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Panza E, Olson K, Sall K, Norris A, Lillis J, Thomas JG, Dunsiger S, Fowler H, Parent H, Wing RR. Sexual Minority Women Report Higher Weight Stigma Levels Than Heterosexual Women in the National Weight Control Registry. Ann Behav Med 2024; 58:603-609. [PMID: 38990532 PMCID: PMC11305126 DOI: 10.1093/abm/kaae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Little is known about weight stigma in sexual minority women, and even less is known about weight stigma in those who have attained substantial weight loss and maintenance. PURPOSE This study examined weight stigma experiences and internalization in sexual minority women from the National Weight Control Registry (NWCR) who had lost ≥30 pounds and maintained this weight loss for ≥1 year, and compared weight stigma levels between sexual minority women versus heterosexual women in the NWCR. METHODS NWCR participants completed an electronic survey. Women who identified as a sexual minority (n = 64; 98% White; MBMI = 29 ± 8; Mage = 47 ± 13) and heterosexual women matched on body mass index (BMI), age, and race (n = 64; 98% White; MBMI = 28 ± 7; Mage = 51 ± 13) were included. Participants completed assessments of experienced and internalized weight stigma. RESULTS Generalized linear models showed that a significantly larger proportion of sexual minority women in the NWCR reported experiencing weight stigma in the past year (24.2%) compared with heterosexual women (4.7%; p < .05). Furthermore, sexual minority (vs. heterosexual) women reported significantly higher levels of internalized weight stigma (p < .001), and a greater proportion of sexual minority women (35%) reported clinically significant internalized weight stigma relative to heterosexual women (2%; p < .001). CONCLUSIONS Sexual minority women are at greater risk for experienced and internalized weight stigma than their heterosexual counterparts among women who have attained significant long-term weight loss. It is critical to expand research on weight stigma in sexual minority women.
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Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla Sall
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa Norris
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Center for Preventive and Behavioral Medicine, The Miriam Hospital, Providence, RI, USA
| | - Jason Lillis
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- College of Psychology, California Northstate University, Rancho Cordova, CA, USA
| | - John Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Halle Fowler
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychology, Brown University, Providence, RI, USA
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Hannah Parent
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychology, Brown University, Providence, RI, USA
- Infectious Diseases and Immunology, The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Zytner ZJE, Stanley JR, Grewal P, Dettmer E, Toulany A, Palmert MR, Sorbara JC. Gender diversity among adolescents with obesity in a weight management programme. Clin Obes 2024; 14:e12664. [PMID: 38622908 DOI: 10.1111/cob.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/11/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Gender dysphoria (GD) and obesity share commonalities, including associations with mental health comorbidities, disordered eating, body dissatisfaction and may intensify with physical and developmental changes during adolescence. While associations of obesity and gender diversity have been identified, rates of gender diversity among adolescents with obesity remain unclear. The aim was to examine gender diversity among adolescents with obesity in a weight management programme. A single-centre cross-sectional questionnaire study was conducted. Eligible adolescents received the Gender Identity/GD Questionnaire for Adolescents and Adults (GIDYQ-AA), a validated instrument measuring gender diversity and GD. Gender identities, sexual orientations, questionnaire scores, and frequency of GD (GIDYQ-AA score <3) were determined. The relationship of GIDYQ-AA scores and BMI Z-score (BMIz) was assessed. Of 72 consenting youth, 29 assigned females (AF) and 17 assigned males (AM) completed GIDYQ-AA and demographic questions. Seventeen (59%) AF reported non-heterosexual orientations, and 6 (21%) reported non-cisgender identities. One (6%) AM reported non-cisgender identity. Two (4%) AF individuals had GD based on GIDYQ-AA scores. GIDYQ-AA scores did not correlate with BMIz. In conclusion, adolescents with obesity, particularly AF with non-heterosexual orientation, reported high rates of non-cisgender identity and GD. Routine screening for gender-related concerns in weight management settings may be warranted.
