Correlates of overweight and obesity among lesbian and bisexual women

Relative Adiposity and Body Dissatisfaction in Young Adult Sexual Minority Women

The purpose of this study was to examine potential differences in body mass index (BMI), relative adiposity (%Fat), and body dissatisfaction (BD) between heterosexual (HSW) and sexual minority women (SMW). Young adult women (n = 84; 23.8% SMW; 21.9 ± 3.8 years) were included in our analysis. %Fat was assessed using a four-compartment model. BD was assessed using the Body Shape Questionnaire (BSQ), the BD subscale of the Eating Disorders Inventory Questionnaire (EDI-BD), the appearance evaluation subscale of the Multidimensional Body Self-Relations Questionnaire (MBSRQ-AE), and the Photographic Figure Rating Scale (PFRS). Potential differences in BMI, %Fat, and BD between sexual orientation groups were assessed using independent samples t-tests. Bivariate correlations were assessed using Pearson's r. No differences in BMI or BD were observed between groups (all p > .05). Higher %Fat was observed in SMW when compared to HSW (p = .046), and higher %Fat was associated with higher BSQ (r = .364), EDI-BD (r = .388), lower MBSRQ-AE (r = .388), and PFRS (r = .521), collectively indicating greater BD. %Fat was higher in SMW, and higher %Fat was associated with greater BD, regardless of sexual orientation. These results suggest that SMW tend to have higher %Fat than heterosexual counterparts which would increase their risk of negative health outcomes.

Demographic and Minority Stress Risk Factors for Obesity Among Sexual Minority Youth Assigned Female at Birth

Purpose: Sexual minority youth (adolescents and young adults) assigned female at birth (SM-AFAB) are at disproportionate risk of developing obesity compared with heterosexual cisgender youth AFAB. Grounded in minority stress theory, this study aimed to identify potential risk factors for obesity among SM-AFAB youth to inform the development of prevention and intervention efforts for this high-risk population. Methods: Data were collected in 2017 from 367 SM-AFAB youth (ages 16-20 years). Multinominal logistic regression was used to assess cross-sectional associations of race/ethnicity, sexuality, gender identity, household income, and sexual minority (SM) stressors (internalized stigma, microaggressions, and victimization) with weight status (normal, overweight, and obese). Results: Roughly half (53.1%) of participants' body mass index were in the normal weight range, with 24.8% in the overweight range and 22.1% in the obese range. Rates of obesity in Black and Latinx participants were 3-4.5 times those of White participants. Bisexual, pansexual, and queer individuals were at greater risk for obesity than gay/lesbian participants; only bisexual participants were at higher risk for overweight. Participants with a household income <$20,000 and between $20,000 and $39,000 were at greater risk for obesity than participants with household income >$80,000. Microaggressions were positively associated with obesity. Conclusion: Findings highlight risk for obesity among SM-AFAB youth, particularly for those who identify as racial minority, as low income, as being attracted to more than one gender, and for those who experience high levels of anti-SM microaggressions. Targeted obesity prevention and treatment programs should consider the unique needs, challenges, and strengths of SM-AFAB youth.

Disparities in physical activity between sexual minority and heterosexual women: A systematic review and meta-analysis

Research examining potential differences in physical activity (PA) between sexual minority women (SMW) and heterosexual women have yielded inconsistent results.

OBJECTIVE

Therefore, the purpose of this systematic review and meta-analysis is to examine potential differences in PA between SMW and heterosexual women and to identify potential moderators that may partially explain observed differences in PA.

METHODS

All studies were peer reviewed, published in English, and included a continuous measure of PA for SMW and heterosexual women. A standardized mean difference effect size (ES) was used to compare groups, with random effects models used to estimate a mean ES and 95% CI using a 3-level meta-analysis model to adjust for the correlation between effects nested within studies.

RESULTS

The cumulative results of 24 effects gathered from 7 studies indicated there was no difference in PA between SMW (n = 1619) and heterosexual women (n = 103,295) (ES = -0.038, 95%CI -0.179 to 0.102, p = 0.576). Despite no mean differences, moderate-high heterogeneity was observed, indicating that the results were not consistent across effects (I2 = 64.8%, Q23 = 36.7, p = 0.035). The difference in PA was associated with age (β = -0.018, 95%CI -0.034 to -0.003, p = 0.022) and BMI (β = -0.145, 95%CI -0.228 to -0.061, p = 0.002), with a quadratic relationship observed for both variables.

CONCLUSIONS

Although the results of the current analysis did not indicate significant differences in PA behaviors between SMW and heterosexual women, age and BMI modify the association and are curvilinear in nature; such that smaller differences in PA were observed between SMW and heterosexual women when samples were middle-aged and overweight.

Rationale and Design of an Ecological Momentary Assessment Study Examining Predictors of Binge Eating Among Sexual Minority and Heterosexual Young Women: Protocol for the Health and Experiences in Real Life (HER Life) Study

BACKGROUND

Previous research has identified health disparities between sexual minority and heterosexual women, including increased rates of obesity and binge eating in sexual minority women. Established predictors of binge eating behavior include negative emotions and sociocultural processes; however, these studies are generally conducted in samples of young women where sexual identity is not known or reported. There is a dearth of research evaluating how sexual minority-specific factors (eg, minority stress and connectedness to the lesbian, gay, bisexual, transgender, and queer community) may affect binge eating in sexual minority women. In addition, no studies have examined these processes in racially diverse samples or considered how intersecting minority identities (eg, Black and sexual minority) may affect eating behaviors.

OBJECTIVE

The Health and Experiences in Real Life (HER Life) Project aims to clarify real-world predictors of binge eating in young heterosexual and sexual minority women using ecological momentary assessment. The role of affective, social, and health behavior factors in binge eating will be examined for all women (aim 1), and sexual minority-specific predictors will also be considered for sexual minority women participants (aim 2). Person-level moderators of race, body- and eating-related factors, and sexual minority-specific factors will also be examined to better understand how real-world binge eating predictors may differ for various demographic groups (aim 3).

