Research and Reflections on Truth #5: Eating Disorders Affect People of all Genders and Sexual Orientation

BY: Melissa Munn-Chernoff, PhD

DATE: August 17, 2015

Recently, Dr. Cynthia Bulik, the Academy for Eating Disorders, and numerous other eating disorder advocacy groups came out with the list of the “Nine Truths about Eating Disorders.” Because my research focus examines eating disorders in traditionally underrepresented populations, I was excited to see: “Truth #5: Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.”

My colleagues and I at Washington University in St. Louis had just finished a study that included the largest sample of transgender individuals ever to be asked about eating disorder diagnoses and symptoms. This research, led by Elizabeth Diemer, then an undergraduate student, and Alexis Duncan, Assistant Professor of Public Health, was published online this past April in the Journal of Adolescent Health. In this study, our group examined the prevalence of self-reported eating disorder diagnoses (anorexia nervosa and bulimia nervosa) by a health professional in the past year and self-reported engagement in compensatory behaviors (vomiting, laxative use, and diet pills) in the past 30 days in nearly 300,000 college students from across the United States! Students were grouped according to their gender identity and sexual orientation. They represented many different racial/ethnic groups, with the highest proportion of individuals identifying as European American, followed by Asian/Pacific Islander, multiracial, Hispanic, and African American.

Here are some highlights of the study’s findings:

  • Among all participants, 479 (0.17%) identified as transgender; 5,977 (2.07%) identified as a sexual minority (i.e., gay or bisexual) male; 9,445 (3.27%) identified as a sexual minority female; 1,662 (0.58%) men and 3,395 (1.17%) women were unsure about their sexual orientation; and 91,599 (31.69%) men and 176,467 (61.06%) women identified as heterosexual.
  • Nearly 1.50% of all individuals in the sample reported that a health professional had told them that they had an eating disorder in the past year. In the past 30 days, roughly 3.50% students reported using diet pills and about 3% reported self-induced vomiting or using laxatives.
  • Transgender individuals had the highest prevalence of eating disorder diagnoses, vomiting or laxative use, and diet pill use (15.82%, 15.01%, and 13.50%, respectively). Heterosexual men had the lowest prevalence of all three outcomes (0.55%, 0.67%, and 1.88%, respectively).
  • After taking into account age, race/ethnicity, binge drinking in the past 2 weeks, cigarette use in the past month, past-year stress levels, college athletic participation, and fraternity/sorority membership, transgender individuals were 4.5 times more likely to have been diagnosed with an eating disorder in the past year, 2.5 times more likely to have used laxatives or reported self-induced vomiting in the past month, and 2 times more likely to have used diet pills in the past month than heterosexual women.
  • Most eating-related pathology was also significantly more prevalent in sexual minority men and women, as well as women who were unsure of their sexual orientation, compared with heterosexual women. Heterosexual men were significantly less likely to report an eating disorder diagnosis or use compensatory behaviors compared with heterosexual women.
  • When looking exclusively at transgender individuals, those who were unsure of their sexual orientation had a significantly higher prevalence of eating disorder diagnosis and compensatory behaviors than those who identified as a heterosexual or sexual minority.

What’s the take home message? Eating disorders and their symptoms occur in individuals from all walks of life, including transgender and sexual minority individuals. In fact, these disorders and behaviors may be more prevalent in certain minority populations, such as sexual and gender minorities, than among heterosexual women. Appropriate prevention and intervention efforts tailored for these individuals are urgently needed. We must, as a society, work to spread awareness that these devastating illnesses are not exclusive to heterosexual women. If anyone you know is showing signs or symptoms or eating disorders, there are several resources to help.

I hope that over my tenure here at UNC, we can continue to provide important clues into risk factors for eating disorders and why they occur so often with other behaviors that can affect one’s quality of life. It is only by including individuals in research who come from every part of the world, with all different life experiences, that we will be able to fully understand and treat eating disorders.


  1. Diemer, E.W., Grant, J.D., Munn-Chernoff, M.A., Patterson, D., Duncan, A.E. (in press). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health. PMID: 25937471. doi: 10.1016/j.jadohealth.2015.03.003.