The queer community has proven its resilience repeatedly in the last several decades. But experts warn that continual exposure to trauma has made the community especially vulnerable to eating disorders and disordered eating.
Research has consistently found that LGBTQ+ adults and adolescents experience eating disorders and disordered eating behaviors more frequently than their heterosexual and cisgender counterparts. The causes can include bullying, poverty, abuse, body-image ideals (as perpetrated through the media) and the political climate, among other issues.
(Note: According to Eating Recovery Center, “while it is possible that disordered eating behaviors can develop into an eating disorder, that is not always the case. Both disordered eating and eating disorders can share similar signs and symptoms.” In this article, the professionals consulted each use a different term.)
Looking at different types
There are several categories of eating disorders, according to Chicago nutritionist Theresa LaMont, RDN, LDN (they/them/theirs).
“Anorexia and bulimia are the disorders most people are familiar with,” LaMont said. “However, there’s one called OSFED, which stands for ‘other specified feeding or eating disorder,’ and I’d say that’s the biggest catch-all bucket. Then there is binge-eating disorder, which is considered to be separate from anorexia and bulimia; it’s different because it doesn’t have a restrictive component.
Avoidant/restrictive food intake disorder (ARFID) is another illness, LaMont said. “This is one that has nothing to do with concerns about weight or shame. It’s kind of an extreme set of sensitivities to food.” A person with ARFID “won’t just eat chicken nuggets,” they added. “They will eat Tyson Chicken Nuggets in the red five-pound bag. It gets very, very specific and when those foods are not available, people will have extreme reactions—even physical, like gagging or vomiting.”
LaMont said that “there are others that are rare—usually niche [disorders]. There’s rumination disorder [when someone repeatedly regurgitates undigested or partially digested food from the stomach] or pica, which some people are familiar with. With pica, people eat food that isn’t food [like chalk]. And then there’s one that’s a diagnosis although it shouldn’t be one: atypical anorexia nervosa, in which you have all the symptoms of anorexia but you’re just [not underweight]. Six percent of people with any eating disorder are considered to be medically underweight; 94% are not considered underweight.”
The role of trauma
The ostensible causes of eating disorders are myriad, but LaMont said trauma almost inevitably emerges as a common factor in the lives of the clients they see.
“With trauma, you could include bullying, sexual assault, homelessness—all of those things,” LaMont said. “I would say, from my personal experience, I can count on one hand the number of people who weren’t dealing with capital-T or lower-t trauma.”
Andersonville therapist Albe Gutierrez (she/her/ella) sees those various causes of disordered eating (a term she prefers in order “to avoid pathologizing”) can be related—especially for the trans community—“to the body, as in restricting food intake as a way of shaping the body. For some, it’s about the ideal of having an attractive body.”
The current political climate, Gutierrez added, is impacting trans people’s “ideas about their bodies, so I think issues like desire, [attractiveness] and passibility are heightened. To an extent, being attractive and passable are indicative of safety with gender identity. For some, it’s about camouflaging oneself.”
And how does one even become aware that he/she/they might have a disorder? “It’s remarkably complex,” LaMont said. “For example, if you think about adolescent-onset eating disorders, you can see family members saying, ‘Something’s wrong. You used to eat all this food and now you’re not,’ ‘You’re eating in a very different way’ or ‘You’re hiding food.’ There’s a lot of outside looking in.”
Gutierrez said, “Working with disordered eating is a unique challenge in that food is always going to be around; it is literally necessary for life. I think the ubiquitousness of it could be a trigger and a barrier. Also, disordered eating could be connected to other mental-health needs that are not being addressed. People could be dealing with symptoms of depression or anxiety, and they turn to food for comfort, for example.”
“With a lot of eating disorders, the way they function is by hiding themselves from the person suffering from them,” LaMont stated. “If someone knew they had an eating disorder—in a black-and-white way—they wouldn’t want to keep doing it. But if it starts as ‘Well, it’s New Year’s so I’ll cut out carbs’—well, everybody does that! Then you might start tracking calories, going lower and exercise more.”
