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Beauty for Sale

Cosmetic surgery has become so pervasive, it is now a $4 billion industry, and is said to be growing at a 30% rate per annum. Now that it’s more accepted, where do you head for the next fix?

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The general acceptability of cosmetic surgery helped spawn an industry all its own – medical tourism, which pits the medical practitioners of developed countries, once regarded as the elite bastions of medical expertise, with the developing countries, now also offering highly qualified and well-trained medical professionals using the most advanced in technology.

The story, seeming like an urban myth, even made it to the pages of Asiaweek Magazine: a wealthy Filipino executive in his 60s took his mistress to a plastic surgeon to make her look like his wife when he married her. Unknowingly, the wife went to the same doctor to undergo cosmetic surgery herself, in a bid to keep her husband. After all the nipping and tucking, the wealthy husband left his mistress to return to the surgically rejuvenated wife – but only after undergoing surgery himself, as he started feeling insecure about his own aging appearance.

In a society that is willing to pay the top price for a youthful look, over $160 billion is spent annually worldwide on cosmetic and toiletry products, including deodorants, shampoos and soaps, makeup, lotions, and fragrances. In 2002, Filipinos spent P70 billion for the same, with the figure estimated to reach P89 billion in 2007.

However, more belatedly, cosmetic surgery has become the somewhat simple, yet long-term answer to the pursuit for beauty. Having a hard time losing the gut despite hundreds of sit-ups every day? Opt for abdominal liposuction (price starts at $1,400). There are even muscle implants for the gym body without ever lifting a gym equipment. Losing hair too fast? Consider hair transplant (from $1,500). Insecure about your manhood? Have a penile enlargement and/or lengthening operation (from $450). For women, the vaginal opening can be tightened (from $550) for another “Like a Virgin” experience. Getting edged by younger guys simply because they look better – and, well, younger? Mull over facelift (from $1,000). And, while doing so, you may consider adding a dimple and a cleft chin (from $360) for the Brad Pitt/Alec Baldwin look.

Once derided as vanity medicine, cosmetic surgery has gone a long way, as it is now largely recognized as a legitimate arm of medicine. While it was once only discussed in hushed voices, now anybody who underwent one or more cosmetic surgical procedures actually boasts of having them – men and women alike.

According to former Philippine Medical Association (PMA) president Bu C. Castro, M.D., Ll.B., FPSP, the Philippines is actually a premier destination when it comes to availing of cosmetic surgical procedures, among others. In fact, balikbayans (returning overseas Filipinos) are known to come home to undergo such treatments “Overseas Filipino workers (OFWs), especially those in the entertainment industry, (are among the biggest markets of cosmetic surgery in the Philippines, as it allows them) to level with their competitors, particularly Caucasians, (by giving them similar physical attributes),” he says.

Plastic and reconstructive surgeon Carlos I. Lasa Jr., M.D. agrees. “First, comparing (our costs with) the costs (of medical treatment) where they are working right now, say in London or New York or Japan, where the charges are very high, they can save by coming here,” he says. The balikbayans are also familiar with the Philippine medical system, so they “have more or less this trust in our medical system.” And third, the treatments are merely side trips when they come over to take a vacation, so their visit becomes one trip for everything.

COMPETITIVE ADVANTAGES

The general acceptability of cosmetic surgery helped spawn an industry all its own – medical tourism, which pits the medical practitioners of developed countries, once regarded as the elite bastions of medical expertise, with the developing countries, now also offering highly qualified and well-trained medical professionals using the most advanced in technology.

“This is a $4 billion industry, which is said to be growing at a 30% rate per annum,” Eddie Uy of rxpinoy.com, the first online community of Filipino doctors and dentists that serves to connect various sectors with the health industry, says. Combined with affiliated industries like tourism, India’s BusinessWorld Magazine estimated that millions of travelers actually spend over $40 billion a year. “We should – and can – break into that.”

The local industry has been changing over time, however. According to Uy, although OFWs continue to be the major market of cosmetic procedures, their portal had been receiving inquiries on these procedures from Europeans, particularly from Germany and Denmark. Also, other procedures mainly attract foreign nationals, such as Australians for dentistry, Japanese and Koreans for ophthalmology, and Americans and Europeans for bariatric surgery.

