Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults.

Purpose: The purpose of the study was to provide initial evidence for the internal consistency and convergent validity of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in a sample of transgender and nonbinary (TGNB) youth and young adults. Methods: Returning patients at a Midwestern gender clinic (n=164) ages 12-23 completed the NIAS, sick, control, one stone, fat, food (SCOFF), patient health questionnaire 9 (PHQ-9), and generalized anxiety disorder 7 (GAD-7) during their clinic visit. Age, sex assigned at birth, gender identity, weight, and height were also collected. Confirmatory factor analysis was used to establish the hypothesized three-factor structure of the NIAS in this sample. Relationships between the NIAS subscales and anthropometric data, SCOFF, PHQ-9, GAD-7, and sex assigned at birth were explored for convergent and divergent validity, and proposed screening cutoff scores were used to identify the prevalence of likely avoidant/restrictive food intake disorder (ARFID) in this population. Results: The three-factor structure of the NIAS was an excellent fit to the current data. Approximately one in five (22%) of the participants screened positive for ARFID. Approximately one in four participants scored above the picky eating (27.4%) or appetite (23.9%) cutoffs. Assigned female at birth participants scored significantly higher on the NIAS-Total, Appetite, and Fear subscales than those assigned male at birth. NIAS-Total was significantly related to all convergent validity variables other than age, with a moderate-strong correlation with other symptom screeners (SCOFF, PHQ-9, GAD-7), and a small negative correlation with body mass index percentile. Conclusions: Evidence supports the NIAS as a valid measure to screen for ARFID among TGNB youth and young adults.

Disordered Eating, Food Insecurity, and Weight Status Among Transgender and Gender Nonbinary Youth and Young Adults: A Cross-Sectional Study Using a Nutrition Screening Protocol.

Purpose: The purpose of this study was to describe the prevalence of and relationships among disordered eating, food insecurity, and weight status among transgender and gender nonbinary youth and young adults. Methods: This cross-sectional study involved a screening protocol to assess disordered eating and food insecurity risk from September to December of 2019 at a gender clinic using five validated measures: (1) previous eating disorder diagnosis (yes/no); (2) Sick, Control, One Stone, Fat, Food Questionnaire (SCOFF); (3) Adolescent Binge Eating Disorder Questionnaire (ADO-BED); (4) Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS); and (5) Hunger Vital Sign. Age, assigned sex at birth, gender identity, stage of medical transition, and body mass index were collected. Pearson's r correlation coefficients, between-groups t-tests, one-way analysis of variance tests, and Tukey's honest significant difference test were used to characterize the relationships between variables. Results: A total of 164 participants ages 12-23 years completed the screener. Using assigned sex at birth, 1.8% were underweight, 53% were a healthy weight, 17.1% were overweight, and 28.0% were obese. An estimated 8.7% reported a previous eating disorder diagnosis, 28.0% screened positive on the SCOFF, 9.1% on the ADO-BED, 75.0% on the NIAS, and 21.2% on the Hunger Vital Sign. Transgender males scored higher on the NIAS than transgender females (p = 0.03). Those with a previous eating disorder diagnosis scored significantly higher on the Hunger Vital Sign (p < 0.05). Conclusion: Gender clinics should routinely screen for disordered eating, food insecurity, overweight, and obesity to identify patients in need of further evaluation and referral.

Nutrition-Related Messages Shared Among the Online Transgender Community: A Netnography of YouTube Vloggers.

Purpose: Nutrition care guidelines for the transgender population do not exist, despite significant nutrition-related clinical and psychosocial considerations. Social networking sites (SNSs) provide multidirectional communication and have expanded in popularity among transgender users as a resource for health information and support. The nature of the content shared among the online transgender community is unknown, but may suggest the nutrition-related areas that are of most importance to the transgender population. The objective of this qualitative netnography was to describe the food and nutrition messages shared among the transgender community using video blogs (vlogs) on the SNS, YouTube. Methods: Public vlogs were assessed using the constant comparative method. Pseudoquantitative methods were used to capture the prevalence of each subtheme; quotes were documented verbatim. Data were collected from transgender users' public vlogs (n=30) self-published on YouTube from 2013 to 2018. Results: Six major themes were generated from the data analysis. These included the following: functions of diet and exercise; diet and exercise philosophies; "how to" vlogs; advice for success; using dietary supplements; and effects of hormone therapy. Conclusions: Nutrition-related messages are widely shared among the online transgender community through YouTube. The identified themes reflect topics of interest and expressed needs of transgender individuals. SNSs provide health care providers with a platform to improve patient education and health literacy. Health care providers may actively engage in online discussions to build trust, answer questions, and provide a source of accurate and evidence-based information.