METHODS

Researchers aim to recruit 150 sexual minority and 150 heterosexual women from across the United States, including at least 50 Black women for each group, using web-based recruitment methods. The eligibility criteria include identifying as a woman, being aged between 18 and 30 years, and having had at least two binge eating episodes in the last 2 weeks. Participants must endorse being only or mostly attracted to men (considered heterosexual) or only or mostly attracted to women or having a current or most recent female partner (considered sexual minority). Eligible participants complete an initial web-based baseline survey and then 14 days of ecological momentary assessment involving the completion of a morning and before-bed survey and 5 prompted surveys per day as well as a user-initiated survey after binge eating episodes. The data will be analyzed using a series of multilevel models.

RESULTS

Data collection started in February 2021. We have currently enrolled 129 sexual minority women and 146 heterosexual women. Data collection is expected to conclude in fall 2022.

CONCLUSIONS

The Health and Experiences in Real Life Project aims to elucidate potential differences between sexual minority and heterosexual women in within-person factors predicting binge eating and inform eating disorder interventions for sexual minority women. The challenges in recruiting sexual minority women, including the determination of eligibility criteria and considerations for remote data collection, are discussed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41199.

Exploring pharmacists' understanding and experience of providing LGBTI healthcare

Background

Lesbian, gay, bisexual, transgender and intersex (LGBTI) people experience health and wellness challenges additional to and separate from those of the wider population. Extant research has identified that LGBTI patients support education for healthcare providers to improve their access to appropriate care. Community pharmacists have a role in providing appropriate care to LGBTI patients.

Aims

This study explores the experiences of Australian community pharmacists in providing LGBTI healthcare.

Methods

Ten pharmacists were interviewed using a semi-structured interview guide and the major themes were identified using Braun and Clark's thematic analysis.

Results

Analysis revealed a demand for professional education in several areas of LGBTI healthcare, especially gender-affirming hormone replacement therapy and safe communication with this group. Barriers to privacy and confidentiality were revealed, including time constraints, Covid-19 social distancing requirements, and the lack of appropriate consultation rooms. Further there is a need to engage LGBTI patients through greater inclusive advertising.

Conclusions

While there is some improvement, more must be done to promote inclusive pharmacy care for LGBTI people. This study demonstrates a demand from Australian pharmacists for increased professional education on LGBTI related healthcare.

Sexual minority bariatric patients: preliminary examination of eating behaviors, anxiety, and depression

BACKGROUND

Disparities in obesity care and bariatric surgery persist among patients of diverse identities. However, little is known about sexual minority (SM) bariatric patients.

OBJECTIVES

This study sought to describe, in a preliminary fashion, sexual orientation variables of outness, self-esteem, and perceived discrimination among a sample of SM patients pursuing bariatric surgery. The study also sought to compare SM and heterosexual bariatric candidates on measures of eating behaviors, anxiety, and depression.

SETTING

Academic medical center in the United States.

METHODS

Data were collected as part of a standard psychological evaluation for surgical clearance between May 1, 2018 and December 31, 2019. Data included demographic characteristics, sexual orientation variables, eating behaviors, anxiety, and depression. Descriptive statistics were included to present findings among SM patients. One-way analyses of covariance were conducted to assess differences between SM and heterosexual patients.

RESULTS

A total of 633 patients were evaluated (38 SM and 595 heterosexual). SM patients had high outness scores with high self-esteem and minimal perceived discrimination. SM patients endorsed lower cognitive restraint, higher disinhibition, and increased hunger compared with heterosexual patients (P < .05). SM patients also reported significantly more symptoms of anxiety and depression compared with heterosexual patients (P < .05).

CONCLUSIONS

Findings provide preliminary evidence toward the importance of assessing for sexual orientation among bariatric patients. Future research is warranted to assess the unique role of sexual orientation, as well as explore causal links between sexual orientation, eating behaviors, and mental health among bariatric patients pre- and post surgery.

A Life History Approach to the Female Sexual Orientation Spectrum: Evolution, Development, Causal Mechanisms, and Health

Women's capacity for sexual fluidity is at least as interesting a phenomenon from the point of view of evolutionary biology and behavioral endocrinology as exclusively homosexual orientation. Evolutionary hypotheses for female nonheterosexuality have failed to fully account for the existence of these different categories of nonheterosexual women, while also overlooking broader data on the causal mechanisms, physiology, ontogeny, and phylogeny of female nonheterosexuality. We review the evolutionary-developmental origins of various phenotypes in the female sexual orientation spectrum using the synergistic approach of Tinbergen's four questions. We also present femme-specific and butch-specific hypotheses at proximate and ultimate levels of analysis. This review article indicates that various nonheterosexual female phenotypes emerge from and contribute to hormonally mediated fast life history strategies. Life history theory provides a biobehavioral explanatory framework for nonheterosexual women's masculinized body morphology, psychological dispositions, and their elevated likelihood of experiencing violence, substance use, obesity, teenage pregnancy, and lower general health. This pattern of life outcomes can create a feedback loop of environmental unpredictability and harshness which destabilizes intrauterine hormonal conditions in mothers, leading to a greater likelihood of fast life history strategies, global health problems, and nonheterosexual preferences in female offspring. We further explore the potential of female nonheterosexuality to function as an alloparental buffer that enables masculinizing alleles to execute their characteristic fast life history strategies as they appear in the female and the male phenotype. Synthesizing life history theory with the female sexual orientation spectrum enriches existing scientific knowledge on the evolutionary-developmental mechanisms of human sex differences.

Increasing cultural competence with LGBTQ patients

Many nurses practicing today lack basic education about LGBTQ (lesbian, gay, bisexual, transgender, queer) patient care. How can they better prepare to care for this population? This article provides insight on LGBTQ people, their health risks and disparities, and how nurses can work with LGBTQ patients to improve outcomes.

