Alexander Testa, Jinbo He, Orsolya Kiss, Jason M Lavender, Fiona C Baker
Author Information
  1. Jason M Nagata: Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. ORCID
  2. Karen Li: Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. ORCID
  3. Angela E Kim: Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. ORCID
  4. Iris Yuefan Shao: Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. ORCID
  5. Christopher D Otmar: Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. ORCID
  6. Kyle T Ganson: Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. ORCID
  7. Alexander Testa: Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA. ORCID
  8. Jinbo He: Division of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China. ORCID
  9. Orsolya Kiss: Center for Health Sciences, SRI International, Menlo Park, California, USA. ORCID
  10. Jason M Lavender: Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. ORCID
  11. Fiona C Baker: Center for Health Sciences, SRI International, Menlo Park, California, USA. ORCID
PMID: 39520143 DOI: 10.1002/eat.24317

Abstract

OBJECTIVE: To assess associations between multiple dimensions of gender diversity with eating disorder symptoms in a national cohort of U.S. early adolescents.
METHOD: This cross-sectional study utilized data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,092, M = 12.9 years, 2019-2021). Gender diversity was measured using multiple dimensions, including categorical gender identity (e.g., transgender, cisgender), categorical and continuous felt gender (congruence between gender identity and assigned sex), ordinal gender non-contentedness (dissatisfaction with one's gender), and ordinal gender expression (communication of gender through appearance and mannerisms). Multivariable logistic regression models were used to analyze the associations among gender diversity measures and eating disorder symptoms, adjusting for potential confounders.
RESULTS: Greater felt gender diversity was associated with self-worth tied to weight (OR 1.30, 95% CI 1.11-1.53), binge eating (OR 1.24, 95% CI 1.06-1.46), and distress with binge eating (OR 1.32, 95% CI 1.09-1.59). Greater gender expression diversity was associated with self-worth tied to weight (OR 1.16, 95% CI 1.02-1.33), distress with binge eating (OR 1.26, 95% CI 1.04-1.51), and characteristics of binge eating episodes (OR 1.33, 95% CI 1.06-1.66). Gender non-contentedness was associated with self-worth tied to weight (OR 1.38, 95% CI 1.20-1.58) and compensatory behaviors related to weight gain (OR 1.12, 95% CI 1.01-1.26). Transgender identity was not significantly associated with any eating disorder symptoms.
DISCUSSION: We found that greater gender diversity across multiple dimensions was associated with various eating disorder symptoms, and that measures beyond binary gender identity may be important to assess gender diversity in early adolescence.

