Differences in Weight-Related Behavioral Profiles by Sexual Orientation Among College Men: A Latent Class Analysis

24-Hour Movement Behaviors of LGBTQA+ Young People: A Systematic Review

BACKGROUND

The movement behaviors of LGBTQA+ young people, who encounter specific health, and other, challenges are not well understood. This systematic review examines the 24-hour movement behaviors of LGBTQA+ young people compared with population estimates of meeting the 24-hour movement guidelines.

METHODS

Seven electronic databases were searched from inception to January 2024. Observational studies published in English and reporting quantitative data for physical activity, sedentary behavior, or sleep duration for LGBTQA+ individuals <24 years old were included. Data were narratively synthesized for children/adolescents (<18 years) and young adults (18-24 years), guided by the Cochrane Synthesis Without Meta-analysis guidelines.

RESULTS

Fifty-six studies were included; 46 were of "fair" quality and 37 were conducted in the United States. Physical activity, sedentary behavior, and sleep outcomes were reported in 46, 11, and 14 studies, respectively. Ninety unique LGBTQA+ terms were identified. Based on outcomes reported in ≥1 study, and compared to population estimates, LGBTQA+ young people were less likely to meet aerobic physical activity and strength/resistance training guidelines. LGBTQA+ children/adolescents were less likely to meet the sleep guidelines. Young adults demonstrated similar adherence to sleep guidelines as population estimates.

CONCLUSIONS

Overall, our results suggest that LGBTQA+ young people have suboptimal 24-hour movement behaviors; in some cases, worse than population estimates. Utilization of more robust measures of exposure and outcome variables is recommended, with a focus on sleep and sedentary behavior.

What Is Healthy Eating? Exploring Profiles of Intuitive Eating and Nutritionally Healthy Eating in College Women

PURPOSE

Research suggests that food's nutritional content and the feelings and behaviors associated with eating contribute to overall health, yet these constructs are rarely considered simultaneously. The current cross-sectional study investigated healthy eating profiles in college women that included both nutritional quality and intuitive eating (IE), with IE being an eating style that prioritizes physiological hunger/satiety cues and minimizes dieting and emotional eating.

DESIGN/SETTING/SUBJECTS

Undergraduate women (n=352) completed an online assessment and daily diaries (80% retention).

MEASURES

Nutritionally healthy eating, IE, dieting, body dissatisfaction, disordered eating, and psychological health were examined.

ANALYSIS

Latent profile analysis explored patterns of nutritionally healthy eating and IE, and determined how these patterns related to psychological and eating disorder outcomes.

RESULTS

A four-profile solution emerged: 1) Dieting (high nutritionally healthy eating + intermediate IE), 2) Unhealthy Eating (low nutritionally healthy eating + low IE), 3) Intuitive Eating (moderately high nutritionally healthy eating + high IE), and 4) Non-Dieting (low nutritionally healthy eating + intermediate IE). These profiles significantly differed from one another, such that the Intuitive Eating and Non-Dieting profiles reported lower psychological distress, BMI, and eating disorder symptoms compared to other profiles, while the Dieting and Unhealthy Eating profiles showed the healthiest and poorest nutritional eating, respectively.

CONCLUSION

These findings suggest that IE and nutritionally healthy eating are distinct factors in conceptualizing the eating patterns of college women, and both should be considered when developing interventions. Future research should replicate these findings in larger/more diverse samples and examine eating profiles longitudinally.

College Climate and Sexual Orientation Differences in Weight Status

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

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSES PERFORMED

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Differences in Chronic Disease Behavioral Indicators by Sexual Orientation and Sex

CONTEXT

Lesbian, gay, and bisexual (LGB) populations experience significant health inequities in preventive behaviors and chronic disease compared with non-LGB populations.

OBJECTIVES

To examine differences in physical activity and diet by sexual orientation and sex subgroups and to assess the influences of home and neighborhood environments on these relationships.

DESIGN

A population-based survey conducted in 2013-2014.

SETTING

A stratified, simple, random sample of households in 20 sites in the United States.

PARTICIPANTS

A total of 21 322 adult LGB and straight-identified men and women.

OUTCOME MEASURES

Any leisure-time physical activity in the past month; physical activity 150 min/wk or more; daily frequency of consumption of vegetables, fruit, water, and sugar-sweetened beverages; and the number of meals prepared away from home in the past 7 days.

RESULTS

Physical activity and diet varied by sexual orientation and sex; differences persisted after adjusting for sociodemographic factors and household and community environments. Bisexual men reported a higher odds of engaging in frequent physical activity than straight men (odds ratio [OR] = 3.10; 95% confidence interval [CI], 1.57-6.14), as did bisexual women compared with straight women (OR = 1.84; 95% CI, 1.20-2.80). LGB subgroups reported residing in more favorable walking and cycling environments. In contrast, gay men and lesbian and bisexual women reported a less favorable community eating environment (availability, affordability, and quality of fruit and vegetables) and a lower frequency of having fruit or vegetables in the home. Lesbian women reported lower daily vegetable consumption (1.79 vs 2.00 mean times per day; difference = -0.21; 95% CI, -0.03 to -0.38), and gay men reported consumption of more meals prepared away from home (3.17 vs 2.63; difference = 0.53; 95% CI, 0.11-0.95) than straight women and men, respectively. Gay men and lesbian and bisexual women reported a higher odds of sugar-sweetened beverage consumption than straight men and women.

CONCLUSIONS

Findings highlight opportunities for targeted approaches to promote physical activity and mitigate differences in diet to reduce health inequities.

Relationship between weight-related behavioral profiles and health outcomes by sexual orientation and gender

OBJECTIVE

Examine relationships between weight-related factors and weight status, body dissatisfaction, chronic health conditions, and quality of life across sexual orientation and gender.

METHODS

Two- and four-year college students participated in the College Student Health Survey (n = 28,703; 2009-2013). Risk differences were calculated to estimate relationships between behavioral profiles and weight status, body satisfaction, diagnosis of a chronic condition, and quality of life, stratified by gender and sexual orientation. Four behavioral profiles, characterized as "healthier eating habits, more physically active," "healthier eating habits," "moderate eating habits," and "unhealthy weight control," were utilized based on latent class analyses, estimated from nine weight-related behavioral survey items.

RESULTS

Sexual orientation differences in weight and quality of life were identified. For example, sexual minority groups reported significantly poorer quality of life than their heterosexual counterparts (females: 22.5%-38.6% (sexual minority) vs. 19.8% (heterosexual); males: 14.3%-26.7% (sexual minority) vs. 11.8% (heterosexual)). Compared with the "healthier eating habits, more physically active" profile, the "unhealthy weight control" profile was associated with obesity, poor body satisfaction, and poor quality of life in multiple gender/sexual orientation subgroups.

CONCLUSIONS

Interventions are needed to address obesity, body dissatisfaction, and poor quality of life among sexual minority college students.