The association between sexual orientation, susceptibility to social messages and disordered eating in men

Self-Objectification, Disordered Eating and Sexual Orientation in Men

The interplay between disordered eating, depressive symptoms and self-objectification differs between genders and sexual orientations, and merits further study in homosexual and heterosexual men. We examined disordered eating, depressive symptoms and self-objectification in a sample of Israeli heterosexual and homosexual men. Participants were 215 men aged 19-65, 108 of whom were classified by the Kinsey scale as being heterosexual and 107 as homosexual. They completed online measures of self-objectification, disordered eating and depressive symptoms. Heterosexual men reported lower levels of disordered eating and self-objectification than homosexual men, however the difference in depressive symptoms was not statistically significant. Correlations between disordered eating, self-objectification and depressive symptoms when controlling for age, BMI and number of children were all significant, with similar patterns of association for heterosexual and homosexual men. Self-objectification partially mediated the association between sexual orientation and disordered eating. However, contrary to our hypothesis, sexual orientation (homosexual/heterosexual) did not moderate the association between disordered eating and self-objectification. The tendency of homosexual men towards self-objectification is linked to unhealthy eating habits. Self-objectification helps explain the propensity of homosexual versus heterosexual men to develop disordered eating and possibly eating disorders. It should therefore be targeted in prevention and in therapy.

Exploring the effects of gender and sexual orientation on disordered eating: an EFA to CFA study of the Eating Disorder Examination Questionnaire

Several problems limit our understanding of the ways that gender and sexual orientation influence disordered eating. These include the reliance on measures that have been developed and validated in samples of cisgender heterosexual women, and the lack of confirmed measurement invariance that allows us to meaningfully compare these experiences between groups. This study was an EFA to CFA exploration of the Eating Disorder Examination Questionnaire in a group of heterosexual, bisexual, gay, and lesbian men and women. In total 1638 participants were recruited via adverts in traditional and social media to complete an online survey. A 14-item, three-factor model of the EDE-Q was confirmed as best fitting the data and measurement invariance between groups was ascertained. Sexual orientation influenced disordered eating and muscularity-related thoughts and behaviours in men but not women. Heterosexual men reported more muscularity-related concerns and behaviours, whereas gay men showed more thinness-related concerns and behaviours. Bisexual participants showed a different pattern, highlighting the importance of treating this group individually and not collating all non-heterosexual participants together. Small but significant effects of sexual orientation and gender have an impact on the kinds of disordered eating thoughts and behaviours one might experience, and could influence prevention and treatment. Clinicians may be able to provide more effective and tailored interventions by taking into account gender and sexual orientation in sensitive ways.

Obesity in Sexual and Gender Minority Populations: Prevalence and Correlates

PURPOSE OF REVIEW

The purpose of this review is to explore the prevalence and correlates of obesity among members of sexual and gender minority (SGM) populations.

RECENT FINDINGS

Research overall finds higher rates of obesity among lesbian and bisexual women than heterosexual women, lower rates of obesity among gay and bisexual men than heterosexual men, and inconsistent findings on obesity among transgender individuals. Rates of mental health disorders and disordered eating are high among all SGM groups. Rates of comorbid medical conditions differ among groups. More research needs to be conducted within all SGM groups but particularly among transgender populations. All members of SGM encounter stigma, including when seeking healthcare, and this may lead to individuals avoiding healthcare. Therefore, it is important to educate providers about population-specific factors. This article serves as an overview of important considerations for providers treating individuals within SGM populations.

Why do queer men experience negative body image? A narrative review and testable stigma model

Queer men (i.e., men who are not heterosexual; sexual minority men) are disproportionately affected by negative body image - they experience greater body dissatisfaction are more likely to develop eating disorders than heterosexual men. While existing literature has examined individual-level predictors of negative body image for queer men, less is known about why queer men as a group are disproportionately affected by negative body image. By synthesising existing theoretical frameworks, research, policy, and media reporting, this narrative review moves towards an understanding of systemic-level negative body image for queer men. Through the lens of hegemonic masculinity, we explain how systemic experiences of stigma work to inform unattainable appearance standards for queer men, and how these standards then contribute to pervasive negative body image concerns among this community. Next, we describe how systemic stigma works to exacerbate negative health outcomes for queer men with body image concerns. Finally, we present a synthesized model of the processes outlined in this review, articulate testable predictions for future studies, and describe practical implications that could be widely employed to improve body image for queer men. Our review is the first to propose a comprehensive explanation of systemic negative body image for queer men.

Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades

OBJECTIVE

Sexual minority (SM) groups (e.g., those who identify as lesbian, gay, bisexual, questioning, queer, asexual, or those who feel their sexual orientation identity cannot be captured with existing terminology [LGBQA+] and those who report same-sex or same-gender attraction and/or behavior) are at elevated risk for eating disorder (ED) symptoms and behaviors. However, the ways in which this risk varies across SM is less clear, and findings are not fully convergent. Evolution in the definition and assessment of SM status may contribute to this divergence. The aim of this study was to systematically review how sexual orientation and SM status have been assessed in the ED literature and how this may relate to patterns of associations between SM status and ED symptoms.

METHODS

A systematic review of the literature focused on ED symptoms and behaviors and SM groups was conducted, yielding 182 studies.

RESULTS

Five categories were created reflecting SM status assessment: identity only (n = 105), attraction only (n = 8), behavior only (n = 4), combinations of identity, behavior, or attraction (n = 58), and articles with unclear or insufficient information about SM status assessment (n = 7). SM status operationalizations varied across studies, with more inclusive assessments in more recent work. Findings revealed persistent conflicting patterns of disordered eating symptomatology for some SM groups. In addition, decisions to selectively combine SM participants in some studies, most often to increase power, decreased the specificity of their results in relation to differential risk and protective factors within specific LGBQA+ groups.

DISCUSSION

Findings highlight the importance of inclusive assessments of sexual orientation in the ED literature and research focused on underrepresented groups with intersecting identities. Identifying modifiable targets for intervention is a critical next step.

PUBLIC SIGNIFICANCE

Sexual minority (SM) groups have been identified as presenting elevated risk for eating disorder symptoms and behaviors. Our findings suggest that the level of risk is variable across SM groups and points to the need for multi-dimensional assessments of SM status, and increased focus on the function of disordered eating behaviors and different profiles that might emerge related to efforts to modify physical appearance or to regulate emotion.

Risk factors for eating disorders: findings from a rapid review

BACKGROUND

Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders.

METHODS

The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper.

RESULTS

A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms.

CONCLUSION

Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.

Understanding eating disorder symptoms in same-gender couples: social environmental factors

BACKGROUND

Sexual minority individuals are at disproportionately greater risk for eating disorders, yet little is known about the ways in which factors in the social environment relate to eating disorder symptoms in this population. Utilizing an ecological systems theory framework, we investigated the relative relationships of macro level (i.e., internalization of sociocultural attitudes about appearance) and micro level (i.e., quality of romantic relationship) social environment influences.

METHODS

Men (n = 144) and women (n = 144) in committed same-gender relationships were recruited as a dyad and completed study questionnaires, including multiple measures of eating disorder symptoms. Multilevel models controlling for key variables (e.g., body mass index) were used to examine gender differences, main effects, and interactions.

RESULTS

Men reported greater internalization of sociocultural attitudes and uncontrolled eating. Greater internalization of sociocultural attitudes was related to greater eating pathology across all measures. For men, greater relationship quality was related to less uncontrolled eating.

CONCLUSIONS

Individuals in same-gender relationships experience macro (e.g., sociocultural) level vulnerability factors in relation to disordered eating; however, internalization of sociocultural attitudes may be greater for men. Support at the microsystem level in the form of a high quality committed romantic relationship appears to be helpful protection against uncontrolled eating for men.

The association between sexual orientation and eating disorders-related eating behaviours in adolescents: A systematic review and meta-analysis

BACKGROUND

Sexual orientation is usually developed during the adolescence, which coincides with the eating disorders peak onset. This paper aims to explore existing literature to identify whether there is an association between sexual orientation and eating disorder-related eating behaviours (EDrEBs) in this age-group.

