By Lauren Means
Editor’s note: This story includes discussions of disordered eating behaviors that may be disturbing or triggering to some.
“Welcome to McDonald’s. Can I take your order?”
“Yes, I’ll have a number one with a Diet Coke and a… um, a… a number five with a Sprite.”
That was me back in the early 2000s placing my order late-night on any given day. And that order was not for two people. It was all for me. I would try to place the order so it sounded like I was trying to order for a second person and was trying to figure out what they wanted. I would always order two different drinks to throw off the people inside. I didn’t need two meals but I wanted it. And the people inside could care less who the food was for. But I was ashamed to order that much for myself. But that shame did not stop me.
I would take my meals up to my room and eat them alone. It was always a Big Mac meal and a six-piece nugget meal. I would feel so good while eating but when I was done, I always had a feeling of regret…disappointment in myself. But somehow, it was not enough to stop me from doing it again.
I have had a dysfunctional relationship with food for as long as I can remember. For me, food was tied to emotions. That is why after I moved away from home for college, the binging escalated. I was dealing with depression and anxiety. I missed my family but also was learning more about myself and knew I could not do that back home. It was hard enough coming out to myself. The anxiety of coming out to family and friends became monumental. Food helped calm that anxiety even if just temporarily.
A Link Between LGBTQ+ Identity and Eating Disorders
Lee Owen, team leader at The Renfrew Center of Tennessee, explained how situations like mine can be a breeding ground for eating disorders. “Eating disorders thrive in isolation and can develop as a way to cope with difficult emotions,” said Owen. “Bullying, discrimination, anxiety about coming out, and rejection by family or peers are all emotionally painful experiences, and for some people, the eating disorder develops as a way to handle that stress. This makes LGBTQ+ people of color, LGBTQ+ people with disabilities, and LGBTQ+ people living in poverty even more vulnerable to eating disorders, since they experience oppression based on multiple identities.”
The Renfrew Center has been a pioneer in the treatment of eating disorders since 1985 with a focus of empowering patients to change their lives. As the nation’s first residential eating disorder facility, Renfrew has helped more than 100,000 cisgender adolescent girls and adult women, transgender, and non-binary individuals move towards recovery by providing them with the tools they need to succeed in recovery and in life. The Nashville location opened in 2007.
Owen also explained how eating disorders may go unrecognized or undertreated in LGBTQ+ people. “One reason is that our society’s image of a person with an eating disorder is very limited, but we know that people of all body sizes, races, ages, and genders experience eating disorders. The stereotype that eating disorders only look one way is a barrier to people recognizing their own eating disorders and from getting treatment,” he said. According to Owen, the gap between someone suspecting they have an eating disorder and getting a diagnosis and treatment is larger for LGBTQ+ youth of color, for example, than the general population. He also noted that eating disorders among men have also long been underdiagnosed and undertreated, and among males who are diagnosed with eating disorders, 42% are gay.
Owen went on to explain body image is even more complicated for transgender and gender-nonconforming people. Gender dysphoria can be a struggle for many trans people. Gender dysphoria is a sense of unease or distress a person may have because of a mismatch between their biological sex and their gender identity. In fact, a 2023 study by the Trevor Project found 87% of LGBTQ+ youth are dissatisfied with their bodies with trans (93%) and non-binary (90%) youth being most affected.
“It makes sense that someone with gender dysphoria might turn to disordered eating behaviors to change or control their body, especially if they don’t have access to gender-affirming treatment like hormone replacement therapy or surgery. Our aim in treatment is to affirm the person’s identity and help them live authentically without relying on disordered eating behaviors like restricting, binging, purging, or compulsively over-exercising,” said Owen.
The Complex Intersection of Mental Health and LGBTQ+ Identity
The intersection of mental health and LGBTQ+ identity can contribute to the development or exacerbation of eating disorders. Owen said it is extremely common that eating disorders co-occur with another mental health diagnosis. Common co-occurring diagnoses are anxiety, depression, substance use, and post-traumatic stress disorder. These co-occurring diagnoses increase the likelihood of developing an eating disorder because we look for ways to control our uncomfortable or distressing emotions. “Many people feel that if they recover from their eating disorder, their depression or anxiety will worsen, and we do see this at the beginning of treatment as clients start to feel their emotions without the buffer of the eating disorder numbing them. This is why having eating disorder programs that address the whole person and not one specific side of the problem is essential in achieving full recovery,” Owen explained.
Like many aspects of healthcare for the LGBTQ+ community, many people do not feel treatment programs or mental health providers offer gender-affirming care, so they do not seek treatment at all. They may not feel comfortable seeking treatment fearing that their provider or their peers will not validate their experiences due to their queer identity.
He also said culture and ethnicity also play a heavy role. “For instance,” said Owen, “many BIPOC individuals do not feel validated in having mental health diagnoses, considering depression and anxiety a ‘white person’s disease. Couple this stigma with their existing queer identity and they may feel further alienated from their picture of someone with an eating disorder or in recovery.”
This is why having an affirming treatment program is paramount. To meet a need for LGBTQ+ affirming eating disorder treatment, the Renfrew Center offers a virtual program called SAGE — Sexuality and Gender Equality — for current LGBTQ+ patients and alumni with a focus on gender identity, body image, and sexual orientation and how they intersect with eating disorders. Owen said this exists to connect with peers who can understand and/or empathize with each other’s struggles specific to LGBTQ+ people recovering from eating disorders. He expounded on this by saying, “Addressing stigma and creating an affirming social environment cannot wait until after the person recovers from the eating disorder. Instead, it should be approached as some of the most important work to prevent or recover from an eating disorder.”
Improving Awareness within the LGBTQ+ Community
While programs like SAGE at the Renfrew Center can help people with eating disorders on the clinical side of things, all of us can help improve education and awareness surrounding eating disorders within the LGBTQ+ community. To start, Owen said we can make our LGBTQ+ spaces more supportive of people struggling with or at risk for eating disorders by fighting back against diet culture and fatphobia that often drives eating disorders.
“In the same way we deliberately cultivate safe spaces by asking pronouns and avoiding assumptions about someone’s sexual orientation or gender identity, we can deliberately look at a space through the eyes of someone struggling with an eating disorder and notice the small cues that indicate if they are welcome.” He said some examples of welcoming cues include furniture comfortable for people in larger bodies, conversation that doesn’t label foods as ‘good’ or ‘bad’, and affirming access to gender-affirming healthcare as a necessary part of mental health care.
As for me, I will always be working on my dysfunctional relationship with food. There will be good days and bad days but knowing I am not alone and that programs like those at the Renfrew Center exist make reaching out for help a little easier.
For more information about the Renfrew Center visit https://renfrewcenter.com/.
