Eating disorder symptoms and obesity at the intersections of gender, ethnicity, and sexual orientation in US high school students

College Climate and Sexual Orientation Differences in Weight Status

Previous research has identified significant sexual orientation disparities in obesity. Contextual factors, like lack of anti-discrimination policies and gay-straight alliances, have been shown to be associated with health outcomes like poor mental health and substance use for lesbian, gay, and bisexual (LGB) individuals moreso than their heterosexual counterparts; however, little work to date has explored the role of contextual factors on sexual orientation disparities in obesity. Individual-level, serial cross-sectional data from the 2009-2013 College Student Health Survey, which includes 2- and 4-year college students (n = 29,118) attending 46 Minnesota colleges, were used. College-level data on LGB context were primarily collected through college websites. Multinomial logistic regression models were fit to examine associations between LGB college climate scores (including non-discrimination policies, presence of LGB or diversity-related student groups, LGB courses offered, LGB housing accommodations, and prevalence of LGB students) and students' weight status (underweight, healthy weight, overweight, and obese), based on self-reported height and weight. Higher LGB climate scores (i.e., more supportive environments) were associated with lower risk of overweight and obesity among all students. Sexual orientation-stratified findings among female students suggested that the association between LGB climate scores and weight status was similar to the overall female sample. Sexual orientation-stratified findings among male students showed a more complex relationship between LGB climate scores and weight status. More work is needed to disentangle the observed associations, and to investigate other contextual factors, like state- and city-level policies, social networks and norms, and individual resiliency within these contexts to better understand the contextual influences on sexual orientation disparities in obesity.

Variation in diet quality across sexual orientation in a cohort of U.S. women

PURPOSE

Extensive prior research has shown that sexual minority women are more likely to have a number of cancer risk factors, thereby putting them at higher risk for cancer than heterosexual women. However, there has been little research evaluating the association between sexual orientation and diet quality.

METHOD

Data come from participants (aged 24-54 years) enrolled in Nurses' Health Study 3, an ongoing, U.S.-based cohort study (N = 15,941). We measured diet using recommendations from the Dietary Approach to Stop Hypertension (DASH) and American Health Association (AHA) 2020 Strategic Impact Goals.

RESULTS

We found limited evidence of differences across diet quality by sexual orientation. When examining predicted DASH scores, mostly heterosexual [predicted mean score (95% confidence interval), 24.0 (23.8, 24.3)] and lesbian [24.3 (23.8, 24.9)] women had healthier predicted DASH scores than the reference group of completely heterosexual women with no same-sex partners [23.6 (23.5, 23.7)]. Even though certain sexual minority women had overall healthier predict DASH scores, their consumption of certain food groups-low-fat dairy and fruit-was lower than completely heterosexual women with no same-sex partners. When measuring AHA scores, most sexual minority groups (completely heterosexual women with same-sex partners, mostly heterosexual women, and lesbian women) had higher diet quality compared to the reference group of completely heterosexual women with no same-sex partners.

CONCLUSION

Sexual minority women, particularly mostly heterosexual women and lesbian women, had healthier diet quality than completely heterosexual women with no same-sex partners. These data suggest that cancer risk factors (e.g., smoking, drinking, and inactivity) other than diet would drive higher cancer rates among sexual minority compared to heterosexual women. Nonetheless, it is critical for all women to improve their diet quality since diet quality was poor among participants of all sexual orientations.

An examination of emotion regulation as a mechanism underlying eating disorder pathology in lesbian, gay, and bisexual individuals

OBJECTIVE

Lesbian, Gay, and Bisexual (LGB) individuals generally experience eating disorders at higher rates than heterosexual individuals. While there is limited research examining why LGB individuals experience higher levels of eating pathology, emotion regulation (ER) deficits have been associated with higher rates of other forms of psychopathology in this population. The present study examined the impact of specific ER deficits on the relationship between LGB status and eating pathology. We hypothesized that 1) LGB individuals would report higher levels of ER deficits, and 2) ER deficits would mediate the relationship between LGB status and eating pathology.

METHOD

Participants were 195 LGB and 193 heterosexual adults recruited via mTurk who completed self-report measures of eating pathology and ER deficits.

RESULTS

One-way ANCOVA analyses revealed that LGB individuals reported higher levels of ER deficits compared to heterosexuals for all DERS subscales except for DERS-Awareness. Nearly all DERS subscales (DERS-Nonacceptance, DERS-Goals, DERS-Strategies, DERS-Impulse) significantly mediated the relationship between LGB status and eating pathology.

DISCUSSION

Consistent with our hypotheses, LGB individuals reported higher levels of ER deficits compared to heterosexuals and specific ER deficits partially accounted for the relationship between LGB status and eating pathology. Future research should utilize longitudinal designs to examine whether the ER deficits identified in the present study prospectively predict eating pathology. Considering the immense mental health burden placed on the LGB community, it is essential that research continue to identify the unique needs of LGB individuals to more effectively treat and prevent psychopathology, including eating disorders, in this population.

Diagnosis of Eating Disorders Among College Students: A Comparison of Military and Civilian Students

INTRODUCTION

Eating disorders are often under-detected, which poses a serious threat to the health of individuals with eating disorder symptoms. There is evidence to suggest that the military represents a subpopulation that may be susceptible to high prevalence of eating disorders and vulnerable to their underdiagnosis. Underreporting of eating disorder symptoms in the military could lead to this underdiagnosis of individuals with eating disorder symptoms. The purpose of this study was to examine the association between military affiliation and eating disorder symptoms among college students and the likelihood of eating disorder diagnosis among those with eating disorder symptoms using a large, diverse college-aged sample of both military-involved and civilian students.

MATERIALS AND METHODS

Participants for this study were from the 2015-2016, 2016-2017, and 2017-2018 Healthy Minds Study (HMS). Healthy Minds Study is a large, cross-sectional cohort study of both undergraduate and graduate students from universities and colleges across the United States and Canada. The Healthy Minds Study survey questions include assessment of demographic information, military status, self-reported eating disorder symptoms using the SCOFF questionnaire, and self-reported eating disorder diagnosis. Univariate analysis, chi-square analysis, and logistic regression with an unadjusted and covariate adjusted model were used to examine the association between eating disorder symptoms and military affiliation. These analyses were also used to examine the association between eating disorder diagnosis among those with eating disorder symptoms and military affiliation. All analyses were conducted using SPSS.

RESULTS

The prevalence of eating disorder symptoms was high among both the civilian (20.4%) and military-involved (14.4%) students. Among females, there was a significantly higher (P value = .041) prevalence of eating disorder symptoms among civilian college students (24.7%) compared to military-involved students (21.3%). Among those with eating disorder symptoms, the prevalence of diagnosis was low in both military and civilian students. Specifically, the prevalence of diagnosis was significantly lower (P value = .032) among military-involved college students (10.8%) compared to civilian college students (16.4%). Differences in sociodemographic characteristics (e.g., gender, race/ethnicity, and age) among military-involved and civilian college students appear to explain this association.

CONCLUSIONS

The underdiagnosis of eating disorders is far too common, and this represents a threat to the health of military and civilian populations alike. Underdiagnosis of eating disorders within military environments may be due to underreporting, particularly among men and racial/ethnic minority groups.