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Affiliation(s)
- Zachary J E Zytner
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joshua R Stanley
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Preeti Grewal
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Dettmer
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alene Toulany
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark R Palmert
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julia C Sorbara
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Olson SM, Muñoz EG, Solis EC, Bradford HM. Mitigating Weight Bias in the Clinical Setting: A New Approach to Care. J Midwifery Womens Health 2024; 69:180-190. [PMID: 38087862 DOI: 10.1111/jmwh.13578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Weight bias toward patients in larger bodies is pervasive among health care providers and can negatively influence provider-patient communication, as well as patients' behavior and health outcomes. Weight bias has historical roots that perpetuate thinness and Whiteness as the cultural norm. Although weight bias remains socially acceptable in US culture, contributing factors to an individual's body size are complex and multifactorial. Providers and health care systems also consistently use body mass index (BMI) as an indicator of health status, despite its limitations and harmful effects in the clinical setting. This state of the science review presents 8 evidence-based strategies that demonstrate how to mitigate harm from weight bias and improve quality of care and health outcomes for patients living in larger bodies. Person-centered approaches to care include (1) eliminating clinical recommendations to lose weight; (2) shifting from a focus on weight to health; (3) implementing a size and weight-inclusive approach; (4) engaging in weight bias self-evaluation; (5) creating a welcoming environment for patients of all sizes; (6) seeking permission and learning the patient's story; (7) using weight-inclusive language; and (8) re-evaluating clinical guidelines and policies based on BMI. Midwives and other health care providers may benefit from training that re-imagines the delivery of health care to patients in larger bodies.
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Affiliation(s)
- Signey M Olson
- Georgetown University School of Nursing, Washington, District of Columbia
| | - Elizabeth G Muñoz
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Ellen C Solis
- University of Washington School of Nursing, Seattle, Washington
| | - Heather M Bradford
- Georgetown University School of Nursing, Washington, District of Columbia
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4
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Vinitchagoon T, Wongpipit W, Phansuea P. Gender Expression, Weight Status, and Risk of Experiencing Eating Disorders among Gender-Diverse Adults Assigned Male at Birth in Bangkok, Thailand. Nutrients 2023; 15:3700. [PMID: 37686732 PMCID: PMC10489815 DOI: 10.3390/nu15173700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
This study examines the association between gender expression, weight status, and the risk of experiencing eating disorders among gender-diverse adults assigned male at birth living in Bangkok, Thailand. Participants completed self-administered questionnaires to provide demographic data and anthropometric measures, and an Eating Attitude Test-26 (EAT-26) to determine the risk of experiencing eating disorders. The associations between gender expression, weight status, and the risk of experiencing eating disorders were analyzed using multivariable logistic regression models. No significant differences were observed in weight-related variables based on gender expression. Participants self-described as feminine/androgynous had lower odds of experiencing a high risk of eating disorders compared to those self-described as masculine (odds ratio (OR) = 0.49; 95% confidence interval (95% CI) = 0.27, 0.88). A higher body mass index (BMI) (OR = 1.07; 95% CI = 1.01, 1.14) and BMI discrepancy (OR = 1.13; 95% CI = 1.03, 1.24) were associated with higher odds of engaging in extreme weight-control behaviors. The risk of experiencing eating disorders among Thai gender-diverse adults assigned male at birth could differ across gender expression and weight status. Further research is needed to expand the understanding of these relationships and develop tailored intervention programs to mitigate the risk.
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Affiliation(s)
- Thanit Vinitchagoon
- Food and Nutrition Academic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom 73170, Thailand;
| | - Waris Wongpipit
- Department of Curriculum and Instruction, Faculty of Education, Chulalongkorn University, Bangkok 10330, Thailand;
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Phenphop Phansuea
- Food and Nutrition Academic and Research Cluster, Institute of Nutrition, Mahidol University, Nakhon Pathom 73170, Thailand;
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Hayes JF, LaRose JG, Hutchinson K, Sutherland M, Wing RR. Health, health behaviors, and medical care utilization among college students with obesity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-7. [PMID: 37437179 PMCID: PMC10784414 DOI: 10.1080/07448481.2023.2225629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/27/2023] [Accepted: 06/01/2023] [Indexed: 07/14/2023]
Abstract
Objective: The study assessed perceived health, health behaviors and conditions, and medical care utilization among students of different weight categories. Participants: Participants were college students (n = 37,583) from 58 institutions who responded to a national survey of student health behaviors. Methods: Chi-squared and mixed model analyses were completed. Results: Compared to healthy weight students, those with obesity were less likely to report excellent health and meet dietary and physical activity recommendations, and more likely to have obesity-related chronic conditions and to have attended a medical appointment in the prior 12 months. Students with obesity (84%) and overweight (70%) were more likely to be attempting weight loss compared to students of healthy weight (35%). Conclusions: Students with obesity have poorer health and health behaviors relative to students of healthy weight; students with overweight were in between. Adapting and implementing evidence-based weight management programs within colleges/universities may be beneficial for student health.
