People commonly associate eating disorders with thin, white, cisgender girls. While eating disorders affect people across body size, gender, race, and age, this stereotype has persisted for decades, and it’s had an effect on both society and the realm of research. One effect is that most of the current modalities for treating eating disorders in young people focus on cisgender girls, leaving cisgender boys and transgender and gender expansive youth out of the equation.

We know that transgender folk are at a heightened risk for developing disordered eating behaviors and eating disorders for a variety of different reasons, and may face barriers to care. We also know that men and boys get eating disorders too, and often go undiagnosed or untreated. Everyone with an eating disorder is equally deserving of effective treatment and lasting recovery, so it’s essential to understand what treatment approaches work for different populations. That was the impetus for our most recent study.

In the study, we looked specifically at the effectiveness of family-based treatment (FBT) for cisgender boys and transgender and gender expansive youth. While FBT is the evidence-based gold standard for treating eating disorders in young people, most of the research supporting its effectiveness was based on cisgender girls. This investigation is an important first step toward understanding how best to treat different populations.

The fundamental components of the study

Our study included 1,235 young people (age 6 to 24) who received FBT-based eating disorder treatment during the time period from September 2020 to November 2022. Of this group, 975 were cisgender girls, 152 were cisgender boys, and 108 were transgender or gender expansive youth.

In our research, we looked at various different outcomes, including:

• Eating disorder symptoms
• Depression
• Anxiety
• Suicidality
• Caregiver burden
• Parental confidence in supervising treatment

We analyzed outcomes for all patients included in the study, and then compared outcomes for cisgender boys and transgender youth with outcomes for cisgender girls. Our analysis showed that regardless of gender identity, all symptoms and outcomes improved during treatment, and improved at similar rates.

Key takeaways for providers

The importance of studying treatment approaches for cisgender boys and transgender youth can’t be overstated. Millions of young people with these identities are struggling with debilitating and potentially life-threatening eating disorders right now, and there is an alarming absence of knowledge about how to treat them. There are no universally accepted, empirically supported eating disorder treatment guidelines for cisgender boys and men, or for transgender youth. Because of this, many boys and men and transgender folk report feeling misunderstood by providers, and it’s tragically common for transgender youth specifically to report having negative treatment experiences.

We know eating disorder treatment isn’t one-size-fits-all, and so it’s essential to understand what adaptations and modifications must be made to ensure that everyone suffering, regardless of identity, gets effective and supportive care. Because FBT involves family and friends (and, at Equip, peer mentors with similar backgrounds and identities), it allows for treatment to be more tailored to the individual patient, and provides a unique opportunity to address issues like social challenges, stigma, and family support of a child’s intersecting identities. However, up until now, we had no quantitative evidence supporting the use of FBT for populations besides cisgender girls (who make up about 90% of participants in other FBT studies).

Our study is the first to demonstrate that FBT leads to meaningful improvements in eating disorder symptoms and other outcomes in young people across the gender identity spectrum. This is promising, especially since FBT is generally the first line of treatment for youth with an eating disorder, and because FBT lends itself well to virtual care, which helps eliminate other barriers to treatment these populations might face.

While more research is needed—specifically with larger and more diverse populations—we’re heartened at these initial outcomes. Our research team is looking forward to doing more research into how FBT works for people of all genders and identities, and how we can continue to adjust and personalize treatment to make it the most effective for every patient who seeks help.

Read the full paper here: https://www.sciencedirect.com/science/article/pii/S1054139X23005967