METHODS

This review was based on the PRISMA guidelines, covering the published articles between 1990 and 2021. A meta-analysis of the proportion of sexual orientation and the adjusted odds ratio (OR) with 95% confident intervals was reported.

RESULTS

Ten studies (412,601 participants) were included in this review. The results demonstrated adolescents identified as minority sexual orientation, particularly homosexual males were with higher OR of EDrEBs, as follows: Homosexual (binge eating: M = 7.20, F = 2.14; purging: M = 5.40, F = 2.41; diet pills use: M = 3.50, F = 2.59; dieting: M = 3.10, F = 1.75); Bisexual (binge eating: M = 4.60, F = 2.26; purging: M = 4.44, F = 2.37; diet pills use: M = 3.42, F = 2.30; dieting: M = 2.36, F = 1.86).

CONCLUSIONS

Adolescents who were of a minority sexual orientation were more vulnerable to EDrEBs than their heterosexual peers. Healthcare professionals and sexual minority communities should be primed to facilitate earlier recognition and access to services in these vulnerable groups.

Body image and associated factors among sexual minority men: A systematic review

Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.

Twinks, Jocks, and Bears, Oh My! Differing subcultural appearance identifications among gay men and their associated eating disorder psychopathology

Gay men have increased risk of body dissatisfaction and disordered eating compared to heterosexual men, and it is unclear what differentiates their risk for thinness- and muscularity-oriented eating psychopathology. Differing subcultural appearance identifications (SAIs) among gay men are one potential factor that may relate to varied eating psychopathology, but this has not been studied. We examined gay men's SAIs: twinks, jocks, and bears; any "other" self-identified SAI; or no SAI, as well as the relationship between men's SAIs and traditional eating psychopathology and unhealthy dieting (both facets of thinness-oriented psychopathology), and muscularity-oriented psychopathology using univariate ANOVAs controlling for participant age. 264 U.S. gay-identified participants self-reported sexual orientation, SAIs, and eating psychopathology. Self-identified twinks did not report higher traditional eating psychopathology or unhealthy dieting than other SAIs or those without a SAI, as hypothesized. Self-identified twinks, jocks, and bears all reported greater muscularity-oriented eating pathology than those without a SAI. Self-identified jocks also reported higher muscularity-oriented disordered eating than those with an "other" self-identified SAI and bears. Thus, having a SAI may increase risk for disordered eating; specifically, identifying as a twink, jock or bear may confer greater risk for muscularity-oriented eating pathology.

Sexual orientation differences in pathways from sociocultural and objectification constructs to body satisfaction: The U.S. Body Project I

Objectification theory and the tripartite influence model provide useful frameworks for understanding the body image experiences of men and women. However, there is little systematic investigation of how sexual orientation moderates the links between these constructs and body image satisfaction. It has been hypothesized, for example, that the associations of surveillance (i.e., monitoring of one's appearance due to objectification by others) would be strongest for groups targeted by the male gaze (e.g., gay men, lesbian women, and bisexual men and women). Here we proposed an integrated sociocultural model and examined these pathways in multigroup structural equation models in a national sample of heterosexual, bisexual, and lesbian women (ns = 5395; 598; 213, respectively), and heterosexual, bisexual, and gay men (4869; 194; and 194, respectively) aged 18-65 years. Sexual orientation moderated some of these pathways. The most consistent pattern was that appearance pressures were internalized to a greater extent among bisexual participants. The pathways to poorer body image were generally similar among heterosexual and gay/lesbian men and women. These findings highlight the importance of examining sexual orientation-specific influences on body image across diverse groups, as well as the commonalities in the experiences of men and women across sexual orientations.

Sexual attraction to men as a risk factor for eating disorders: the role of mating expectancies and drive for thinness

BACKGROUND

Men tend to give more importance than women to physical aspects when selecting a partner; thus, the internalization of beauty standards and the ideal of thinness may be greater in populations attracted to men, placing them at a higher risk of eating disorders.

METHODS

In a sample (n = 398) of heterosexual and gay men and women, we evaluated the drive for thinness, body dissatisfaction, and bulimic symptomatology. Using ANCOVAs, we analyzed the differences in symptoms score according to sex, sexual orientation and relational status including body mass index (BMI) as covariate; we also evaluated the mediating role of drive for thinness in the relationship between sexual orientation and body dissatisfaction.

