Weight Stigma Among Sexual Minority Adults: Findings from a Matched Sample of Adults Engaged in Weight Management

Weight Stigma and Mental and Emotional Health Among Sexual and Gender Minority Individuals: A Scoping Review

Purpose: Weight stigma is associated with poor mental and emotional health and may be especially harmful to sexual and gender minority (SGM) individuals due to co-occurring minority stress. The literature on this topic has not been synthesized. We conducted a scoping review of the literature on weight stigma and mental and emotional health among SGM individuals to synthesize findings, highlight gaps, and identify clinical and research implications. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we searched PubMed, CINAHL, PsycINFO, and Scopus in April 2022. Included studies examined the relationship between weight stigma and mental and emotional health among SGM people of any age. We did not restrict study design or publication date. Results: Of 513 records identified, 23 met inclusion criteria. Most focused on sexual minority individuals; one focused specifically on gender minority individuals. Weight stigma was associated with poorer mental and emotional health in nearly all studies. The most common outcomes examined were self-esteem, maladaptive eating, and depressive symptoms. Five studies, all using the same dataset, focused on adolescents; none focused on older adults. Conclusions: Weight stigma is associated with poorer mental and emotional health among SGM individuals and, through its intersections with minority stress, might impact SGM individuals differently than their cisgender and heterosexual counterparts. There are important gaps regarding weight stigma's effect on SGM adolescents and gender minority individuals and its relationship with a broader range of mental and emotional health outcomes.

Sociodemographic predictors of perceived weight discrimination

BACKGROUND

Perceived weight discrimination is associated with increased risk for chronic diseases and reduced life expectancy. Nevertheless, little is known about perceived weight discrimination in racial, ethnic, and sexual minority groups or in individuals at the intersections of those groups. The goal of this study was to identify sociodemographic predictors of perceived weight discrimination.

SUBJECTS/METHODS

A diverse sample of adults (37% Black/African American, 36% Latino, 29% sexual minority) with a body mass index (BMI) ≥ 18.5 kg/m2 were recruited from a national US panel to complete an online survey (N = 2454). Perceived weight discrimination was assessed with the Stigmatizing Situations Survey-Brief (SSI-B). Using hierarchical linear regression analysis, SSI-B scores were predicted from the four sociodemographic characteristics of interest (gender, race, ethnicity, and sexual orientation) while controlling for BMI, age, education, and income (Step 1). At Step 2, all two-way interactions between the four sociodemographic characteristics were added to the model.

RESULTS

At Step 1, higher SSI-B scores were observed for Latino (vs. non-Latino) adults, sexual minority (vs. heterosexual) adults, younger (vs. older) adults, adults with higher (vs. lower) levels of education, and adults with higher (vs. lower) BMI. At Step 2, race interacted with gender, ethnicity, and sexual orientation to predict SSI-B scores such that relatively higher scores were observed for non-Black women, Black men, adults who identified as Black and Latino, and non-Black sexual minority adults.

CONCLUSIONS

Perceived weight discrimination varied across sociodemographic groups, with some subgroups reporting relatively high frequency. Black race appeared to be protective for some subgroups (e.g., Black women), but risk-enhancing for others (e.g., Black men, individuals who identified as Black and Latino). Additional research is needed to identify specific factors that cause certain sociodemographic groups -and indeed, certain individuals-to perceive higher levels of weight discrimination than others.

Obesity and sexual health trends among a large, national sample of men who have sex with men on Grindr in the USA

Background A growing number of men who have sex with men (MSM) utilise Grindr for seeking relationships and immediate/casual sexual encounters. Grindr and other mobile applications can be a valuable source of information on sociological predictors of health. One topic that is under reported is the use of Grindr by MSM with obesity. We described differences in Grindr use between MSM with and without obesity, and to use Grindr information to reveal trends which may serve as potential predictors of health. Methods Data was collected from 3744 Grindr users (mean age [s.d.], 32.3 years [9.1]) from the largest 50 metropolitan centres in the USA between February and May 2018. Users were divided into two cohorts based on BMI: (1) MSM with obesity (BMI>30), n =253; and (2) MSM without obesity, n =3491. Profile characteristics were compared. Results When evaluating potential predictors for obesity, we found that black/African-American and older MSM were significantly more likely to have obesity. Further, we found that obesity among MSM was significantly inversely associated with the population percent lesbian, gay, bisexual, and transgender (LGBT) within a city. Additionally, we found that MSM with obesity were significantly more likely to indicate interest in immediate sexual encounters. Conclusions These results highlight important trends that may serve as predictors of health in urban settings. Furthermore, our results suggest that MSM with obesity may be more likely to engage in risky sexual behaviours. These findings may be useful in informing providers and healthcare officials on when and how to provide outreach to this unique population.

