Eating and exercise experiences of Australian trans and gender diverse folks: lived experience and stakeholder perspectives

Objective:
Trans individuals face elevated health risks and socio-environmental challenges, influencing their engagement in health-protective behaviors (e.g. exercise and nutrition). Despite these challenges, there is a significant gap in understanding the specific eating and exercise experiences of Australian trans adults, including barriers to healthy behaviors and healthcare experiences. This study aims to address this gap by exploring these experiences, informing targeted interventions and healthcare practices to improve health outcomes.

Method:
We conducted semi-structured interviews with 25 participants to explore their experiences with eating and exercise behaviors (12 transgender individuals and 13 healthcare; six were from both categories). Participants were recruited from health and community services, interviews were recorded and transcribed, and data analyzed using reflexive thematic analysis.

Results:
The eating and exercise behaviors of trans adults appear to be influenced positively (e.g. health promoting) and/or negatively (e.g. harmful) by their gendered experiences and socio-environmental context. Healthy behaviors included individual- and social-based exercise within the community and intentional eating practices to support health, whereas potentially harmful behaviors included compulsive exercise and restrictive eating. Analysis resulted in identification of three themes that shaped the motivation and behaviors of trans folk: (1) gender affirmation, (2) neurodivergence, and (3) environmental influences.

Discussion:
The findings underscore that eating and exercise behaviors among trans people are shaped by complex factors including gender expression and gender dysphoria, co-occurring neurodivergence, and systemic disadvantages. These dynamics contribute significantly to the high prevalence of harmful behaviors, including disordered eating and eating disorders in this population, and necessitate the integration of gender-affirming and person-centered approaches in healthcare and public policy. The current assessment and management of disordered eating and exercise behaviors fail to address the specific needs of trans individuals and highlights the need for inclusive and effective strategies to prevent and treat disordered exercise and eating behaviors.