Genetic Counselors' and Genetic Counseling Students' Implicit and Explicit Attitudes toward Homosexuality

Members of the lesbian, gay, and bisexual (LGB) community experience significant health disparities. Widespread preferences for heterosexual over homosexual people among healthcare providers are believed to contribute to this inequity, making recognition (and ultimately reduction) of healthcare providers' sexual prejudices of import. The present study sought to characterize North American genetic counselors' and genetic counseling students' implicit and explicit attitudes toward homosexuality. During January 2017, 575 participants completed a Web-based survey and Sexuality Implicit Association Test (SIAT). A majority of participants (60.2%) harbored implicit preferences for heterosexual over homosexual people. Mean implicit attitude score (0.24) indicated a slight automatic preference for heterosexual over homosexual people, while mean explicit attitude score (0.033) indicated no preference for either group. Although participants' implicit and explicit attitudes were positively correlated (p < 0.001), there was greater implicit bias for heterosexual over homosexual people than suggested by explicit attitude scores (p < 0.001). Implicit attitudes differed across self-reported sexual orientation (p < 0.001), but not across gender, race, or genetic counseling specialty. Education has been demonstrated to be moderately effective at reducing sexual prejudices, and almost all participants (95.8%) indicated that they would support the implementation of genetic counseling curricula addressing lesbian, gay, bisexual, and transgender (LGBT) issues. The study's combined findings suggest that North American genetic counselors and genetic counseling students support, and may benefit from, the implementation of genetic counseling curricula addressing LGBT issues.

Sexual orientation and sex differences in socioeconomic status: a population-based investigation in the National Longitudinal Study of Adolescent to Adult Health

BACKGROUND

Socioeconomic status (SES) is a fundamental contributor to health; however, limited research has examined sexual orientation differences in SES.

METHODS

2008-2009 data from 14 051 participants (ages 24-32 years) in the US-based, representative, National Longitudinal Study of Adolescent to Adult Health were analysed using multivariable regressions that adjusted for age, race-ethnicity, childhood SES, urbanicity and Census region, separately for females and males. Modification by racial minority status (black or Latino vs white, non-Hispanic) was also explored.

RESULTS

Among females, sexual minorities (SM) (10.5% of females) were less likely to graduate college, and were more likely to be unemployed, poor/near poor, to receive public assistance and to report economic hardship and lower social status than heterosexuals. Adjusting for education attenuated many of these differences. Among males, SM (4.2% of males) were more likely than heterosexuals to be college graduates; however, they also had lower personal incomes. Lower rates of homeownership were observed among SM, particularly racial minority SM females. For males, household poverty patterns differed by race-ethnicity: among racial minority males, SM were more likely than heterosexuals to be living at >400% federal poverty level), whereas the pattern was reversed among whites.

CONCLUSIONS

Sexual minorities, especially females, are of lower SES than their heterosexual counterparts. SES should be considered a potential mediator of SM stigma on health. Studies of public policies that may produce, as well as mitigate, observed SES inequities, are warranted.

Biological origins of sexual orientation and gender identity: Impact on health

Gynecologic Oncologists are sometimes consulted to care for patients who present with diverse gender identities or sexual orientations. Clinicians can create more helpful relationships with their patients if they understand the etiologies of these diverse expressions of sexual humanity. Multidisciplinary evidence reveals that a sexually dimorphic spectrum of somatic and neurologic anatomy, traits and abilities, including sexual orientation and gender identity, are conferred together during the first half of pregnancy due to genetics, epigenetics and the diversity of timing and function of sex chromosomes, sex-determining protein secretion, gonadal hormone secretion, receptor levels, adrenal function, maternally ingested dietary hormones, fetal health, and many other factors. Multiple layers of evidence confirm that sexual orientation and gender identity are as biological, innate and immutable as the other traits conferred during that critical time in gestation. Negative social responses to diverse orientations or gender identities have caused marginalization of these individuals with resultant alienation from medical care, reduced self-care and reduced access to medical care. The increased risks for many diseases, including gynecologic cancers are reviewed. Gynecologic Oncologists can potentially create more effective healthcare relationships with their patients if they have this information.

Prevalence of Obesity, Prediabetes, and Diabetes in Sexual Minority Women of Diverse Races/Ethnicities: Findings From the 2014-2015 BRFSS Surveys

Purpose

The purpose of this study is to assess the weighted prevalence and odds ratios of obesity, prediabetes, and diabetes by (1) female sexual orientation (lesbian, bisexual, and straight) with racial/ethnic (Hispanic, non-Hispanic black, and non-Hispanic white) groups combined and (2) across and within racial/ethnic groups by sexual orientation.

Methods

A secondary analysis of pooled 2014-2015 Behavioral Risk Factor Surveillance System data from 28 states (N = 136 878) was conducted. Rao-Scott chi-square test statistics were computed and logistic regression models were developed to assess weighted prevalence and odds ratios of obesity, prediabetes, and diabetes with adjustments for demographics (age, income, and education), depression, and health care access factors.

Results

With racial/ethnic groups combined, lesbian and bisexual women, relative to straight women, had a significantly increased likelihood for obesity when controlling for demographics. Bisexual women were found to have significantly reduced odds for diabetes, compared with straight women, with adjustments for demographics, depression, and health care access factors. Compared with their non-Hispanic white counterparts, Hispanic lesbian women had significantly increased odds for obesity and diabetes, while non-Hispanic black bisexual women had a significantly greater likelihood for obesity, holding demographics, depression, and health care access factors constant. Non-Hispanic white lesbian women had an increased likelihood for obesity relative to their straight, ethnic/racial counterparts. Prediabetes subsample analysis revealed the prevalence was low across all female sexual orientation groups.

Conclusion

Sexual minority women, particularly those of color, may be at increased risk for obesity and diabetes. Research is needed to confirm the findings.