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Affiliation(s)
- Jacqueline F. Hayes
- Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond, Richmond, Virginia
| | | | - Melissa Sutherland
- College of Nursing, University of Rhode Island, Providence, Rhode Island
| | - Rena R. Wing
- Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island
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Garbarski D. The measurement of gender expression in survey research. SOCIAL SCIENCE RESEARCH 2023; 110:102845. [PMID: 36797002 DOI: 10.1016/j.ssresearch.2022.102845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
Previous research on the survey measurement of sexual orientation, gender identity, and gender expression (SOGIE) often focuses on the measurement of identity, with comparably little research focused on gender expression as a key feature of how gender is lived and experienced. This study examines the reliability and validity of survey questions about gender expression in a 2-by-5-by-2 factorial experiment that varies the question order, type of response scale, and the order of gender presentation in the response scale. The results indicate that the effect of which (side of the) scale is presented first on gender expression varies by gender for each of the unipolar items and one of the bipolar items (behavior). In addition, the unipolar items also show distinctions among the gender minority population in ratings of gender expression as well as more nuance with respect to concurrent validity in predicting health outcomes among cisgender respondents. The results of this study have implications for researchers who are interested in accounting for gender holistically in survey and health disparities research.
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Affiliation(s)
- Dana Garbarski
- Department of Sociology Loyola University Chicago 1032 W. Sheridan Rd. Chicago, IL 60660, USA.
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Williams DR, Chaves E, Greenwood NE, Kushner J, Chelvakumar G, Swaringen SE, Leibowitz SF. Care of Gender Diverse Youth with Obesity. Curr Obes Rep 2022; 11:215-226. [PMID: 36050541 DOI: 10.1007/s13679-022-00480-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The relationships between gender identity, body image, and gender expression are complex, requiring a gender affirming approach to address weight management. This purpose of this review is to describe the essentials to caring for gender diverse youth, as well as the differences and intersections among those with obesity. RECENT FINDINGS Gender-affirming hormone therapy may lead to abnormal weight gain and increased body mass index, or worsen obesity and exacerbate weight-related complications. Moreover, given the high prevalence of victimization, marginalization, and stigmatization among gender diverse people and youth with obesity, care guidelines and treatment goals should also include reducing the negative impact of social-related complications. Despite the overlap in clinical care and lived experiences that impact the health of gender diverse youth with obesity, there is very little research to help guide clinicians. Careful attention to medical and behavioral comorbidities, barriers to care, and health disparities can inform clinical practice. Future research that specifically addresses nuances to care for gender diverse youth with obesity can help to establish standards of care to address their unmet needs and further support clinicians, patients and their families.
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Affiliation(s)
- Dominique R Williams
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, USA.
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, 43210, USA.
