Sarah K. Lipson

Introduction There are documented inequities in eating disorders (EDs) by gender and race/ethnicity, yet, little is known about population‐level prevalence of ED risk factors, symptoms, and diagnosis at the intersection of diverse gender and racial/ethnic identities. Methods Data from the Healthy Minds Study 2015–2019 ( N = 251,310 U.S. university students) were used in a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Participants were nested in 35 intersectional strata given by all combinations of 5 gender and 7 racial/ethnic categories. Multilevel logistic models with participants at level 1 and intersectional strata at level 2 were used to estimate stratum‐specific predicted prevalence estimates for self‐reported thin‐ideal internalization, ED symptoms, and ED diagnosis. The variance partition coefficient (VPC) was calculated to quantify the contextual effect of the strata. Results There was considerable heterogeneity in the predicted prevalence of our ED outcomes across the strata (e.g., .3%–18.3% for ED diagnoses). There were large disparities in all three outcomes, with transgender participants of color having a higher predicted prevalence than expected based on the additive effects of gender and race/ethnicity. Moderation by race/ethnicity was also apparent, such that racial/ethnic disparities were wider within the cisgender groups relative to the transgender groups. VPCs indicated that ~10% of the total variance in ED outcomes was due to intersectionality between gender and race/ethnicity, over and above variance due to individual‐level differences. Conclusion Findings suggest that gender and racial/ethnic disparities in EDs are interrelated, underscoring the need to develop preventive interventions centering health equity. Public significance Despite evidence that sexism, racism, and cissexism (i.e., anti‐transgender prejudice) can impact EDs risk, little research examines the social patterning of EDs at the intersection of diverse gender and racial/ethnic identities. Using data from a sample of 250,000 U.S. university students, this study found that gender and racial/ethnic disparities in eating disorder risk are interrelated, highlighting the need to develop health equity centered preventive interventions.

Objective The present study aimed to: (1) identify recent temporal changes in the prevalence of different cognitive and behavioral eating disorder (ED) symptoms, current probable EDs, lifetime ED diagnoses, and mental healthcare use among college students across the United States; (2) determine whether established disparities in ED prevalence and receiving mental healthcare have widened or narrowed over time for marginalized groups within this population. Method Participants included a large national sample of U.S. college students ( N = 286,720) who completed the repeated cross‐sectional Healthy Minds Study from 2013 to 2020. Descriptive statistics and polynomial regressions quantified time‐trends in participants' ED symptoms and past 12‐month mental healthcare. Moderated regressions examined temporal changes in ED symptoms and mental healthcare based on sociodemographic characteristics. Results Individuals' engagement in different cognitive and behavioral ED symptoms, and likelihoods of exhibiting current probable EDs, reporting lifetime ED diagnoses, and (for individuals with current probable EDs) receiving therapy or counseling in the past 12‐months exhibited nonlinear increases from 2013 to 2020. Further, the prevalence of current and lifetime ED symptoms and (for symptomatic individuals) past 12‐month mental healthcare differed over time for individuals with different BMIs and gender, sexual, and racial/ethnic identities (but not ages). In particular, individuals with higher BMIs and those who identified as male, bisexual, and gay, lesbian, or queer exhibited increasing ED pathology over time. Discussion These findings provide important information on groups of U.S. college students that have experienced increasing burden of ED symptoms and may help guide ED prevention, treatment, and research priorities. Public Significance Recent temporal changes in the prevalence of eating disorder (ED) symptoms and mental healthcare were examined in a national sample of U.S. young adults. Non‐linear increases in ED symptoms and mental healthcare were identified among U.S. young adults overall from 2013 to 2020. U.S. young adults with higher BMIs, males, bisexual, and gay, lesbian, or queer individuals exhibited increasing ED burden over time.