State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women

This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.

Ethnic/racial and gender differences in body image disorders among a diverse sample of sexual minority U.S. adults

This study assessed the occurrence of probable eating disorders (EDs), ED symptoms, probable body dysmorphic disorder (BDD), BDD symptoms, drive for muscularity, and appearance and performance enhancement drug (APED) misuse, in an ethnically/racially diverse sample of 962 cisgender sexual minority (SM) individuals in the United States, aged 18-30 years old. The overall occurrence of probable ED, probable BDD, and APED misuse in the current sample was 32.7 %, 50.9 %, and 30.6 %, respectively. With respect to ethnicity/race, Hispanic SMs reported the highest rates of EDs, BDD, APED misuse, and drive for muscularity, and may therefore be particularly at risk for developing body image disorders (BIDs). With respect to gender, SM men reported significantly greater drive for muscularity and APED misuse compared to SM women, while SM women reported significantly higher occurrence of probable ED and ED symptoms. The occurrence of EDs, BDD, and APED misuse were higher among SMs in this sample compared to previous rates found among heterosexual samples, suggesting that SMs, regardless of gender and ethnicity/race, are vulnerable to experiencing BIDs and APED misuse. Future research is needed to identify the mechanisms that place SMs at (increased) risk for BIDs, which will aid prevention/intervention development.

Sexual orientation and disordered eating in women: a meta-analysis

PURPOSE

Homosexuality is a clear risk factor for disordered eating in men; however, for women, research has yielded contradictory results. We conducted a meta-analysis to examine the association between sexual orientation and disordered eating in women.

METHODS

PRISMA guidelines were used. Studies comparing disordered eating between lesbians and heterosexual women were identified using PsycNet database and Google Scholar. Twenty-one studies met inclusion criteria. Overall disordered eating, restricting, binging and purging were examined for heterosexual, lesbian, bisexual and 'mostly heterosexual' women.

RESULTS

Whereas there was no significant difference in overall disordered eating between lesbians and heterosexual women, lesbians reported restricting less and binging more than heterosexual women. Bisexual women were more likely than lesbian women to restrict food intake and purge, and more likely than heterosexual women to have overall disordered eating and restrict food intake. "Mostly heterosexual" women were more likely than heterosexual women to restrict food intake, binge and purge.

CONCLUSIONS

Women of different sexual orientations show distinct patterns of disordered eating. Bisexual and "mostly heterosexual" women appear to be particularly at risk. Stress resulting from binegativity and rigid views of sexuality in a dichotomous society, rather than sexual orientation itself, may be associated with disordered eating in women. Findings should be viewed with caution because there were few studies with bisexual and "mostly heterosexual" women. This study elucidates the nature of the association between disordered eating and sexual orientation. Findings provide a possible explanation for previous inconsistencies, since opposing trends for different behaviors cancel each other out.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Role of Sex on the Relationship Between Sexual Minority Status and Misperceptions of Body Weight Among High School Students

PURPOSE

Misperception of body weight during adolescence is a risk factor for negative self-image, harmful eating/dietary habits (e.g., binge eating and purging), and body dysmorphia. Sexual minority youth, particularly males, may be at increased risk for misperceptions of body weight, relative to youth who do not identify as a sexual minority. This study examines the risk for misperception of body weight among sexual minority youth and explores biological sex as an effect modifier in this relationship.

METHODS

We pooled data from the 2015 and 2017 Youth Risk Behavior Surveillance Surveys. Participants were 18,634 high school students who were not overweight/obese. Multivariable logistic regression examined the association between sexual minority status (i.e., gay, lesbian, bisexual, and unsure) and misperceptions of body weight (i.e., self-perceived as overweight/severely overweight). Weighted multivariable logistic regression analyses, stratified by biological sex, were used to compare this relationship across males and females. Covariates included race/ethnicity, grade, bullying victimization, television/electronic screen time, and tobacco use.

RESULTS

Overall, 16.6% of the sample self-reported misperceptions of body weight. Sexual minority youth had 1.49 (95% confidence interval [CI]: 1.28-1.73) greater odds of misperception of body weight, adjusting for covariates; this relationship was found across biological sex, but that the main effect was significantly greater among sexual minority males (adjusted odds ratio: 2.24, 95% CI: 1.65-3.03) relative to sexual minority females (adjusted odds ratio: 1.33, 95% CI: 1.11-1.59).

CONCLUSIONS

Sexual minority youth had greater odds of overestimating their weight status. Biological sex appears to modify this relationship with sexual minority males being at particularly high risk for overestimating their weight status.

Identification and Management of Eating Disorders in Children and Adolescents

Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services. This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy.

Where identities converge: The importance of intersectionality in eating disorders research

Disparities in eating disorder (ED) risk, diagnosis, and treatment for those who occupy multiple marginalized social identities (e.g., combined racial/ethnic and sexual minority statuses), underscore the need for advancing multicultural research in the ED field. In this article, we argue that intersectionality-informed approaches, which examine the ways in which one's multiple social identities interact to inform risk for ED outcomes, offer an established framework for identifying frequently underserved individuals who may be at greatest risk for EDs. We highlight preliminary intersectional research in EDs and offer suggestions for further progression. In particular, we encourage future intersectionality-informed research to incorporate a broader range of social identities (e.g., age, ability status), consider the ways in which these identities may be dimensional and fluid, and embrace strengths-based approaches to illuminate dimensions of identity that may serve as protective factors. To support such research, we describe quantitative and qualitative methods for pursuing questions of intersectionality in ED investigations. Given the success of intersectionality-informed research in other areas of psychopathology and its relevance to ED as suggested by initial research, the continued pursuit of these approaches in EDs has high potential to improve identification and treatment for patients who have too often been overlooked.

A Descriptive Study of Transgender Active Duty Service Members in the U.S. Military

Purpose: Department of Defense policy prohibits, with limited exceptions, transgender individuals from serving in their affirmed gender in the U.S. Military, citing potential impact on unit cohesion and military readiness. To date, however, little is known about the sociodemographic profile and health of transgender military personnel. Methods: U.S. Military personnel who self-identified as transgender completed anonymous online measures of demographics and military service. Participants also completed measures of health, mood, eating pathology, and risk behaviors. Results: One hundred ninety-five service members (mean age: 28.9±7.2 years, 48.7% transmale, 70.3% non-Hispanic White, 7.83±5.9 years in service) completed the survey. The majority of respondents first identified as transgender before military accession. Most had disclosed their gender identity to their command and providers, and had undertaken steps toward gender affirmation. The sample as a whole reported above average physical health, with mood symptoms within normal ranges and few reported risk behaviors. Analyses of covariance indicated that transmales reported significantly better mental health and psychosocial functioning compared with transfemales. Conclusion: In light of current policy that precludes, with limited exceptions, transgender individuals from serving in the U.S. Military in their affirmed gender, the current study provides an initial sociodemographic profile of this understudied population and indicates that transgender service members report above average physical health and few risk behaviors. Preliminary analyses indicated that transfemales in the military may be at higher risk for mental health concerns, compared with transmales. Additional research is needed to elucidate risk and protective factors among transgender service members.

