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Fan J, Nagata JM, Cuccolo K, Ganson KT. Associations between dieting practices and eating disorder attitudes and behaviors: Results from the Canadian study of adolescent health behaviors. Eat Behav 2024; 54:101886. [PMID: 38788552 DOI: 10.1016/j.eatbeh.2024.101886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
This study aimed to describe the frequency of dieting practices among adolescents and young adults in Canada, as well as determine the association between dieting and eating disorder attitudes and behaviors. Data from 2762 Canadian adolescents and young adults from the Canadian Study of Adolescent Health Behaviors were analyzed. Frequencies were used to determine the prevalence of 11 different diets among the sample, and chi-square tests were used to assess gender differences. Multiple modified Poisson and linear regression analyses were conducted to determine the associations between any dieting and eating disorder attitudes and behaviors. Among the sample, 15.7 % of girls and women, 10.4 % of boys and men, and 13.0 % of transgender/gender expansive (TGE) participants reported any dieting in the past 12 months, with the Ketogenic diet being most common among all genders. Results from regression analyses showed that engaging in any dieting in the past 12 months was associated with greater eating disorder psychopathology among girls, women, boys, and men, but not TGE participants. There were varying trends in association between specific types of dieting practices and eating disorder behaviors among girls, women, boys, and men. Dieting is relatively common among a national sample of Canadian adolescents and young adults, and engagement is associated with greater eating disorder psychopathology and behaviors. Healthcare and public health professionals should consider screening for eating disorders among adolescents and young adults who report engaging in dieting practices.
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Affiliation(s)
- Jingchuan Fan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Kelly Cuccolo
- Department of Psychology, Alma College, Alma, MI, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
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Smith EK, Harrop EN. "That's not at all what I needed" trans adults' perspectives on trans-affirming primary care and eating disorders. Soc Sci Med 2024; 348:116836. [PMID: 38569289 DOI: 10.1016/j.socscimed.2024.116836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/28/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Transgender and gender diverse adults, referred to collectively as trans, experience eating disorders (EDs) at high rates and struggle to find primary care providers (PCPs) knowledgeable in both gender-affirming care and EDs. Most research regarding healthcare experiences of trans people with EDs focuses on specialized treatment. This qualitative study explored the experiences of trans patients with ED symptoms in trans-affirming primary care, which offers clinical support for gender affirmation in the context of interpersonally gender-affirming primary care services. Twenty-two participants were recruited via social media to participate in focus groups (n = 5). Researchers utilized thematic analysis. Participants reported gender-affirming and non-affirming experiences, experienced unwelcome comments from providers regarding bodies and gender, encountered barriers to disclosing their ED symptoms, felt transition-related medical care supported recovery but did not always resolve their ED symptoms, felt they had to self-advocate, and wanted their providers to recognize them as whole people (beyond their ED and transness) who experience joy. Importantly, despite being trans-affirming, participants critiqued trans-affirming primary care as perpetuating weight stigma and binary gender norms. Participants recommended providers receive ED training, implement universal ED screening, and explore how sociocultural norms regarding weight and gender negatively impact trans health outcomes.
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Affiliation(s)
- Emil K Smith
- University of Pittsburgh School of Social Work, 2117 Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA, 15260, USA.
| | - Erin N Harrop
- University of Denver Graduate School of Social Work, 2148 South High Street, Denver, CO, 80208, USA
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Vélez C, Newman KL, Paul S, Berli JU, Tangpricha V, Targownik LE. Approaching Digestive Health Care in Transgender and Gender-Diverse Communities. Gastroenterology 2024; 166:369-375.e2. [PMID: 38395524 DOI: 10.1053/j.gastro.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Christopher Vélez
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kira L Newman
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Sonali Paul
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois
| | - Jens U Berli
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, Oregon
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Emory University, Atlanta, Georgia
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
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Vélez C, Newman KL, Paul S, Berli JU, Tangpricha V, Targownik LE. Approaching Digestive Health Care in Transgender and Gender-Diverse Communities. Clin Gastroenterol Hepatol 2024; 22:441-447.e2. [PMID: 38395527 DOI: 10.1016/j.cgh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Indexed: 02/25/2024]
Affiliation(s)
- Christopher Vélez
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kira L Newman
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Sonali Paul
- Section of Gastroenterology Hepatology, and Nutrition, University of Chicago, Chicago, Illinois
| | - Jens U Berli
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, Oregon
| | - Vin Tangpricha
- Division of Endocrinology Metabolism, and Lipids, Emory University, Atlanta, Georgia
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
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Mittertreiner EJE, Hunter A, Lacroix E. Nutritional considerations for gender-diverse people: a qualitative mini review. Front Nutr 2024; 11:1332953. [PMID: 38419847 PMCID: PMC10899494 DOI: 10.3389/fnut.2024.1332953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Dietitians working with gender-diverse people may require different skills and knowledge than those caring for cisgender men and women, as indicated by a growing body of literature that highlights gender-diverse people's unique experiences with and relationships to nutrition and eating behaviors. To provide insight into how dietitians can best serve this population, this mini review identifies and summarizes qualitative studies that investigate gender-diverse people's lived experiences and perspectives regarding nutrition, eating disorders, and access to eating-related healthcare services. Fourteen studies examining nutrition or eating behaviors among gender-diverse samples were selected through a systematic search and screening process: 11 focused on disordered eating or eating disorders and the remaining three focused on nutritional needs, nutritional knowledge, and food insecurity. Extracted themes included: using dietary restriction to suppress secondary sex characteristics or conform to societal norms; the impact of gender-affirming care on disordered eating; negative experiences with, and beliefs about, nutrition and eating disorders healthcare services; and suggestions for clinicians. Recommendations discuss the need for increased trans literacy among clinicians, the creation of safe spaces for gender-diverse people with eating disorders, and the importance of dual competencies in eating disorders treatment and gender-affirming care.