| | - Eileen Chaves
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, USA
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
- Division of Pediatric Neuropsychology and Psychology, Nationwide Children's Hospital, Columbus, USA
| | - Nicole E Greenwood
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, USA
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Jennifer Kushner
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- THRIVE Gender Development Program, Nationwide Children's Hospital, Columbus, USA
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, USA
| | - Gayathri Chelvakumar
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
- THRIVE Gender Development Program, Nationwide Children's Hospital, Columbus, USA
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Shanna E Swaringen
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
- THRIVE Gender Development Program, Nationwide Children's Hospital, Columbus, USA
- Division of Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, USA
| | - Scott F Leibowitz
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
- THRIVE Gender Development Program, Nationwide Children's Hospital, Columbus, USA
- Division of Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, USA
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Fornander MJ, Roberts T, Egan AM, Moser CN. Weight Status, Medication Use, and Recreational Activities of Treatment-Naïve Transgender Youth. Child Obes 2022; 18:228-236. [PMID: 34762510 DOI: 10.1089/chi.2021.0155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight management behavior. This study describes the association of weight status with medication use and recreational activities among treatment-naïve, pediatric TGD patients. Methods: This study is a chart review of 277 patients [aged 9-18 years, 79.1% female sex assigned at birth (SAB), and 86.3% white] seen at a medical center from 2017 to 2020. BMI was calculated by age and SAB using CDC growth charts. BMI percentile (BMI%) and BMI z-score (BMIz) were used to define weight status. Results: By BMI% category, 3.6% patients were in the underweight range (BMI <5%); 50.5% had BMI >85%; and 30.3% had BMI >95%. Overweight and obesity rates were higher than national norms (χ2 = 15.152, p < 0.01). Female SAB participants had higher BMIz values than male SAB participants. Youth who reported watching/listening to media (t = 3.50, p < 0.01) and parent-reported creative arts involvement (t = 1.97, p = 0.05) were associated with higher BMIz values. Conversely, spending time with friends and family was associated with a lower BMIz. Over half of the patients were prescribed medications, and those patients taking medications had higher BMIz values than those not taking medications (t = -1.96, p < 0.05). Female SAB, involvement in sedentary recreational activities, and taking medications to treat gastrointestinal conditions were associated with elevated BMIz. Conclusions: Overweight/obesity is a common problem among TGD youth. TGD youth should be considered a high-risk group and targeted in obesity prevention and treatment efforts. Interventions to decrease sedentary activities and improve connections with friends and family are promising strategies to address overweight and obesity among TGD youth.
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Affiliation(s)
- Mirae J Fornander
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Timothy Roberts
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Anna M Egan
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Christine N Moser
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
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Panza E, Fehling KB, Pantalone DW, Dodson S, Selby EA. Multiply marginalized: Linking minority stress due to sexual orientation, gender, and weight to dysregulated eating among sexual minority women of higher body weight. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2021; 8:420-428. [PMID: 34926715 PMCID: PMC8675908 DOI: 10.1037/sgd0000431] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE This study assessed whether baseline levels of distal and proximal minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating in daily life among sexual minority women with overweight/obesity. METHODS Fifty-five sexual minority women ages 18-60 (M = 25 ± 9) with BMI > 25kg/m2 (M = 32 ± 5) completed baseline assessments of distal and proximal minority stressors due to sexual orientation, gender, and weight. Participants then completed an Ecological Momentary Assessment (EMA) protocol. For five days, participants responded to five random prompts assessing engagement in dysregulated eating (i.e., overeating, binge eating). The cumulative number of EMA-measured overeating and binge eating episodes was summed per participant. RESULTS Several minority stressors related to sexual orientation, gender, and weight were associated with prospective risk for dysregulated eating behaviors during EMA. Women with higher (vs. lower) baseline levels of internalized homophobia reported more cumulative episodes of binge eating during the EMA period. Women reporting greater (vs. less) baseline sexual orientation concealment reported more episodes of overeating during the EMA period. Women with greater (vs. less) baseline weight bias experiences and internalization reported more overeating and binge eating episodes during the EMA period. CONCLUSIONS Findings from this pilot study identify internalized homophobia, sexual orientation concealment, and experienced and internalized weight bias as potential risk factors for dysregulated eating behaviors among sexual minority women of higher body weight.