Once derided as vanity medicine, cosmetic surgery has gone a long way, as it is now largely recognized as a legitimate arm of medicine. While it was once only discussed in hushed voices, now anybody who underwent one or more cosmetic surgical procedures actually boasts of having them – men and women alike.

The biggest edge of the Philippines over other countries, particularly in Asia, is its relatively cheap rates for the procedures. For example, breast augmentation could cost up to $5,043 in the US, and at a much lower price of $2,500 in Thailand’s Preecha Aesthetic Institute, but would only cost $2,100 in the Philippines. Similarly, full facelift could cost up to $5,000 in the US, and $4,000 in Thailand, but only $2,500 in the Philippines.

“Among others, there’s an interest in general surgery and cardiovascular surgery because (if they have the surgeries in their home countries) they are sometimes required to co-pay, which they can’t afford, and cosmetic surgery because it is not covered by medical insurance offered to them abroad. So they see (us),” Lasa says. He nonetheless stressed, “The reality is we can’t have fees as high as our counterparts in US and Europe. We also have to have fees that are affordable to the local patients. So when I put up my rates and publish them on the website, it was with due cognizance of the rates in other countries, and of course, the prevailing rates in the Philippines.”

“If you compare the (rates) in peso, (they may look expensive),” Castro says. “But if you go to Singapore, (it’s even more expensive). Even (compared to) Hong Kong, we’re still cheaper when you convert (the rates) to peso. A P150,000 procedure here could cost P250,000 in Hong Kong, and even more in Singapore and Thailand.”

It helps, too, that the standard of living is cheaper in the Philippines by foreign standards. “The Philippines’ highly favorable exchange rate can benefit both local and foreign patients,” Lasa says. With the foreign exchange rate averaging at P56 per $1, the amount brought in by a foreigner visiting the Philippines “can get more for less.”

Another advantage Lasa sees is that “over Thailand and India, the language barrier is non-existent (in the Philippines) for those who speak English well.”

Dr. Castro, however, believes that the country’s biggest edge is the expertise of the Filipino medical practitioners. “We can be competitive – especially with the skills we have. For example, the medical education in China is only four years, (while) ours is 16 years. So how could you rate their qualifications with ours?” he says.

“And with many of our professionals trained abroad, they don’t mind coming here for their treatments,” adds Lasa.

TAKING WINGS

However, while the Philippine government acknowledges that medical tourism is a potential source of dollar income, there are currently no “nationally palpable efforts done (to advance it), so we’re still off the radar of most Europeans, Americans and other nationals (who are considering availing of medical services outside their home countries),” Lasa says.

Lasa contends that government support will help develop a young industry. “For example, the Indian government (gives certain) incentive to dollar earners,” he says. “We need something like that to really promote (medical tourism in the Philippines). As it is right now, we just (get involved in medical tourism) as part of our regular practices.”

That Philippine government has, in fact, included the medical profession in the expanded value added tax (E-VAT). “The government thinks that by taxing, they can generate more income. Actually, they may be mistaken in that assumption,” Lasa says.

“Necessarily, we’ll have to increase the prices also – we’ll have to throw to the patients the costs of the E-VAT. That’s the problem,” Castro says. “The E-VAT has a negative effect on medical tourism – it will jack up the prices. But it will be costly not only to medical tourism but to local patients, who will primarily bear the burden because of the E-VAT.”

Lasa, however, said that while not necessarily translating to increase in prices, “the implementation of E-VAT will mean a decrease in our net income – it will amount to that.”

A bigger problem bothering the local medical tourism industry is its lack of cohesion. “Aside from the medical, dental, cosmetic and other procedures, medical tourism actually bundles hotel stays, destination tours, concierge services including interpreters, caregivers and tourist guides, and many others” Uy of rxpinoy.com says. “But at the moment, most of these (related) industries and sectors (go it alone).”

Castro recommends the establishment of a national call center for medical tourism, preferably with the assistance of medical staff because they would know what the industry is all about and has to offer. “When prospective clients would call up to ask specific questions, our agents should be able to answer them. Else, they’d ask their questions elsewhere – it could be India, Singapore or Thailand – then end up going there,” he says.