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Affiliation(s)
- Em Jun Eng Mittertreiner
- Maritime Eating and Appearance Lab, Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Abbey Hunter
- School of Education, St. Thomas University, Fredericton, NB, Canada
| | - Emilie Lacroix
- Maritime Eating and Appearance Lab, Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
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Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Curr Opin Psychiatry 2023; 36:412-418. [PMID: 37781981 DOI: 10.1097/yco.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW This review summarizes recent research on eating disorders among gender minorities, transgender and gender diverse people. The focus is on research published in 2022 and the first half of 2023. RECENT FINDINGS Up to 1.2% of young people and 0.3-0.5% of adults identify as transgender, and 2.7-8.4% of young people and 0.3-4.5% of adults report some degree of gender diversity. About 20-50% of transgender and gender diverse people report engaging in disordered eating and >30% screen positive for eating disorder symptoms, and 2-12% have received an eating disorder diagnosis from a health professional. Many transgender and gender diverse people describe eating disorder symptoms as a way of coping with gender dysphoria. They also report high levels of mental and behavioral symptoms, particularly mood and anxiety disorders, suicidal thoughts and behaviors, trauma-related symptoms and disorders, alcohol and substance use, and autism. Gender minorities frequently experience discrimination, victimization, and violence, primarily sexual and physical violence. The minority stress model attributes mental health symptoms to these factors. Promising interventions based on the minority stress model have recently become available, but more research is needed on how to support transgender and gender diverse people with eating disorders. To manage eating disorders in this population, gender-affirming care should be combined with specialist eating disorder treatment. SUMMARY Gender minorities are at high risk for eating disorders. Future studies should assess what is the most appropriate treatment for transgender and gender diverse people with eating disorders.
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Harrop EN, Hutcheson R, Harner V, Mensinger JL, Lindhorst T. "You Don't Look Anorexic": Atypical anorexia patient experiences of weight stigma in medical care. Body Image 2023; 46:48-61. [PMID: 37236121 PMCID: PMC10524894 DOI: 10.1016/j.bodyim.2023.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Eating disorders (ED) and weight stigma pose significant healthcare challenges. Patients at higher weights, like some with atypical anorexia (AAN), may face increased challenges due to weight stigma. This study analyzed patients' lived experiences with weight stigma in healthcare. Thirty-eight adult patients with AAN completed in-depth, semi-structured interviews regarding healthcare experiences. Guided by narrative inquiry approaches, transcripts were thematically coded. Across the illness trajectory (ED development, pre-treatment, treatment, post-treatment), patients reported that weight stigma in healthcare contributed to initiation and persistence of ED behaviors. Themes included "providers pathologizing patient weight," which patients reported triggered ED behaviors and relapse, "provider minimization and denial" of patients' EDs, which contributed to delays in screening and care, and "overt forms of weight discrimination," leading to healthcare avoidance. Participants reported that weight stigma prolonged ED behaviors, delayed care, created suboptimal treatment environments, deterred help-seeking, and lowered healthcare utilization. This suggests that many providers (pediatricians, primary care providers, ED treatment specialists, other healthcare specialists) may inadvertently reinforce patients' EDs. Increasing training, screening for EDs across the weight spectrum, and targeting health behavior promotion rather than universal weight loss, could enhance quality of care and improve healthcare engagement for patients with EDs, particularly those at higher weights.
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Affiliation(s)
- Erin N Harrop
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA; University of Denver Graduate School of Social Work, 2148 South High Street, Denver, CO 80208, USA.
| | - Rebecca Hutcheson
- University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Vern Harner
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
| | - Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing at Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA; Nova Southeastern University, 3301 College Ave, Fort Lauderdale, FL 33314, USA
| | - Taryn Lindhorst
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
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