Eating Disorders in the LGBTQ+ Community: Prevalence & Disparities

By Casey Shamy, LSW

LGBTQ+ individuals face a higher risk of eating disorders and other psychiatric illnesses. From body image pressures to gender dysphoria, understanding these unique risk factors is essential to delivering high-quality, evidence-based and identity-affirming LGBTQ-competent care.

LGBTQ+ Community & Eating Disorders 

Compared to their non-LGBTQ+ peers, members of the LGBTQ+ community often face health disparities medically, psychiatrically and socially.1 This includes a higher risk of developing an eating disorder than their non-LGBTQ+ peers.2

Unfortunately, they are also more likely to encounter barriers to care than the general population.1 Without treatment, eating disorders can lead to serious psychiatric issues and severe medical complications, emphasizing the need for effective, accessible and affirming eating disorder care for this group. 

LGBTQ+ Health Disparities

LGBTQ+ individuals are over twice as likely to have a chronic health condition or disability and are also more likely to report needing mental health services.1 Additionally, LGBTQ+ people, are more likely to report experiencing negative provider interactions, including:1

  • Providers dismissing concerns
  • Providers making assumptions about them without asking
  • Providers not believing them
  • Providers suggesting they were personally to blame for a health problem
  • Experiencing discrimination

Eating Disorders in Gay & Bisexual Men

Gay and bisexual men are at a higher risk of developing an eating disorder. While it’s commonly reported that 10% of those with eating disorders are men, population-based studies suggest that eating disorders are equal between men and women.3

Up to 22% of young men resort to dangerous methods to bulk up muscle through disordered eating behaviors.4 Despite gay men only representing 5% of the total male population, of the men who have an eating disorder, up to 42% identify as gay.5 

Gay men also report greater body shape and weight dissatisfaction and are more likely to consider physical appearance to be critical to their sense of self.6

Social stigma for men

Social stigma can discourage men from seeking treatment for an eating disorder, and when they do seek help, clinicians are often less likely to screen for or diagnose an eating disorder. Parents of teenage boys may also fail to recognize eating disorder symptoms, sometimes attributing significant weight loss or excessive exercise to puberty. 

The thin ideal in the gay community

The thin ideal also affects gay and bisexual men in their own way. These men face extra pressures within their community to meet certain body standards. 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 who desire to be thin may engage in restriction or bingeing and purging, while men seeking muscularity might excessively or compulsively exercise to improve their attractiveness or gain validation. 

Eating Disorders in Lesbian & Bisexual Women 

Research on eating disorders among lesbian and bisexual women is limited and shows conflicting results. While some studies suggest that lesbian women experience less body dissatisfaction overall, other research indicates there are no significant differences in the prevalence of eating disorders between heterosexual women and lesbians.7  

Other studies have found that lesbian, bisexual and mostly heterosexual females are about twice as likely to report binge eating at least once a month in the past year.2 Bisexual and questioning women have been found to have particularly higher rates of disordered eating compared to their lesbian and straight peers.2 

Due to conflicting research, it is difficult to determine whether lesbian culture acts as a protective factor against negative body image or if the lesbian community is more likely to reject heteronormative beauty standards or embrace diverse body types. 

Eating Disorders in Transgender Men & Women 

About 16% of transgender individuals suffer from an eating disorder.8 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.9 With suicide being a major cause of death for those with eating disorders, transgender individuals with eating disorders are particularly at risk.  

Gender dysphoria

As transgender people come out or begin to transition, they may start to internalize diet culture messages about the idealized male or female body. This can be a source of gender dysphoria, as they compare their bodies to the ideal.

Transgender men may aim for a more muscular physique to meet society’s expectations for men and masculinity, while transgender women might want a slim and delicate frame to align with society’s expectations for women and femininity. 

Pressure to “pass”

Transgender men and women may feel serious social pressure from their family, friends and peers to “pass,” or being perceived as the gender one identifies as.10 Additionally, passing may also be necessary to maintain safety, as those who do not “pass” or are gender non-confirming may be identified as transgender. This can put trans people at risk of targeted harassment, discrimination, being outed or anti-trans violence. 