Health Care of Sexual Minority Women

Sexual minority women may be invisible in health care settings unless practitioners ask every patient about sexual attractions/behaviors and identity. Sexual minority women need to feel comfortable and able to share information about their sexual identity, partners, and lives. No medical diagnoses are found more commonly in sexual minority women, but problems such as overweight/obesity, increased tobacco and alcohol use, increased mental health problems, and a past history of childhood sexual abuse are common. These factors intertwine when treating sexual minority women.

A Systematic Scoping Review of Engagement in Physical Activity Among LGBTQ+ Adults

BACKGROUND

LGBTQ+ (lesbian, gay, bisexual, transgender, queer, etc) persons are subject to elevated rates of chronic diseases and health concerns that can be addressed through regular participation in physical activity. However, LGBTQ+ adults experience unique challenges to engaging in physical activity. Subsequently, the aim of this study is to describe the dominant narratives related to the complex intersection of sexual orientation, gender identity, and physical activity.

METHODS

A systematic search and scoping review of existing literature was conducted in June 2016. Studies were identified by searching 9 electronic databases. Data were then extracted, summarized, and organized by LGBTQ+ subgroups. Conceptual maps of prominent narratives were created.

RESULTS

Separate narratives were identified for sexual minority men and women. The dominant trend for sexual minority men was increased physical activity levels, often motivated by a perceived body ideal of being thin and/or muscular. The dominant trend for sexual minority women was decreased physical activity levels, predicated on a social norm that emphasizes bodily acceptance.

CONCLUSIONS

Sexual orientation affects engagement in physical activity differentially by gender. Our findings suggest that physical activity interventions should be targeted to unique subgroups of the LGBTQ+ population.

Healthy Weight in Lesbian and Bisexual Women Aged 40 and Older: An Effective Intervention in 10 Cities Using Tailored Approaches

BACKGROUND

Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks.

METHODS

Overweight women aged 40 or older who self-identified as lesbian, bisexual, or "something else" participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables, sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report.

ANALYTICAL PLAN

Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models.

RESULTS

Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer (n = 43) and mindfulness (n = 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18-2.36; p = .004; RR, 1.38; 95% CI, 1.01-1.89; p = .042, respectively) and those in the gym program (n = 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97-3.68, p = .06) compared with the comparison group (n = 67).

CONCLUSION

This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.

Methodological Issues in Identifying Sexuality for Research

Sexuality is a complex concept that can be measured based on various aspects. Depending on the variable of interest, investigators may wish to focus on sexual behavior (activity), sexual orientation (attraction to a particular gender), or sexual identity (self-identification with a particular group of people). Further complicating the process is the fact that these aspects of sexuality are not always congruent with one another. Lesbian, gay, and bisexuals (LGB) are sexual minorities that have been identified as one of several groups that experience health disparities. For researchers working with the LGB population, properly identifying and defining which aspect of sexuality is of interest to the investigator is paramount in obtaining accurate outcomes.

Sexual Minority Health and Health Risk Factors: Intersection Effects of Gender, Race, and Sexual Identity

INTRODUCTION

Although population studies have documented the poorer health outcomes of sexual minorities, few have taken an intersectionality approach to examine how sexual orientation, gender, and race jointly affect these outcomes. Moreover, little is known about how behavioral risks and healthcare access contribute to health disparities by sexual, gender, and racial identities.

METHODS

Using ordered and binary logistic regression models in 2015, data from the 2013 and 2014 National Health Interview Surveys (n=62,302) were analyzed to study disparities in self-rated health and functional limitation. This study examined how gender and race interact with sexual identity to create health disparities, and how these disparities are attributable to differential exposure to behavioral risks and access to care.

RESULTS

Conditional on sociodemographic factors, all sexual, gender, and racial minority groups, except straight white women, gay white men, and bisexual non-white men, reported worse self-rated health than straight white men (p<0.05). Some of these gaps were attributable to differences in behaviors and healthcare access. All female groups, as well as gay non-white men, were more likely to report a functional limitation than straight white men (p<0.05), and these gaps largely remained when behavioral risks and access to care were accounted for. The study also discusses health disparities within sexual, gender, and racial minority groups.

CONCLUSIONS

Sexual, gender, and racial identities interact with one another in a complex way to affect health experiences. Efforts to improve sexual minority health should consider heterogeneity in health risks and health outcomes among sexual minorities.

Rates and Predictors of Obesity Among African American Sexual Minority Women

PURPOSE

The purpose of this study is to examine rates of and risk factors for obesity in a community sample of African American sexual minority women (SMW).

METHODS

Data were collected using self-administered paper-and-pencil survey questionnaires (n = 219).

RESULTS

Participants were primarily middle aged (M = 40.1; standard deviation [SD] = 10.5 years), well educated (56.9% with a college education and above), insured (82.3%), and had a median income range from $30,000 to $39,999. The mean body mass index (BMI) of the sample was 31.6 (SD = 8.0). Based on BMI scores, over half of the participants were identified as obese (53.9%) and 25.6% were overweight. A number of comorbid illnesses were reported that could be exacerbated by excess weight, including arthritis (21.3%), adult-onset diabetes (4.9%), back problems (23.2%), high cholesterol (15.3%), high blood pressure (19.2%), and heart disease (12%). Multiple risk factors for obesity were observed, including infrequent exercise (<3 times/week = 50.9%), low levels of fruit/vegetable consumption (≤1 serving daily = 39.9%), and frequent consumption of red meat (≥3 times/week = 21.2%). Psychosocial risk factors were also reported, including "eating in response to stress" (46.0%). Depression scores predicted eating in response to stress. One-third of the sample reported interest in weight management interventions.

CONCLUSIONS

African American SMW report high rates of obesity, chronic health conditions exacerbated by weight, and health and dietary behaviors that increase risk for weight-related health disparities. These study findings have implications for additional research and intervention development.

