Satisfação com a imagem corporal e risco de transtorno alimentar em pessoas trans acompanhadas em um serviço multiprofissional especializado

Abstract

Introduction: Transgender individuals present high levels of body image dissatisfaction and comprise a risk group for developing eating disorders (ED). Objective: To evaluate the levels of body image satisfaction and the risk of developing eating disorders among transgender people followed at a specialized gender-affirming care service. Methodology: This is a prospective longitudinal study conducted at the Transgender Outpatient Clinic of the University Hospital of Lagarto between January and November 2025. Transgender individuals aged 18 to 60 years were included in the research. Participants were evaluated at two distinct moments: at admission (T1) and after six months (T2). In the first moment, sociodemographic and clinical data were collected, alongside the assessment of body image satisfaction, ED risk, and gender incongruence levels. In the second phase, the instruments assessing body image satisfaction, ED risk, and gender incongruence were reapplied. Data analysis was performed using RStudio and JASP softwares. Non-parametric tests were conducted to evaluate correlations or associations between variables. A significance level of 0.05 was adopted. Results: At T1, 28 users participated in the study, and 21 at T2. Participants had a median age of 24.5 (IQR = 6.5) years, with the majority consisting of trans men (60.7%; n = 17). Regarding the assessment of body image satisfaction, ED risk, and gender incongruence at both times, it was observed that only 21.4% (n = 6) of the interviewees were satisfied with their body image at T1 and 9.5% (n = 2) at T2; 28.6% (n = 8) presented a risk for developing eating disorders at T1 and 33.3% (n = 7) at T2; and 67.9% (n = 19) showed high levels of gender incongruence at T1 and 66.7% (n = 14) at T2. Body image satisfaction was associated with gender incongruence at both evaluated moments (T1: p = 0.002 and T2: p = 0.009). Regarding potential factors related to body image satisfaction and ED risk, the following were observed at admission: a negative correlation between the weight concern domain and BMI (r = -0.475; p = 0.011); a positive correlation between the dieting domain and BMI (r = 0.583; p = 0.001); a negative correlation between oral control and BMI (r = -0.466; p = 0.012); and an association between the appearance domain and hormone therapy (p = 0.017). On the other hand, the appearance domain showed a negative correlation with gender incongruence at both times (T1: r = -0.662; p = 0.001; T2: r = -0.478; p = 0.028). Conclusion: The majority of the service users who participated in the study present low levels of body image satisfaction, an increased risk for developing eating disorders, and high levels of gender incongruence. Body image dissatisfaction was associated with higher levels of gender incongruence at both times, and elevated BMI and greater gender incongruence levels appear to negatively influence body image perception and ED risk. However, hormone therapy seems to act as a protective factor for body image satisfaction.