Weight Misperception and Thin-Ideal Overvaluation Relative to the Positive Functioning and Eating Disorder Pathology of Transgender and Nonbinary Young Adults

Abstract

The present study examined associations among weight misperception (discrepancies between individuals’ perceived and actual weight statuses), thin-ideal overvaluation, positive mental health, and eating disorder symptoms in a large national sample of college and university students. Participants included 3,371 adult students from 78 campuses who identified as transgender or nonbinary (TNB) and completed the 2017–2018 or 2018–2019 waves of the cross-sectional multi-institute Healthy Minds Study. Via an online survey, participants completed validated measures assessing perceptual and cognitive-affective body image constructs, positive mental health, and eating disorder pathology. A structural equation model examined whether weight misperception (over and underperception) and thin-ideal overvaluation were associated with positive mental health and, in turn, eating disorder pathology. Whether these associations differed among individuals who identified as trans men, trans women, and genderqueer/gender nonconforming and individuals with self-identified TNB identities was examined via a multiple-group structural equation model. Overall, 35% of participants exhibited elevated eating disorder pathology. Overvaluation of the thin ideal and weight overperception, but not weight underperception, were associated with lower levels of positive mental health, which in turn was associated with elevated eating disorder pathology. These associations did not differ across the assessed TNB identity groups. These findings support the continued use of a positive psychological perspective in research seeking to explain the elevated risk for eating disorder pathology found among individuals with TNB identities. Screening individuals comprising these historically overlooked groups for the presence of weight overperception and thin-ideal overvaluation via brief screening forms during routine health care visits is recommended.