Action-Oriented Affirmations: Providing Better Care to Clients Who Identify as LGBTQ+

Action-Oriented Affirmations | Food & Nutrition Magazine | Volume 9, Issue 3

A first step in providing better care to individuals who identify as LGBTQ+ is to gain a better understanding of related terminology and concepts. The abbreviation LGBTQIA+ stands for lesbian, gay, bisexual, transgender, queer or questioning, intersex and ally or asexual. The plus sign is meant to represent other sexual orientations and gender identities not included.

Lesbian refers to women who are sexually or romantically attracted to women. Although gay can be used as a general term, it typically refers to men who are sexually or romantically attracted to men. Bisexual is being attracted to two or more gender identities. Transgender or trans (but not transgendered) is a term used to describe someone who does not identify with the biological sex assigned at birth; this may be (but is not limited to) a man who was assigned female at birth or a woman who was assigned male at birth.

The term queer can be viewed as derogatory by some but is gaining positive acceptance and refers to a variety of sexual orientations and gender identities. Questioning represents someone who is unsure of their sexual orientation or gender identity. Ally is a person who provides support and serves as an advocate. Asexual is the sexual orientation of someone who identifies as having no sexual attraction to anyone, and intersex is a person born with sexual anatomy that does not fit conventional classifications of male or female.

Gay, lesbian, bisexual and asexual are terms used to describe sexual orientation, or how a person characterizes their physical, emotional and romantic attachments to other people. Other sexual orientations include pansexual (attracted to all gender identities), demisexual (attracted only to those with whom an emotional connection is formed), graysexual (occasionally or infrequently experience sexual attraction but usually at a lower intensity) and more.

Gender Concepts and Terminology
While individuals have a sex assigned at birth based on factors such as genitalia and chromosomes, a person’s gender identity refers to their inner sense of being male, female, both or possessing no gender at all. Nonbinary is a term used to describe an individual who identifies as neither male nor female. Gender-neutral describes an individual who prefers not to be defined by a gender or pronouns such as she/her/hers or he/him/his, preferring instead the pronoun “they” or “them.” Nonbinary individuals may also prefer they or them pronouns.

Gender identity may or may not match sex assigned at birth or it may change over time, which can be described as gender-fluid. When an individual’s gender identity matches sex assigned at birth, it is known as cisgender.

Gender expression is how an individual expresses their gender identity and can include aspects such as clothing choices, hair style and other physical traits or social expression through choice of pronouns or name. Gender nonconforming refers to an individual with gender expression outside the norms of traditional femininity and masculinity. Gender perception refers to the way an individual’s gender is perceived by others.

Creating a More Inclusive Practice
Registered dietitian nutritionists and other nutrition and dietetics practitioners can take simple and practical steps to be more inclusive and affirming in their practice. Becoming familiar with basic terminology and concepts is a great start; remaining interested and open to learning more to enhance cultural competence is equally important. There is always something left to learn; do not be afraid to ask clarifying questions of clients or patients, if needed.

The abbreviation that started as LGBT is ever-changing and evolving, sometimes referred to as LGBTQ, LGBTQ+ or LGBTQIA+. Approximately 20 percent of millennials and 12 percent of the total population identify as LGBTQ. As the abbreviation shifts and expands to be more inclusive, it’s important for the health care community to follow suit.

Ask clients or patients their preferred pronouns and consider purchasing pronoun pins to wear. When in doubt, use gender-neutral pronouns. Avoid gender-specific words such as sir, ma’am, guys and girls; opt instead for words such as you, folks and you all. Practice using they/them pronouns — if a slipup occurs during a session, simply apologize and move on without making it a big deal. Additionally, keep in mind that LGBTQ+ identities are considered protected health information and covered by the Health Insurance Portability and Accountability Act of 1996, or HIPAA.

Modifying the language on client and patient intake forms is another way to be more inclusive. Consider asking an individual’s gender identity in addition to sex assigned at birth. Pediatric RDNs may consider changing “mother and father” to “parents and guardians.”

Additional steps may include designating an all-gender restroom, training staff on appropriate language and behaviors and ensuring referrals to other health care practitioners are LGBTQ+ inclusive.

What are the biases and health disparities experienced by those in the LGBTQ+ community? What is the best way to determine caloric needs for transgender clients or patients and how do hormone therapies affect nutrition-related labs? Get the answers and learn more about affirming language and terms to avoid, plus the prevalence of eating disorders in the transgender population by listening to the webinar “Building a Foundation: LGBTQ+ Terminology, Concepts, and Affirming Communication” and the FNCE® 2018 session “Engaging LGBTQ Clients in Nutritional Counseling Through Cultural Humility.”


443. Engaging LGBTQ Clients in Nutritional Counseling Through Cultural Humility webinar. FNCE® 2018. Academy of Nutrition and Dietetics.
All About Being LGBTQ. Planned Parenthood website. Accessed May 20, 2020.
Building a Foundation: LGBTQ+ Terminology, Concepts, and Affirming Communication webinar. Academy of Nutrition and Dietetics.
Gender identity & expression. Smart Sex Resource website. Accessed May 20, 2020.
GLAAD Accelerating Acceptance 2017. GLAAD website.  Accessed May 19, 2020.
Gold A. The ABCs of L.G.B.T.Q.I.A.+. The New York Times website. Updated June 7, 2019. Accessed May 19, 2020.
Intersex. Medline Plus website. Reviewed August 7, 2019. Accessed May 26, 2020.
LGBTQIA Resource Center Glossary. UC Davis website. Updated January 14, 2020. Accessed May 20, 2020.

Esther Ellis
Esther L Ellis, MS, RDN, LDN, is an associate editor of Food & Nutrition Magazine.