Weight and shape control behaviors among young transgender women: Findings from Project Body Talk

Background: Despite recent research suggesting that eating disorders may be a key health concern among transgender populations, little is known about potentially harmful weight and shape control behaviors in at-risk transgender women. The present study explored weight and shape control practices among low-income, ethnically diverse young transgender women in the Boston metropolitan area.

Methods: Semi-structured in-depth interviews were conducted with 21 participants (ages 18-31 years; mean annual income<$10,000; ethnic identity: Multiracial [n=8], Black [n=4], Latina [n=4], White [n=4], Asian [n=1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation model.

Results: Study participants described using a variety of strategies to address body image concerns.  Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Participants described a social context with gender-related and other discriminatory experiences, which shaped participants’ access to social and material resources as well as stress and coping behaviors. Several participants discussed the interaction of social and biological processes, particularly in relation to gender-affirming cross-sex hormone use and its role in both body satisfaction and weight gain concerns. Individual and community-level resiliencies related to the development of positive body image included peer and family networks and receipt of gender-affirming healthcare.

Conclusion: This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for research, treatment, and public health interventions to enhance resilience factors.