While there are entrepreneurs interested to open services like Singapore’s MNC, a one-stop information center for all medical services offered by the country state, “they want it to be outright business operations, not service-oriented, which increases the prices,” Castro says. “If that happens, then we lose our competitive advantage over our competitors.”

Pinoyrx.com is gearing towards the establishment of a “specific hub for medical tourism” when it recently established http://mtpshow.rxpinoy.com, which lists accredited hospitals, current rates and the credentials of Filipino practitioners. “But beyond that, we would like to cross sell other services in the country – if a person undergoes dental implant that requires for him to stay for up to 10 days in the country, then he has to choose accommodation. While here, he could go on tour. And while touring, he may need other services. rxpinoy.com could help arrange all those,” Uy says.

Dr. Bu Castro believes that the country’s biggest edge is the expertise of the Filipino medical practitioners. “We can be competitive – especially with the skills we have. For example, the medical education in China is only four years, (while) ours is 16 years. So how could you rate their qualifications with ours?” he says.

Another problem the industry is facing is the lack of “related infrastructure,” Lasa says. In Thailand, for example, Bumrungrad Hospital has its own hotel facility, connected by a walkway to the hospital, so families can be close to a family member undergoing treatment. “If local hospitals can afford such facilities, it will definitely help promote our medical tourism,” he says.

The urgency to address this situation varies, nonetheless, says Castro. “Makati City, for example, has hotels not far from hospitals. It is in other places like Quezon City that problems arise, since they are far from each other,” he says. Already, however, efforts are already done to establish a hospital cum accommodation facility in Subic Bay Metropolitan Area, among others.

The lack of solidity in the industry also poses a problem when it comes to regulating practitioners. “The Philippine law allows all licensed doctors to do any kind of surgery – mainly, this is to allow doctors in provinces to be able to give emergency treatments without worrying about legal consequences,” Lasa says. “This is good for the provinces, but (in cosmopolitan areas) this is problematic.”

While the PMA and other professional associations can regulate medical practitioners, their grasps are limited only to members. “(Medical tourism) is a very good concept,” Castro says. “But it could be subject to abuse with the sprouting of fly-by-night cosmetic centers that we need to control. The government should issue a listing on the qualified and accredited (practitioners). There should be some kind of a regulation to tell the customer that they are also protected.”

At the end of the day, Castro believes it all boils down to marketing. “When you say tourism, marketing is very important,” he says. “And when you say medical tourism, you’re not only marketing the medical services, but the Philippines itself – places to go to, accommodations and services, everything. We should realize that marketing is an indispensable arm of medical tourism.”

GROWING DEMAND

“I think there is a future (for medical tourism in the Philippines),” Lasa says. “Definitely, as long as there is an economic need for people abroad, as long as there is a perceived benefit of coming (here) to have treatments given by competent – let me emphasize competent – practitioners, there will always be people coming here for such reasons, so medical tourism will continue to prosper.”

Uy says that people live longer, “and you need to provide people to look after them (as they age).” “Coupled that with the escalating cost of health care – instead of chasing the expenses, they might as well outsource it,” he says. “With the advent of technology, information has become fluid, so it helps our cause (to promote the Philippine medical tourism). Who knows, this may just avert the brain drain of our medical professionals.”

While arguing that a concerted effort needs to be done in order for the local industry to realize its full potential, “I do not conduct my practice with grandiose visions – I conduct my practice with a simple philosophy: providing excellent patient care on a one-to-one basis. I don’t regard this as a business. I went into this field because I like treating patients on a one-to-one basis. If dadami ang patients ko (the number of my patients grow) because (they were referred to me by satisfied patients) then well and good,” Lasa says. “In the end, it is because of how good we are at our profession that is the driving force of people coming to avail of our services.”

 

Health & Wellness

Trans women can safely maintain estrogen treatments during gender affirming surgery

The practice of withholding estrogen prior to gender affirming surgery was not necessary. Most transgender women can now safely remain on their estrogen therapy throughout surgery.

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There was no difference in blood clots when estrogen hormone therapy was maintained during gender affirming surgery.

This is according to a study (titled, “No Venous Thromboembolism Increase Among Transgender Female Patients Remaining on Estrogen for Gender Affirming Surgery”) helmed by John Henry Pang with Aki Kozato from Mount Sinai, and was published in the Journal of Clinical Endocrinology & Metabolism.

