title: "I have to constantly prove to myself, to people, that I fit the bill": Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women.
abstract: The impact of societal femininity ideals on disordered eating behaviors in non-transgender women has been well described, but scant research has explored these processes among transgender women. The present study explored weight and shape control behaviors among low-income, ethnically diverse young transgender women at high risk for HIV or living with HIV in a Northeastern metropolitan area. Semi-structured in-depth interviews were conducted with 21 participants (ages 18-31 years; mean annual income <$10,000; ethnic identity: Multiracial [n = 8], Black [n = 4], Latina [n = 4], White [n = 4], Asian [n = 1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation framework. Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Study participants described using a variety of strategies to address body image concerns in the context of gender-related and other discriminatory experiences, which shaped participants' access to social and material resources as well as stress and coping behaviors. Disordered weight and shape control behaviors were discussed in relation to four emergent themes: (1) gender socialization and the development of femininity ideals, (2) experiences of stigma and discrimination, (3) biological processes, and (4) multi-level sources of strength and resilience. This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for future research, treatment, and public health intervention.
authors: Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Electronic address: argordon@mail.harvard.edu.
authors: Allegra R
authors: AR
authors: Gordon
authors: Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: S Bryn
authors: SB
authors: Austin
authors: Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Nancy
authors: N
authors: Krieger
authors: The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
authors: Jaclyn M
authors: JM
authors: White Hughto
authors: The Fenway Institute, Fenway Health, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors: Sari L
authors: SL
authors: Reisner
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D044383:Black People / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D001828:Body Image / Q000523:psychology*; D001835:Body Weight; D001900:Boston / Q000453:epidemiology / Q000208:ethnology; D002032:Bulimia / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005215:Fasting / Q000523:psychology; D005247:Feeding Behavior / Q000208:ethnology / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D010465:Perception; D011203:Poverty / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D001741:Black or African American; D008297:Male
chemical_list: D054368:Laxatives
keywords: Discrimination; Eating disorders; Gender; Health behaviors; Stigma; Transgender; United States; Women