This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.
“I’m straight thin, but I’m gay fat.”
It’s a throwaway joke in an old episode of American Dad, one that made me laugh ruefully when I first heard it, and that’s lodged itself in my memory since. At age 42, I can still enumerate everything I don’t like about my own body, and which mirrors in my home are better or worse for my self-esteem, despite a regimen of (mostly) healthy eating and regular running. I am all too familiar with the unrealistic expectations gay men can place on ourselves when it comes to how we look.
The joke is funny because it’s true. But for many LGBTQ people, there isn’t a lot of humor there.
Earlier this year, a survey conducted jointly by the Trevor Project, the National Eating Disorders Association (NEDA), and Reasons Eating Disorder Center reported a shockingly high rate of eating disorders among LGBTQ youth. Of the 1,034 respondents to the survey, all LGBTQ-identifying people between 13–24 years old, 54 percent had been diagnosed with an eating disorder, and an additional 21 percent suspected they may have one despite lacking a formal diagnosis. While these results aren’t perfectly representative, they call much-needed attention to a serious problem within our community.
Cisgender female LGBTQ respondents had the highest rate of eating disorders among genders—most commonly bulimia—followed by trans and gender-nonconforming males, then cis males and trans females. Trans, non-binary, and gender non-conforming youth respondents who identify as straight reported the highest percentage of eating disorder diagnosis, at a staggering 71 percent. Bisexual youth had the next highest rate, though gay and lesbian youth weren’t far behind. Tallying all gender and sexual identities surveyed together, some form of overly restricted caloric intake or another was the most common pattern of disordered eating.
These results complement other data reported by the National Eating Disorders Association indicating that 42 percent of men with eating disorders identify as gay—a substantially higher proportion than the percentage we comprise in the general population. NEDA reports significantly higher rates of binging and purging among gay males compared to heterosexual peers, as well as about twice the rate of regular binge eating among non-heterosexual women.
Viewed together, these findings indicate that risk of disordered eating is something that permeates all segments of the LGBTQ community.
The release of the survey’s results joins a couple of other recent developments that brought attention to the problem of eating disorders among gender and sexual minorities. Adam Rippon, breakout star of this year’s Winter Olympics, was as frank about his history of disordered eating as he was about being a gay man, though it was framed by the New York Times more within the context of figure skating. (Two of the three other male figure skaters quoted by the Times, Brian Boitano and Johnny Weir, are also openly gay men, and Weir reportedly still eats only one meal per day.) Season 9 of RuPaul’s Drag Race included a conversation between a few of the queens about their own past and current struggles with eating disorders. It’s encouraging to see these frank discussions crop up in popular media.
Nonetheless, the elements of LGBTQ culture that may perpetuate risk of eating disorders within our community are pervasive and durable. Unattainable standards of physical attractiveness didn’t establish themselves overnight.
“I began to feel like I needed to conform to what I was seeing in magazines and movies. I wanted that slim body to catch the eyes of the guys,” a gay man, who asked to be identified only as Travis, told me. “As I lost weight, I started receiving more positive attention from everyone. It made me feel good. After a month or so, I felt like I wasn’t losing enough weight and I started upping the exercise and lowering my caloric intake by only eating protein bars. Sometimes I would even binge on food, but I never swallowed it. I would purchase a dozen doughnuts and chew them all and spit it out before swallowing any of it.”
“My eating disorder stemmed from being LGBTQ,” he continued. “I felt like I had to conform to the societal expectations of being that slim runner-type guy you see at the gym.”
Sam Miller had a similar experience. Miller is the author of The Art of Starving, a searing young adult novel written from the perspective of a gay teenage boy with an eating disorder, drawn from the author’s own experiences.
“My eating disorder definitely came from being gay,” he told me, “in the sense that homophobia and toxic masculinity made it impossible for me to see how magnificent I really was. Being the constant target of bullying, and not having any positive out role models in my life, and not feeling desired by any of the boys that I desired, filled me up with self-loathing, and made me feel awful about the body I saw in the mirror.”
Other health issues that have hit the gay community with particular force have also had a ripple effect on the pressure to look a certain way.
“Prior to HIV, gay men did not view their bodies in the same way that they do now. To be thin was not seen as problematic,” Sharon Nesselle, a mental health clinician at the Los Angeles LGBT Center, told me. Nesselle has been on the staff there for 24 years. “However, once HIV arrived in full force, being very thin began to be equated with being positive. I saw a significant shift in those that started to work out at the gym and pay greater attention to their bodies.”
“When meth entered the scene, it provided a means by which to address long-standing gay shame,” Nessell continued, “often shame not known consciously to those that struggled with it. It gave men the opportunity to keep their weight down until the substance use got out of control, and then being too thin became gaunt, and that was seen as connected to addiction. One of the most difficult things for men to deal with in recovery from meth use is how to re-establish a relationship with their sexuality that doesn’t include crystal meth, and also how to deal with gaining weight. The weight gain often causes them to feel bad about themselves again, and can be a factor in relapse if they fear they will no longer be seen as attractive to other men.”
Of course, it’s not only societal pressure to look sexually attractive or healthy that can put LGBTQ people at risk for eating disorders.
“My eating disorder had everything to do with being trans. I wore men’s clothing in high school and college, but when I graduated I believed I needed to present in a more feminine way to enter adulthood,” I was told by a trans man, who asked that I call him Isaac. “The restricting started within months of starting to wear women’s clothes, maybe even within weeks. I never connected the two then, but looking back, it’s unmissable. My fear of gaining weight was entirely about not wanting larger breasts and hips, and those parts filling out were what would trigger my relapses.”
As LGBTQ people gain greater visibility and acceptance in American society, the sense of shame and isolation that Miller identifies as triggers for his own eating disorder may be lessened for younger gender and sexual minorities. But he sees other harmful attitudes holding on.
“Understand, I am approximately 600 years old, and when I came out we didn’t have the internet, or television shows with gay characters, and in health class we were told that gay sex would lead to immediate painful horrible death from AIDS,” Miller said. (He’s 39.) “But that’s not to say that in our own more enlightened times, things are perfect. Gay men are exposed to the same whitewashed buff unrealistic representation of male hotness as the rest of America.”
Social media helps to promulgate these images of physical perfection. Instagram users are surely familiar with “Instagays,” those impossibly gorgeous men who share immaculately staged photos of their impeccable bodies for maximum appreciation. (It is a pop culture irony that Netflix selected Antoni Porowski, apotheosis of Instagay perfection, as the food and wine expert in the Queer Eye reboot. Porowski is such a flawless specimen I found myself wondering how regimented he keeps his intake of both his putative specialties.)
“I hear from so many, mostly men, that social media plays a significant role in how they view themselves,” Nesselle said. “They often use what they are able to post on Facebook or Instagram, or what they see on these sites, as weathervanes as to where they stand.”
No one factor can tidily explain why a community as diverse as the LGBTQ population would be at risk of eating disorders. Some social pressures may be more tractable than others. But these new survey results draw attention to a problem too little discussed. Those of us who provide medical or mental health care to gender and sexual minorities should take care to screen our patients for these problems. And all LGBTQ people should consider re-examining what we expect of each other and ourselves.
