Community Needs Assessment Report

Introduction

The state of Utah has a wide variety of unique dynamics in varying populations throughout the state. It is typically known for the dominant religious sect, LDS members or Mormons, that is most commonly associated with the state of Utah. Another unique element is the paralleled high population of LGBTQ+ individuals who live in the state. Some may often think that these individuals migrated to the beehive state because of the LDS (Latter Day Saint) faith’s strong resistance on LGBTQ rights, but oddly enough, many of the LGBTQ individuals within the state grew up in LDS families and have since found community outside the church and within the state where they can feel acceptance.

A significant evolution of accepting the LGBTQ community has occurred within the state of Utah since the early 90s and early 2000’s and this may be due to the variety of people moving into the state from various locations. The past few decades have brought a number of new initiatives and organizations promoting the acceptance of the growing LGBTQ population throughout the state of Utah, and the dire need for acceptance and equality among a richly conservative native state. These organizations have slowly been popping up throughout the state due to the unfortunate events that occur among LGBTQ individuals who experience discrimination, bullying, and oppression. The lack of resources and support often lead these folks to cope in unhealthy ways such as manipulating eating, self-harm, over exercising, and even suicide.

The community of interest for this assessment is the LGBTQ+ adolescent and early adult community ages 12-35 within the Salt Lake City valley of Utah. Uniquely enough, Utah ranks 7^th in LGBTQ population.¹ So while the state is divided, the population is not going anywhere despite those facts. 3.7% of the adult population of Utah is LGBTQ.¹Eating disorders are more and more commonly recognized as society has grown to understand how prevalent they can exist as the recognition of food rules and societal pressures has come to light.⁴

LGBTQ adolescents and youth are at incredibly high risks for health complications. Data from the National Longitudinal Study of Adolescent Health revealed that sexual minority youth scored significantly higher on the scale for depressive symptomology and had a high prevalence of depression, suicide, substance abuse, eating disorders and physical health problems in comparison to their heterosexual counterparts.⁵ The assessment of this population will depict the need for nutrition resources and accessibility for the LGBTQ population in Utah while also showing the prevalence of eating disorders that occurs within this community.

The community needs assessment strives to understand the frequency of eating disorders plague the LGBTQ youth and young adults within the Salt Lake City, Utah valley. This among many other disparities that LGBTQ individuals are experiencing comes in conjunction with many of the conservative rhetoric’s that come with the common religion amongst the state. This community assessment oversees how the difficulties that exist when coping with struggles of sexuality and how those difficulties may result in the manipulation of food due to body image insecurity and emotional distress.

This particular community of interest initially began through the observation of binary thinking within the state of Utah regarding the LGBTQ population and the rights and freedoms associated with individuals accepting and owning their sexuality publicly and the emotional coping that these folks exist with, primarily the eating disorder prevalence that reportedly occurs among this population.⁶ With this information, a key informant with clinical mental health credentials in the state of Utah was chosen to discuss the LGBTQ dynamics and the occurrence of eating disorders that she sees among her clients. This interview depicts a perspective of the way eating and food is used to cope with the struggles that can be experienced when the LGBTQ folks are transitioning in their lives and working to fully embrace their identity despite what loved ones or society says or does about that identity.

Population of Interest

The state of Utah has a wide variety of unique dynamics in varying populations throughout the state. It is typically known for the dominant religious sect, LDS members or Mormons, that is most commonly associated with the state of Utah. Another unique element is the paralleled high population of LGBTQ+ individuals who live in the state. Some may often think that these individuals migrated to the beehive state because of the LDS (Latter Day Saint) faith’s strong resistance on LGBTQ rights, but oddly enough, many of the LGBTQ individuals within the state grew up in LDS families and have since found community outside the church and within the state where they can feel acceptance.⁷

A significant evolution of accepting the LGBTQ community has occurred within the state of Utah since the early 90s and early 2000’s and this may be due to the variety of people moving into the state from various locations. The past few decades have brought a number of new initiatives and organizations promoting the acceptance of the growing LGBTQ population throughout the state of Utah, and the dire need for acceptance and equality among a richly conservative native state. These organizations have slowly been popping up throughout the state due to the unfortunate events that occur among LGBTQ individuals who experience discrimination, bullying, and oppression. The lack of resources and support often lead these folks to cope in unhealthy ways such as manipulating eating, self-harm, over exercising, and even suicide.⁴ There is clear evidence to show that LGBTQ youth experience eating disorders at much higher rates than their heterosexual counterparts and the resources for eating disorder treatment and therapy is often advertised to heterosexual individuals rather than marketing to a wide variety of sexualities.⁴

The focus of this population is to effectively determine the rate of occurrence of eating disorders due to the emotional strain that comes with the daily struggles of living in Utah. There are different variables that could contribute to disordered eating behaviors that may happen among these individuals.

