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Supporting LGBTIQ+ clients: how dietitians can be more inclusive - an interview with Tom Scully, APD

By Paula Goodyer

Up to 11 per cent of Australians now identify as LGBTIQ+* - and some are likely to need help from an APD at some point in their lives.

So how could you best support a young gay man with disordered eating? Or an older trans client whose risk of heart disease may be higher as a result of hormone therapy?

You could join a new discussion group designed to help dietitians dealing with LGBTIQ+ clients.

“The aim is to put these clients on the radar of dietitians and highlight their health concerns, as well as help dietitians who might have a client who’s transgender, for instance, and needs advice on how to help them,” says Melbourne based APD Tom Scully who launched the LGBTQI+ discussion group in September. “The goal is to eventually form an Interest Group for dietitians working in this area.”

Are some health problems more common in people in the LBGTIQ+ community?

They have the same health problems as anyone else but are more likely to have conditions related to metabolic health such as type 2 diabetes, Tom explains. They’re also more likely to develop an eating disorder compared to the general public, especially if they’re transgender.

“The reason for the higher risk of metabolic conditions is partly because when people are exposed to discrimination and prejudice it creates a chronic stress response which can lead to poor health. If people are anxious or depressed they’re also more likely to drink, smoke or not look after themselves,” he says.

Why there’s a higher risk of eating disorders

“Body ideals aren’t the cause of eating disorders but they can contribute, leading to changes in eating and/or working out. When people are stressed they might use eating or overdoing exercise as a way of coping.

“Eating disorders can also affect people in the trans community if their gender identity (internal sense of gender) doesn't match their outward appearance (gender expression). For example, a trans woman in the early stages of treatment might still be treated as a male by the people around her and may try to alter how she looks by eating differently. A trans man who’s undergoing treatment but still continuing to menstruate may restrict his eating to suppress menstruation.”

Hormone therapy and cardiovascular disease

Trans women and men may also have a higher risk of cardiovascular disease as a result of hormone therapy according to research reported by the American Heart Association.

“But it’s also important to know that with hormone therapy people generally feel better and their overall health improves,” Tom stresses. “An increased risk of heart disease is a concern but it’s a small risk and the risk of denying someone hormone treatment can be worse and lead to self-harm. Still, dietitians need to be aware of this risk and keep an eye on levels of blood pressure and cholesterol. If there are concerns, recommend eating more foods that help keep blood pressure and cholesterol levels healthy

“There’s a definite role for dietitians with this community but we need to be well prepared. Inclusivity is important because when people have negative experiences with health practitioners they don’t go back.”

How can dietitians be more inclusive?

  • Create an environment where people can feel comfortable about being themselves - a gay man needs to be able to mention his husband without raising eyebrows, for example, Tom points out.  “Be sensitive about asking questions and don't make assumptions about a person’s sexuality or gender. If you need to know more about a client’s lifestyle, for instance, try open ended questions like 'tell me about your home life'. Use neutral terms like ‘partner’ or use the language that people use to describe themselves and their relationships. “
  • Know who’s who in the LBGTIQ+ community and be familiar with the relevant terms - see this resource sheet from the Australian Institute of Family Studies.
  • Learn more about the community’s health needs. Good resources include: The Transgender and Gender Diverse Health and Wellbeing report from VicHealth; Caring for Transgender Patients and Clients: Nutrition-Related Psychosexual Considerations published in the Journal of  the Academy of Nutrition and Dietetics; Towards Providing Culturally Aware Nutritional Care for Transgender People: Key Issues and Considerations published in the Canadian Journal of Dietetic Practice and Research.
  • Look at your own attitude to the community - are you biased in any way? “We all have to reflect on our thoughts and beliefs about people with different characteristics,” Tom says.
  • Join the LGBTIQ+ discussion group by going to Member Connect on the DAA website.

For more information, contact Tom Scully  

* The term LGBTIQ+ is a way of recognising that the acronym isn't a complete list of queer identities.