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Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight control behavior.

Objective: Describe BMI and the association of medication use, well-being, and recreational activities in treatment-naïve pediatric TGD patients.

Design/Methods: Chart review of 302 patients (age 3-19, 73.5% sex assigned at birth (SAB) female; 85.8% white) from 2017-2020. BMI was calculated by age and SAB using CDC growth charts. Parents reported medication use; parent and self-reported Pediatric Quality of Life (PEDS-QL) Well-Being and activities were surveyed electronically.

Results: By BMI category, 3.3% were underweight (BMI<5%); 49.4% were >85% and 29.5% fell >95%. Overweight and obesity rates were higher than national norms (31.2% >85%; X2=45.92, p<.01; 16.4% >95%; X2=37.11, p< .01). BMI Z-scores varied by SAB (Female M=0.91, SD=1.18; Male .54, 1.32; F(1, 300)=5.2, p<.05). PEDS-QL parent-reported well-being was a significant predictor of BMI (b=-.018, p<.01, R2=.059); an increase in well-being predicted a decrease in BMI. Parent-reported activities (i.e., participation in performing arts/debate, social/advocacy groups, exercise); creative arts involvement was associated with BMI >85% (M=1.49, .89, t=2, p<.05). Self-reported activities (i.e., creative arts, performing arts/debate, academics, exercise, games, spending time with family/friends, social advocacy); watching/listening to media was associated with BMI >85% (M=1.38,.79, t=3.63, p<.01). Conversely, spending time with friends and family was associated with average BMI (M=.63, 1.04, t=-2.09, p<.05). Medications were used by 55% of patients; gastrointestinal (M=1.91, .77, t=7.69, p< .01), anti-emetic (M=2.29, .78, t=13.12, p< .01), anxiolytic (M=1.43, .79, t=3.11, p<.01), diabetes (M=2.12, .79, t=2.44, p<.01), endocrine (M=1.88, .79, t=1.97, p<.05), mood stabilizer (M= 1.67, .77, t= 2.71, p<.01), norepinephrine/dopamine reuptake inhibitor (M=1.69, .80, t=4.01, p<.05), and SSRI/SNRI (M=1.04, .72, t=2.05, p<.05) were associated with BMI >85%.

Conclusion(s): Obesity is a common problem among TGD youth presenting for gender affirming care. Female SAB, lower well-being, involvement in sedentary recreational activities, and taking medications to treat gastrointestinal, endocrinologic, or psychiatric conditions were associated with elevated BMI. Spending time with family and friends was protective. Providers should address high BMI. TGD youth should be encouraged to decrease sedentary activities and improve connection with friends and family.

Presented at the 2021 PAS Virtual Conference

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Behavioral Medicine | Pediatrics

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Presented at the 2021 PAS Virtual Conference

BMI and Associated Variables in A Pediatric Gender Clinic Sample