Statement or Problem, Related Causes, and Importance

The means by which LGBTQ folks are coping is not always the healthiest and can be due to lack of resources. LGBTQ youth are at risk from a young age and experience poor quality of care due to stigma, lack of resources, lack of healthcare providers’ awareness, and insensitivity to the unique needs of the community.³ These unfortunate circumstances will often times spill over into how the individual eats. Emotional eating is a very common coping mechanism for many individuals going through emotional pain.³ While many psychological coping mechanisms are recognized among this community, the coping mechanisms that seems to pose just as much of a threat, but receive far less coverage, is the likelihood for disordered eating among the LGBTQ community.

There is particular concern among the LGBTQ community within the state of Utah because of the dichotomy of opinions, common conservative religious standards, and growing community of LGBTQ individuals who experience the disparities that come with existing as themselves. It is important to acknowledge that these disparities begin as early as adolescents in many of these folks and continue through adulthood. Unless addressed and resourced, an increase of eating disorders will continue to prevail throughout the community of LGBTQ adolescents, youth, and adults.

LGBTQ individuals face a unique level of gender-based body image struggles. Though these folks face the same levels of sociocultural and biological influences on body dissatisfaction and disordered eating as their cis-gendered, heterosexual peers, the gender specific factors and dissatisfaction that occurs to specifically transgendered individuals pose a need for more nuanced space and increased resources and research for the LGBTQ population.⁸

Disordered eating very commonly arises in adolescence, the same time young people are typically figuring out themselves and learning the truths of their own person. This is the same time period that we sexual orientation and gender identity come forth for many individuals which also brings the heartache of adjusting to society and the responses from friends and family. While navigating this part of life, eating disorders can arise and must be acknowledged to provide resources and assistance.

Non-heterosexual individuals have a high degree of disordered eating that is common researched and reported. Fewer studies have been done among the LGBTQ population, but nonetheless each research examination proves that higher rates of shape-control and weight obsessions occur within the LGBTQ community of individuals.¹⁰

Analysis and Interpretation of Data

Approximately 3.5% of United States population identifies as part of the LGBTQ community. Utah has high eating disorder statistics compared to the rest of the nation. In 2011, about 4% of female students and 1.4% of male students in grades 9-12 met the requirements for disordered eating.⁹ These rates were associated with higher combined higher rates of suicide, depression, and anxiety. The most commonly reported coping mechanism for adolescent girls was the attempt to lose weight, regardless of their health status.⁹ Understanding these statistics for Utah females, and then recognizing the dangers of being LGBTQ in the state of Utah, the correlation of eating disorders among the LGBTQ population is of great concern to our public health.

Sexual minorities common have worse outcomes than their heterosexual peers across all of the disordered eating behaviors. However, studies that could examine deeper into sexual orientation by identity, attraction, or behavioral subgroups indicate that not all sexual minority subgroups are at significantly greater risk for disordered eating behaviors compared to heterosexuals. Furthermore, sexual orientation disparities were generally more pronounced among men than among women. Transgendered folks may pose a higher level of risk with specific gender weight and shape control mechanisms, thus indicating the need to examine gender diversity as it intersects with sexual orientation.¹⁰

Within the unique culture of Utah, eating disorder prevalence has been on the rise in the last few decades. The dynamics of the state and the common religion that is present among the population has been within speculation of influence regarding the high levels of body dissatisfaction. Some research has evidenced that higher extrinsic and more orthodox religions were associated with higher levels of eating disorders within the religious congregation which could be an association within the Utah prevalence.¹¹

Food insecurity has also been considered with the levels of eating disorders that occur among LGBTQ individuals. In a retrospective research study that examined this population and the relation of food insecurity, it was reported that food insecurity was reported by 54.4% of respondents with trans males reporting the highest proportions (64.8%). High levels of depressive symptoms were reported by 68.2% of men, 89.8% of women, 91.4% of trans males, and 95.5% of gender-nonconforming respondents (P = 0.009). High anxiety was reported by 20.5%.¹² Eating Disorder Examination Self-Report Questionnaire scores were significantly higher (P < 0.001) compared with a community-based sample. The eating disorder behavior most frequently reported by respondents was binge eating. Only 4.3% reported having sought treatment for an eating disorder.¹²

Addressing Unmet Needs

To help combat the level of unhealthy coping such as eating disorders that we see in these folks, many organizations have focused on reducing stigma, fighting for equality, and providing change. Equality Utah is one the most prominent and largest organizations in Utah that has taken upon itself the responsibility of instigating efforts of LGBTQ civil rights at state and local levels by sponsoring LGBTQ legislation and opposing negative bills, lobbying elected officials, building coalitions, and empowering individuals and organizations alike to engage in the legislative process.² Equality Utah saw a need within the state and was among the first organizations to see the range of problematic elements occurring among the state’s response to LGBTQ members, and then decided to do something about it to promote equality and fairness throughout such a divided state. The significance of Equality Utah demonstrates the severe need for acceptance throughout the state due to significant alarming statistics showing prominent unacceptance. While there are many improvements that have been made, it is also important to acknowledge that there is a long way to go before we can rest from creating a safe space for the LGBTQ members of our society. This is clearly evidenced by statistics that show the oppression that still occur within the community from critical individuals who largely discriminate the community and oppress those coming out as their true identity.

