200. EAT-26 Performance In Gender Health Clinic Patients

Abstract

Emerging literatures suggests that transgender individuals report higher rates of eating disorder (EDO) symptomatology than their cis-gender counterparts. This association is supported by population-level data, but there is a paucity of information on the clinical practice level. This study seeks to characterize the experiences of individuals with gender dysphoria through analysis of their responses to the EAT-26 questionnaire, which is a robust clinical screening tool. We aimed to examine EDO prevalence, characterized by a positive or negative overall EAT score, as well as prevalence of disordered eating behaviors, within a transgender patient population. Eligible individuals between the ages of 18-25 engaged with the University of Rochester’s Gender Health Services for transgender adolescents and young adults were sent an EAT-26 questionnaire via electronic health record communication. Of 107 invited individuals, 66 completed the EAT-26 questionnaire (response rate 61.6%). Chart review data included items and scores from the EAT-26 questionnaire, demographics, and treatment information including presence of hormonal or surgical treatment for gender dysphoria. Data analysis included descriptive statistics and Wilcoxon rank-sum test of equality. The study was reviewed by the URMC IRB. Forty-six (79.3%) of screened patients had a negative EAT-26 screen; 12 (20.7%) were positive for eating disorder concerns. Responses had a mean of 10.2, SD of 8.4 and range of 0-29. Alpha coefficient of the scale is 0.82. There were no statistically significant differences in performance on the EAT-26 based on the demographic or clinical factors examined (age, affirmed gender, typic of health insurance, race or ethnicity). For individual items, responses of “never”, “rarely” or “sometimes” were considered negative, while “often”, “usually” and “always” were considered positive responses. Frequently positive items included "display of self-control around food” (n=35, 60%), “think about burning calories exercising” (n=25, 41%), “preoccupied with desire to be thinner” (n=24, 41%), “aware of calorie content of foods” (n=22, 38%), preoccupied with thought of fat on body (n=21, 36%) and “terrified about being overweight” (n=20, 34%). Items with relatively low positivity were “vomiting after eating” (n=1, 2%), “vomiting after eating” (n=1, 2%), and “impulse to vomit after meals” (n=3, 5%) and “gone on eating binges, not able to stop” (n=4, 7%). This study serves as a pilot to describe the experiences of eating disorder symptoms in individuals with gender dysphoria presenting for gender related medical care. Our overall prevalence of a positive EAT screen was 21%, where a positive screen is defined by a score equal to or greater than 20. This is higher than the general adolescent/young adult population which has been estimated at 7-10%. We did not find the use of hormones and gender affirming surgery to be significantly associated with the EAT-26 score, although low sample size likely precluded sufficient statistical power. A number of individual disordered eating behaviors were present in our sample, regardless of EAT positive/negative status, which offers initial insights into eating disorder symptoms and experiences within this population.