Historically, the lack of published data contributed to heterogeneity in the practice of whether doctors and surgeons advised transgender women to withhold their estrogen therapy before surgery. The sudden loss of estrogen in the blood was sometimes very uncomfortable with symptoms that amounted to a sudden, severe menopause.

So the researchers tapped 919 transgender patients who underwent gender affirming surgery at Mount Sinai’s Center for Transgender Medicine and Surgery between November 2015 and August 2019. Notably, including 407 cases of transgender women who underwent primary vaginoplasty surgery.

This study found that the practice of withholding estrogen prior to gender affirming surgery was not necessary. Most transgender women can now safely remain on their estrogen therapy throughout surgery.

The bottom line: This study found that most transgender women can  safely maintain their estrogen hormone treatments during gender affirming surgery.

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Facebook posts help facilitate belief that HPV vaccine is dangerous to health

Nearly 40% of Facebook posts about the HPV vaccine amplified a perceived risk, and the data suggests these posts had momentum over time.

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The human papillomavirus infection, or HPV, is one of the most common sexually transmitted infections, according to the Centers for Disease Control and Prevention (CDC). HPV is associated with health problems including genital warts and cancers, but a vaccine has been available since 2006 to help stop the virus. The CDC reports more than 12 years of data supports the HPV vaccine is safe and effective, yet HPV vaccination rates still remain low.

Social media has a history of being a popular place for sexual health discussions, and the HPV vaccine is one of the most discussed vaccines on the internet. Monique Luisi, an assistant professor in the University of Missouri School of Journalism, has studied more than 6,500 public HPV vaccine-related posts on Facebook from 2006 to 2016. In a previous study, Luisi used these Facebook posts to identify a negative trend on Facebook related to how people perceive the HPV vaccine.

Now, she suggests this negative trend on Facebook may also cause people to develop a false perception of the health risk of the vaccine. After looking at the percentage of posts that made the vaccine seem more dangerous, less dangerous or neither, Luisi found nearly 40% of Facebook posts about the HPV vaccine amplified a perceived risk, and the data suggests these posts had momentum over time.

“We should not assume that only the disease is perceived as a risk, but when research supports it, that medical treatments and interventions might unfortunately also be perceived as risks,” she said. “It’s more likely that people are going to see things on social media, particularly on Facebook, that are not only negative about the HPV vaccine, but will also suggest the HPV vaccine could be harmful. It amplifies the fear that people may have about the vaccine, and we see that posts that amplify fear are more likely to trend than those that don’t.”

Luisi suggests the spread of this negative information may lead people to have a false perception of the vaccine, so people should consult their doctor or health care provider before making an informed decision.

“Facebook remains a very popular social media platform for adult audiences, which necessitates action to address HPV vaccine risk messages,” she said. “People are going to see what they are going to see on social media, so it’s important to not only take what you see on social media, but also talk to a doctor or health care provider. Just because it’s trending doesn’t mean it’s true.”

Luisi notes research must continue to address the perception of vaccine safety where the vaccine is perceived as a greater health threat than the virus or disease it prevents, and her study could also inform officials for the ongoing COVID-19 vaccine roll out and distribution.

“As the COVID-19 vaccine is being rolled out, people are likely going to see a lot of negative information, and that negative information will be what trends on social media,” she said. “But, if the public can anticipate this negative information, it will be interesting to see if that will that make them less sensitive to the perceived risk of the vaccine.”

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Health & Wellness

Depression and stress could dampen efficacy of COVID-19 vaccines

Even though rigorous testing has shown that the COVID-19 vaccines approved for distribution are highly effective at producing a robust immune response, not everyone will immediately gain their full benefit. Environmental factors, as well as an individual’s genetics and physical and mental health, can weaken the body’s immune system, slowing the response to a vaccine.

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Decades of research show that depression, stress, loneliness, and poor health behaviors can weaken the body’s immune system and lower the effectiveness of certain vaccines.

A new report accepted for publication in Perspectives on Psychological Science suggests that the same may be true for the new COVID-19 vaccines that are in development and the early stages of global distribution. Fortunately, it may be possible to reduce these negative effects with simple steps like exercise and sleep.

