Exploring eating disorder risk among Thai transfeminine youth: a comparative study with cisgender females.

Background: Adolescents, particularly vulnerable during puberty, often face heightened concerns about dieting and body image. Transfeminine youth, especially in Asian cultures, are understudied in this context. This study investigates eating disorder risks among Thai transfeminine youth and compares to cisgender females, focusing on the association with body dissatisfaction. This study aims to explore 3 objectives: (1) to assess and compare the prevalence of eating disorder risks between Thai transfeminine youth and cisgender females; (2) to examine the link between body dissatisfaction and eating disorder risks; (3) to identify risk factors associated with abnormal eating disorder screening outcomes. Method: This is a cross-sectional comparative study conducted between September 2021 and October 2022. The study questionnaire includes Thai version of the Eating Attitude Test-26 (EAT-26) to assess the risks of eating disorders and Thai version of the Body Image Concern Inventory (BICI) to assess body dissatisfaction. The questionnaire was distributed through social media platforms to transfeminine and cisgender females, aged 12–25 years. The correlation between eating disorder risks and body dissatisfaction was analyzed with linear regression, while the comparisons between transfeminine individuals and cisgender female groups were analyzed with Wilcoxon rank-sum test. Results: The study included 241 transfeminine individuals and 388 cisgender females, median age 19.0 years (interquartile range [IQR] 18–21) and 18 years (IQR 16–20), respectively. Ninety (37.3%) transfeminine individuals had an EAT-26 score ≥ 20, suggesting concerns for dieting and eating behaviors, compared to 70 (18%) cisgender females (p < 0.001). Risk factors for EDs included obesity (odds ratio [OR] 3.22, confidence interval [CI] 1.36–7.6) and low income (OR 3.66, CI 1.59–8.4). Protective factors were negligible exercise (OR 0.24, CI 0.09–0.66), gender identity disclosure (OR 0.27, CI 0.1–0.77), and high levels of happiness (OR 0.85, CI 0.73–0.98). There is a significant correlation between the positive eating behavior screening and the body dissatisfaction scores. Conclusions: Transfeminine youths show significantly higher concerns about dieting, body weight, and eating behaviors than their cisgender females, highlighting the unique challenges they face. These results emphasize the needs for targeted screening, health care access for treatment and support for eating disorders in transfeminine youths. Plain English summary: Teenagers often worry intensely about their body image, a concern that can escalate to eating disorders. Transfeminine teenagers—those assigned male at birth who identify and express themselves as female—may encounter even greater challenges, yet research on this topic, especially in Asian contexts, remains sparse. This study investigated the eating habits of transfeminine teenagers in Thailand and compared them with those of their cisgender female counterparts. Conducted online with participants aged 12 to 25 from September 2021 to October 2022, the results indicate that transfeminine youths are more susceptible to behaviors that heighten the risk of eating disorders. Contributing factors include obesity and low income, which exacerbate these risks, while openly disclosing their gender identity and experiencing high levels of happiness appear to offer some protective effects. These findings underscore the urgent need for enhanced support and greater awareness for transfeminine adolescents at risk. [ABSTRACT FROM AUTHOR]