Addressing the Gap: Eating Disorders in LGBTQIA+ and Gender-Diverse Communities in North Carolina

Though Pride Month has ended, the health disparities facing LGBTQIA+ and gender diverse individuals continue—and in some cases worsen under the pressure of an increasingly hostile political climate. One urgent issue that too often flies under the radar: eating disorders.

In North Carolina, more than 900,000 people—about 9% of the population—will experience an eating disorder in their lifetime, costing the state approximately $2.1 billion per year. This illness doesn’t discriminate by age, race, gender, or sexual orientation, but the impact is not equally felt.

Among a survey of LGBTQIA+ adolescents and young adults, 54% report having been diagnosed with an eating disorder. Another 21% suspect they have one, according to the National Eating Disorders Association. While some programs, like The Emily Program’s eating disorder treatment centers in Durham and Charlotte North Carolina, offer affirming, identity-informed care, this level of support isn’t yet the norm. There is a widespread gap in care, research, and understanding.

Recent data from the University of North Carolina, at Chapel Hill shows how identity-based stress, discrimination, and invisibility in care settings can contribute to the problem:

• 15% of gay & bisexual men reported having a full or sub-threshold eating disorder at some point in their life, versus 4.6% of straight men.
• Gay men are 7 times more likely to binge & 12 times more likely to purge than straight men.
• Up to 42% of men with eating disorders identify as being gay or bisexual, despite making up just 3% if the U.S. male population.
• Members of the LGBTQIA+ community are at increased risk of developing bulimia and anorexia.
• Lesbian women report higher levels of self-esteem regarding their body image and sexual attractiveness and are less likely to adopt narrow cultural standards for physical appearance.

Why is this happening? Partly because most eating disorder research has historically focused on straight, cisgender women. This limited scope has shaped everything from diagnostic criteria to treatment protocols. It has contributed to a lack of understanding about how eating disorders show up in LGBTQIA+ communities—especially for transgender and nonbinary people.

When the research that guides care doesn’t include LGBTQIA+ people, it becomes harder for them to find providers who understand their experiences or offer the support they need and less likely that healthcare providers will screen for eating disorder behaviors.

Many LGBTQIA+ individuals find themselves navigating treatment systems that weren’t built with them in mind. They might fill out intake forms that don’t reflect their identity, attend group sessions that feel alienating, or work with providers who have never been trained in LGBTQIA+-affirming care. Past experiences of discrimination in healthcare make it even harder to trust the system. These barriers don’t just complicate access, they can push people away from care altogether.

Improving eating disorder care in North Carolina means highlighting the spaces where LGBTQIA+ individuals feel seen and supported. That starts with providers who ask open-ended questions, use inclusive language, and recognize how identity shapes a person’s experience with food and body image.

The Emily Program offers this kind of affirming care. Their staff are trained in cultural humility, adapt treatment to reflect lived experiences like gender dysphoria or family rejection, and avoid one-size-fits-all ideas about recovery. These are the kinds of spaces that foster meaningful, individualized care.

Pride Month was a time to honor progress. Now we must recommit to the work that remains. No one should have to choose between being fully themselves and getting the help they need to heal.