The effect of GLP-1 receptor agonist use on negative evaluations of women with higher and lower body weight

BACKGROUND

GLP-1 receptor agonists (GLP-1 RAs) have dramatically altered obesity treatment. Media reports suggest that GLP-1 RAs users often report feeling judged for taking a "shortcut" to lose weight, which may be related to negative stereotypes toward people with larger bodies. Media reports also describe negative attitudes about lean people who take GLP-1 RAs to enhance their appearance. The present research used a 2 × 2 experimental design to test the effects of GLP-1 RA use and body size on attitudes and egocentric impressions.

SUBJECTS/METHODS

A sample of 357 U.S. adults (Mage = 37.8, SD = 13) were randomly assigned to read about a woman, who either was lean or had obesity, and who lost 15% of her body weight either with diet/exercise or a GLP-1 RA. Participants answered questions measuring endorsement of negative weight-related stereotypes and egocentric attitudes toward the woman, as well as beliefs that she took a shortcut to lose weight and beliefs that biogenetic factors caused her baseline weight.

RESULTS

Negative evaluations and egocentric impressions were stronger toward a woman who lost weight with a GLP-1 RA compared to diet/exercise. Losing weight with a GLP-1 RA led to stronger negative evaluations through higher weight loss shortcut beliefs irrespective of body size. Losing weight with a GLP-1 RA also led to higher egocentric impressions through higher shortcut beliefs, and this effect was stronger for a lean woman. Finally, losing weight with a GLP-1 RA led to more negative evaluations through stronger endorsement of biogenetic causal beliefs for a lean woman only.

CONCLUSIONS

This timely study provides evidence that people with larger and smaller bodies alike are at-risk for being judged for using GLP-1 RAs due to beliefs that these medications are a shortcut. Findings also demonstrate novel reactions related to egotism when weight loss is achieved with pharmacological interventions. PRE-REGISTRATION AND DATA: osf.io/xme4w.

Associations between weight bias internalization, weight status, and health among a diverse cohort of freshman college students

Mental health concerns are common among college students, especially students with higher body mass index (BMI). Weight bias internalization (WBI) is thought to contribute to these mental health disparities. However, little is known about how WBI differs among more diverse students, and to what extent WBI may explain associations between BMI and health in college populations. This study compared rates of WBI in Freshman college students (N = 1289) across gender, race/ethnicity, and sexual orientation, and assessed whether WBI mediated associations between BMI and mental health (depression, self-esteem, stress, loneliness) and behavioral health (disordered eating, physical activity, gym use). Black students and men demonstrated reduced WBI while bisexual women showed increased WBI. Further, WBI mediated the association of BMI with mental health and disordered eating, but not physical activity. These findings suggest that stigma may account for mental health disparities among higher-BMI students, and that minoritized groups are disproportionately impacted.

Demographic, socioeconomic and life-course risk factors for internalized weight stigma in adulthood: evidence from an English birth cohort study

Background

Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with demographic, socioeconomic, and wider social factors in a large general population birth cohort study for the first time.

Methods

In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, sexual orientation, and family and wider social influences, using confounder-adjusted multivariable regression.

Findings

In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (standardized beta: 0.56, 95% CI: 0.50, 0.61), sexual minorities (0.17 S.D. higher, 95% CI: 0.09, 0.24), and less socioeconomically advantaged individuals (e.g., 0.16 S.D. higher (95% CI: 0.08, 0.24) for participants whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (by 0.13 S.D., 95% CI: 0.03, 0.23), and the media (by 0.17, 95% CI: 0.10, 0.25), or had experienced bullying (e.g., 0.25 S.D., 95% CI: 0.17, 0.33 for bullying at age 23 years).

Interpretation

Internalized weight stigma differs substantially between demographic groups. Risk is elevated for females, sexual minorities, and socioeconomically disadvantaged adults, and this is not explained by differences in BMI. Pressure to lose weight from family and the media in adolescence may have long-lasting effects on IWS.

Funding

The ESRC, MRC, NIHR, and Wellcome Trust.

A dyadic analysis of anti-fat attitudes and partners' diet-related influence among gay married men

OBJECTIVES

The focus on physical appearance among gay men has potential implications for anti-fat attitudes, including those directed toward romantic partners. Partners often influence each other's behaviors including those linked to weight, but most research has examined the consequences of these influence strategies versus their antecedents. To address this research gap, we examined how men's own and their partners' anti-fat attitudes were related to both health-promoting (control) and health-compromising (undermining) types of diet-related influence and whether these associations differed by weight status.

