ESPE Abstracts

Introduction: Elevated obesity prevalence among transgender individuals compared to cisgender control groups or general population have been reported in some studies. Whether there is a higher prevalence for obesity in transfeminine and transmasculine persons at different age groups has not yet been systematically studied.

Methods: We performed a systematic literature search using Pubmed and Google Scholar. Following search terms were used “Obesity”,“BMI”,“Overweight” AND “Gender dysphoria”,“Gender identity disorder”,“Transgender*” and “Transsexual*”. Inclusion criteria was that data on the proportion of participants with gender dysphoria and obesity (OB) had been reported. 1,552 records were screened (116 duplicates). 1.380 records were removed after title and abstract screening (n=898), and after full-text screening and bias risk assessment (n=482). 56 records were included in analysis. The published obesity prevalence of the study populations was extracted. Comparisons were either drawn to cisgender control groups included in the study or descriptive comparisons to general population data (World Obesity Federation). We categorized a record to have: higher, lower or similar obesity prevalence as comparative populations. In a further step, we looked whether there were differences in the reported obesity prevalence depending on gender (transmasculine (TM) versus transfeminine (TF)), treatment status (treatment-naïve), sample type (treatment-seeking, i.e. diagnosis-based versus non-treatment seeking samples (nTS), e.g. community-based and probability samples), countries of origin (USA versus Non-USA) and sample size (n>200, n>1000).

Results: 21/37 TM cohorts had a higher OB prevalence than comparative populations, in contrast to only 6/31 TF cohorts. Cohorts with mixed genders showed higher prevalence in 8/14 reports. nTS were not associated with higher OB prevalence among TM study populations. 12/16 treatment-naïve TM cohorts had higher than expected obesity rates. 11/20 youth cohorts (all genders) and 6/9 TM youth cohorts had higher OB proportions than comparative populations. The observation of higher OB prevalence in TM samples was more pronounced in cohorts with a sample size>200 (12/19) and among Non-US cohorts (9/13).

Conclusion: No differences in obesity prevalence were observed for transgender women compared to control group. Obesity is more common among transgender boys and men compared to general population data or cisgender control groups. Hormonal treatment is not likely to be the cause as reports of treatment-naïve patients already show elevated obesity rates compared to control group. Healthcare providers working with transgender men should be aware of the increased rate of obesity in this population compared to general population and incorporate appropriate management strategies into their care.