Differences in Psychosocial Predictors of Obesity Among LGBT Subgroups

PURPOSE

The purpose of the current study was to examine the overall presence of and differences in rates of overweight/obesity among a large, nationally diverse sample of lesbian, gay, bisexual, transgender (LGBT)-identified individuals (i.e., cisgender lesbians, cisgender gay men, cisgender bisexual women, cisgender bisexual men, transgender women, and transgender men) and to identify specific psychosocial predictors of obesity within each of the six LGBT subgroups.

METHODS

A total of 2702 LGBT-identified participants participated in the online study. Participants completed a series of demographic questions (including weight and height) and the Depression Anxiety Stress Scale 21.

RESULTS

The percentage of participants who were overweight/obese did not differ significantly across LGBT subgroups, with 61.1% of the total sample being overweight/obese. However, the percentage of participants who self-reported body mass indexes in the obese range differed significantly across the six LGBT subgroups, with the highest prevalence in transgender men (46.0%). In addition, the predictors of obesity varied by subgroup, with age a significant predictor for cisgender lesbians, cisgender gay men, and cisgender bisexual women, relationship status for cisgender bisexual women, employment status for both cisgender gay men and cisgender bisexual women, education level for cisgender lesbians, and depression, anxiety, and stress for cisgender gay men. None of the examined psychosocial factors emerged as predictors of obesity for cisgender bisexual men, transgender women, or transgender men.

CONCLUSION

These findings suggest that there are substantial variations in the presence and predictors of obesity across LGBT subgroups that support the need for culturally tailored healthy weight promotion efforts within the LGBT community.

Binge Eating and Overweight and Obesity Among Young Adult Lesbians

PURPOSE

Lesbians are more likely to be obese compared to heterosexual women, but little research has examined correlates of obesity among lesbians. The purpose of this study was to examine the association of binge eating and overweight and obesity among lesbians.

METHODS

Self-identified lesbians (N = 377) between the ages of 18-30 completed an online survey.

RESULTS

Binge eating was a salient predictor of both overweight and obesity after controlling for demographic variables, outness, diet, and physical activity.

CONCLUSION

Health promotion and weight loss intervention programs for lesbians should assess binge eating behaviors as a possible contributor to overweight and obesity.

Primary care of women who have sex with women. Recommendations from the research

Research on women who have sex with women has increased in the last decade. Attention has been brought to this group of women through the IOM report, which noted a lack of research related to their care. Most of the research has not been published in nursing literature. This article reviews this literature with recommendations for primary care practice.

Understanding same-sex male and female partners' restrained eating in the context of their relationships

This study examined weight status and dietary restraint among same-sex couples using Actor-Partner Interdependence Models. Body mass indices and restrained eating behaviors (i.e., cognitive dietary restraint, uncontrolled eating, and emotional eating) were assessed for members of 144 same-sex couples (72 lesbian and 72 gay couples; mean age = 33.74 years, standard deviation = 11.27 years). Results indicated that both men and women who were relatively heavy and who had relatively thin partners were at particular risk of engaging in restrained eating. These findings extend our understanding of partner comparison processes within the context of same-sex relationships in determining men and women's eating behaviors.

Sexual Minority Women's Health Behaviors and Outcomes After Breast Cancer

PURPOSE

Sexual minority women (e.g., lesbians, bisexual women, and women who prefer a female partner) are a known risk population for overweight, obesity, and mental health problems. Our objective is to compare sexual minority women with breast cancer to a control sample of sexual minority women without cancer to identify differences in healthful lifestyle practices, weight, well-being and mental health.

METHODS

This is a cross-sectional study of 85 sexual minority women with a breast cancer history (cases) matched by age and partner status to 85 sexual minority controls without cancer. We compared self-reported physical activity, fruit and vegetable intake, weight, quality of life, anxiety, and depression.

RESULTS

Cases and controls had similar health behaviors, BMI, quality of life, anxiety, and depression. Of the weight-related behaviors, meeting the recommended guidelines of physical activity was significantly associated with lower likelihood of being overweight or obese, less depression, and better mental quality of life.

CONCLUSIONS

Sexual minority women with breast cancer are similar to sexual minority women without cancer with respect to healthful behaviors, body weight, anxiety, depression, and quality of life. Lifestyle interventions to reduce the risk of poor outcomes after cancer should be implemented in this population as well as in sexual minority women without cancer.

Minority Stress, Depression, Relationship Quality, and Alcohol Use: Associations with Overweight and Obesity Among Partnered Young Adult Lesbians

PURPOSE

Although lesbian women are more likely to be obese compared to heterosexual women, relatively little research has examined correlates of overweight and obesity among lesbians. The purpose of this study was to examine the association of minority stress and depression, relationship quality, and alcohol-use variables to overweight and obesity among lesbians in relationships.

METHOD

Self-identified lesbians (n=737) in current relationships completed measures of demographics, minority stress, depressive symptoms, relationship variables, and alcohol use.

RESULTS

Overweight and obesity were associated with more public identification as a lesbian, more depressive symptoms, increased heavy drinking, longer relationship length, and lower relationship consensus.

CONCLUSION

Health promotion and weight loss intervention programs for lesbians should incorporate psychological, relationship, and alcohol use components to reduce overweight and obesity among lesbians.

Challenges in Intervention Research for Lesbian and Bisexual Women

PURPOSE

More than one-third of U.S. adults are obese, the highest prevalence occurring among women age 60 and older (42.3%), and women ages 40 to 59 (36.0%). This issue is even more pronounced among lesbian and bisexual (LB) women. Studies suggest this population may be twice as likely to be overweight or obese as heterosexual women. Despite this public health issue, little has been done to reduce overweight and obesity in LB women.

METHODS

During the design of healthy-weight interventions aimed at reducing overweight and obesity in older LB women through increased physical activity and improved nutrition, we conducted a systematic review of health interventions targeting older LB women to identify and describe core characteristics present in such interventions. We identified 878 articles and studies as potentially relevant to our review and evaluated them for inclusion in our analysis. We analyzed five interventions, including two on smoking cessation and one each on physical activity, breast cancer screening, and alcohol abuse.

