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Jonathan L. Tobkes, M.D. and Wesley C. Davidson
Jonathan L. Tobkes, M.D. and Wesley C. Davidson
Eating Disorders

Eating Disorders in the LGBT Community

Why does the community have higher rates of eating disorders?

Eating disorders have always been associated with straight, young, white females, but research shows that eating disorders disproportionately impact some segments of LGBT populations.

In a 2007 study of lesbian, gay, and bisexual-identified participants, which was the first to assess DSM diagnostic categories, gay and bisexual men had a significantly higher prevalence of lifetime full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder.

  • Gay men are thought to only represent 5 percent of the total male population but among men who have eating disorders, 42 percent identify as gay.
  • Both males and females who identified as gay, lesbian, bisexual or "mostly heterosexual" have elevated rates of binge-eating (seven times) and purging by vomiting (twelve times) or laxative abuse, than their heterosexual peers.
  • Research shows that as early as age 12, GLB teens may be at higher risk of binge-eating and purging than their heterosexual peers.

Why Do Eating Disorders Weigh More Heavily on LGBT People?

I often wondered this as I saw my son in his twenties and early thirties vacillating between stuffing (eating beyond feeling full) and fasting, colonics, and working out at the gym for hours. He arranged the clothes in his closet by "thin" or "fat."

Potential factors that may interact with an LGBT person's predisposition for developing an eating disorder include:

  • Being bullied.
  • The impact of stress from discrimination.
  • Homelessness or an unsafe home environment.
  • Fear of rejection by friends, family, and coworkers.
  • Internalized negative messages/beliefs.
  • Experiences of gay bashing that can develop into PTSD.

Since teens are so concerned with their appearance, how can a parent know the difference between his child "looking his best" as he tries to fit in, and trying to change his body through dieting and exercise to resemble who he believes he is internally?

Signs to Watch Out For

  • The child has restrictive, unusual rules around. They may eat only one type of food, such as gelatin, for example.
  • They won't eat in front of others (because their secret will be discovered).
  • They collect recipes and cook meals for others without eating. They may want to eat vicariously through menus or feeding others.
  • Food goes missing. Was it a late-night snack?
  • They avoid you and others. They don't want to be told that they are too fat and don't want to be offered food.
  • They constantly focus on their body shape and size.
  • There is a change in the clothes they wear; they may want to cover up bodies they think are flawed. Or they lose weight too quickly.

The struggle to feel accepted and safe is a mental health condition. Over the years, gay males have been thought of as "effeminate" in nature and consequently weak. To be loved, some felt they needed to adhere to an impossible Adonis-like ideal. Bulking up may feel "more masculine," and an overweight teen may feel less lonely if he loses his girth and his insecurities.

Psychiatrist Jonathan Tobkes, coauthor of When Your Child Is Gay: What You Need To Know, says, "I would speculate that perhaps eating disorders are higher in gay and lesbian patients because this population tends to be self-critical and, at times, perfectionistic in order to make up for what they may perceive to be a 'deficit' of their sexual orientation. In addition, eating disorders tend to be about maintaining control, especially when one experiences a lack of control in other areas of life."

Food becomes a coping tool for dealing with feelings of self-loathing and regret, unpleasant emotions or feelings of stress, depression or anxiety. Over time, people with eating disorders can't see themselves objectively. They need to rediscover who they are beyond eating habits, weight, and body image.

Ways to Combat Eating Disorders

  • Show concern. Find out why your child feels insecure. Steer conversations to their feelings.
  • Use "I" statements: "I worry when I see you wasting away," for example.
  • Don't shame and blame—and avoid commenting on appearance or weight.
  • Model good behavior. Don't "yo-yo" diet yourself or comment about other people's appearances.
  • Promote self-esteem in your child in other areas in which they excel.
  • Make meal times fun. Family members can plan and cook meals together.
  • Encourage your child to get help.

Some Sources

  • Information and Referral Helpline (National Eating Disorders Associations). Eating disorders helpline offers advice and referrals, and includes a directory of treatment providers and support groups.
  • Comprehensive, easy-to-search database of eating disorder treatment providers.
About the Author
Jonathan L. Tobkes, M.D. and Wesley C. Davidson

Wesley C. Davidson is a journalist who researches straight parents of LGBT children. Jonathan L. Tobkes, M.D. is a psychiatrist in New York and supervises residents at Weill Cornell Medical Center.

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