Keywords

LGBTQ adolescent eating disorders gender identity gender minority transgender

References

  1. Baker, J. H., D. Freestone, K. Cai, S. Silverstein, B. Urban, and D. Steinberg. 2024. “Eating Disorder Clinical Presentation and Treatment Outcomes by Gender Identity Among Children, Adolescents, and Young Adults.” Journal of Adolescent Health 75, no. 2: 254–260. https://doi.org/10.1016/j.jadohealth.2023.11.015.
  2. Blum, R. W., N. M. Astone, M. R. Decker, and V. C. Mouli. 2014. “A Conceptual Framework for Early Adolescence: A Platform for Research.” International Journal of Adolescent Medicine and Health 26, no. 3: 321–331. https://doi.org/10.1515/ijamh‐2013‐0327.
  3. Burke, S. M. 2021. “Commentary:Gender Diversity and Adolescent Mental Health—A Reflection on Potter et al. (2020).” Journal of Child Psychology and Psychiatry, and Allied Disciplines 62, no. 2: 180–183. https://doi.org/10.1111/jcpp.13309.
  4. Cheng, C. M., J. Chu, K. T. Ganson, et al. 2023. “Cyberbullying and Eating Disorder Symptoms in US Early Adolescents.” International Journal of Eating Disorders 56, no. 12: 2336–2342. https://doi.org/10.1002/eat.24034.
  5. Deutsch, M. B., J. Green, J. Keatley, G. Mayer, J. Hastings, and A. M. Hall. 2013. “Electronic Medical Records and the Transgender Patient: Recommendations From the World Professional Association for Transgender Health EMR Working Group.” Journal of the American Medical Informatics Association 20, no. 4: 700–703. https://doi.org/10.1136/amiajnl‐2012‐001472.
  6. Diemer, E. W., J. D. Grant, M. A. Munn‐Chernoff, D. A. Patterson, and A. E. Duncan. 2015. “Gender Identity, Sexual Orientation, and Eating‐Related Pathology in a National Sample of College Students.” Journal of Adolescent Health 57, no. 2: 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003.
  7. Diemer, E. W., J. M. White Hughto, A. R. Gordon, C. Guss, S. B. Austin, and S. L. Reisner. 2018. “Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample.” Transgender Health 3, no. 1: 17–23. https://doi.org/10.1089/trgh.2017.0043.
  8. Eisenberg, M. E., A. Carlson‐McGuire, S. E. Gollust, and D. Neumark‐Sztainer. 2015. “A Content Analysis of Weight Stigmatization in Popular Television Programming for Adolescents.” International Journal of Eating Disorders 48, no. 6: 759–766. https://doi.org/10.1002/eat.22348.
  9. Eisenstadt, B. E., G. R. Murchison, Z. A. Soulliard, and A. R. Gordon. 2023. “Body Image and High‐Risk Weight and Shape Control Behaviors Among Transgender and Nonbinary Young Adults: The Role of Sexual Assault.” LGBT Health 10, no. 8: 586–594. https://doi.org/10.1089/lgbt.2022.0324.
  10. Garavan, H., H. Bartsch, K. Conway, et al. 2018. “Recruiting the ABCD Sample: Design Considerations and Procedures.” Developmental Cognitive Neuroscience 32: 16–22. https://doi.org/10.1016/j.dcn.2018.04.004.
  11. Hall, W. J., H. C. Dawes, and N. Plocek. 2021. “Sexual Orientation Identity Development Milestones Among Lesbian, Gay, Bisexual, and Queer People: A Systematic Review and Meta‐Analysis.” Frontiers in Psychology 12: 753954. https://doi.org/10.3389/fpsyg.2021.753954.
  12. Heeringa, S., and P. Berglund. 2020. “A Guide for Population‐Based Analysis of the Adolescent Brain Cognitive Development (ABCD) Study Baseline Data.” bioRxiv, 2020.02.10.942011. https://doi.org/10.1101/2020.02.10.942011.
  13. Kaltiala, R., E. Heino, M. Marttunen, and S. Fröjd. 2023. “Family Characteristics, Transgender Identity and Emotional Symptoms in Adolescence: A Population Survey Study.” International Journal of Environmental Research and Public Health 20, no. 4: 2948. https://doi.org/10.3390/ijerph20042948.
  14. Keski‐Rahkonen, A. 2023. “Eating Disorders in Transgender and Gender Diverse People: Characteristics, Assessment, and Management.” Current Opinion in Psychiatry 36, no. 6: 412–418. https://doi.org/10.1097/YCO.0000000000000902.
  15. McGregor, K., V. Rana, J. L. McKenna, C. R. Williams, A. Vu, and E. R. Boskey. 2024. “Understanding Family Support for Transgender Youth: Impact of Support on Psychosocial Functioning.” Journal of Adolescent Health 75, no. 2: 261–266. https://doi.org/10.1016/j.jadohealth.2024.04.006.
  16. Miller, K., S. Willson, and V. Ryan. 2021. “An Initial Cognitive Evaluation of a 2‐Step Gender Identity Measure.” National Center for Health Statistics. https://stacks.cdc.gov/view/cdc/150774.
  17. Nagata, J. M., E. J. Compte, F. H. McGuire, et al. 2023a. “Investigating the Factor Structure and Measurement Invariance of the Eating Disorder Examination‐Questionnaire (EDE‐Q) in a Community Sample of Gender Minority Adults From the United States.” International Journal of Eating Disorders 56: 1570–1580. https://doi.org/10.1002/eat.23978.