RESULTS

Results indicate that, regardless of desired health outcome, typical intervention characteristics included: social support, education, goal setting, peer-based facilitation, and lesbian, gay, bisexual, and transgender (LGBT)-friendly intervention environments.

CONCLUSION

The lack of health interventions in this population is disconcerting. Coupled with the high and disparate prevalence of overweight and obesity in LB women, the lack of published evidence of efforts targeting this population presents a critical opportunity for policymakers and researchers to respond to this public health concern.

Evidence of Syndemics and Sexuality-Related Discrimination Among Young Sexual-Minority Women

PURPOSE

Syndemics, or the co-occurrence and interaction of health problems, have been examined extensively among young men who have sex with men, but their existence remain unexamined, to our knowledge, among sexual-minority (i.e., lesbian, gay, and bisexual) women. Thus, we investigated if syndemics were present among young sexual-minority women, and if sexual-orientation discrimination was an independent variable of syndemic production.

METHODS

A total of 467 sexual-minority women between the ages of 18 and 24 completed a cross-sectional online survey regarding their substance use, mental health, sexual behaviors, height, weight, and experiences of discrimination. We used structural equation modeling to investigate the presence of syndemics and their relationship to sexual-orientation discrimination.

RESULTS

Heavy episodic drinking, marijuana use, ecstasy use, hallucinogen use, depressive symptoms, multiple sexual partners, and history of sexually transmitted infections (STIs) comprised syndemics in this population (chi-square=24.989, P=.201; comparative fit index [CFI]=0.946; root mean square error of approximation [RMSEA]=0.023). Sexual-orientation discrimination is significantly and positively associated with the latent syndemic variable (unstandardized coefficient=0.095, P<.05), and this model fit the data well (chi-square=33.558, P=.059; CFI=0.914; RMSEA=0.029). The reverse causal model showed syndemics is not an independent variable of sexual-orientation discrimination (unstandardized coefficient=0.602, P>.05).

CONCLUSIONS

Syndemics appear to be present and associated with sexual-orientation discrimination among young sexual-minority women. Interventions aimed at reducing discrimination or increasing healthy coping may help reduce substance use, depressive symptoms, and sexual risk behaviors in this population.

An Examination of Past and Current Influences of Rurality on Lesbians' Overweight/Obesity Risks

PURPOSE

The purpose of our study was to separately examine past (i.e., rural or non-rural background) and present (i.e., current rural or urban location) influences of rurality on the weight status and diet/exercise behaviors of lesbians.

METHODS

A total of 895 lesbians participated in the online study. Participants were surveyed regarding their rurality status, weight/height, and diet/exercise patterns. A 2×2 (location×background) ANCOVA was conducted to explore influences of rurality on body mass index (BMI), while controlling for age, race, and education. Chi-square analyses were used to examine the relationship between dimensions of rurality and diet/exercise behaviors.

RESULTS

There was a significant main effect of current location on BMI. No significant interaction between location and background on BMI was found nor was there a significant main effect of background. Lesbians currently living in rural areas were on average obese (M=30.61), with significantly higher BMIs than urban-residing lesbians (M=28.53). The only significant differences that emerged for lesbians' diet/exercise patterns were for current location-more rural-residing lesbians reported they never engage in exercise in comparison to their urban-residing counterparts, with a greater percentage of urban-residing lesbians reporting frequent exercise. Rural lesbians were also more likely to report a diet high in protein.

CONCLUSION

Findings suggest that current rather than past influences of rurality may have a significant impact on lesbians' weight and diet/exercise behaviors and highlight significant obesity-related health disparities for rural-residing lesbians. These findings offer support for the development of culturally-appropriate healthy diet/exercise and weight promotion efforts that are accessible to rural lesbians.

An ecological framework for sexual minority women's health: factors associated with greater body mass

In recent years, many studies have focused on the body of sexual minority women, particularly emphasizing their larger size. These studies rarely offer theoretically based explanations for the increased weight, nor study the potential consequences (or lack thereof) of being heavier. This article provides a brief overview of the multitude of factors that might cause or contribute to larger size of sexual minority women, using an ecological framework that elucidates upstream social determinants of health as well as individual risk factors. This model is infused with a minority stress model, which hypothesizes excess strain resulting from the stigma associated with oppressed minority identities such as woman, lesbian, bisexual, woman of color, and others. We argue that lack of attention to the upstream social determinants of health may result in individual-level victim blaming and interventions that do not address the root causes of minority stress or increased weight.

Application of the Rosner-Wei risk-prediction model to estimate sexual orientation patterns in colon cancer risk in a prospective cohort of US women

PURPOSE

We examined whether lesbian and bisexual women may be at greater risk of colon cancer (CC) than heterosexual women.

METHODS

Working with a large cohort of US women ages 25-64 years, we analyzed 20 years of prospective data to estimate CC incidence, based on known risk factors by applying the Rosner-Wei CC risk-prediction model. Comparing to heterosexual women, we calculated for lesbian and bisexual women the predicted 1-year incidence rate (IR) per 100,000 person-years and estimated incidence rate ratios (IRR) and 95 % confidence intervals (CI), based on each woman's comprehensive risk factor profile.

RESULTS

Analyses included 1,373,817 person-years of data from 66,257 women. For each sexual orientation group, mean predicted 1-year CC IR per 100,000 person-years was slightly over 12 cases for each of the sexual orientation groups. After controlling for confounders in fully adjusted models and compared with heterosexuals, no significant differences in IRR were observed for lesbians (IRR 1.01; 95 % CI 0.99, 1.04) or bisexuals (IRR 1.01; 95 % CI 0.98, 1.04).

CONCLUSIONS

CC risk is similar across all sexual orientation subgroups, with all groups comparably affected. Health professionals must ensure that prevention, screening, and treatment programs are adequately reaching each of these communities.

