Some transgender and gender-diverse college students are at a heightened risk of developing an eating disorder, research shows.

Just before swimmer Schuyler Bailar made history as the first openly transgender athlete to compete in an NCAA Division I men’s team, he took a year out to deal with an eating disorder. After five months in treatment, Bailar returned ready to swim—and share publicly that he was trans. It was through the treatment program that he “realized I am transgender, and was finally able to speak that truth aloud,” he told Authority Magazine. “Discovering that I was transgender was imperative to my healing.”

Bailar is not alone in both confronting an eating disorder and in discovering it is deeply tied to their gender identity. The new study finds that certain transgender and gender-diverse (TGD) college students—including genderqueer or gender-nonconforming (GQ/NC) individuals, and transgender men—are at a heightened risk of developing an eating disorder (ED). The findings appear in the journal Annals of Epidemiology.

“Disordered eating—whether restricting, binging, purging—is often about control,” says study coauthor Sarah K. Lipson, an assistant professor of health law, policy, and management in the Boston University School of Public Health. She’s the principal investigator of the Healthy Minds Network, a research initiative that studies adolescent and young adult mental health.

“Eating disorder risk can be exacerbated by situations that take the control and autonomy from individuals, as is the case with restrictive health care policies and practices that prioritize binary sex assigned at birth, rejecting gender identity and expression,” she says.

College years are an important developmental period, and a time during which many students have the autonomy to explore gender identity, some for the first time. For TGD students—defined as people whose gender identity and/or expression exists outside of the cisnormative gender binary—this exploration may lead to an increased focus on body shape and distress from potential gender dysphoria.

Read the full article about transgender and gender-diverse college students by Jillian McKoy at Futurity.