Risk of disordered eating at the intersection of gender and racial/ethnic identity among U.S. high school students

Eat Behav. 2019 Aug:34:101299. doi: 10.1016/j.eatbeh.2019.05.002. Epub 2019 May 9.


Background: Gender and racial/ethnic disparities in disordered eating among youth exist, although whether having multiple marginalized identities disproportionately increases risk is unclear. Therefore, we aimed to quantify the risk of disordered eating associated with intersecting gender and racial/ethnic identities of U.S. adolescents.

Methods: We analyzed data from 11,514 U.S. high school students identifying as White, Black/African American, or Hispanic/Latino who participated in the 2013 National Youth Risk Behavior Surveillance System. Age-adjusted relative risks (RR) of purging, fasting, diet pill use, and any disordered eating were estimated using log-binomial models. Relative excess risk due to interaction (RERI) was estimated to evaluate the degree to which the combined effect of marginalized gender and racial/ethnic identity was larger than the sum of their individual effects.

Results: Disordered eating was prevalent (girls: 20.4% Black/African American, 29.2% Hispanic/Latina, 21.4% White; boys: 13.4% Black/African American, 12.4% Hispanic/Latino; 8.1% Whites). Girls of all racial/ethnic identities and racial/ethnic minority boys had elevated risks of purging, fasting, and any disordered eating compared to White boys (RR range = 1.57-7.43); Hispanic/Latina and White girls also had elevated risk of diet pill use (RR range = 1.98-3.20). Among Hispanic/Latina girls, positive interaction between gender and race/ethnicity produced excess risk of any disordered eating and purging (RERI: any = 0.42 (95% confidence interval (CI) = -0.02, 0.87); purging = 1.74 (95% CI = 0.06, 3.42).

Conclusions: Findings illustrate the advantages of adopting an intersectional approach to disordered eating research. Future research should investigate the mechanisms of these disparities.

Keywords: Adolescence; Disordered eating; Disparity; Gender; Intersectionality; Race/ethnicity.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Black or African American / psychology
  • Black or African American / statistics & numerical data
  • Feeding and Eating Disorders / epidemiology*
  • Feeding and Eating Disorders / psychology*
  • Female
  • Hispanic or Latino / psychology
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Minority Groups / psychology*
  • Minority Groups / statistics & numerical data
  • Prevalence
  • Sex Distribution
  • Students / psychology*
  • Students / statistics & numerical data
  • United States / epidemiology
  • White People / psychology
  • White People / statistics & numerical data