Sexual Orientation Disparities in Preconception Health

Objective: In the United States, there have been very few improvements in adverse birth outcomes, such as infant mortality, low birthweight, and preterm birth in recent years. Health promotion before pregnancy (e.g., preconception care) has been increasingly recognized as an important strategy by which to improve these reproductive outcomes. As of yet, no research has examined sexual orientation disparities in preconception health which has important implications for birth outcomes in the United States, since sexual minority women (SMW) are more likely to report stillbirths, low birthweight, and preterm infants than heterosexual women. Methods: This study addresses this gap by utilizing data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine sexual orientation disparities in women's preconception health 1 and 3 years before a live birth (n = 3,133). Results: Our findings suggest that, even after controlling for maternal characteristics, SMW are more likely to report adverse health conditions and behaviors before pregnancy relative to heterosexual women 1 year before the survey, including higher odds of binge drinking, other substance use, having a sexually transmitted infection diagnosis, and depression. Conclusions: Despite new public health policies aimed at improved preconception health, our findings suggest that SMW are even more vulnerable to poor preconception health than their heterosexual counterparts, which has important implications for maternal and child health. This study provides important evidence for the need to invest in the reproductive health of SMW, particularly in the context of pregnancy.

Gender Dysphoria, Eating Disorders and Body Image: An Overview

Background::

Gender dysphoria is a clinical condition in which a state of inner suffering, stress and anxiety is detected when biological sex and a person's gender identity do not coincide. People who identify themselves as transgender people are more vulnerable and may have higher rates of dissatisfaction with their bodies which are often associated with a disorderly diet in an attempt to change the bodily characteristics of the genus of birth and, conversely, to accentuate the characteristics of the desired sexual identity.

Aim::

The purpose of this work is to examine the association between dissatisfaction with one's own body and eating and weight disorders in people with gender dysphoria.

Results::

Gender dysphoria and eating disorders are characterized by a serious discomfort to the body and the body suffers in both conditions. The results of our study suggest that rates of pathological eating behaviors and symptoms related to a disordered diet are high in patients with gender dysphoria and that standard screening for these symptoms must be considered in both populations at the time of evaluation and during the course of the treatment.

Conclusions::

In light of this evidence, clinicians should always investigate issues related to sexuality and gender identity in patients with eating disorders, to develop more effective prevention measures and better strategies for therapeutic intervention..

Associations between perceived everyday discrimination, discrimination attributions, and binge eating among Latinas: results from the National Latino and Asian American Study

PURPOSE

The aim of the study was to quantify the association between perceived everyday discrimination and binge eating among Latinas in the United States.

METHODS

Participants included 1014 Latinas from the 2002-2003 National Latino and Asian American Study. Modified Poisson models with robust standard errors were used to estimate sociodemographic-adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) of binge eating associated with overall and attribution-specific discrimination.

RESULTS

Approximately 7% of Latinas reported binge eating. Increased frequency of discrimination was associated with a higher prevalence of binge eating (aPR, 1.59; 95% CI, 1.23-2.06), and Latinas reporting frequencies of discrimination in the top tertile had the greatest prevalence elevation (aPR, 3.63; 95% CI, 1.32-10.00). There were important differences by discrimination attribution: Latinas experiencing primarily height/weight-based or skin color-based discrimination had the greatest prevalence elevation relative to those reporting no discrimination (aPR, 10.24; 95% CI, 2.95-35.51; and aPR, 8.83; 95% CI, 2.08-37.54, respectively), whereas Latinas reporting primarily race-based discrimination had the lowest prevalence elevation (aPR, 1.64; 95% CI, 0.47-5.69).

CONCLUSIONS

Discrimination may be an important social determinant of Latinas' binge eating. Future research should incorporate expanded conceptual models that account for Latinas' complex social environment, focusing on intersecting dimensions of identity.

Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment

Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care.

OBJECTIVE

To (a) compare history of abuse-related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs.

METHOD

We analyzed data from 2,818 individuals treated at a large, US-based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed-effects models.

RESULTS

SGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE-Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE-Q scores did not differ between SGMs and CHs.

DISCUSSION

Our main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs-possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention.

Sexual orientation correlates with baseline characteristics but shows no moderating effects of dissonance-based eating disorder prevention programs for women

This study provided the first test of whether sexual orientation (categorized as heterosexual vs. sexual minority) is associated with baseline eating disorder risk factors and symptoms, moderated the intervention effects of variants of the dissonance-based Body Project, or moderated the relation of baseline risk factors to future change in eating disorder symptoms. A total of 680 women with body image concerns were randomized to clinician-or peer-led Body Project groups, the eBody Project, or educational video control and completed assessment of eating disorder risk factors and symptoms at pretest, posttest, and at six-, 12-, 24-, and 36-month follow-up. Results indicated that sexual minority women had significantly higher negative affect and impaired psychosocial functioning at baseline, but did not differ on other eating disorder risk factors or symptoms. We found no evidence that sexual orientation moderates the effects of the Body Project on risk factor or symptom change over follow-up or the relation of baseline risk factors to future change in eating disorder symptoms. Overall, sexual minority and heterosexual women differ on two, less specific eating disorder-related risk factors at baseline, but did not differ in response to different versions of the Body Project or the relations of risk factors to future symptom change.

Disparities in DSM-5 defined eating disorders by sexual orientation among U.S. adults

OBJECTIVE

The increased occurrence of disordered eating behaviors among sexual minorities is well established; however, few studies have examined disparities in eating disorder diagnoses among this population. This study sought to examine lifetime prevalence estimates of DSM-5 defined EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) as a function of sexual orientation. We then compared prevalence of EDs based on experiences with perceived discrimination.

METHOD

A nationally representative sample of U.S. adults (N = 35,995) participating in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III completed structured diagnostic interviews.

RESULTS

Prevalence rates were significantly higher among sexual minorities than heterosexual respondents for all EDs: AN = 1.71% (SE = 0.50) versus 0.77% (SE = 0.07), BN = 1.25% (SE = 0.37) versus 0.24% (SE = 0.03), BED = 2.17% (SE = 0.52) versus 0.81% (SE = 0.05). Odds of lifetime diagnosis were significantly greater among sexual minorities for AN (adjusted odds ratio [AOR] = 1.93), BN (AOR = 3.69), and BED (AOR = 2.32), after adjusting for sociodemographic variables. Sexual minorities reporting experiences with perceived discrimination had significantly higher prevalence of AN than those not endorsing perceived discrimination: 3.78% (SE = 1.43) versus 0.82% (SE = 0.33); AOR = 5.06. There were no significant differences in prevalence of BN or BED by perceived discrimination.

DISCUSSION

Findings indicate that sexual minorities are disproportionately affected by EDs. Further research is needed to better understand mechanisms contributing to these disparities and heightened risk for EDs.

Evidence of Diverse Identities in a Large National Sample of Sexual and Gender Minority Adolescents

Adolescence is a time of identity exploration, and preliminary evidence indicates the ways adolescents are describing their sexual and gender identities (SOGI) are changing. A nuanced understanding of SOGI is necessary for valid assessment in developmental research. Current measures do not capture the diversity of emerging identities among young people. Our study analyzed a national sample of 17,112 sexual and gender minority adolescents (13-17 years) to better understand how identity labels are reported across sexual, gender, and ethnoracial minorities. Adolescents reported 26 distinct SOGI categories; 24% of adolescents utilized nontraditional SOGI labels, such as pansexual and nonbinary. These identifications varied significantly as a function of ethnoracial identity. Results have implications for how scholars conceptualize and measure SOGI among adolescents.

