Nutrition Considerations for Transgender Adolescents and Young Adults: Screening for Disordered Eating and Food Insecurity at a Midwestern Transgender Center

Objectives 1) Define a nutrition screening protocol for transgender and nonbinary youth and adolescents, and 2) Identify the prevalence of disordered eating and food insecurity in transgender and nonbinary patients using multiple validated measures at a Midwestern transgender center. Methods Return patients at the Washington University in St. Louis Transgender Center at Children's Hospital were screened for disordered eating and food insecurity from 9/2019–12/2019. The screener included five sections: 1) Yes/no question regarding previous diagnosis of an eating disorder; 2) SCOFF Questionnaire; 3) Nine-Item Avoidant and Restrictive Food Intake Disorder Screen (NIAS); 4) Adolescent Binge Eating Disorder Questionnaire (ADO-BED); 5) Hunger Vital Sign. The completed screeners were collected weekly and scored by a registered dietitian. Positive screens for disordered eating and food insecurity were referred to adolescent medicine and case management, respectively. Results A total of 159 transgender and nonbinary adolescents and young adults completed the screener. Two major findings emerged: 1) Food insecurity was a potential concern for one in five patients. Of the n = 159 patients that completed the screener, n = 32 (20%) screened positive for food insecurity on the Hunger Vital Sign. Food insecurity and disordered eating were not mutually exclusive; over half (56%) of the patients that screened positive for food insecurity also screened positive on at least one disordered eating measure. 2) Disordered eating was a potential concern for the majority of patients. Of the 159 patients that completed the screener, n = 115 (72%) screened positive for disordered eating. Conclusions Disordered eating and food insecurity are prominent nutrition-related concerns for transgender and nonbinary adolescents and young adults. Providers working with this population may utilize a screening and referral protocol to address patient needs that may be otherwise unmet. Funding Sources This project was supported by a workload release awarded to the primary investigator through the Doisy College of Health Sciences at Saint Louis University.