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

UMMS Affiliation

Clinical and Population Health Research Program, Graduate School of Biomedical Sciences; Department of Population and Quantitative Health Sciences; Department of Family Medicine and Community Health; Eunice Kennedy Shriver Center

Publication Date


Document Type



Dietetics and Clinical Nutrition | Gender and Sexuality | Health Services Research | Mental Disorders | Psychiatry and Psychology | Race and Ethnicity


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.


Adolescence, Disordered eating, Disparity, Gender, Intersectionality, Race/ethnicity

DOI of Published Version



Eat Behav. 2019 Aug;34:101299. doi: 10.1016/j.eatbeh.2019.05.002. Epub 2019 May 9. Link to article on publisher's site

Journal/Book/Conference Title

Eating behaviors

PubMed ID


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Link to Article in PubMed