Family Weight Teasing, LGBTQ Attitudes, and Well-being Among LGBTQ Adolescents

This study explored weight-based victimization by family members, accepting lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) attitudes, and family connectedness, and how these experiences are associated with health, self-esteem, and depressive symptoms among LGBTQ adolescents. Data came from the LGBTQ National Teen Survey (N = 9261, mean age = 15.6 years). The 3 key variables were significantly associated with poorer self-rated health, self-esteem, and depressive symptoms. For example, weight-based victimization was associated with approximately 2 more points on the depressive symptoms scale (β = 1.81, P < .001), adjusting for covariates. Findings highlight the negative impact of weight-based victimization among LGBTQ youth, even in the context of other types of family support.

Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature

BACKGROUND

According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM).

MAIN

This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals).

CONCLUSION

LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.

Community norms for the Eating Disorder Examination Questionnaire among cisgender gay men

OBJECTIVE

Prior norms of the Eating Disorders Examination Questionnaire (EDE-Q) among men have not considered sexual orientation. This study's objective was to assess EDE-Q community norms among cisgender gay men.

METHOD

Participants were 978 self-identified cisgender gay men from The PRIDE Study recruited in 2018.

RESULTS

We present mean scores and standard deviations for the EDE-Q among cisgender gay men ages 18-82. Among cisgender gay men, 4.0% scored in the clinically significant range on the global score, 5.7% on the restraint, 2.1% on the eating concern, 10.5% on the weight concern, and 21.4% on the shape concern subscales of the EDE-Q. The global score as well as weight and shape concerns in a young adult subsample (18-26 years) from The PRIDE Study were higher than previously reported norms in young men (Lavender, 2010). Participants reported any occurrence (≥1/28 days) of dietary restraint (19.8%), objective binge episodes (10.9%), excessive exercise (10.1%), laxative misuse (1.1%), and self-induced vomiting (0.6%). Binge eating, excessive exercise, and self-induced vomiting in The PRIDE Study subsample were lower than previously reported in young men.

DISCUSSION

We provide EDE-Q norms among cisgender gay men, which should aid clinicians and researchers to interpret the EDE-Q scores of cisgender gay men.

Nutrition-Related Messages Shared Among the Online Transgender Community: A Netnography of YouTube Vloggers

Purpose: Nutrition care guidelines for the transgender population do not exist, despite significant nutrition-related clinical and psychosocial considerations. Social networking sites (SNSs) provide multidirectional communication and have expanded in popularity among transgender users as a resource for health information and support. The nature of the content shared among the online transgender community is unknown, but may suggest the nutrition-related areas that are of most importance to the transgender population. The objective of this qualitative netnography was to describe the food and nutrition messages shared among the transgender community using video blogs (vlogs) on the SNS, YouTube. Methods: Public vlogs were assessed using the constant comparative method. Pseudoquantitative methods were used to capture the prevalence of each subtheme; quotes were documented verbatim. Data were collected from transgender users' public vlogs (n=30) self-published on YouTube from 2013 to 2018. Results: Six major themes were generated from the data analysis. These included the following: functions of diet and exercise; diet and exercise philosophies; "how to" vlogs; advice for success; using dietary supplements; and effects of hormone therapy. Conclusions: Nutrition-related messages are widely shared among the online transgender community through YouTube. The identified themes reflect topics of interest and expressed needs of transgender individuals. SNSs provide health care providers with a platform to improve patient education and health literacy. Health care providers may actively engage in online discussions to build trust, answer questions, and provide a source of accurate and evidence-based information.

Validation of the Body Appreciation Scale-2 and relationships to eating behaviors and health among sexual minorities

Although the study of positive body image continues to expand, researchers have predominantly focused the study of this newer construct among presumed heterosexual participants. The purpose of the present study was to examine the factor structure of a measure of positive body image, the Body Appreciation Scale-2 (BAS-2), among sexual minority participants. The present study also sought to psychometrically validate the BAS-2 among sexual minorities by assessing its relationship with other facets of positive body image, including functionality appreciation and body image flexibility, as well as other related constructs, such as body dissatisfaction, disordered eating behaviors, intuitive eating behaviors, and physical and mental health. Results from a confirmatory factor analysis of 223 sexual minority adults (M_age = 32.45, SD = 10.07) indicated that the BAS-2 displayed strong factorial validity with a unitary factor structure. Furthermore, the BAS-2's construct validity was supported based on correlations with other measures of positive body image, body dissatisfaction, and disordered eating behavior. Results from this cross-sectional study supported a relationship between body appreciation and intuitive eating behaviors, as well as physical and mental health among sexual minority participants. These findings provide an initial understanding of body appreciation and other related constructs among sexual minority individuals.

Gender Expression and Sexual Orientation Differences in Diet Quality and Eating Habits from Adolescence to Young Adulthood

BACKGROUND

Diet and eating habits during youth have implications on diet and eating habits during adulthood, however, little longitudinal research has examined sexual orientation and gender expression differences in diet.

OBJECTIVE

Our aim was to examine sexual orientation and gender expression differences in diet quality and eating habits from adolescence to young adulthood.

DESIGN

Data across multiple time points from the longitudinal Growing Up Today Study cohorts (1997 to 2011) were used.

PARTICIPANTS/SETTING

Participants (n=12,880; aged 10 to 23 years) were the children of women from the Nurses' Health Study II cohort.

MAIN OUTCOME MEASURES

Diet quality scores were assessed using the Alternative Healthy Eating Index-2010. In addition, breakfast consumption (≥5 days/wk) and family dinners (≥5 days/wk) were assessed.

STATISTICAL ANALYSES PERFORMED

Multivariable generalized estimating equation regression models were fit to estimate sexual orientation and gender expression differences in diet quality scores, breakfast consumption, and family dinners, stratified by sex assigned at birth over available repeated measures.

RESULTS

"Gender-nonconforming" males had significantly higher diet quality scores than "very gender-conforming" males (P<0.05). Diet quality scores did not differ by gender expression among females. "Mostly heterosexual" females and gay males had higher diet quality scores than their same-sex completely heterosexual counterparts (P<0.05). Adjustment for mother's diet quality scores attenuated effects, except for gay males (P<0.05). "Gender-nonconforming" females were less likely to consume breakfast than "very gender-conforming" females (P<0.05). Similar results were found for "mostly heterosexual" and bisexual compared to completely heterosexual females. There were no gender expression or sexual orientation differences in family dinners among males and females.

CONCLUSIONS

Sexual orientation and gender expression have independent effects on diet quality scores and eating habits for both males and females. Very gender-conforming and completely heterosexual males had the lowest diet quality scores compared to other gender expression and sexual orientation groups. Additional research to explore the effects of sexual orientation and gender expression on diet-related health is needed to build upon these findings.