METHODS AND RESULTS

Analyzing data from a cross-sectional online survey of 450 U.S. adult gay married men (225 couples), Actor-Partner Interdependence Models revealed that individuals' own anti-fat attitudes (all types) were positively associated with more frequent receipt of spousal control and undermining. Additionally, partner's fears about gaining weight were positively associated with more frequent receipt of spousal control and dislike of higher weight people and fear of gaining weight (among those of higher weight status) were positively associated with more frequent receipt of spousal undermining.

CONCLUSION

Our findings add to the literature on diet-related interactions among gay married men, highlight the value of examining these processes dyadically, and suggest the importance of including both members of couples in health promotion and intervention efforts.

Gender Expression, Weight Status, and Risk of Experiencing Eating Disorders among Gender-Diverse Adults Assigned Male at Birth in Bangkok, Thailand

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.

Weight Discrimination and Health Risk Behavior in Racial, Ethnic, and Sexual Minority Adults

BACKGROUND

People with obesity face significant discrimination due to their weight. Exposure to such discrimination is associated with poor health outcomes. Little is known about pathways that explain that association, and even less is known about those pathways in racial, ethnic, and sexual minorities. Health risk behaviors may serve as one such pathway.

PURPOSE

We examined associations between weight discrimination and health risk behaviors and assessed whether associations are moderated by gender, race, ethnicity, or sexual orientation.

METHODS

Quota sampling was used to oversample Black (36%), Latino (36%), and sexual minority (29%) adults (n = 2,632) who completed an online survey. Using regression analysis, health risk behaviors (maladaptive eating behaviors, physical inactivity, sitting, smoking, alcohol use, and sleep disturbance) were predicted from previous experience with weight discrimination while controlling for demographic characteristics, BMI, and depressive symptoms. Additional analyses tested for interactions between weight discrimination and key demographic variables (i.e., gender, race, ethnicity, and sexual minority status).

RESULTS

Weight discrimination was associated with greater emotional eating, binge eating, unhealthy weight control behaviors, cigarette smoking, problematic alcohol use, and sleep disturbance. Gender moderated the association between weight discrimination and binge eating, alcohol use, and physical activity, with stronger effects observed in men than women. Exploratory analyses provided limited evidence for differential effects of weight discrimination across specific combinations of intersecting identities.

CONCLUSIONS

Weight discrimination was associated with engagement in unhealthy behaviors and relationships were largely similar across diverse demographic groups. Health risk behaviors may represent a key pathway through which weight discrimination harms health.

Weight Stigma and Barriers to Effective Obesity Care

Weight stigma is prevalent with negative consequences for health and well-being. This problem is present in health care; stigmatizing attitudes toward patients with obesity are expressed by medical professionals across diverse specialties and patient care settings. This article summarizes the ways in which weight stigma creates barriers to effective care, including poor patient-provider communication, reduced quality of care, and healthcare avoidance. Priorities for stigma reduction in healthcare are discussed, with a clear need for multifaceted approaches and inclusion of people with obesity whose perspectives can inform strategies to effectively remove bias-related barriers to patient care.

An examination of theory-based suicidal ideation risk factors in college students with multiple marginalized identities

Social marginalization increases the risk of suicidal ideation (SI) among individuals with diverse identities, yet research examining the effects of marginalization has focused on one identity. Emerging adulthood is a critical period of identity development and the age group with the highest rates of SI. Considering the challenges of living in potentially heterosexist, cissexist, racist, and sizeist environments, we tested whether possessing multiple marginalized identities was associated with severity of SI through factors proposed in the interpersonal-psychological theory (IPT) and the three-step theory (3ST) of suicide and if mediation paths were moderated by sex. A sample of 265 college students completed a cross-sectional online survey assessing SI and constructs related to IPT and 3ST. The number of marginalized identities was generated by adding minoritized sexual orientation, race/ethnicity other than non-Hispanic White, body mass index >25 kg/m2, sexual attraction to same sex but identified as heterosexual, and gender-fluid identity. In IPT multiple mediation analyses, possessing more marginalized identities was associated with SI severity through burdensomeness and hopelessness, but not belonging. Indirect paths through burdensomeness and belonging were moderated by sex. For 3ST, possessing more marginalized identities was associated with SI severity through hopelessness and psychological pain, but not social connection or meaning in life. Future research should consider intersecting social identities and test mechanisms by which multiply marginalized college students develop resilience to SI risk factors, such as support within their marginalized groups, to inform suicide assessment and intervention efforts on college campuses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Vulnerability and resilience to the harmful health consequences of weight discrimination in Black, Latina, and sexual minority women