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Affiliation(s)
- Emily Panza
- Rutgers, the State University of New Jersey, New Brunswick, NJ
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert School of Medicine, Brown University
| | - Kara B. Fehling
- Rutgers, the State University of New Jersey, New Brunswick, NJ
| | - David W. Pantalone
- University of Massachusetts Boston, Boston, MA
- The Fenway Institute, Fenway Health, Boston, MA
| | - Samira Dodson
- Rutgers, the State University of New Jersey, New Brunswick, NJ
- Binghamton University, Binghamton, NY
| | - Edward A. Selby
- Rutgers, the State University of New Jersey, New Brunswick, NJ
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Rozga M, Linsenmeyer W, Cantwell Wood J, Darst V, Gradwell E. Hormone therapy, health outcomes and the role of nutrition in transgender individuals: A scoping review. Clin Nutr ESPEN 2020; 40:42-56. [DOI: 10.1016/j.clnesp.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023]
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VanKim NA, Corliss HL, Jun HJ, Calzo JP, AlAwadhi M, Austin SB. Gender Expression and Sexual Orientation Differences in Diet Quality and Eating Habits from Adolescence to Young Adulthood. J Acad Nutr Diet 2019; 119:2028-2040. [PMID: 31375461 PMCID: PMC6885120 DOI: 10.1016/j.jand.2019.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/16/2019] [Indexed: 11/28/2022]
Abstract
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.
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Grammer AC, Byrne ME, Pearlman AT, Klein DA, Schvey NA. Overweight and obesity in sexual and gender minority adolescents: A systematic review. Obes Rev 2019; 20:1350-1366. [PMID: 31334601 DOI: 10.1111/obr.12906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022]
Abstract
Population data indicate that sexual and gender minority adolescents may be at increased risk for excess weight gain compared with cisgender, heterosexual youth. However, no studies, to our knowledge, have systematically reviewed the literature on weight disparities in this population nor explored risk for overweight and obesity by sexual and gender minority subgroup across studies. The current systematic review, therefore, identified 21 studies that assessed the relationship between sexual and gender minority status and weight among adolescents. Results indicated an overall greater prevalence of overweight and obesity among sexual and gender minority adolescents compared with cisgender, heterosexual youth. However, cisgender sexual minority males demonstrated lower or no added risk for overweight and obesity, whereas cisgender sexual minority females demonstrated greater risk for overweight and obesity. Findings were mixed among gender minority adolescents. This study highlights weight disparities in sexual and gender minority youth, although important subgroup differences exist. Additional research is needed to elucidate the mechanisms that may contribute to differential weight trajectories in this population and to develop tailored approaches for prevention and treatment.
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Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Meghan E Byrne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814.,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892
| | - Arielle T Pearlman
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814
| | - David A Klein
- Department of Family Medicine, Fort Belvoir Community Hospital (FBCH), Fort Belvoir, Virginia, 22032.,Department of Family Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814.,Department of Pediatrics, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814.,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892
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Sinclair KA, Pritchard D, McElfish PA. An intersectional mixed methods approach to Native Hawaiian and Pacific Islander men's health. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2019; 10:268-281. [PMID: 32864038 PMCID: PMC7453840 DOI: 10.1037/aap0000156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We used a convergent parallel design to explore NHPI men's multi-level perspectives of the factors that influence healthy eating, physical activity, and weight, to elicit recommendations for lifestyle interventions, and to understand the intersection of masculinity and health from a social constructionist perspective. From June to December 2017, NHPI men 18 years and older were recruited to participate in a survey and focus groups. The survey included demographic questions and questions about physical and cultural activities men engage in, perceived social support for lifestyle behaviors, dietary behaviors, masculine characteristics and values important to NHPI men. The Kessler Psychological Distress Scale was used to assess psychological distress. Focus groups were audio recorded and transcribed for a thematic analysis. Descriptive statistics were computed for survey data. We conducted eight focus groups with 89 NHPI men (50% Samoan, 20% Native Hawaiian, 30% Marshallese). The mean age of participants was 39 years, 43% reported some college or college graduate, 64% were currently married, and 63% were working full time. Ninety percent of men scored 20 or higher on the K10 scale indicating mild to severe psychological distress. Men described food as a major part of their culture and their identity. Men's roles were defined as provider and protector, with little attention is paid to their own health. Our study found that hegemonic, or traditional masculinity and social norms may encourage some men to put their health at risk but may also be used to motivate healthy behaviors.