The influence of Grindr, a geosocial networking application, on body image in gay, bisexual and other men who have sex with men: An exploratory study

Recent evidence indicates use of geosocial networking apps is associated with body image-related issues among gay, bisexual, and other men who have sex with men. The current study aims to elaborate upon these findings by investigating how Grindr, the most widely-used dating app among this population, impacts users' body image and body satisfaction. Using an exploratory, qualitative study design, semi-structured interviews were conducted with 13 current and previous Grindr users and analyzed thematically. Our findings suggest Grindr affects users' body image through three primary mechanisms: weight stigma, sexual objectification, and social comparison. In each case, normative user attitudes and behaviours interact with the app's constitutional elements to affect bodily perceptions in a way that differs in form or intensity from social influence via offline exchanges. These interactions are often enabled by features shared with traditional social networking sites, like asynchronous, text-based communication and technology-assisted appearance augmentation, but certain features unique to Grindr may also play an important role. Moreover, participants identified several protective factors and coping strategies which suggest the relationship between Grindr and body image is dependent on a number of complex interactions between technology, user, and environment. Limitations and suggestions for future research are also discussed.

The Impact of a Dissonance-Based Eating Disorders Intervention on Implicit Attitudes to Thinness in Women of Diverse Sexual Orientations

Dissonance-based body image programs have shown long-term effectiveness in preventing eating disorders and reducing risk factors for eating disorders in women. Here we report on the potential for one such intervention to impact on implicit attitudes toward thinness as well as an explicit measure of eating attitudes, across a sexually diverse group of young women. The Succeed Body Image Programme was adapted to remove heteronormative assumptions and was delivered to a final sample of 56 undergraduate women who reported their sexual orientation as either “predominantly heterosexual” (our term; 1 or 2 on a 7-point Kinsey scale, n = 38) or non-heterosexual (3–7 on the Kinsey scale, n = 18). Before and after the intervention, they completed the Eating Attitudes Test-26, and an associative reaction time task based on the Implicit Association Test, in which bodies of low and higher weight were paired with socially desirable or undesirable traits. A total of 37 predominantly heterosexual women completed a control intervention in which they read NHS leaflets on eating disorders and healthy weight. Results showed that the intervention made predominantly heterosexual participants less prone, versus control, to associating thinness with positive traits on the IAT and all women completing the intervention reported a lower level of disordered eating attitudes at post- than pre-test. Non-heterosexual women, however, showed a non-significant increase in thin-bias on the IAT, perhaps due to their low baseline. These results imply that intensive dissonance-based programs can change attitudes at the automatic, implicit level as well as merely giving women tools to overcome those implicit attitudes.

Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study

BACKGROUND

Sexual minority adolescents are more likely to have mental health problems, adverse social environments, and negative health outcomes compared with their heterosexual counterparts. There is a paucity of up-to-date population-level estimates of the extent of risk across these domains in the UK. We analysed outcomes across mental health, social environment, and health-related domains in sexual minority adolescents compared with their heterosexual counterparts in a large, contemporary national cohort.

METHODS

The Millennium Cohort Study (MCS) is a birth cohort study in the UK following up children born between Sept 1, 2000, and Jan 11, 2002 across England, Wales, Scotland, and Northern Ireland. Children recruited from the MCS have been followed up over six recruitment sweeps to date at ages 9 months, 3 years, 5 years, 7 years, 11 years, and 14 years. We analysed mental health, social, and health-related outcomes in sexual minority versus heterosexual adolescents at age 14 years. Additionally, we estimated the accumulation of multiple adverse outcomes in both groups. The primary aim of the study was to assess whether sexual minority adolescents experienced more adverse outcomes than heterosexual adolescents.

FINDINGS

Between January, 2015, and April, 2016, 9885 adolescents provided a response about their sexual attraction. 629 (6%) of 9885 adolescents (481 female participants and 148 male participants) were identified as sexual minorities. 9256 (94%) of 9885 participants (4431 female and 4825 male) were attracted to the opposite sex or not attracted to the same sex and identified as heterosexual. Sexual minority adolescents were more likely to experience high depressive symptoms (odds ratio [OR] 5·43, 95% CI 4·32-6·83; p<0·0001), self-harm (5·80, 4·55-7·41; p<0·0001), lower life satisfaction (3·66, 2·92-4·58; p<0·0001), lower self-esteem (β 1·83, 95% CI 1·47-2·19; p<0·0001), and all forms of bullying and victimisation. Sexual minorities were more likely to have tried alcohol (OR 1·85, 95% CI 1·47-2·33; p<0·0001), smoking (2·41, 1·92 -3·03; p<0·0001), and cannabis (3·22, 2·24-4·61; p<0·0001), and also had increased odds of being less physically active (β 0·36, 95% CI 0·25-0·46; p<0·0001), perceiving themselves as overweight (OR 1·73, 95% CI 1·40-2·14; p<0·0001), and dieting to lose weight (1·98, 1·58-2·48; p<0·0001). Sexual minority adolescents had more co-occurring mental health outcomes (mean 1·43 of 3 outcomes, 95% CI 1·34-1·52) compared with heterosexual adolescents (0·40 of 3 outcomes, 0·38-0·41), and more total cumulative difficulties (mean 9·43 of 28 outcomes, 95% CI 9·09-9·76 in sexual minority adolescents vs 6·16 of 28 outcomes, 6·08-6·23 in heterosexual adolescents).

INTERPRETATION

Sexual minority adolescents in the UK experience disparities in mental health, social, and health-related outcomes despite living in a time of substantial progress in rights for sexual minorities. These adverse outcomes co-occur, with implications for lifelong health and social outcomes. Health and educational practitioners should be aware of the increased risk for adverse outcomes in sexual minority adolescents.

FUNDING

None.

Overweight and obesity in sexual and gender minority adolescents: A systematic review

Population data indicate that sexual and gender minority adolescents may be at increased risk for excess weight gain compared with cisgender, heterosexual youth. However, no studies, to our knowledge, have systematically reviewed the literature on weight disparities in this population nor explored risk for overweight and obesity by sexual and gender minority subgroup across studies. The current systematic review, therefore, identified 21 studies that assessed the relationship between sexual and gender minority status and weight among adolescents. Results indicated an overall greater prevalence of overweight and obesity among sexual and gender minority adolescents compared with cisgender, heterosexual youth. However, cisgender sexual minority males demonstrated lower or no added risk for overweight and obesity, whereas cisgender sexual minority females demonstrated greater risk for overweight and obesity. Findings were mixed among gender minority adolescents. This study highlights weight disparities in sexual and gender minority youth, although important subgroup differences exist. Additional research is needed to elucidate the mechanisms that may contribute to differential weight trajectories in this population and to develop tailored approaches for prevention and treatment.

Eating Disorders in Males

Eating disorders are serious psychiatric disorders, associated with significant psychiatric and medical consequences. Although traditionally considered a female disorder, more recent evidence has determined that EDs among males are not uncommon and are equally severe in symptom presentation. Among youth and adolescent males, certain factors increase the risk for ED, including muscularity-focused body image concerns and sexual orientation. Future study of these and other factors that may increase the risk for or maintain EDs among adolescent males is critical to improving screening, assessment, and precision treatment efforts.