RESULTS

We found an increased drive for thinness and body dissatisfaction in men-attracted compared with women-attracted participants; also, body dissatisfaction was greater in women than in men. Heterosexual women presented higher bulimia scores than lesbian women. Gay men open to relationships presented higher drive for thinness and body dissatisfaction scores than those not-open to relationships. Finally, differences in body dissatisfaction between gay and heterosexual men were fully explained by drive for thinness, while, in the case of women, drive for thinness only partially explained these differences.

CONCLUSIONS

Attraction to men seems to be a risk factor for EDs in the case of gay men and heterosexual women. In addition, in the case of heterosexual women, other factors independent of the desire to attract men seem to be important.

Establishing initial validity and factor structure for the muscularity-oriented eating test in gay men

Eating disorders (EDs) affect men at higher rates than previously estimated, with many traditional ED measures likely underestimating the prevalence of eating and exercise-related pathology among males. The development of the Muscularity-Oriented Eating Test (MOET) represents an important advancement in ED assessment, enabling valid and reliable assessment of muscularity-oriented ED pathology among men. The current study sought to provide initial validity of the MOET among gay men. N = 264 gay men, recruited via MTurk, participated in a brief online survey, completing the MOET and other well-validated measures of eating pathology and body image psychopathology. Factor structure, mean, standard deviation, and intercorrelation between measures were assessed. The MOET demonstrated adequate factor structure, similar to that reported in the initial validation sample, and was significantly correlated with other measures of eating and body image psychopathology. The current study suggests initial validity of the MOET for use among gay men. Future research is needed among younger and more diverse samples of SM men, along with evidence of adequate test-retest reliability and absence of differential item functioning among gay men.

Associations of self-repression with disordered eating and symptoms of other psychopathologies for men and women

BACKGROUND

Disordered eating has been found to be associated with constructs involving self-repression, such as selflessness (the tendency to relinquish one's needs for others'), and concern for appropriateness (an alertness to information about social comparison and tendency to vary one's behavior in different social situations). This study aimed to examine associations between these self-repression variables and symptoms of general psychopathology for women and men in a community sample.

METHODS

Two hundred and thirty-six participants (92 men) aged 18-76 (M = 29.11 ± 10.10) volunteered to complete online measures of disordered eating, concern for appropriateness (cross-situational variability and attention to social comparison information), selflessness, and symptoms of depression, anxiety and somatization. Structural equation models were built to assess pathways between the study variables for men and women separately.

RESULTS

A MANOVA 2*7 design showed that women scored significantly higher than men on measures of selflessness, disordered eating and depression. For men, selflessness scores were positively and significantly associated only with depression scores. Cross-situational variability scores were positively associated with depression, somatization and anxiety scores. For women, selflessness scores were positively and significantly associated with depression, disordered eating, somatization and anxiety scores. Cross-situational variability scores were positively and significantly associated with depression, anxiety and somatization scores but not with disordered eating scores. Attention to Social Comparison Information scores were positively and significantly associated only with disordered eating scores.

CONCLUSIONS

Self-repression is more closely linked to psychopathology in women than in men. For men, self-suppression seems to be associated with symptoms of internalizing disorders, but not disordered eating. Even for women, it appears that self-repression is not connected exclusively with disordered eating, but with symptoms of psychopathology in general. Future research should explore why self-suppression plays such a central role in women's psychopathology.

Examining foodwork and eating behaviors among heterosexual and gay male couples

OBJECTIVES

Spouses play an important role in their partner's eating behaviors, including both promoting and impeding healthy eating. The division of foodwork in the relationship (i.e., if there is individual or shared responsibility for food roles) may vary as a function of gender or sexual orientation and may be important in understanding eating behaviors.

METHOD

Using cross-sectional, dyadic data from 462 heterosexual and gay married couples (N = 921 individuals) residing in the United States, we accordingly sought to examine which partner was most responsible for two food roles, food shopping and meal preparation (Aim 1); whether these roles differed by gender (Aim 1a) and sexual orientation (Aim 1b); whether these food roles were related to the frequency of eating healthy and unhealthy foods (Aim 2); and whether these associations differed by gender (Aim 2a) and sexual orientation (Aim 2b).