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Affiliation(s)
- Kàimi A Sinclair
- Initiative for Research and Education to Advance Community Health (IREACH), College of Nursing, Washington State University, Seattle, Washington, USA
| | - Dan Pritchard
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, Washington, USA
| | - Pearl A McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA; College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA
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Body size and weight, and the nutrition and activity behaviours of sexual and gender minority youth: findings and implications from New Zealand. Public Health Nutr 2019; 22:2346-2356. [PMID: 31159912 DOI: 10.1017/s1368980019001149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared. DESIGN Data were from a nationally representative health survey. SETTING Secondary schools in New Zealand, 2012. PARTICIPANTS A total of 7769 students, 9 % were SGM individuals. RESULTS Overall, weight-control behaviours, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students (adjusted OR; 95 % CI) were significantly more likely to have tried to lose weight (1·95; 1·47, 2·59), engage in unhealthy weight control (2·17; 1·48, 3·19), consume fast food/takeaways (2·89; 2·01, 4·15) and be physically inactive (2·54; 1·65, 3·92), and were less likely to participate in a school sports team (0·57; 0·44, 0·75), compared with other males. Female SGM students (adjusted OR; 95 % CI) were significantly more likely to engage in unhealthy weight control (1·58; 1·20, 2·08), be overweight or obese (1·24; 1·01, 1·53) and consume fast food/takeaways (2·19; 1·59, 3·03), and were less likely to participate in a school sports team (0·62; 0·50, 0·76), compared with other females. Generally, female SGM students were more negatively affected than comparable males, except they were less likely to consume fast food/takeaways frequently (adjusted OR; 95 % CI: 0·62; 0·40, 0·96). CONCLUSIONS SGM students reported increased weight-control behaviours, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities.
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Gordon AR, Krieger N, Okechukwu CA, Haneuse S, Samnaliev M, Charlton BM, Austin SB. Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults. Qual Life Res 2017; 26:2129-2138. [PMID: 28315179 PMCID: PMC5511094 DOI: 10.1007/s11136-017-1545-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Gender nonconformity, that is, transgressing conventionally "masculine" vs. "feminine" characteristics, is often stigmatized. Stigmatization and discrimination are social stressors that raise risk of adverse mental and physical health outcomes and may drive health inequities. However, little is known about the relationship between such social stressors and health-related quality of life (HRQOL). This paper aimed to examine associations between perceived gender nonconformity and HRQOL in a cohort of U.S. adolescents and young adults. METHODS Using data from 8408 participants (18-31 years) in the U.S. Growing Up Today Study (93% white, 88% middle-to-high income), we estimated risk ratios (RRs) for the association of gender nonconformity (three levels: highly gender conforming, moderately conforming, and gender nonconforming) and HRQOL using the EuroQol questionnaire (EQ-5D-5L). Models were adjusted for demographic characteristics, including sexual orientation identity. RESULTS Gender nonconformity was independently associated with increased risk of having problems with mobility [RR (95% confidence interval): 1.76 (1.16, 2.68)], usual activities [2.29 (1.67, 3.13)], pain or discomfort [1.59, (1.38, 1.83)], and anxiety or depression [1.72 (1.39, 2.13)], after adjusting for sexual orientation and demographic characteristics. Decrements in health utility by gender nonconformity were observed: compared to persons who were highly gender conforming, mean health utility was lower for the moderately gender conforming [beta (SE): -0.011 (.002)] and lowest for the most gender nonconforming [-0.034 (.005)]. CONCLUSIONS In our study, HRQOL exhibited inequities by gender nonconformity. Future studies, including in more diverse populations, should measure the effect of gender-related harassment, discrimination, and violence victimization on health and HRQOL.
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Affiliation(s)
- Allegra R Gordon
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mihail Samnaliev
- Department of Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, USA
| | - Brittany M Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
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VanKim NA, Erickson DJ, Eisenberg ME, Lust K, Rosser BRS, Laska MN. Relationship between weight-related behavioral profiles and health outcomes by sexual orientation and gender. Obesity (Silver Spring) 2016; 24:1572-81. [PMID: 27193906 PMCID: PMC5024549 DOI: 10.1002/oby.21516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Nicole A VanKim
- Institute for Behavioral and Community Health, San Diego State University, San Diego, California, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katherine Lust
- Boynton Health Service, University of Minnesota, Minneapolis, Minnesota, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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