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Transgender people face greater risk, fewer resources in eating disorder treatment 

Queer & There

Feb. 25 marks the start of National Eating Disorder Awareness Week, an annual event organized by the National Eating Disorder Association (NEDA), the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders. This year’s theme is “Come as You Are,” which “sends a message to individuals at all stages of body acceptance and eating disorder recovery that their stories are valid. We invite everyone, especially those whose stories have not been widely recognized, to have the opportunity to speak out, share their experiences, and connect with others,” according to the NEDA website.

This year’s theme resonates with many transgender people, who the medical community has only recently begun to discuss in conjunction with eating disorders. Historically, mainstream medicine has generally ignored — except for treatments relating to gender dysphoria — trans people’s medical needs, though recent studies have found that transgender people disproportionately struggle with eating disorders compared to their cisgender peers. A 2015 study of college students in the Journal of Adolescent Health found that almost 16 percent of transgender people surveyed had a past-year eating disorder diagnosis, compared to almost 2 percent of cisgender women. Yet the majority of eating disorder narratives (such as the 2017 Netflix original film To the Bone) center on cisgender women.
“Personally, I am finding myself serving a lot of trans clients,” says Amy Scott, co-founder of the Colorado Springs-based Center for Food and Body Therapy. “This definitely confirms what we know about the disproportionate incidence of eating disorders in the trans population.” The dearth of accessible information for therapists and other professionals working with trans populations has prompted Scott to begin developing treatment options with trans people in mind.

“On the International Association for Eating Disorder Professionals’ website, in 11 pages of viewable lectures and trainings, there was not one training that focused on the needs of the queer community, let alone the trans community,” Scott says. “I’ve been looking and haven’t found trainings specifically for the intersection of eating disorders in the trans community. I have had to go out and look hard for resources to help me better understand the experience of my trans clients.”
Scott is quick to note the role societal expectations play in the high number of eating disorder instances in the trans community. “There is some qualitative research out there where trans folks have the opportunity to provide their perceived reasons for this struggle. Generally, trans folks already have had very negative experiences of their physical body (namely, weight and shape), which is already in and of itself a symptom commonly found in eating disorders. Additionally, after transitioning, trans folks are more likely to attune to the social expectations of their gender and internalize the pressure to shift weight on their form in order to pass.”

While dieting in order to pass (“passing” is a trans person’s ability to be correctly perceived as the gender they identify as) is a significant risk factor for trans people developing an eating disorder, many struggles of existing as a trans person in our society — a pronounced lack of supportive friends and family, steady employment and safe housing — present additional risk factors. “It’s important to include dieting as a major risk factor into any eating disorder,” says Scott. “Trans women report wanting to lose weight in order to appear more petite and pass as a feminine, delicate woman. Trans men may want to gain muscle weight and eat ‘perfectly’ in order to appear more masculine or simply want to lose the curves around the midline of the body.”

The Center for Food and Body Therapy, which Scott has founded with registered dietician Stephanie Scott (no relation), “is about cultivating a community with membership-based experiences. My practice is unique because I am able to offer yoga sessions, psychotherapy sessions, EMDR therapy and other forms of experiential body-based therapy like paddleboarding or hiking,” Scott says. “Having worked in residential treatment utilizing a lot of nature therapy, I am fond of finding space for that in my outpatient clinical work. We want to offer an alternative to dieting and create a space where anyone is welcome who wants to have a healthy relationship with their body.”

People struggling with an eating disorder can reach out to Scott or call the NEDA hotline at 800/931-2237.

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