Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) of the Growing Up Today Study cohorts

The objective of this study was to investigate how gender identity, the overwhelmingly prioritized dimension of social identity/position in eating-related pathology research, intersects with gender expression, sexual orientation, and weight status to structure the social patterning of eating disorders and disordered eating behaviors among young people in the U.S. Data were drawn from the 2010/2011 Growing Up Today Study (GUTS; N = 11,090-13,307). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) by nesting participants within social strata defined by intersecting gender identity, gender expression, sexual orientation, and weight status categories in a series of multilevel logistic models for four outcomes (past-year purging, overeating, and binge eating; lifetime eating disorder diagnosis). To illustrate the advantages of intersectional MAIHDA, we compared the results to those from unitary and conventional intersectional analyses. The intersectional MAIHDA revealed a complex social patterning of eating-related pathology characterized by heterogeneity and outcome-specificity. Several multiply marginalized strata (e.g., those including gender nonconforming, sexual minority, and/or larger-bodied girls/women) had disproportionately elevated prevalence, although all estimates were driven by additive effects. Notably, these patterns were obscured within the unitary and conventional intersectional analyses. Future epidemiologic research on eatingrelated pathology should continue to adopt an intersectional approach through the use of appropriate methodologies.

Automated summary

This study aimed to investigate the social patterning of eating disorders and disordered eating behaviors among young people in the U.S by examining how gender identity intersects with gender expression, sexual orientation, and weight status. The findings revealed a complex social patterning characterized by heterogeneity and outcome-specificity, with certain marginalized groups showing disproportionately elevated prevalence. It was suggested that future epidemiologic research should continue to adopt an intersectional approach using appropriate methodologies.