Vaccines are among the safest and most effective advances in medical history, protecting society from a wide range of otherwise devastating diseases, including smallpox and polio. The key to their success, however, is ensuring that a critical percentage of the population is effectively vaccinated to achieve so-called herd immunity.

Even though rigorous testing has shown that the COVID-19 vaccines approved for distribution are highly effective at producing a robust immune response, not everyone will immediately gain their full benefit. Environmental factors, as well as an individual’s genetics and physical and mental health, can weaken the body’s immune system, slowing the response to a vaccine.

This is particularly troubling as the novel coronavirus continues to rage across the world, trigging a concurrent mental health crisis as people deal with isolation, economic stressors, and uncertainty about the future. These challenges are the same factors that have been previously shown to weaken vaccine efficacy, particularly among the elderly.

“In addition to the physical toll of COVID-19, the pandemic has an equally troubling mental health component, causing anxiety and depression, among many other related problems. Emotional stressors like these can affect a person’s immune system, impairing their ability to ward off infections,” said Annelise Madison, a researcher at The Ohio State University and lead author on the paper. “Our new study sheds light on vaccine efficacy and how health behaviors and emotional stressors can alter the body’s ability to develop an immune response. The trouble is that the pandemic in and of itself could be amplifying these risk factors.”

Vaccines work by challenging the immune system. Within hours of a vaccination, there is an innate, general immune response on the cellular level as the body begins to recognize a potential biological threat. This frontline response by the immune system is eventually aided by the production of antibodies, which target specific pathogens. It is the continued production of antibodies that helps to determine how effective a vaccine is at conferring long-term protection.

The good news, according to the researchers, is that the COVID-19 vaccines already in circulation are approximately 95% effective. Even so, these psychological and behavioral factors can lengthen the amount of time it takes to develop immunity and can shorten the duration of immunity.

“The thing that excites me is that some of these factors are modifiable,” said Janice Kiecolt-Glaser, director of the Institute for Behavioral Medicine Research at The Ohio State University and senior author on the paper. “It’s possible to do some simple things to maximize the vaccine’s initial effectiveness.”

Based on prior research, one strategy the researchers suggest is to engage in vigorous exercise and get a good night’s sleep in the 24 hours before vaccination so that your immune system is operating at peak performance. This may help ensure that the best and strongest immune response happens as quickly as possible.

“Prior research suggests that psychological and behavioral interventions can improve vaccine responsiveness. Even shorter-term interventions can be effective,” said Madison. “Therefore, now is the time to identify those at risk for a poor immune response and intervene on these risk factors.”

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Health & Wellness

Bisexual men more prone to eating disorders than gay or straight men – study

80% of bisexual men reported that they “felt fat”, and 77% had a strong desire to lose weight, both figures higher than the 79% and 75% for gay men, respectively.

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Bisexual men are more likely to experience eating disorders than either heterosexual or gay men. This is according to a report from the University of California San Francisco, published in the journal Eating and Weight Disorders.

A handful of studies have actually indicated that gay men are at increased risk for disordered eating, including fasting, excessive exercise and preoccupation with weight and body shape. This newer study, however, suggests that bisexual men are even more susceptible to some unhealthy habits.

For this study, the researchers surveyed over 4,500 LGBTQ adults, and a quarter of the bisexual male participants reported having fasted for more than eight hours to influence their weight or appearance. This is higher when compared to 20% for gay men.

The research also found that 80% of bisexual men reported that they “felt fat”, and 77% had a strong desire to lose weight, both figures higher than the 79% and 75% for gay men, respectively.

Now this is worth stressing: According to study co-author Dr. Jason Nagata, not everyone who diets or feels fat has an eating disorder. “It’s a spectrum — from some amount of concern to a tipping point where it becomes a pathological obsession about body weight and appearance,”Nagata was quoted as saying by NBC News.

For Nagata, several factors may be at play here, including “minority stress” (the concept that the heightened anxiety faced by marginalized groups can manifest as poor mental and physical health outcomes).

“LGBTQ people experience stigma and discrimination, and stressors can definitely lead to disordered eating,” Nagata was also quoted as saying. “For bi men, they’re not just facing stigma from the straight community but from the gay community, as well.”

