Weight-related disparities for transgender college students.

Research on weight-related health, including obesity, nutrition, physical activity, and disordered eating, among the transgender community is virtually non-existent.1 Despite a large body of literature demonstrating meaningful differences in weight and weight behaviors between males and females,2-6 little research has examined weight disparities across gender beyond the male—female dichotomy. Transgender generally describes “individuals whose gender identity differs from the sex originally assigned to them at birth or whose gender expression varies significantly from what is traditionally associated with or typical for that sex … as well as other individuals who vary from or reject traditional cultural conceptualizations of gender in terms of the male—female dichotomy.”1 A recent report from the Institute of Medicine has highlighted transgender health as a priority area for future research.1 Although existing research is fairly limited, studies have suggested that very high proportions of transgender individuals experience adverse health outcomes including negative mental health, suicidal ideation and attempts, physical and sexual victimization, HIV infection, and lack of access to care.1,7-10 There has also been research highlighting sociodemographic disparities with transgender adults more likely than the general adult population to be living in poverty and unemployed.10,11 These sociodemographic disparities are of concern given their strong association with health among all populations. A limitation of the majority of existing literature on transgender health, however, has been the reliance on convenience samples as well as not having appropriate non-transgender comparison groups.1,7-10 These studies have focused on transgender communities for the purpose of addressing HIV infection and needs, thus targeting recruitment to a particular subset of the transgender community rather than examining the health of the transgender community at-large.1 Despite being a national public health priority, as highlighted within Healthy People 2020,12 research on weight and weight-related behaviors among transgender individuals is limited. To our knowledge, only one population-based study to date has explored weight-related health among transgender people.11 Conron and colleagues utilized statewide surveillance data from Massachusetts to examine disparities across a broad variety of health indicators, including weight status. Findings indicated that compared to non-transgender adults (ages 18-64 years), transgender adults were less likely to be overweight. A limitation of this study, however, is that the results were not adjusted for economic factors, such as unemployment and poverty, which are known to differ for transgender and weight-related health. The inclusion of a broad age range may also not capture age-specific disparities in health. Furthermore, measures of weight-related behaviors, such as physical activity and dietary intake, were not included in the analyses. No population-based studies have explored transgender disparities for these weight-related behaviors. Understanding weight-related behaviors is vital for supporting weight loss and weight gain prevention. Emerging adulthood, typically defined as ages 18-25 years,13 is a critical age for weight gain prevention14 given significant declines in physical activity levels and dietary quality as well as excess weight gain during this stage of life.4,15-22 This developmental period is frequently associated with attending a post-secondary educational institution, some level of independent living, and identity exploration and formation. According to data from the National Transgender Discrimination Survey, a survey of over 6,400 transgender adults in the U.S. and territories, a large proportion of these adults transitioned between the ages of 18-24 years (eg, 46% of female-to-male transgender individuals) or soon after. This finding suggests that emerging adulthood is a substantive period in gender development. Furthermore, 87% of transgender adults in the National Transgender Discrimination Survey had attained as least some college education (compared to only 55% of the general population), thus indicating that the college setting may be a particularly important arena to address weight-related health for transgender people. This study fills an important research gap by using population-based data to explore transgender disparities across weight status (ie, categories of weight: underweight, normal weight, overweight, and obese) and a variety of weight-related behaviors (including food and drink consumption, physical activity, screen time, unhealthy weight control, and body satisfaction) among college students.