A new study shows almost 40% of transgender and non-binary youth in Aotearoa are at risk of developing an eating disorder, but researchers say the biggest gap may be in what we don’t know yet. Capsule speaks to an expert about what trans youth could be experiencing, and how to best support those with eating disorders.
Two in five of Aotearoa’s transgender youth are at risk of developing an eating disorder, according to a new study published in the New Zealand Medical Journal.
The study also found almost 40% of young people who identify as transgender or non-binary met the threshold for eating disorder risks – almost twice the global average of 22% for young people.
AND there’s an even HIGHER risk for 14 to 18-year-olds.
“Transgender youth are often at a critical point in their lives,” says Dr Michaela Pettie (Ngāti Pūkenga), an Otago University research fellow and co-chair of Te Tira Wānanga Ngā Māuiui Kai (Aotearoa Māori Eating Issues or Disorders Network).
“It’s saddening to know that our transgender youth are experiencing such distressing symptoms, but also, this study is a massive step in the right direction. We have such little research and evidence about eating disorders, and this paper [is] a great contribution.”
Why Trans Youth are More at Risk
The study, drawn from the 2022 Counting Ourselves national survey, explored whether the unmet need for gender-affirming hormone therapy might explain the high risk of eating disorders among transgender youth.
It found the two are linked – but the unmet need alone isn’t the cause.
The researchers pointed out that Aotearoa still lacks the data to fully understand what’s driving these increased risks, highlighting the urgent need for better research and national data collection.
Why transgender youth are more at risk is something being grappled with not just in Aotearoa, but internationally too, says Michaela.
Being an adolescent is a time to explore and learn more about yourself, she says, but it’s also a time we experience discrimination, bullying, stigma and societal pressures.
On top of that, she says transgender and non-binary youth are also dealing with other factors that can sometimes be more distressing for them – particularly when puberty hits and the development of secondary sex characteristics begins.
Michaela says this could be a time when gender dysphoria – the distress a person feels when their experienced gender is different from the sex they were assigned at birth – hits quite hard.
Without the right and culturally safe tools to help manage that, she says this is where the intersection with eating disorders could come in.
“Eating disorders can be functional. Behaviours like restrictive or compensatory behaviours can be used as coping mechanisms to delay or control the development of secondary sex characteristics at puberty … which can sometimes reduce the distress from that gender incongruence.”
How HARMFUL Eating Disorders Are
According to Mayo Clinic, eating disorders, such as anorexia, bulimia, binge-eating disorder and avoidant/restrictive food intake disorder, can seriously affect someone’s physical and mental health.
They could damage the heart, digestive system, bones and teeth, and increase risk of other illnesses.
Left untreated, these disorders can become life-threatening. A recent Clinical Psychology Review study found that having an eating disorder increases the chances of dying by 339%, with anorexia nervosa being the deadliest – a 521% higher risk of death.
These numbers are confronting, but Michaela says prevention and early support can be life-changing.
Prevention and Support Starts at Home
“Prevention is best,” says Michaela. If whānau could understand what disordered eating behaviours are early on, recovery outcomes are so much better.
She explains disordered eating behaviors are like the stage before clinically defined eating disorders – things like skipping meals, restricting food groups, or maybe feeling shame or guilt around eating.
“Being able to understand what disordered eating behaviors are and addressing those, people’s recovery, their lifetime success and wellbeing are far better than those who aren’t able to access treatment or don’t have the treatment that supports their needs.”
Creating safe and open spaces for kōrero within whānau can make a huge difference. For parents and families of transgender and non-binary kids experimenting with their identity, she says that might mean talking about body image and gender expression in a safe way.
“That can be quite a scary conversation if we’ve not necessarily done the reflections ourselves, but learning about how people see themselves in the world can be really useful,” says Michaela.
“This is tied into the idea that for some transgender people, particularly young ones, body image can be something they focus on because that’s the way they feel represented in the world.
“It’s often how we express our gender identity. The way in which some people control their gender expression can be through changing their body shape and changing the way that they see their body image.”
Signs to Watch For
Of course, prevention means knowing what signs and symptoms to look out for in your whānau.
In Michaela’s experience with family members, she noticed changes in their eating behaviours – like skipping meals, avoiding shared mealtimes, being overly particular about food or hiding and hoarding food.
Here are some common signs and symptoms of eating disorders, according to KidsHealth | Hauora Taitamariki:
- Prepares food for others but won’t eat it themselves
- Cuts down portions or limits their diet
- Eats large amounts of food in a relatively short period of time
- Complains about colour, smell, texture or taste of food
- Seem anxious, angry or irritable around mealtimes
- Experiences shame, guilt and disgust with food
- Goes to the bathroom or toilet straight after meals
- Vomits or uses laxatives
- Exercises too much – like exercising along in their bedrooms
When noticing these behaviours, Michaela says to approach it with empathy.
“Rather than [saying] ‘I’m confused and I don’t understand what’s happening’, approach it with open non-judgmental communication”
She also recommended having those conversations away from mealtimes, as being talking it out around food could add to their distress.
It can also be INCREDIBLY DIFFICULT for whānau supporting someone through an eating disorder.
Michaela says there’s help out there for them too – and getting support for yourself means you’re better able to support your young person.
Where to get help:
- Need to talk?: Free call or text 1737 to talk to a trained counsellor.
- Healthline: Call 0800 611 116, available 24/7
- EDANZ (Eating Disorders Association of NZ): Call 0800 2 EDANZ: Support for the family of those with an eating disorder
- Contact Eating Disorders Carer Support on info@edcs.co.nz
- If you think you are suffering from an eating disorder, see your GP or healthcare professional immediately for a referral to specialist services.
- If it is an emergency or you or someone else is in immediate danger, call 111.