An eating disorder “shape-shifts” so that the person with the condition, and the people around them, regard it as normal, LaMont noted.
“Quite frequently, eating disorders only become identifiable when there’s someone close who sees the [sufferer] every day, or if there are medical consequences,” they said. “And, even then, with 94% of people with eating disorders having a normal or higher-weight body, the possibility of a doctor screening the person for an eating disorder is very, very low. The doctor might say, ‘You’ve lost 30 pounds? Keep up the good work.’”
And this lends itself to a lack of culturally competent care, according to LaMont: “Doctors get a little bit of training, like what an eating disorder looks like in a 13-year-old white girl who’s underweight—but they don’t know how to screen anybody else.”
Gutierrez suggested relying on family and friends, saying, “If there’s a pattern of comments that you’re getting, solicited or not, that might be a sign.”
Weight-loss drugs present new complications
LaMont called the proliferation of weight-loss drugs such as Mounjaro, Wegovy and Ozempic one of their “hot buttons.”
“GLP-1 drugs are a phenomenal medication for the treatment of diabetes,” they explained. “They’re life-changing for people suffering from it. The medications themselves are not good or bad—they’re just medications. However, the unfettered rise of GLP-1s on the landscape is an absolute harm, especially given that there are all of these online places where you can get medications without seeing a doctor or being monitored. It’s something I discuss with my clients day in and day out. People want a magic solution—but, like any medication, it has benefits and side effects; it’s not great for everybody. But by making this so easily accessible, people who are already suffering from eating disorders are going to suffer more.
“The justification I keep hearing is that it’s not like ephedrine or the diet pills of the past; it’s different. But there are decades of research [with weight-loss medications]—for people with diabetes. We don’t have decades of research for people who don’t have diabetes.”
On the road to recovery
LaMont was skeptical that LGBTQ+ culture would retreat from the bodily standards perpetuating eating disorders anytime soon.
“Societally, the very short version is that we’re fucked,” they said. “I say that not just because our current political administration is divorced from meaningful science or healthcare. But back in 2020, when COVID was first on the scene, a lot of the fat liberationist scholars and content creators said, ‘If we live through this, there’s going to be a huge backlash against fat bodies.’ They broke down this historical relationship between global health events, like the Spanish flu pandemic in 1918, and how thinness became this body ideal after the events—and this was connected with health and morality. So if you survive a pandemic, you’re a good person—and you should look like a good person, which is healthy and thin.”
So this intersection of post-COVID society and the rise of GLP-1 is wildly unsurprising to me. So, from a social standpoint, I don’t see this getting better for a good five to 10 years—but I hope I’m wrong.”
Regarding recovery for a queer individual, LaMont said, “Let’s pretend we live in a world where everyone has equitable access to healthcare. The first person you want to go to is a therapist; if they’re [properly] trained, they’ll know what to look for. Emotionally, you have nothing to lose. But if you can’t get a therapist, try a dietician—but about 90% of them are cisgender white men. Plus, the academic qualifications have been raised, which means the field will look even more cisgender and white across the board. If you can’t reach a therapist or nutritionist, try a primary-care doctor.”
Gutierrez concurred about the importance of therapists, saying, “Understanding the factors influencing behavior is an important first step in changing any maladaptive behavior. [But] for the queer community, there can be a problem finding competent clinicians, especially for people who are minorities within minorities, like queer people of color.” For those who may find such care geographically inaccessible, Gutierrez suggested turning to the internet or social media (such as YouTube), adding that people “should practice due diligence.”
LaMont urged solidarity among members of the LGBTQ+ community as difficult times most certainly lie ahead.
“The thing that feels really important to me—given the social and political moment we’re in—is that there is no LGB without the T,” they said.” Trans women of color are the reason that queer people have any of the rights that we have today, and they should be protected at all costs. The concept that trans people are under attack in this country significantly increases the likelihood of them suffering from eating disorders. People use the disorders as a coping skill—as a tool to survive. Even before this administration, I worked with a lot of transgender siblings who were already trying to modify the appearance of their bodies to conform with their gender ideal—and I [fear] that it’s only going to get worse when trans people lose access to gender-affirming care.”