Understanding Eating Disorders and Body Image in LGBT+ Communities

People from LGBT+ communities are at increased risk of developing eating disorders, disordered eating and body image difficulties. Appearance stereotypes within these communities can create unique pressures, from the “ideal” body types online to the expectation that certain queer identities should look and perform gender in a particular way.

Body image can be closely tied to identity, belonging and acceptance. Eating disorders are often linked to much deeper experiences involving identity, shame, discrimination, trauma and safety. For many people, disordered eating can be a way of coping with difficult emotions or regaining a sense of control when life is overwhelming.

For those from LGBT+ communities, these experiences can be shaped by minority stress. This refers to the additional stress experienced by people from marginalised groups as a result of stigma, discrimination, prejudice and exclusion. This can include experiences such as hiding aspects of identity, anticipating rejection, being misgendered, facing discrimination, or feeling unable to fully be oneself.

Why Are LGBT+ Communities at Greater Risk of Eating Disorders?

People who experience discrimination, rejection or exclusion are more likely to experience shame, anxiety, depression and low self-esteem. These experiences can impact how someone feels about their body and may contribute to disordered eating behaviours.

Restricting food, binge eating, purging or over-exercising can sometimes become attempts to cope with emotional distress or regain a sense of control. When people feel disconnected from themselves, unsafe in their environment, or unable to express their identity freely, the body can become a focus for managing those feelings.
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Gay and Bisexual Men: Body Image and Eating Disorders

Studies suggest gay men are seven times more likely to report binge eating and twelve times more likely to report purging compared to heterosexual men (House of Commons, 2021). This may be influenced by appearance standards within some gay male spaces, particularly online. Dating apps can place a high value on being young, lean or muscular, with pressure to share pictures and present a particular image. Physical appearance can become a form of social currency and validation.
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For those who don’t fit these ideals, this can contribute to feelings of exclusion, inadequacy and a lack of belonging within their own communities. Constant comparison with highly edited/filtered pictures also reinforces body dissatisfaction and increases vulnerability to disordered eating behaviours.
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Lesbian and Bisexual Women and Disordered Eating

A meta-analysis found that while lesbian women did not differ significantly from heterosexual women in overall rates of disordered eating, bisexual women were more likely to restrict food and use purging behaviours (Dotan et al., 2021).

Research has also found that experiences of minority stress among lesbian and bisexual women, including feeling pressure to hide aspects of identity or anticipating rejection, were linked with binge eating as a way of coping (Mason et al., 2015).
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These findings highlight the importance of looking beyond food and body image alone. For many people, eating behaviours are connected to emotional experiences, social acceptance and the stress of navigating discrimination or invisibility.

(Note: people identify in many more ways than the limited terms here or in the research, and also there is an array of relationship diversity which also is not considered here. For another blog post!)

Transgender and Non-Binary People

For transgender and non-binary people, the relationship between body image and gender identity can be especially complex. When the body feels misaligned with one's gender identity, food and exercise can sometimes become tools for managing dysphoria or navigating a world that expects people to fit within gender binaries. Eating disorders, disordered eating behaviours and body dissatisfaction are more common amongst gender minority populations (Nagata et al., 2020).

For some trans and non-binary people, disordered eating may be linked to gender dysphoria, although this is not always the case. There may be a desire to suppress or accentuate certain physical characteristics to align more closely with a person's sense of self.

Examples of this may include:
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• Restricting food to reduce body fat in areas that may be perceived as feminine
• Exercising excessively to change body shape and appear more masculine or androgynous
• Avoiding eating as a way to disconnect from a body that feels uncomfortable or distressing
• Binge eating to cope with shame, distress or other difficult emotions
• Attempting to change appearance in ways that feel safer within wider society
 
Experiences such as discrimination, misgendering, lack of safe spaces and the emotional labour involved in navigating healthcare systems can all impact mental health and body image. Long waiting lists for gender affirming care can add further distress.

Research suggests that gender affirming care can improve body image and reduce eating distress (Gómez Gallego et al., 2023). Gender affirming care refers to support that helps people live more comfortably and authentically in their gender identity. This may include social changes, medical care, legal recognition and psychological support. Feeling more comfortable and secure in one's gender identity is associated with fewer eating disorder symptoms (Nagata et al., 2020).
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For many people in therapy, feeling seen, respected and affirmed as their authentic selves is a crucial step towards reducing the urge to control or punish the body. This can also reduce vulnerability to self-harm, suicidal thoughts and eating disorder behaviours.
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Minority Stress, Discrimination and Eating Disorders

​Research shows that intersecting marginalised identities increase the risk of minority stress, which in turn increases the risk of disordered eating and body image difficulties (Convertino et al., 2021).

​This means that the more ways a person is marginalised, in terms of ethnicity, ability, sexuality, class, etc, the more likely they may be to struggle with body image and eating. The image below can be a helpful way of understanding the intersections of power and privilege:
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Wheel of Power, Privilege, and Marginalization, by Sylvia Duckworth.

The experience of marginalisation can lead to feelings of shame, powerlessness and disconnection. Restricting, bingeing or over-exercising can become attempts to regain control when life feels unpredictable or unsafe.