Weight-based victimization, eating behaviors, and weight-related health in Sexual and Gender Minority Adolescents

Weight-based victimization (WBV) is a common form of bullying associated with maladaptive eating, and poor weight-related health. Although sexual and gender minority (SGM) youth experience a number of eating and weight-related health disparities, the link between WBV and these outcomes has not been investigated in this vulnerable population. Data came from the LGBTQ Teen Study, a national survey of SGM adolescents. Participants provided data to assess body mass index (BMI), WBV, sexual identity, gender identity, dieting, binge eating, eating to cope with stress, weight control behaviors, exercise, and stress (N = 9679). The sample was 66% White, with a mean age of 15.6 years; 58.5% had healthy weight, and 37.2% had overweight or obesity. Over half of participants reported WBV from family members and peers. WBV from family members was associated with maladaptive eating (i.e., binge-eating, unhealthy weight-control behaviors), dieting, and poor weight-related health (i.e., stress, exercise avoidance, less physical activity and poorer sleep); relationships remained significant after accounting for participants' age, BMI percentile for age and sex, race, gender identity, and sexual identity. Higher frequency of WBV at school, but not history of peer weight-based victimization, was associated with more maladaptive eating, dieting, and poorer weight-related health on all outcomes except physical activity. This is the first large-scale study that examined links between WBV, maladaptive eating behaviors, and weight-related health in SGM adolescents. These results suggest the need for increased awareness that WBV may play a role in maladaptive eating, and weight-related health of SGM youth, and may contribute to both elevated levels of eating disorders and obesity in this population.

Risk of disordered eating at the intersection of gender and racial/ethnic identity among U.S. high school students

BACKGROUND

Gender and racial/ethnic disparities in disordered eating among youth exist, although whether having multiple marginalized identities disproportionately increases risk is unclear. Therefore, we aimed to quantify the risk of disordered eating associated with intersecting gender and racial/ethnic identities of U.S. adolescents.

METHODS

We analyzed data from 11,514 U.S. high school students identifying as White, Black/African American, or Hispanic/Latino who participated in the 2013 National Youth Risk Behavior Surveillance System. Age-adjusted relative risks (RR) of purging, fasting, diet pill use, and any disordered eating were estimated using log-binomial models. Relative excess risk due to interaction (RERI) was estimated to evaluate the degree to which the combined effect of marginalized gender and racial/ethnic identity was larger than the sum of their individual effects.

RESULTS

Disordered eating was prevalent (girls: 20.4% Black/African American, 29.2% Hispanic/Latina, 21.4% White; boys: 13.4% Black/African American, 12.4% Hispanic/Latino; 8.1% Whites). Girls of all racial/ethnic identities and racial/ethnic minority boys had elevated risks of purging, fasting, and any disordered eating compared to White boys (RR range = 1.57-7.43); Hispanic/Latina and White girls also had elevated risk of diet pill use (RR range = 1.98-3.20). Among Hispanic/Latina girls, positive interaction between gender and race/ethnicity produced excess risk of any disordered eating and purging (RERI: any = 0.42 (95% confidence interval (CI) = -0.02, 0.87); purging = 1.74 (95% CI = 0.06, 3.42).

CONCLUSIONS

Findings illustrate the advantages of adopting an intersectional approach to disordered eating research. Future research should investigate the mechanisms of these disparities.

Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments

Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Adequate LGBT sexual health education for emerging health professionals is currently lacking. Clinical training programs and healthcare organisations are well poised to start addressing these disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Health education programs can emphasise mastery of basic LGBT concepts and terminology, as well as openness towards and acceptance of LGBT people. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for the health needs of LGBT patients also involves the creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.

Racial/Ethnic Differences in Cardiometabolic Risk in a Community Sample of Sexual Minority Women

Purpose: To examine the intersection of sexual identity and race/ethnicity on self-reported cardiometabolic risk in sexual minority women (SMW). Methods: Data from the Chicago Health and Life Experiences of Women study were analyzed. Logistic regression models examined racial/ethnic differences in cardiometabolic risk (including obesity, hypertension, and diabetes) in SMW, accounting for psychosocial and behavioral factors. A variable accounting for the intersection of sexual identity and race/ethnicity was added to regression models (White lesbian women were the reference group). Results: The analytic sample included 601 SMW (237 White, 219 Black, 145 Latina). Black (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI]=1.48-5.94) and Latina (AOR 2.30, 95% CI=1.18-4.48) SMW had higher rates of lifetime trauma than White SMW. Black SMW reported higher rates of obesity (AOR 3.05, 95% CI=1.91-4.88), hypertension (AOR 1.99, 95% CI=1.08-3.66), and diabetes (AOR 3.77, 95% CI=1.46-9.74) relative to White SMW. Intersectional analyses revealed that Black lesbian (AOR 2.94, 95% CI=1.74-4.97) and Black bisexual (AOR 3.43, 95% CI=1.69-6.96) women were more likely to be obese than White lesbian women. Black lesbian women also reported higher rates of hypertension (AOR 2.09, 95% CI=1.08-4.04) and diabetes (AOR 3.31, 95% CI=1.26-8.67) than White lesbian women. No differences in cardiometabolic risk were found between Latina and White SMW. Conclusion: This study extends previous research on racial/ethnic differences in cardiometabolic risk among SMW. Prevention strategies are needed to reduce cardiometabolic risk in Black SMW. Findings highlight the need for cardiovascular disease research in SMW that incorporates longitudinal designs and objective measures.

Weight-based victimization among sexual and gender minority adolescents: Findings from a diverse national sample

OBJECTIVES

Children and adolescents with overweight and obesity are vulnerable to weight-based victimization. Research on weight-based victimization and sexual identity have been largely isolated from one another; little is known about the nature of weight-based victimization in sexual and gender minority (SGM: eg, lesbian, gay, bisexual, and transgender) youth. Our study is the first to examine the nature, extent, and sources of weight-based victimization in a large sample of SGM adolescents.

METHODS

This study utilized data from the LGBTQ National Teen Survey, a comprehensive online survey assessing victimization, school experiences, health behaviors, and sexuality-specific experiences of SGM adolescents across the United States. The sample was composed of 9838 SGM adolescents (M_age  = 15.6 years).

RESULTS

Across diverse sexual orientation and gender identity groups, 44% to 70% of adolescents reported weight-based teasing from family members, and 42% to 57% reported weight-based teasing from peers. Approximately one-third of adolescents reported these experiences from both family and peers. Weight-based victimization was prevalent across body weight categories, particularly at highest (obesity) and lowest (underweight) extremes. Moreover, weight-based victimization was prevalent across adolescents who endorsed established sexual identity labels (eg, gay, lesbian, bisexual) and emerging labels (eg, pansexual, asexual).

CONCLUSIONS

Weight-based victimization, from family members and peers, is prevalent among SGM adolescents, across diverse body sizes and sexual and gender identities. Pediatric providers should be aware that SGM youth may be vulnerable to weight-based victimization, across diverse body sizes.

Body size and weight, and the nutrition and activity behaviours of sexual and gender minority youth: findings and implications from New Zealand

OBJECTIVE

To describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared.

DESIGN

Data were from a nationally representative health survey.

SETTING

Secondary schools in New Zealand, 2012.

PARTICIPANTS

A total of 7769 students, 9 % were SGM individuals.

