Rampant eating disorders in the trans community and a lack of healthcare access creates a devastating public health issue that needs to be addressed immediately.
CW: eating disorders, transphobia
By Connie Tran
A few months into my eating disorder recovery, I remember having the somber realization halfway into a meal that a relapse was imminent if I couldn’t figure out how to deal with my gender dysphoria. As a trans person, noticing my hips widen and other body parts grow in unfamiliar ways put me in a state of constant emotional distress, and complicated the already difficult process of mending my relationship with food.
My eating disorder recovery was a confusing attempt to improve my mental health while simultaneously tearing it down. Should I ignore my gender dysphoria for the time being and take the “one issue at a time” approach, listening to my body’s hunger pains while disregarding my emotions entirely to subject myself to more miserable nights in bed? Or should I take the same approach and flipping around, preserving a body shape that somewhat made me somewhat happy and deferring my recovery yet again? I always felt like I had to choose between my physical well-being and my bodily autonomy.
It wasn’t long until I figured out that passing out from low blood sugar levels was an easy way to temporarily solve my dilemma. For me, eating or a lack thereof, allowed me to tinker my own levels of consciousness and mental clarity, serving as a control switch for what I did or didn’t want to experience. When I felt like my hips jut out to the side just a tad too much and didn’t feel like dealing with strangers calling me “miss” or “ma’am,” I would simply not eat. Quite frankly, I would rather forgo my next few meals, pass out, and skip the next few days than subject myself to playing a cis woman’s prescribed role in the world.
My experience as a trans person with an eating disorder wasn’t actually that uncommon. Upon watching several videos on Youtube on this topic, I learned that many trans people view controlling food as a way to control the societal pressures or problems around their transness, such as coming out to an unsupportive family or being bullied in school. The research confirms that this is a community-wide phenomenon: studies have shown trans college students were at least four times as likely to report having an eating disorder than their cis women counterparts. Another study found similar results with trans highschool students being more than three times as likely to restrict their eating than their cis peers, including increased usage of both diet pills and laxatives. Disordered eating is a grim reality many trans individuals are willing to accept if it means that we can mitigate some of the constricting gender roles that the cisheteropatriarchy wishes to inflict upon us.
My dilemma would’ve been solved if I’d had access to an HRT (hormone replacement therapy) provider at the time, but trans healthcare is generally inaccessible to most folks in the US. Either most insurance companies don’t cover gender-affirming treatments, it’s too expensive to pay outright, or it requires an absurd number of recommendation letters or minimum years in “gender therapy”—a form of medical gatekeeping. We also saw a series of legislative attacks on trans healthcare in 2020, notably the Trump administration attempting to remove nondiscrimination healthcare protections under the Affordable Care Act for trans folks this past June. Although a federal judge thankfully ruled against it in August, these sorts of decisions endanger trans individuals who are already disproportionately affected by the pandemic.
Rampant eating disorders in the trans community and a lack of healthcare access creates a devastating public health issue that needs to be addressed immediately. Yet the current healthcare system seems unprepared to treat this problem, as white cis women are overwhelmingly represented in all stages of eating disorder research, treatment, and prevention. The stereotype that eating disorders are just a “white woman’s problem” was popularized by media portrayals in the late 1900s when Karen Carpenter died from anorexia in 1983 and Princess Diana spoke out about her bulimia in the 1990s during the “Waif Wave”. The one-size fits all treatment models that build off of this stereotype ends up harming individuals who don’t fall within the narrow category of cis white women. Many people have written about this stereotype has played a role in delaying their diagnoses and eventual treatments.
But while some advocates might try to combat this problem by showing more diverse stories, hiring more diverse medical professionals, or making general statements such as “eating disorders don’t discriminate,” that isn’t enough to unravel the centuries-long history of Eurocentrism in the field. Approaches like that “lack nuance and complexity… and [don’t] advance meaningful conversation[s] about race-related body, food, and illness experiences,” states the Emily Program.
Instead, we need to be more principled in our collective political education. It is not enough to simply concede that food is a political commodity and that eating disorders are a public health issue that hits marginalized communities the hardest, such as people of color, fat people, LGBTQIA+ folks, and low income households.
We must also study eating disorders under new lenses, such as Black radical feminism, to better examine the roles of racial capitalism and neoliberalism to ensure we’re accurately capturing the depth to which eating disorders affect our society. If the oppressive systems affecting us continue to evolve, so must our analytical tools.
State-imposed sanctions on trans healthcare are a deathwish against our people, to systematically kill off those who are unfavorable to the Eurocentric and colonized understandings of gender. The lack of healthcare access for trans folks is a direct translation of which bodies our society thinks are worth saving and which ones are not.
When comprehensive healthcare is hard to come by, eating disorders serve as a quick and cheap alternative for trans folks. When the world doesn’t give us the tools to create new and beautiful trans futures, many of us will do whatever we can to get the liberated bodies we deserve—however disturbing the methods.
Connie Tran (he/they) is a Vietnamese trans organizer from Columbus, GA who is constantly building upon the different ways in which he can engage in alternative world building, whether through his abolitionist organizing, writing, or interactive art. In his free time, he enjoys connecting with nature, reading, and doing spiritual-related things.
JOIN WEAR YOUR VOICE ON PATREON — Every single dollar matters to us—especially now when media is under constant threat. Your support is essential and your generosity is why Wear Your Voice keeps going! You are a part of the resistance that is needed—uplifting Black and brown feminists through your pledges is the direct community support that allows us to make more space for marginalized voices. For as little as $1 every month you can be a part of this journey with us. This platform is our way of making necessary and positive change, and together we can keep growing.