For people living in larger bodies, anti-fat bias and weight stigma may intersect with gender-related expectations, creating additional barriers. Weight stigma can affect access to healthcare, including gender-affirming care, e.g. some people may be denied surgery until they reach a particular BMI (despite significant criticism of BMI).
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Masculinity, Muscularity and Male Body Image

Although eating disorders are often stereotyped as a "girls' problem" cisgender heterosexual men can experience any type of eating disorder too. This misconception can make it more difficult for men to recognise their struggles and seek support.

For men or masculine-presenting people, pressures around masculinity may contribute to a drive for muscularity, leanness and physical strength. In some cases, this can develop into muscle dysmorphia, a subtype of body dysmorphic disorder involving a preoccupation with leanness or building muscle.

The rise of gym culture and fitness influencers has amplified these pressures, promoting overexercising, compensatory exercise, restrictive eating and the use of questionable supplements or products. For men who engage in manosphere/red pill communities, there are very high appearance ideals, with comparisons, “market value” ratings and “looksmaxing”. These narratives can encourage constant comparison and self-critique, while also promoting harmful attitudes towards women.
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Traditional gender norms towards men can discourage emotional expression and vulnerability. As a result, changing the body may become a way of seeking control, safety or self-worth, while underlying emotional needs remain unaddressed.
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Femininity, Thinness and Social Expectations

Women and girls are often exposed to powerful messages about appearance from a young age. Although beauty ideals have changed over time, they often remain unattainable, leaving many people feeling trapped in striving to be perfect. Women’s beauty standards are particularly focused on young, white, thin, hairless bodies – influenced by patriarchal systems, racism and ableism. This can also link to the sexualisation and objectification of young girls and children.

From a feminist perspective, body image concerns are not simply individual issues. In Fat Is a Feminist Issue, Susie Orbach argued that the pursuit of thinness is connected to wider social expectations placed upon women. Thinness becomes associated with acceptability, self-discipline and worth. Feminist approaches have expanded beyond these earlier frameworks to become more intersectional, recognising the experiences of marginalised people, and that experiences of body image and eating disorders are shaped by other aspects of identity such as disability, neurodiversity, ethnicity and body size.
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Why an Intersectional Approach Matters

Bodies exist within social, cultural and political systems, so body image and eating disorders are not only personal issues but socio-cultural issues too. People's experiences of eating disorders are shaped by factors such as discrimination, poverty, ableism, racism, transphobia, homophobia, sexism and weight stigma. These experiences can influence how safe people feel in their bodies and whether they feel they belong.
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Unfortunately, eating disorder treatment services can sometimes overlook the impact of minority stress, discrimination and systemic barriers, leading people to feel misunderstood or excluded from support. This is why taking an intersectional approach is so important; it allows us to understand eating disorders within the wider context of people's lives rather than viewing them solely through the lens of food, weight and individual behaviour.
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Reflections from LGBT+ Eating Disorder Therapy Practice

In my practice, I work with many people who have found that typical approaches to eating disorder recovery have not worked for them because these wider experiences have not been acknowledged. They don’t tick the boxes they are expected to, and often feel this is their own fault.

Many of the people I work with are queer, neurodivergent and/or living in larger bodies. Many have experienced stigma, discrimination or invalidation within services because they do not fit narrow expectations around identity, gender or recovery. Others have faced weight stigma, transphobia, ableism or racism from systems that were meant to support them. Eating disorder treatment often assumes norms around ways of thinking and being, and for those who don’t fit these, they can further blame themselves.

These experiences can reinforce feelings of shame, trauma, exclusion and a lack of safety. It can exacerbate self-blame, which in turn further erodes self-worth. This is why I work in an intersectional and trauma-informed way, collaborating with clients to explore the broader context of eating and body image difficulties and working towards whatever recovery means for them.

Safety is crucial, so I won’t make assumptions or expect clients to act, look or behave a certain way. I offer a weight-neutral, LGBT+-affirming, neuro-affirming, anti-oppressive approach, with my values rooted in social justice. (I’m also aware that the terminology I use may update in the future – I’m always learning!)

I offer counselling sessions online and I offer a free 15-minute introductory call. Please get in touch via my contact page if you’d like to book.

Find out more about online counselling here.

Read more of my blogs here.

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References:
Convertino, A.D, Helm, J. L, Pennesi, J., Gonzales, M., Blashill, A. J (2021) Integrating minority stress theory and the tripartite influence model: A model of eating disordered behavior in sexual minority young adults, Appetite, Volume 163, 105204, https://doi.org/10.1016/j.appet.2021.105204
Dotan, A., Bachner-Melman, R., & Dahlenburg, S. C. (2021). Sexual orientation and disordered eating in women: a meta-analysis. Eating and weight disorders : EWD, 26(1), 13–25. https://doi.org/10.1007/s40519-019-00824-3
House of Commons, Women and Equalities Committee (2021) Changing the perfect picture: an inquiry into body image. Sixth Report of Session 2019–21. https://committees.parliament.uk/publications/5357/documents/53751/default/
Nagata, J. M., Ganson, K. T., & Austin, S. B. (2020). Emerging trends in eating disorders among sexual and gender minorities. Current opinion in psychiatry, 33(6), 562–567. https://doi.org/10.1097/YCO.0000000000000645
Mason, T. B., & Lewis, R. J. (2015). Minority stress and binge eating among lesbian and bisexual women. Journal of homosexuality, 62(7), 971–992. https://doi.org/10.1080/00918369.2015.1008285