RESULTS

Overall, weight-control behaviours, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students (adjusted OR; 95 % CI) were significantly more likely to have tried to lose weight (1·95; 1·47, 2·59), engage in unhealthy weight control (2·17; 1·48, 3·19), consume fast food/takeaways (2·89; 2·01, 4·15) and be physically inactive (2·54; 1·65, 3·92), and were less likely to participate in a school sports team (0·57; 0·44, 0·75), compared with other males. Female SGM students (adjusted OR; 95 % CI) were significantly more likely to engage in unhealthy weight control (1·58; 1·20, 2·08), be overweight or obese (1·24; 1·01, 1·53) and consume fast food/takeaways (2·19; 1·59, 3·03), and were less likely to participate in a school sports team (0·62; 0·50, 0·76), compared with other females. Generally, female SGM students were more negatively affected than comparable males, except they were less likely to consume fast food/takeaways frequently (adjusted OR; 95 % CI: 0·62; 0·40, 0·96).

CONCLUSIONS

SGM students reported increased weight-control behaviours, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities.

Weight-based victimization among sexual and gender minority adolescents: Implications for substance use and mental health

OBJECTIVE

Weight-based victimization (WBV) involves being the target of intentional physical, verbal, or psychological harm because of one's body weight. Youth experience harmful health consequences from WBV, but this literature has neglected sexual and gender minority (SGM) youth, despite their high rates of overweight and obesity, and mental health problems. The present study assessed health behaviors (substance use), self-rated health, perceived control over stressors, depressive symptoms and self-esteem as a function of WBV in a large, national sample of LGBTQ (lesbian, gay, bisexual, transgender, and queer) adolescents.

METHOD

Participants (N = 9,838, M_age = 15.6 years, SD = 1.26) completed a web-based battery of questionnaires examining victimization, health, family, and school experiences of LGBTQ adolescents in the United States.

RESULTS

WBV was associated with increased odds of alcohol use, binge drinking, marijuana use, and cigarette use, independent of adolescents' age, race, body mass index (BMI), sexual identity, gender identity, caregiver education, and U.S. region. Frequency of WBV at school and weight teasing from family members were both consistently associated with lower self-rated health, lower perceived control over stressors, lower self-esteem, and higher depressive symptom scores.

CONCLUSIONS

These findings present the first large-scale evidence of the relationship between WBV and adverse health behaviors in SGM youth. Sexual minority youth who experience WBV, especially from family members, may be vulnerable to adverse health behaviors and low perceived health, regardless of their BMI. These findings highlight the importance of considering WBV when examining health behaviors in LGBTQ youth, and increased awareness of these issues among health care professionals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Systematic Review of Sexual Orientation Disparities in Disordered Eating and Weight-Related Behaviors among Adolescents and Young Adults: Toward a Developmental Model

Adolescence is a sensitive period for the development of disordered eating and weight-related behaviors, and sexual minorities may be particularly at risk due to heightened minority stress and challenges related to sexual identity development. This review synthesized findings from 32 articles that examined sexual orientation disparities (each with a heterosexual referent group) in four disordered eating behaviors (binging, purging, restrictive dieting, diet pill use) and four weight-related behaviors (eating behaviors, physical activity, body image, and Body Mass Index [BMI]). Potential variations by outcome, sex, race/ethnicity, and developmental stage were systematically reviewed. Evidence supporting sexual orientation disparities in disordered eating and weight-related behaviors was more consistent among males than females. Among females, sexual orientation disparities in disordered eating behaviors appeared to be more pronounced during adolescence than in young adulthood. Sexual minority females generally reported more positive body image than heterosexual females but experienced disparities in BMI. Sexual orientation differences in eating behaviors and physical activity were especially understudied. Incorporating objectification and minority stress theory, a developmental model was devised where body image was conceptualized as a key mechanism leading to disordered eating behaviors. To advance understanding of sexual orientation disparities and tailor intervention efforts, research in this field should utilize longitudinal study designs to examine developmental variations and incorporate multi-dimensional measurements of sexual orientation and body image.

Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents

PURPOSE

To investigate the relationship between selected disordered eating behaviors and self-reported sexual minority status (gay/lesbian, bisexual, and unsure) among a representative sample of high school adolescents.

METHODS

The 2013 Centers for Disease Control and Prevention (CDC)-sponsored Connecticut Youth Risk Behavior Survey was utilized (N = 2242). Unadjusted and adjusted logistic regression analyses, separated by gender, examined sexual minority adolescents (gay/lesbian, bisexual, and unsure) and selected eating behaviors. Analyses adjusted for race, age, cigarette use, binge drinking, organized school activity participation, body mass index (BMI), and depression.

RESULTS

Gay males were significantly more likely to report exercising or eating less to lose weight in the unadjusted models (p < 0.05) and fasting, vomiting, and taking diet pills in both adjusted (p < 0.05) and unadjusted models (p < 0.01) when compared to the referent heterosexual males. Bisexual females were significantly more likely to report fasting, vomiting, and taking diet pills in the unadjusted model (p < 0.05) when compared to the referent heterosexual females and significantly less likely to report exercising or eating less to lose weight in the adjusted models (p < 0.05).

CONCLUSIONS

Although additional studies are needed owing to small sample sizes, preliminary findings support previous research suggesting that high school-aged sexual minority youth subgroups are a priority target population for increased efforts to prevent disordered eating.

A scoping review of sexual minority women's health in Latin America and the Caribbean

OBJECTIVES

Despite research documenting significant health disparities among sexual minority women (lesbian, bisexual, and other non-heterosexual women) in high-income countries, few studies of sexual minority women's health have been conducted in low- and middle-income countries. The purpose of this scoping review was to examine the empirical literature related to the health disparities and health needs of sexual minority women in Latin America and the Caribbean (LAC), and to identify research gaps and priorities.

DESIGN

A scoping review methodology was used.

DATA SOURCES

We conducted a comprehensive search of seven electronic databases. The search strategy combined keywords in three areas: sexual minority women, health, and LAC. English, Spanish, and Portuguese language studies published through 2017 in peer-reviewed journals were included.

REVIEW METHODS

A total 1471 articles were retrieved. An additional 5 articles were identified following descendancy search; 3 of these met inclusion criteria. After removal of duplicates and title and abstract screening, we screened the full text of 37 articles, of which 22 (representing 18 distinct studies) met inclusion criteria. At least two authors independently reviewed and abstracted data from all articles.

RESULTS

More than half of the studies were conducted in Brazil (n = 9) and Mexico (n = 5). Sexual health was the most studied health issue (n = 11). Sexual minority women were at elevated risk for sexually transmitted infections related to low use of barrier contraceptive methods during sexual encounters with men. Findings suggest that sexual minority women are generally distrustful of healthcare providers and view the healthcare system as heteronormative. Providers are believed to lack the knowledge and skills to provide culturally competent care to sexual minority women. Sexual minority women generally reported low levels of sexual health education and reluctance in seeking preventive screenings due to fear of mistreatment from healthcare providers. Sexual minority women also reported higher rates of poor mental health, disordered eating, and substance use (current tobacco and alcohol use) than heterosexual women. Gender-based violence was identified as a significant concern for sexual minority women in LAC.