BACKGROUND AND OBJECTIVE

Because they deviate from societal expectations regarding thinness, women with high body weight or large body size frequently experience social devaluation and discrimination and such experiences can negatively affect health. Yet relatively little is known about experiences of weight discrimination among people impacted by overlapping forms of oppression such as racism, sexism, and heterosexism or how high body weight may intersect with other marginalized identities to contribute to health disparities. Guided by an intersectional lens, the purpose of the current study was to assess Black, Latina, and sexual minority women's experiences with weight discrimination and to identify factors associated with vulnerability or resilience to the harmful health consequences of weight discrimination in these women.

METHODS

Semi-structured interviews were conducted with thirty-two cisgender women from the United States who identified as Black, Latina, and/or a sexual minority (e.g., lesbian, bisexual) to assess their experiences with and responses to weight discrimination. All participants had a body mass index ≥30 kg/m² and had previously experienced weight discrimination. Data collection took place from June to August of 2020.

RESULTS

Five factors associated with vulnerability or resilience to experiencing or being negatively affected by weight discrimination were identified: 1) sociocultural norms about weight and perceived acceptance of high body weight, 2) perceived links among weight, perceived femininity, and attractiveness, 3) childhood experiences, 4) internalized weight stigma, and 5) coping strategies. The intersectional nature of women's experiences with weight discrimination was apparent in each theme.

CONCLUSIONS

This study identified key factors that may amplify or mitigate the negative health consequences of weight discrimination in socially marginalized women with high body weight. Findings highlight novel research questions to be explored in future research. Such research will be critical for guiding future interventions aimed at reducing the harmful health consequences of weight discrimination.

Experienced weight stigma, internalized weight bias, and maladaptive eating patterns among heterosexual and sexual minority individuals

PURPOSE

The current study examined experienced weight stigma (EWS), internalized weight bias (IWB), and maladaptive eating patterns (ME) among sexual minority (SM) and heterosexual individuals.

METHODS

The sample consisted of cisgender heterosexual and SM men and women. Participants were drawn from introductory psychology classes and a variety of supplemental recruitment methods (Facebook, Instagram, MTURK, etc.).

RESULTS

SM individuals reported higher levels of EWS, IWB, and maladaptive eating patterns than heterosexual individuals. Heterosexual men reported the lowest levels of EWS, IWB, and ME compared to all other groups. Additionally, there was a significant association between greater EWS and IWB and greater ME. Gender identity and sexual orientation impacted the strength of the relationship between IWB and ME and, to a lesser extent, EWS and ME.

CONCLUSION

This investigation contributes to knowledge of the impact of gender identity and sexual orientation on EWS and IWB, and demonstrates that IWB and EWS are significant concerns for the SM community, especially in relation to ME.

LEVEL OF EVIDENCE

Level IV, cross-sectional study.

Fat is feminine: A qualitative study of how weight stigma is constructed among sexual minority men who use Grindr

Why is weight stigma so potent among sexual minority men? We propose that sexual minority men may be more vulnerable to weight stigma because of factors not captured by existing measures - for instance, men's perception of fatness as less masculine and/or more feminine. To investigate, we qualitatively examined how 17 sexual minority men (M_age = 28.52, SD_age = 1.63, range: 18-49) described fatness in their discussions of body ideals and appearance pressures. We generated two themes: (i) Masculinity is a currency that fat men have less of and (ii) Fatness is stigmatized or fetishized. Participants described appearing masculine (i.e., lean, muscular) as particularly valuable within the gay community - opposingly, fatness was framed as unmasculine and undesirable. Fat men's treatment was understood as rarely divorced from their body size, either being stigmatized or fetishized because of their weight. Finally, being unattracted to fat men was constructed as a personal preference that ought not be criticised. These findings suggest the value of masculinity within the gay community may exacerbate weight stigma experiences and internalization among sexual minority men. Future research should account for the anticipated effects of fatness on men's masculinity and clarify whether sexual preferences and fetishization should be subsumed in weight stigma definitions.

