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Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) of the Growing Up Today Study cohorts

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  • Beccia, Ariel L.
  • Baek, Jonggyu
  • Austin, S. Bryn
  • Jesdale, William M.
  • Lapane, Kate L.

Abstract

The objective of this study was to investigate how gender identity, the overwhelmingly prioritized dimension of social identity/position in eating-related pathology research, intersects with gender expression, sexual orientation, and weight status to structure the social patterning of eating disorders and disordered eating behaviors among young people in the U.S. Data were drawn from the 2010/2011 Growing Up Today Study (GUTS; N = 11,090–13,307). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) by nesting participants within social strata defined by intersecting gender identity, gender expression, sexual orientation, and weight status categories in a series of multilevel logistic models for four outcomes (past-year purging, overeating, and binge eating; lifetime eating disorder diagnosis). To illustrate the advantages of intersectional MAIHDA, we compared the results to those from unitary and conventional intersectional analyses. The intersectional MAIHDA revealed a complex social patterning of eating-related pathology characterized by heterogeneity and outcome-specificity. Several multiply marginalized strata (e.g., those including gender nonconforming, sexual minority, and/or larger-bodied girls/women) had disproportionately elevated prevalence, although all estimates were driven by additive effects. Notably, these patterns were obscured within the unitary and conventional intersectional analyses. Future epidemiologic research on eating-related pathology should continue to adopt an intersectional approach through the use of appropriate methodologies.

Suggested Citation

  • Beccia, Ariel L. & Baek, Jonggyu & Austin, S. Bryn & Jesdale, William M. & Lapane, Kate L., 2021. "Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminat," Social Science & Medicine, Elsevier, vol. 281(C).
    • Handle: RePEc:eee:socmed:v:281:y:2021:i:c:s027795362100424x
    DOI: 10.1016/j.socscimed.2021.114092
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    References listed on IDEAS

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    4. Hankivsky, Olena, 2012. "Women’s health, men’s health, and gender and health: Implications of intersectionality," Social Science & Medicine, Elsevier, vol. 74(11), pages 1712-1720.
    5. Evans, Clare R. & Williams, David R. & Onnela, Jukka-Pekka & Subramanian, S.V., 2018. "A multilevel approach to modeling health inequalities at the intersection of multiple social identities," Social Science & Medicine, Elsevier, vol. 203(C), pages 64-73.
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    1. Zubizarreta, Dougie & Beccia, Ariel L. & Trinh, Mai-Han & Reynolds, Colleen A. & Reisner, Sari L. & Charlton, Brittany M., 2022. "Human papillomavirus vaccination disparities among U.S. college students: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)," Social Science & Medicine, Elsevier, vol. 301(C).
    2. Beccia, Ariel L. & Austin, S. Bryn & Baek, Jonggyu & Agénor, Madina & Forrester, Sarah & Ding, Eric Y. & Jesdale, William M. & Lapane, Kate L., 2022. "Cumulative exposure to state-level structural sexism and risk of disordered eating: Results from a 20-year prospective cohort study," Social Science & Medicine, Elsevier, vol. 301(C).

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