Eating Disorders in Non-binary 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
  • Pangender

There is little research specifically focusing on non-binary individuals, with many studies including them alongside their binary transgender peers. However, budding research does suggest that those who fall outside of the gender binary may be at a heightened risk of disordered eating behaviors.11

Lack of social acceptance

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 dismissed.

The androgynous ideal & gender dysphoria

Those who idealize an androgynous body shape and gender expression may experience gender dysphoria associated with aspects of their body that may be incongruent with what they consider the androgynous ideal.11

The Minority Stress Model & Eating Disorder Risk

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.   

Social pressure

Societal and community norms related to appearance can increase body dissatisfaction among LGBTQ+ individuals. Peer comparisons, dating expectations, and media representations can exacerbate pressures that contribute to disordered eating behaviors.

Stress

Chronic stress from dealing with identity-related issues, shame, stigma, or family rejection can cause LGBTQ+ individuals to turn to disordered eating as a way to cope. The ongoing pressure to handle minority stress may trigger eating disorders.

Discrimination

Experiences of discrimination in healthcare, workplaces or social settings can negatively impact self-esteem and body image, increasing vulnerability to eating disorders. Feeling marginalized often leads individuals to try to control their bodies when other parts of life feel uncontrollable.

Violence

Exposure to verbal, physical, or sexual violence disproportionately impacts LGBTQ+ individuals and can lead to trauma-related disordered eating. Eating disorders may develop as a maladaptive way to regain a sense of safety, control and protection.

How Can Eating Disorders Be Prevented in LGBTQ+ Individuals?

While eating disorders are multifactorial illnesses impacted by genetic predisposition, sociocultural factors, psychiatric comorbidities and personality traits, there are protective factors that can help mitigate this risk for LGBTQ+ people.12

Support from peers

Acceptance and affirmation from peers can protect LGBTQ+ individuals from the harmful effects of minority stress, offering a safe space to express themselves and decreasing dependence on disordered eating as a coping strategy.

Strong family relationships and friendships

Positive connections with family and close friends foster resilience, self-worth and emotional stability, which help protect against body dissatisfaction and unhealthy eating behaviors.

Self-compassion

Practicing self-compassion helps LGBTQ+ individuals respond to setbacks, stigma or body image issues with understanding instead of self-criticism, reducing the likelihood of turning to disordered eating for control or comfort.

Get Identity-Affirming Care for a Severe Eating Disorder

Eating disorders can be life-threatening. If you are experiencing severe medical complications of an eating disorder, medical stabilization and nutritional rehabilitation are important first steps for long-term recovery.

Start with a free assessment.

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. National Eating Disorders Association. (2012). Eating Disorders in LGBT (Gay/Lesbian/Bisexual/Transgender) Populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdf 
  3. Mehler, P. S., & Andersen, A. E. (2022). Eating Disorders: A comprehensive guide to medical care and complications (Fourth Edition). Johns Hopkins University Press.
  4. Nagata, J. M., Murray, S. B., Bibbins‐Domingo, K., Garber, A. K., Mitchison, D., & Griffiths, S. (2019b). Predictors of muscularity‐oriented disordered eating behaviors in U.S. young adults: A prospective cohort study. International Journal of Eating Disorders, 52(12), 1380–1388. https://doi.org/10.1002/eat.23094
  5. Feldman, M. B., & Meyer, I. H. (2007b). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40(3), 218–226. https://doi.org/10.1002/eat.20360
  6. McClain, Z., & Peebles, R. (2016). Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics of North America, 63(6), 1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008
  7. 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. https://doi.org/10.1089/heq.2019.0003
  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. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality
  10. FAQ: What is Passing? (2020, December 17). Teen Health Source. 
  11. Simone, M., Hazzard, V. M., Askew, A. J., Tebbe, E. A., Lipson, S. K., & Pisetsky, E. M. (2022). Variability in eating disorder risk and diagnosis in transgender and gender diverse college students. Annals of Epidemiology, 70, 53–60. https://doi.org/10.1016/j.annepidem.2022.04.007
  12. Watson, R. J., Veale, J. F., & Saewyc, E. M. (2016). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50(5), 515–522. https://doi.org/10.1002/eat.22627

Related Resources

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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