Broadening definitions of family for older lesbians: modifying the Lubben social network scale

Lesbian seniors have triple vulnerability (gender, sexual orientation, and age), necessitating inquiry into their social support needs, yet research about that is scare. Investigators identify relationships between social support and senior health. The Lubben Social Network Scale, Revised (LSNS-R), has provided such evidence and has been used to study many diverse senior groups. We modified it to include a Family of Choice category and qualitative questions to give context to responses among a sample of older lesbians. Our pilot demonstrated that the modification made a difference in accurately measuring social support among the sample, yet further investigation is warranted.

Sexual orientation disparities in BMI among U.S. adolescents and young adults in three race/ethnicity groups

Obesity is a key public health issue for US youth. Previous research with primarily white samples of youth has indicated that sexual minority females have higher body mass index (BMI) and sexual minority males have lower BMI than their same-gender heterosexual counterparts, with sexual orientation differences in males increasing across adolescence. This research explored whether gender and sexual orientation differences in BMI exist in nonwhite racial/ethnic groups. Using data from Waves I-IV (1995-2009) of the US National Longitudinal Study of Adolescent Health (N = 13,306, ages 11-34 years), we examined associations between sexual orientation and BMI (kg/m2) over time, using longitudinal linear regression models, stratified by gender and race/ethnicity. Data were analyzed in 2013. Among males, heterosexual individuals showed greater one-year BMI gains than gay males across all race/ethnicity groups. Among females, white and Latina bisexual individuals had higher BMI than same-race/ethnicity heterosexual individuals regardless of age; there were no sexual orientation differences in black/African Americans. Sexual orientation disparities in BMI are a public health concern across race/ethnicity groups. Interventions addressing unhealthy weight gain in youth must be relevant for all sexual orientations and race/ethnicities.

Are they family or friends? Social support instrument reliability in studying older lesbians

We know little about the support needs and health of older lesbians because participant sexual identity has typically not been identified in aging studies. The Lubben Social Network Scale, Revised (LSNS-R) is found widely reliable for testing perceived social support among elders but has never been tested with an exclusively lesbian population. This pilot tested the instrument with an exclusively lesbian population in the Midwest. Our analysis suggests it may not be reliable with this population, even with minor modifications that were made. Further examination adding a category for "family of choice" is warranted and supported by the originator of the tool.

Culturally (in)competent? Dismantling health care barriers for sexual minority women

Lesbian and bisexual (LB) women exhibit elevated rates of a variety of behaviors (i.e., smoking, excessive caloric intake, physical inactivity, heavy alcohol consumption) that put them at risk for adverse health consequences. Furthermore, LB women experience numerous barriers to obtaining culturally competent health care. In this article we review risk behaviors and health care barriers and we discuss the role of stress as an important contributing factor in LB women's health outcomes. We suggest future research, health care delivery changes, and training improvements that will prepare social workers to effectively address the needs of their LB clients.

Educational attainment and obesity: a systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Sociodemographic and lesbian-specific factors associated with physical activity among adult lesbians

BACKGROUND

Although participation in moderate and vigorous physical activity (MVPA) results in health benefits, the majority of adult lesbians are not sufficiently active. The purpose of this study was to examine the relationships between sociodemographic factors (age, education level, body mass index [BMI], race, partner status, employment status, annual household income, general health status, diagnosis of chronic conditions, children under 18 years living at home) and lesbian-specific factors (connection with the lesbian community, public identification as a lesbian) to participation in MVPA.

METHODS

Participants included 847 self-identified lesbians 18 to 74 years old (M(age) = 40.5; SD = 11.6) who completed a 20-minute, web-based survey.

FINDINGS

The binary logistic regression model that included the 10 demographic factors was significantly associated with MVPA, χ(2) (15, N = 847) = 105.62, p < .001. However, when the two lesbian-specific factors were added, the model did not improve significantly, χ(2) (2, N = 847) = 5.20, p = .07. BMI and general health status were significantly associated with MVPA (Wald χ(2) (2) = 19.5, p < .001) and (Wald χ(2) (4) = 41.2, p < .001). Obese participants had 54.5% lower odds than healthy weight participants to engage in sufficient amounts of MVPA. Participants who reported general health status as excellent compared with those who reported poor had 12.7 times greater odds of engaging in sufficient amounts of MVPA.

CONCLUSIONS

Future research should extend on this study by utilizing sampling methods that target the recruitment of lesbian women not actively involved in lesbian-related activities.

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

OBJECTIVES

We examined purging for weight control, diet pill use, and obesity across sexual orientation identity and ethnicity groups.

METHODS

Anonymous survey data were analyzed from 24 591 high school students of diverse ethnicities in the federal Youth Risk Behavioral Surveillance System Survey in 2005 and 2007. Self-reported data were gathered on gender, ethnicity, sexual orientation identity, height, weight, and purging and diet pill use in the past 30 days. We used multivariable logistic regression to estimate odds of purging, diet pill use, and obesity associated with sexual orientation identity in gender-stratified models and examined for the presence of interactions between ethnicity and sexual orientation.

RESULTS

Lesbian, gay, and bisexual (LGB) identity was associated with substantially elevated odds of purging and diet pill use in both girls and boys (odds ratios [OR] range = 1.9-6.8). Bisexual girls and boys were also at elevated odds of obesity compared to same-gender heterosexuals (OR = 2.3 and 2.1, respectively).

CONCLUSIONS

Interventions to reduce eating disorders and obesity that are appropriate for LGB youths of diverse ethnicities are urgently needed.