RESULTS

We found that one individual was responsible for these roles in a majority of couples, although meal preparation was more likely to be shared in gay than in heterosexual couples. We also found that, in general, the person responsible for these food roles ate healthy more frequently compared to when their partner was responsible; findings for shared responsibility were more equivocal. These associations did not differ, however as a function of gender or sexual orientation.

CONCLUSION

Our findings contribute to a further understanding of food dynamics among heterosexual and gay male couples and have important implications for health promotion and intervention efforts.

Community norms for the eating disorder examination questionnaire (EDE-Q) among cisgender bisexual plus women and men

PURPOSE

Cisgender bisexual plus (including bisexual, pansexual, and polysexual) women and men experience unique health concerns including eating disorders. The purpose of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in cisgender bisexual plus women and men using the Eating Disorders Examination Questionnaire (EDE-Q).

METHODS

Participants were cisgender bisexual plus women (n = 462) and men (n = 93) participants in The PRIDE Study, an existing study of sexual and gender minority people.

RESULTS

Mean and standard deviation of EDE-Q scores among cisgender bisexual plus women and men, respectively, were: Global (1.75 ± 1.26, 1.56 ± 1.18), Restraint (1.34 ± 1.44, 1.42 ± 1.53), Eating Concern (0.96 ± 1.13, 0.63 ± 0.96), Weight Concern 2.27 ± 1.55, 1.89 ± 1.46), and Shape Concern 42 ± 1.62, 2.30 ± 1.57). Among cisgender bisexual plus women and men, respectively, 27.5% and 22.6% scored in the clinically significant range on the Global score. Bisexual plus women and men reported any occurrence (≥ 1/28 days) of dietary restraint (19.3%, 23.7%), objective binge episodes (11.1%, 10.8%), excessive exercise (4.5%, 5.4%), self-induced vomiting (1.7%, 0.0%), and laxative misuse (0.4%, 1.1%), respectively. A lower percentage of age-matched cisgender bisexual plus women (18-25 years) reported any occurrence of objective binge episodes, self-induced vomiting, laxative misuse, and excessive exercise than previously published in young women. Age-matched cisgender bisexual plus men (18-26 years) reported higher weight concern subscale scores than previously published in young men.

CONCLUSIONS

These norms should aid clinicians in applying and interpreting the EDE-Q scores of cisgender bisexual plus women and men.

LEVEL OF EVIDENCE

Level V: cross-sectional descriptive study.

The role of sexual orientation in the relationships between body perception, body weight dissatisfaction, physical comparison, and eating psychopathology in the cisgender population

PURPOSE

Body weight dissatisfaction (BWD) and visual body perception are specific aspects that can influence the own body image, and that can concur with the development or the maintenance of specific psychopathological dimensions of different psychiatric disorders. The sexual orientation is a fundamental but understudied aspect in this field, and, for this reason, the purpose of this study is to improve knowledge about the relationships among BWD, visual body size-perception, and sexual orientation.

METHODS

A total of 1033 individuals participated in an online survey. Physical comparison, depression, and self-esteem was evaluated, as well as sexual orientation and the presence of an eating disorder. A Figure Rating Scale was used to assess different valences of body weight, and mediation analyses were performed to investigated specific relationships between psychological aspects.

RESULTS

Bisexual women and gay men reported significantly higher BWD than other groups (p < 0.001); instead, higher body misperception was present in gay men (p = 0.001). Physical appearance comparison mediated the effect of sexual orientation in both BWD and perceptual distortion. No difference emerged between women with a history of eating disorders and without, as regards the value of body weight attributed to attractiveness, health, and presence on social media.