Of all the respondents, 3.2% of bisexual males were clinically diagnosed with eating disorders (compared to 2.9% of gay men). For heterosexual men, it’s only 0.6%.

For the researchers, there is a need to conduct eating disorder research on various sexual identities independently. This is also to raise awareness on this issue (and how it affects different people of various SOGIESCs).

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Timing and intensity of oral sex may affect risk of oropharyngeal cancer

Love giving head? Consider this: Having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer.

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Human papillomavirus (HPV) can infect the mouth and throat to cause cancers of the oropharynx.

This is according to a study published in CANCER, a peer-reviewed journal of the American Cancer Society, which has found that having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer. The study also shows that having oral sex at a younger age and more partners in a shorter time period (oral sex intensity) were associated with higher likelihoods of having HPV-related cancer of the mouth and throat.

Previous studies have shown that performing oral sex is a strong risk factor for HPV-related oropharyngeal cancer. To examine how behavior related to oral sex may affect risk, Virginia Drake, MD, of Johns Hopkins University, and her colleagues asked 163 individuals with and 345 without HPV-related oropharyngeal cancer to complete a behavioral survey.

In addition to timing and intensity of oral sex, individuals who had older sexual partners when they were young, and those with partners who had extramarital sex were more likely to have HPV-related oropharyngeal cancer.

“Our study builds on previous research to demonstrate that it is not only the number of oral sexual partners, but also other factors not previously appreciated that contribute to the risk of exposure to HPV orally and subsequent HPV-related oropharyngeal cancer,” said Dr. Drake. “As the incidence of HPV-related oropharyngeal cancer continues to rise… our study offers a contemporary evaluation of risk factors for this disease. We have uncovered additional nuances of how and why some people may develop this cancer, which may help identify those at greater risk.”

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Health & Wellness

Sexual, gender minority youths more likely to have obesity, binge eating disorder

Findings suggest that weight and eating disorder disparities observed in SGM adolescents/adults may emerge in childhood. As such, “clinicians should consider assessing eating- and health-related behaviors among SGM youths.”

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Sexual and gender minorities (SGM) youths were more likely to have obesity and full-threshold or subthreshold binge eating disorder. This is according to research – “Obesity and Eating Disorder Disparities Among Sexual and Gender Minority Youth” by Natasha A. Schvey, PhD; Arielle T. Pearlman, BA; David A. Klein, MD, MPH; et al -published in JAMA Pediatrics.

SGM are those who identify as lesbian, gay, bisexual and/or transgender, or whose sexual orientation and/or gender identity/expression do not conform to societal conventions.

For this study, the researchers noted that as it is, “obesity and eating disorders in youth are prevalent, are associated with medical and psychosocial consequences, and may persist into adulthood. Therefore, identifying subgroups of youth vulnerable to one or both conditions is critical.”

For them, one group that may be at risk for obesity and disordered eating is SGM.

In total, 11,852 participants were considered (aged 9-10 years), derived from the Adolescent Brain Cognitive Development Study. The mean age was 9.91, and 5,672 (47.9%) of the total number were female. The sample comprised 1.6% (n = 190) probable sexual (n = 151) and/or gender minority (n = 58) youths, of whom 24.7% (n = 47) responded yes and 75.3% (n = 143) responded maybe to the SGM queries.

The researchers found that one in six youths (1,987 [16.8%]) had obesity and 10.2% (n = 1,188) had a full-threshold (86 [0.7%]) and/or subthreshold (1103 [9.4%]) eating disorder.

They also reported that adjusting for covariates, SGM youths were more likely to have obesity (odds ratio, 1.64; 95% CI, 1.09-2.48) and full-threshold or subthreshold binge eating disorder (odds ratio, 3.49; 95% CI, 1.39-8.76).

SGM and non-SGM youths did not differ in the likelihood of full-threshold or subthreshold anorexia nervosa or bulimia nervosa. The same pattern of results remained when limiting SGM youths to those responding yes to the SGM items, although significance for the likelihood of obesity was attenuated.

For the researchers, the findings suggest that weight and eating disorder disparities observed in SGM adolescents/adults may emerge in childhood. As such, “clinicians should consider assessing eating- and health-related behaviors among SGM youths.”

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