Prevalence of Disordered Eating Behaviors Among Sexual and Gender Minority Youth Varies at the Intersection of Gender Identity and Race/Ethnicity

OBJECTIVE: Prior work has documented inequities in disordered eating behavior (DEB) prevalence across gender identity, race, and ethnicity, yet has often ignored the fact that individuals belong to multiple social groups simultaneously. The present study assessed DEB inequities at the intersection of gender identity and race/ethnicity. METHOD: The sample included n = 10,287 adolescents (68% gender-diverse, 33% belonging to marginalized racial/ethnic groups). Past-year prevalence of dietary restriction, self-induced vomiting, diet pill use, and binge eating was assessed. Data were analyzed with multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). MAIHDA nests individuals within social strata defined by all combinations of gender identity and race/ethnicity (a proxy for exposure to structural (cis)sexism and racism). MAIHDA allows for comparison of outcome prevalence across strata and identifies strata with disproportionately high or low prevalence. RESULTS: Hispanic gender-nonconforming youth had a high prevalence of multiple DEBs: restricting prevalence was 67.1% (95% CI 62.1%-72.2%), vomiting prevalence was 25.9% (95% CI 21.6%-31.0%), and binge eating prevalence was 46.0% (95% CI 40.2%-51.4%). For all outcomes, at least one stratum had disproportionately low prevalence; for all outcomes except vomiting, at least one stratum had disproportionately high prevalence, indicative of intersectional interactions between gender identity and race/ethnicity. DISCUSSION: DEB prevalence among adolescents varies substantially at the intersection of gender and race/ethnicity, with the highest prevalence among those belonging to multiple marginalized groups. Future research is needed on the multilevel drivers of DEBs.