CONCLUSION

This study contributes to understanding the relationship between sexual orientations and body image representation and evaluation. Physical appearance comparisons should be considered as critical psychological factors that can improve and affect well-being. The impact on subjects with high levels of eating concerns is also discussed.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Sexual orientation identity in relation to unhealthy body mass index: individual participant data meta-analysis of 93 429 individuals from 12 UK health surveys

Background

Lesbian, gay and bisexual adults are more likely than heterosexual adults to experience worse health outcomes. Despite increasing public health interest in the importance of maintaining a healthy body weight, no study has considered sexual orientation identity (SOI) and unhealthy BMI categories among adults in the UK population.

Methods

Individual participant data meta-analysis using pooled data from population health surveys reporting on 93 429 adults with data on SOI, BMI and study covariates.

Results

Adjusting for covariates and allowing for between-study variation, women identifying as lesbian (OR = 1.41, 95% CI: 1.16, 1.72) or bisexual (OR = 1.24, 95% CI: 1.03, 1.48) were at increased risk of overweight/obesity compared to heterosexual women, but men identifying as gay were at decreased risk (OR = 0.72, 95% CI: 0.61, 0.85) compared to heterosexual men. Increased risk of being underweight was seen for women identifying as ‘other’ (OR = 1.95, 95% CI: 1.07, 3.56), and men identifying as gay (OR = 3.12, 95% CI: 1.83, 5.38), bisexual (OR = 2.30, 95% CI: 1.17, 4.52), ‘other’ (OR = 3.95, 95% CI: 1.85, 8.42).

Conclusions

The emerging picture of health disparities in this population, along with well documented discrimination, indicate that sexual orientation should be considered as a social determinant of health.

Body image disturbance and sexual orientation: An updated systematic review and meta-analysis

Negative body image, or body image disturbance (BID) has been associated with depression, low self-esteem, and the development of eating disorders. Furthermore, BID may affect an individual regardless of gender or sexual orientation. To synthesise the current literature, we conducted a meta-analysis of 48 studies to determine if BID differed between lesbian versus heterosexual women, lesbian women versus gay men, and gay versus heterosexual men. Body image measures were grouped according to similarities in constructs measured, resulting in five different categories (global satisfaction, figural-rating scales, cognitive measures, affect measures, and male body image). The results indicated that lesbian women reported experiencing less BID compared to heterosexual women on measures of global satisfaction, but more compared to gay men, and gay men reported experiencing greater BID compared to heterosexual men on three out of five analyses. Moderation analyses indicated that the study quality was not a statistically significant moderator of the effect sizes. Results from this updated meta-analysis indicate that, to some degree, BIDs affect individuals regardless of gender and sexual orientation; however, there is some variability associated with sexual orientation.

The Utility of Clinical Notes for Sexual Minority Health Research

INTRODUCTION

Despite improvements in electronic medical record capability to collect data on sexual orientation, not all healthcare systems have adopted this practice. This can limit the usability of systemwide electronic medical record data for sexual minority research. One viable resource might be the documentation of sexual orientation within clinical notes. The authors developed an approach to identify sexual orientation documentation and subsequently derived a cohort of sexual minority patients using clinical notes from the Veterans Health Administration electronic medical record.

METHODS

A hybrid natural language processing approach was developed and used to identify and categorize instances of terms and phrases related to sexual orientation in Veterans Health Administration clinical notes from 2000 to 2019. System performance was assessed with positive predictive value and sensitivity. Data were analyzed in 2019.

RESULTS

A total of 2,413,584 sexual minority terms/phrases were found within clinical notes, of which 439,039 (18%) were found to be related to patient sexual orientation with a positive predictive value of 85.9%. Documentation of sexual orientation was found for 115,312 patients. When compared with 2,262 patients with a record of administrative coding for homosexuality, the system found mentions of sexual orientation for 1,808 patients (79.9% sensitivity).

CONCLUSIONS

When systemwide structured data are unavailable or inconsistent, deriving a cohort of sexual minority patients in electronic medical records for research is possible and permits longitudinal analysis across multiple clinical domains. Although limitations and challenges to the approach were identified, this study makes an important step forward for the Veterans Health Administration sexual minority research, and the methodology can be applied in other healthcare organizations.

Rising dysmorphia among adolescents : A cause for concern

Introduction:

Body dysmorphic disorder is defined as a preoccupation with apparent defects in patient's appearance which causes significant distress and impairment. This study was conducted in 186 students who attended premedical preparation classes with the mean age of 16.81 years with the primary motive of determining body dysmorphia among adolescent age group.

