Ngā māuiui kai: a cross-sectional study of elevated eating disorder risk and related experiences among trans people in Aotearoa

Purpose Little is known about disordered eating and eating disorders (ngā māuiui kai) among transgender and non-binary (trans) communities in Aotearoa New Zealand. This cross-sectional study sought to provide evidence of the prevalence and experiences of ngā māuiui kai among these communities. Methods We analyzed data from a national trans health survey of people using chi-square tests of independence to examine associations between sociodemographic characteristics and elevated eating disorder risk measured by the SCOFF screening tool. A content analysis of open-text survey comments identified themes across participants’ self-reported experiences of ngā māuiui kai. Results Overall, 34.3% of participants met criteria for increased risk for an eating disorder. Age, neurodivergence, material hardship, functional impairment, and Māori ethnicity were associated with elevated risk among this sample. No associations were found for gender, self-identified disability, or other ethnicities. The content analysis found that several participants reported connections between their māuiui kai and gender incongruence, broader mental health issues, or structural barriers. Some reported challenges seeking related healthcare, and a lack of providers’ awareness of the relationship between gender-affirming healthcare needs and ngā māuiui kai. Conclusions A high proportion of trans participants met the criteria for elevated risk of eating disorders, with higher risk among those belonging to other marginalized groups. These findings highlight the unique risk factors among trans people who belong to multiple marginalized groups. They signal need for appropriate prevention and provision of responsive care for trans people at the intersections of ngā māuiui kai and gender-affirming healthcare.