CONCLUSIONS

Significant knowledge gaps regarding sexual minority women's health in LAC were identified. Additional investigation of understudied areas where health disparities have been observed in other global regions is needed. Future research should explore how the unique social stressors sexual minority women experience impact their health. Nurses and other healthcare providers in the region need training in providing culturally appropriate care for this population.

Methodological Considerations for Advancing Research on the Health and Wellbeing of Sexual and Gender Minority Youth

Continued research with sexual and gender minority (SGM) youth is essential both to understand health disparities and to develop interventions targeting those disparities, but conducting rigorous, ethical research with these populations remains a substantial challenge. In addition to considerations for research with adolescents in general, such as utilizing developmentally appropriate measures and obtaining parental permission, factors unique to SGM youth must be addressed at every step of the research process. Defining the study population is complex, as is recruiting a sample once it is defined. Measurement is another challenge, given the paucity of measures developed for or validated with SGM samples. Key constructs, such as sexual orientation, gender identity, and family acceptance, are not amenable to randomization and involving minor participants' parents poses ethical concerns given the precarious home and safety situations that can arise from employing typical study procedures with youth who have a stigmatized identity. In this article, we examine some of these unique methodological challenges. Informed by theoretical and empirical literature, practical experience, and an ongoing dialogue with SGM youth themselves, we present a guide to best practices for ethical, productive research with SGM youth. By discussing existing approaches to studying SGM youth and suggesting innovative ways to approach the questions that remain, we hope to assist the research community in addressing methodological gaps to advance research on SGM youth in relation to families and schools.

Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in Men

PURPOSE

This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors.

METHODS

Pooled data from male adult participants (n = 72,214) in the 2003-2012 California Health Interview Survey were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity.

RESULTS

Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity. Among gay and bisexual men, the associations were stronger and statistically significant-with the exception of lifetime asthma-particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity.

CONCLUSIONS

Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.

Alcohol Use and Disordered Eating in a US Sample of Heterosexual and Sexual Minority Adolescents

OBJECTIVE

To expand knowledge of co-occurring alcohol use and disordered eating behaviors (DEB) among sexual minority (ie, nonheterosexual) youth.

METHOD

Using pooled 2009 to 2015 US Youth Risk Behavior Surveys (322,687 students; 7.3% lesbian, gay, bisexual), multivariable logistic regression models examined the following: (1) associations of age of onset of drinking and past month binge drinking with past year DEB (fasting, diet pill use, purging, steroid use); and (2) effect modification by sexual orientation.

RESULTS

Alcohol use and sexual minority identity were independently associated with elevated odds for diet pill use and purging among female adolescents, and with fasting and steroid use among male adolescents. Odds of fasting increased with greater frequency of monthly binge drinking among heterosexual adolescent female youth, and odds of diet pill use increased with greater frequency of monthly binge drinking among heterosexual adolescent male youth. DEB prevalence was particularly pronounced among adolescents who binge drank and who were not sure of their sexual orientation identity. Among male adolescents not sure of their sexual orientation identity, those who binge drank more than 1 day in the past month had 8.63 to 23.62 times the odds of using diet pills relative to those who did not binge drink, and 13.37 to 26.42 times the odds of purging relative to those who did not binge drink.

CONCLUSION

More research is needed on psychosocial factors underlying alcohol use and DEB in youth of all sexual orientations.

Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-conforming Adults: Comparative Levels and a Proposed Mediational Model

In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder (“ED proneness”), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion.

Dating app use and unhealthy weight control behaviors among a sample of U.S. adults: a cross-sectional study

BACKGROUND

Online dating has become increasingly popular over the years. Few research studies have examined the association between dating apps and disordered eating. In this study, we evaluated the association between dating app use and unhealthy weight control behaviors (UWCBs) among a sample of U.S. adults.

METHODS

Our sample includes 1769 adults who completed an online survey assessing dating app use and UWCBs in the past year. Survey assessed participants' self-reported frequency of using dating apps within the past 30 days and engagement in six UWCBs with the purpose of lowering weight or changing their body shape within the past 12 months. UWCBs included vomiting, laxative use, fasting, diet pill use, muscle building supplement use, and use of anabolic steroids.

RESULTS

Results of multivariate logistic regression models suggest dating app users had substantially elevated odds of UWCBs compared with non-users (odds ratios [OR] range = 2.7-16.2). These findings were supported by results of additional gender-stratified multivariate logistic regression analyses among women and men.

CONCLUSIONS

This study's findings contribute to the limited literature exploring the association between dating app use and adverse health outcomes, particularly UWCBs. While additional longitudinal and representative research is needed, public health professionals ought to explore dating app use as a potential risk factor for UWCBs.

Sexual Minority Status and Adolescent Eating Behaviors, Physical Activity, and Weight Status

INTRODUCTION

This study examined sexual orientation differences in eating behaviors, physical activity, and weight status among adolescents in the U.S. Moreover, this study tested whether parental and peer influences contribute to sexual orientation disparities in adolescent eating behaviors, physical activity, BMI, and examined disparities in weight misperception.

METHODS

Cross-sectional data were from 1,926 adolescents who participated in the NEXT Generation Health Study in 2010-2011. Linear and multinomial logistic regressions conducted in 2017-2018 were used to test disparities and interactions with social influences.

RESULTS

Relative to their heterosexual peers, sexual minority males and females consumed fruits and vegetables more frequently; sexual minority males engaged in less frequent physical activity; and sexual minority females were more likely to be overweight, perceive themselves as overweight, and to overestimate their weight. High parental expectation for physical activity was associated with more frequent vigorous physical activity among heterosexual adolescents, but less frequent vigorous physical activity among sexual minority males. Exercising with a same-sex peer buffered against the risk of higher BMI among sexual minority females.

CONCLUSIONS

Parental and peer influences may serve as potential intervention targets to reduce disparities in weight-related behaviors. Longitudinal research is needed to understand the consequences of weight misperception among sexual minority females.

Sexual orientation disparities in eating disorder symptoms among adolescent boys and girls in the UK

Much of the research on sexual orientation disparities in eating disorder behaviors has been conducted in the USA, Canada, and Australia. Data on the associations of sexual orientation and eating disorder symptoms among adolescents in the UK are lacking. Participants were children from the Avon Longitudinal Study of Parents and Children, a youth cohort born 1991-1992 (n = 5048; 53% female; 12% sexual minority). Sexual orientation was assessed at 16 years. Eating disorder symptoms were assessed at 14 and 16 years. Multivariable regression models (adjusting for BMI, ethnicity, socioeconomic status) examined associations between sexual orientation and (1) odds of past-year purging and binge eating, and (2) mean differences in body dissatisfaction, pressure to increase muscularity (boys only), and Dutch Eating Behavior Questionnaire subscales. At age 14, gay and bisexual boys and mostly heterosexual girls reported greater body dissatisfaction than their same-gender heterosexual peers. All sexual minority boys and mostly heterosexual girls reported greater mean dysfunctional eating behaviors than their same-gender heterosexual peers. At age 16, gay and bisexual boys had 12.5 times the odds of heterosexual boys of binge eating; mostly heterosexual boys had over three times the odds of reporting binge eating. Sexual minority girls had over twice the odds of heterosexual girls of purging and binge eating. By mid-adolescence, sexual minority youth in the UK had elevated risk for eating disorder symptoms, suggesting the need for early prevention efforts.