The Utah Pride Center is a community within Utah that aims to unite, empower, and celebrate Utah’s diverse culture of LGBTQ+ members by providing a safe space for education, partnerships, services, and events which advance collective health and wellness.¹⁴ While the Utah Pride Center does not currently have a sole purpose of combatting eating disorders within the community, they do strive to make a safe place for individuals to accept themselves, be themselves, and strive for a healthy future with many resources and access to healthcare needs and food.¹⁴ Providing this population with a safe environment to be themselves and available food reaches many links that contribute to eating disorders within this population. It reduces food insecurity with available nutritious foods and making a safe place where individual struggling through navigating their sexuality. Safe places for LGBTQ+ folks to feel safe in their skin without the pressure of society or family to be something different is a great place to start when combating the eating disorders that occur within this population.

Poor access to healthcare needs for the LGBTQ community is well known, but there is much to be done to change that. Training healthcare providers and professionals on how to be an inclusive, accepting healthcare provider is a vital element that needs to be implemented so that our LGBTQ folks feel comfortable receiving healthcare and reaching out for their personal health needs. In systematic reviews of these types of trainings for healthcare employees, the research showed that it was very effective in leading to improved quality of life for LGBTQ+ individuals.¹⁵ LGBTQ health is a rapidly evolving field and a lot of providers are unfamiliar with the terminologies, protocols and recommendations for providing quality care.¹⁵ This could be one of the underlying factors preventing them from teaching their students. Two issues require addressing in order to identify the root causes of the deficiency in training: the availability of an integrated curriculum for teaching and the availability of competent faculty.¹⁴ If the LGBTQ community felt safe receiving proper healthcare, they may be more willing to address their needs such as body image struggles with trained therapists, reduced gender fluidity struggles, and an accepting place where individuals can come as they are.

References

1. Movement advancement Project: State Profiles. Movement Advancement Project | State Profiles. https://www.lgbtmap.org/equality-maps/profile_state/UT. Accessed August 10, 2021.
2. Mission & Vision: Equality Utah. Mission & Vision | Equality Utah. https://www.equalityutah.org/mission. Accessed August 6, 2021.
3. Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus. 2017;9(4):e1184. Published 2017 Apr 20. doi:10.7759/cureus.1184
4. McClain Z, Peebles R. Body Image and Eating Disorders Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatr Clin North Am. 2016;63(6):1079-1090. doi:10.1016/j.pcl.2016.07.008
5. Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus. 2017;9(4):e1184. Published 2017 Apr 20. doi:10.7759/cureus.1184
6. Jackman K, Honig J, Bockting W. Nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations: an integrative review. J Clin Nurs. 2016;25(23-24):3438-3453. doi:10.1111/jocn.13236
7. Dahl AL, Galliher RV. LGBTQ adolescents and young adults raised within a Christian religious context: positive and negative outcomes. J Adolesc. 2012;35(6):1611-1618. doi:10.1016/j.adolescence.2012.07.003
8. Romito M, Salk RH, Roberts SR, Thoma BC, Levine MD, Choukas-Bradley S. Exploring transgender adolescents’ body image concerns and disordered eating: Semi-structured interviews with nine gender minority youth. Body Image. 2021;37:50-62. doi:10.1016/j.bodyim.2021.01.008
9. Utah Health Status Update: Eating Disorders Among Adolescents . Utah Department of Health. https://ibis.health.utah.gov/ibisph-view/pdf/opha/publication/hsu/2017/1701_Anorexia.pdf. Published January 2017.
10. Calzo JP, Blashill AJ, Brown TA, Argenal RL. Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations. Curr Psychiatry Rep. 2017;19(8):49. doi:10.1007/s11920-017-0801-y
11. Castellini G, Zagaglioni A, Godini L, et al. Religion orientations and eating disorders. Riv Psichiatr. 2014;49(3):140-144. doi:10.1708/1551.16911
12. Arikawa AY, Ross J, Wright L, Elmore M, Gonzalez AM, Wallace TC. Results of an Online Survey about Food Insecurity and Eating Disorder Behaviors Administered to a Volunteer Sample of Self-Described LGBTQ+ Young Adults Aged 18 to 35 Years. J Acad Nutr Diet. 2021;121(7):1231-1241. doi:10.1016/j.jand.2020.09.032
13. LGBTQ+ SafeZone RESOURCES. Utah LGBTQ+ Chamber of Commerce. https://www.utahlgbtqchamber.org/lgbtq-safezone-resources/. Published July 12, 2021.Accessed August 7, 2021.
14. About us. Utah Pride Center. https://utahpridecenter.org/about-us/. Published May 6, 2021. Accessed August 9, 2021.
15. Sekoni AO, Gale NK, Manga-Atangana B, Bhadhuri A, Jolly K. The effects of educational curricula and training on LGBT-specific health issues for healthcare students and professionals: a mixed-method systematic review. J Int AIDS Soc. 2017;20(1):21624. doi:10.7448/IAS.20.1.21624