The promotion of unhealthy habits in gay, lesbian, and straight intimate partnerships

Health habits are linked to nearly half of U.S. and British deaths annually. While a legacy of research suggests that marriage has important positive consequences for health habits, recent work emphasizes that intimate ties can also deter from healthy habits and promote unhealthy habits. However, few studies examine the mechanisms through which unhealthy habits are promoted in marriage. Moreover, little research explores how unhealthy habits are promoted in intimate ties other than marriage-such as in gay and lesbian cohabiting relationships. The present study analyzes the mechanisms through which gay, lesbian, and straight long-term partners (N = 120) contribute to one another's unhealthy habits. Three distinct mechanisms emerge. First, respondents identify a process of unilateral health habit diffusion wherein one partner's health habits directly influence the other partners' habits. Second, respondents describe bilateral unhealthy habit diffusion, wherein both partner's unhealthy habits are reinforced via mutual pleasure seeking or mutual failed motivation. Third, respondents describe a discourse of personal responsibility, wherein both partners purposefully fail to deter one another's unhealthy habits. Analysis further illustrates how these mechanisms operate differently for men and women in gay, lesbian, and straight relationships.

Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources

Lesbian, gay, bisexual, and transgender (LGBT) persons, while widely diverse in many ways, share health disparities related to the stigma and discrimination they experience, including disproportionate rates of psychiatric disorders, substance abuse, and suicide. Lesbians, gay men, bisexuals, and the transgender communities have additional health concerns and disparities unique to each population. This paper highlights the national recognition of these health issues and disparities and presents web-based information resources about them and their mitigation.

Risk of breast cancer mortality among women cohabiting with same sex partners: findings from the National Health Interview Survey, 1997-2003

BACKGROUND

Lesbians and bisexual women are more likely than other women to evidence a unique mix of common breast cancer risk factors. It is not known if this results in greater breast cancer mortality risk. We investigate possible sexual orientation-related differences in risk for fatal breast cancer in a large representative U.S. sample of married and cohabiting women.

METHODS

Between 1997 and 2003, the National Health Interview Survey (NHIS) interviewed married or cohabiting female participants, aged 18-80 years inclusively, who reported either a male (n=136,174) or female (n=693) coresidential relationship partner. These records are linked to the National Death Index to provide information on mortality status as of December 31, 2006. Employing these data, we estimated the age-adjusted relative risk (RR) and its 95% confidence interval (CI) for mortality attributed to breast cancer using a Cox proportional hazard model.

RESULTS

Women in same-sex couples, compared to women in different-sex relationships, had greater age-adjusted risk for fatal breast cancer (RR=3.2, CI 1.01-10.21) but did not differ in their overall risk for mortality.

CONCLUSIONS

Our findings provide tentative support that sexual orientation is differentially linked to risk of fatal breast cancer. These findings underscore the need to investigate further breast cancer morbidity and mortality risk among women with minority sexual orientation.

Older lesbians: experiences of aging, discrimination and resilience

Older lesbians are, at minimum, a triple threat of marginalization due to ageism, heterosexism, and sexism. A national survey specific to this often-invisible population has not occurred in over 25 years. The present study was completed to reveal the needs, strengths, and experiences of the current cohort of older lesbians. Four hundred fifty-six older lesbians responded to an online survey on topics including sociodemographics, social activity, health, sexual identity, family relationships, romantic relationships, service/program use, mental health, end-of-life care, and discrimination. The results and implications are included as well as a comparison to the last studied cohort.

Perceived discrimination is associated with binge eating in a community sample of non-overweight, overweight, and obese adults

OBJECTIVE

The present study examined the relationship between experiences of discrimination and occurrence of binge eating among overweight and obese persons, a population which has previously shown elevated rates of binge eating.

METHODS

Internet-based questionnaires were used to measure frequency and impact of discrimination, binge eating frequency, and emotional eating.

RESULTS

Pearson correlation analyses demonstrated significant positive relationships between the measures of discrimination and measures of eating behaviors (r = 0.12-0.37). Regression models significantly predicted between 17 and 33% of the variance of emotional eating scores and frequency of binge eating; discrimination measures contributed significantly and independently to the variance in emotional eating and binge eating. Weight bias internalization was found to be a partial mediator of the relationship between discrimination and eating disturbance.

CONCLUSION

Results demonstrate the relationship of discrimination to binge eating. Weight bias internalization may be an important mechanism for this relationship and a potential treatment target.

Gender, health behavior, and intimate relationships: lesbian, gay, and straight contexts

Many studies focus on health behavior within the context of intimate ties. However, this literature is limited by reliance on gender socialization theory and a focus on straight (i.e., heterosexual) marriage. We extend this work with an analysis of relationship dynamics around health behavior in 20 long-term straight marriages as well as 15 gay and 15 lesbian long-term cohabiting partnerships in the United States (N = 100 individual in-depth interviews). We develop the concept of "health behavior work" to align activities done to promote health behavior with theories on unpaid work in the home. Respondents in all couple types describe specialized health behavior work, wherein one partner works to shape the other partner's health behavior. In straight couples, women perform the bulk of specialized health behavior work. Most gay and lesbian respondents-but few straight respondents--also describe cooperative health behavior work, wherein partners mutually influence one another's health behaviors. Findings suggest that the gendered relational context of an intimate partnership shapes the dynamics of and explanations for health behavior work.

Adult health behaviors over the life course by sexual orientation

OBJECTIVES

We estimated differences in health behaviors among adults by sexual orientation.

METHODS

We pooled 4 years of data (2001, 2003, 2005, and 2007) from the California Health Interview Survey. We estimated the frequency of smoking, alcohol use, healthy dietary behaviors, physical activity, and health care utilization, and we used logistic regression modeling to determine the odds of each behavior with increasing age and for 2 age groups: younger than 50 years and 50 years old or older.

RESULTS

At any adult age, lesbians had greater odds of smoking and binge drinking than did heterosexual women, and gay and bisexual men had greater health care utilization than did heterosexual men. Other risk behaviors differed with age.

CONCLUSIONS

Some behavioral change interventions should target lesbians, gays, and bisexuals at all ages, whereas other interventions should specifically target individuals at younger ages.