  18. Nagata, J. M., K. T. Ganson, and S. B. Austin. 2020. “Emerging Trends in Eating Disorders Among Sexual and Gender Minorities.” Current Opinion in Psychiatry 33: 562–567.
  19. Nagata, J. M., Z. Smith‐Russack, A. Paul, et al. 2023b. “The Social Epidemiology of Binge‐Eating Disorder and Behaviors in Early Adolescents.” Journal of Eating Disorders 11, no. 1: 182. https://doi.org/10.1186/s40337‐023‐00904‐x.
  20. Nagata, J. M., E. Stuart, J. O. Hur, et al. 2024. “Eating Disorders in Sexual and Gender Minority Adolescents.” Current Psychiatry Reports 26, no. 7: 340–350. https://doi.org/10.1007/s11920‐024‐01508‐1.
  21. National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences and Education, Committee on National Statistics, and Committee on Measuring Sex, Gender Identity, and Sexual Orientation. 2022. Measuring Sex, Gender Identity, and Sexual Orientation, edited by T. Becker, M. Chin, and N. Bates. Washington, DC: National Academies Press. http://www.ncbi.nlm.nih.gov/books/NBK578625/.
  22. Pham, A. H., H.‐M. Eadeh, M. M. Garrison, and K. R. Ahrens. 2023. “A Longitudinal Study on Disordered Eating in Transgender and Nonbinary Adolescents.” Academic Pediatrics 23, no. 6: 1247–1251. https://doi.org/10.1016/j.acap.2022.12.013.
  23. Pont, S. J., R. Puhl, S. R. Cook, W. Slusser, and Section on Obesity, & Obesity Society. 2017. “Stigma Experienced by Children and Adolescents With Obesity.” Pediatrics 140, no. 6: e20173034. https://doi.org/10.1542/peds.2017‐3034.
  24. Potter, A., S. Dube, N. Allgaier, et al. 2021. “Early Adolescent Gender Diversity and Mental Health in the Adolescent Brain Cognitive Development Study.” Journal of Child Psychology and Psychiatry, and Allied Disciplines 62, no. 2: 171–179. https://doi.org/10.1111/jcpp.13248.
  25. Potter, A. S., S. L. Dube, L. C. Barrios, et al. 2022. “Measurement of Gender and Sexuality in the Adolescent Brain Cognitive Development (ABCD) Study.” Developmental Cognitive Neuroscience 53: 101057. https://doi.org/10.1016/j.dcn.2022.101057.
  26. Puhl, R. M., and M. S. Himmelstein. 2018. “Weight Bias Internalization Among Adolescents Seeking Weight Loss: Implications for Eating Behaviors and Parental Communication.” Frontiers in Psychology 9: 2271. https://doi.org/10.3389/fpsyg.2018.02271.
  27. Roberts, S. R., A. J. Maheux, R. J. Watson, R. M. Puhl, and S. Choukas‐Bradley. 2022. “Sexual and Gender Minority (SGM) Adolescents' Disordered Eating: Exploring General and SGM‐Specific Factors.” International Journal of Eating Disorders 55, no. 7: 933–946. https://doi.org/10.1002/eat.23727.
  28. Rozzell, K., D. Y. Moon, P. Klimek, T. Brown, and A. J. Blashill. 2019. “Prevalence of Eating Disorders Among US Children Aged 9 to 10 Years: Data From the Adolescent Brain Cognitive Development (ABCD) Study.” JAMA Pediatrics 173, no. 1: 100–101. https://doi.org/10.1001/jamapediatrics.2018.3678.
  29. Silén, Y., and A. Keski‐Rahkonen. 2022. “Worldwide Prevalence of DSM‐5 Eating Disorders Among Young People.” Current Opinion in Psychiatry 35, no. 6: 362–371. https://doi.org/10.1097/YCO.0000000000000818.
  30. Simone, M., A. Askew, K. Lust, M. E. Eisenberg, and E. M. Pisetsky. 2020. “Disparities in Self‐Reported Eating Disorders and Academic Impairment in Sexual and Gender Minority College Students Relative to Their Heterosexual and Cisgender Peers.” International Journal of Eating Disorders 53, no. 4: 513–524. https://doi.org/10.1002/eat.23226.
  31. Swanson, S. A., S. J. Crow, D. L. Grange, J. Swendsen, and K. R. Merikangas. 2011. “Prevalence and Correlates of Eating Disorders in Adolescents. Results From the National Comorbidity Survey Replication Adolescent Supplement.” Archives of General Psychiatry 68, no. 7: 714–723. https://doi.org/10.1001/archgenpsychiatry.2011.22.
  32. Townsend, L., K. Kobak, C. Kearney, et al. 2020. “Development of Three Web‐Based Computerized Versions of the Kiddie Schedule for Affective Disorders and Schizophrenia Child Psychiatric Diagnostic Interview: Preliminary Validity Data.” Journal of the American Academy of Child and Adolescent Psychiatry 59, no. 2: 309–325. https://doi.org/10.1016/j.jaac.2019.05.009.
  33. Urban, B., D. Knutson, D. Klooster, and J. Soper. 2023. “Social and Contextual Influences on Eating Pathology in Transgender and Nonbinary Adults.” Eating Disorders 31, no. 4: 301–319. https://doi.org/10.1080/10640266.2022.213571.
  34. Watson, R. J., J. F. Veale, and E. M. Saewyc. 2017. “Disordered Eating Behaviors Among Transgender Youth: Probability Profiles From Risk and Protective Factors.” International Journal of Eating Disorders 50, no. 5: 515–522. https://doi.org/10.1002/eat.22627.

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Journal Article

Word Cloud

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