Aim:

The main objective of this study is to assess body dysmorphia among teenage adolescents and young adults.

Methods and Materials:

This cross-sectional study was conducted in premedical preparation class in January 2019. The student's ages range from 16 to 18 years with mean age being 16.81 years. Once verbal consent was obtained the students were asked to fill an anonymous predesigned questionnaire. Continuous variables were summarized as mean and standard deviations, whereas categorical variables were summarized as proportion (%).

Statistical Analysis Used:

All the data from the questionnaire were extracted and compiled in MS Excel and percentage and frequencies were applied as needed.

Results:

The mean age of the participants was 16.81+/- 0.82 years with almost equal percentage of females (52.13%) and males (47.84%). Our study shows that in general females are more dissatisfied from their body than males. Both sexes have different areas of concerns. In females, there is more discontent about body fat, facial hair, height, and complexion. In comparison in males the frustration is more regarding muscular body, acne, height, weight, and hair thinning. Despite differences in areas of concern both males and females show dissatisfaction with their body image.

Conclusions:

It has been concluded that there is a rising surgence of body dysmorphia in adolescents.

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.

Lives on the Line: The Online Lives of Girls and Women With and Without a Lifetime Eating Disorder Diagnosis

This study aimed to compare the scope, internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder (ED) diagnosis. Participants were 122 females aged 12-30, 53 with a lifetime ED diagnosis recruited via a hospital-based treatment program, and 69 age-matched controls recruited via normative social media sites. Participants completed questionnaires assessing disordered eating, body image, positive and negative affect, general distress, and life satisfaction, and completed an online survey about the scope of their internet use, the frequency of watching and posting pictures and videos, online friendships and social comparison, fulfillment of needs online, and mood after internet use. All questionnaire scores differed significantly between groups in the expected directions. Whereas overall, ED and control groups spent similar amounts of time online (6.21, SD = 5.13), they spent this time differently. ED participants reported devoting 56.7% of their online time to eating, weight and body image, versus 29.1% for controls, and spent significantly more time than controls on forums and blogs (t = -5.3, p < 0.0001, Cohen's d = 0.87). They also engaged more often in social comparison (t = 3.6, p < 0.005, Cohen's d = 0.65), had a higher online-offline friend ratio (t = 3.7, p < 0.0001, Cohen's d = 0.65), and more online friends with ED (t = 5.4, p < 0.0001, Cohen's d = 0.89). In comparison to controls, ED participants reported that their use of forums and blogs gave them more eating- and weight-related advice, and a greater sense of belonging, social support, and safety resulting from anonymity, with effect sizes of 0.63-0.96. However, they also reported more negative affect after posting online. Most online behaviors and patterns correlated positively with measures of symptomatology and negatively with measures of psychological health, in both groups. Internet use was rarely addressed in therapy. Professionals, families and friends should help people with disordered eating and EDs to broaden the scope of their internet use. They should invest less in food- and weight-related forums/blogs, expand their "real life" social lives and develop their interpersonal skills, so that their legitimate needs can be satisfied face-to-face, rather than virtually. Clinicians should address the online lives of their ED clients in therapy.

Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations

PURPOSE OF REVIEW

This review summarized trends and key findings from empirical studies conducted between 2011 and 2017 regarding eating disorders and disordered weight and shape control behaviors among lesbian, gay, bisexual, and other sexual minority (i.e., non-heterosexual) populations.

RECENT FINDINGS

Recent research has examined disparities through sociocultural and minority stress approaches. Sexual minorities continue to demonstrate higher rates of disordered eating; disparities are more pronounced among males. Emerging data indicates elevated risk for disordered eating pathology among sexual minorities who are transgender or ethnic minorities. Dissonance-based eating disorder prevention programs may hold promise for sexual minority males. Continued research must examine the intersections of sexual orientation, gender, and ethnic identities, given emergent data that eating disorder risk may be most prominent among specific subgroups. More research is needed within sexual minorities across the lifespan. There is still a lack of eating disorder treatment and prevention studies for sexual minorities.