Sexual and gender minority (SGM) adolescents' disordered eating: Exploring general and SGM-specific factors

OBJECTIVE

Sexual and gender minority (SGM) adolescents disproportionately report disordered eating, yet have primarily been considered under a larger SGM umbrella. The current study 1) compared disordered eating between sexual minority (SM) and gender minority (GM) adolescents; 2) examined how general psychological factors (self-esteem, depression, and stress) and SGM-specific factors (e.g., feelings about SGM identity, access to SGM resources) were associated with disordered eating; and 3) examined whether associations between these factors differed for SM versus GM adolescents.

METHOD

SGM adolescents in the U.S. (N = 8814; 35.0% GM; 43.7% cisgender girls; 66.9% White; M_age  = 15.6) reported their disordered eating, depressive symptoms, stress, self-esteem, and SGM-related experiences on an anonymous, cross-sectional online survey.

RESULTS

GM adolescents exhibited a higher prevalence of clinical threshold disordered eating than SM adolescents. Self-esteem was associated with lower odds of caloric restriction, purging, and binge eating. Depression was associated with higher odds of caloric restriction, diet pill use, purging, laxatives, and binge eating. Stress was associated with higher odds of purging. Associations were stronger for GM adolescents' caloric restriction. Positive feelings about SGM identity were associated with lower odds of caloric restriction, purging, and binge eating, whereas greater stress of "coming out" was associated with higher odds of caloric restriction, purging, and binge eating.

DISCUSSION

These results suggest that SGM adolescents' disordered eating is associated with both general psychological factors and unique SGM experiences. Results highlight the importance of considering how the unique experiences of SGM youth may leave them vulnerable to disordered eating behaviors.

PUBLIC SIGNIFICANCE STATEMENT

Sexual and gender minority (SGM) youth are disproportionately affected by disordered eating. The current study found that higher depression and stress, and lower self-esteem, were associated with SGM adolescents' disordered eating. Furthermore, unique SGM experiences, such as stress about coming out, were also associated with eating pathology. Results highlight the importance of considering SGM adolescents' perceptions of their identity and social support.

Weight Status, Medication Use, and Recreational Activities of Treatment-Naïve Transgender Youth

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.

Addressing Weight Bias in the Cisgender Population: Differences between Sexual Orientations

(1) Background: Weight bias (WB) is an implicit psychological construct that can influence attitudes, beliefs, body experience, and evaluation of specific psychopathology relationships. Sexual orientation has played a crucial role in developing and maintaining psychiatric conditions linked to body evaluation, but few studies have evaluated possible connected biases. Thus, the paper aims to assess potential relationships between sexual orientation and WB, looking at potential roles in specific psychopathology; (2) Methods: A total of 836 cisgender subjects participated in an online survey, aged between 18 and 42 years old. Two specific aspects of WB were evaluated with validated scales about beliefs about obese people and fat phobia. Demographic variables, as well as depression and eating concerns were evaluated; (3) Results: Gay men and bisexual women showed higher levels of fat phobia, depression, and eating concerns. Regression analysis showed that sexual orientation significantly predicted fat phobia (p < 0.001) and beliefs about obese people (p = 0.014); (4) Conclusions: This study confirms the vulnerability of gay men and bisexual women to cognitive bias about their own bodies, showing a potential vulnerability about body and weight concerns.

Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis

This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD −1.50 [−1.93, −1.08] kg/m²) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox—a sustained catabolic state presenting with lower BMI—is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.

Weight stigma predicts reduced psychological wellbeing and weight gain among sexual minority men: A 12-month longitudinal cohort study using random intercept cross-lagged panel models

Weight stigma among sexual minority men predicts negative health outcomes; however, existing research is cross-sectional. Therefore, we longitudinally examined the presence, strength, and direction of relationships between weight stigma and health outcomes in a multi-national cohort of 2953 sexual minority men (M_age = 37.70, SD_age = 13.70). Participants reported their Body Mass Index (BMI), experiences of weight discrimination, internalized weight bias, and psychological quality of life at three time-points over 12 months (~August 2019-20). Analyses revealed feedback loops of internalized weight bias with BMI and psychological quality of life: over time, increases in internalized weight bias were associated with small BMI increases (β = 0.07) and small decreases in psychological quality of life (β = 0.12). Reciprocally, increases in BMI and decreases in psychological quality of life were associated with increases in internalized weight bias (βs = 0.18). Experiences of weight discrimination were not longitudinally predictive and were associated with higher BMI (β = 0.29), greater internalized weight bias (β = 0.29), and lower psychological quality of life (β = 0.26) between-persons/cross-sectionally only. Weight stigma is longitudinally and reciprocally associated with reduced psychological wellbeing and weight gain among sexual minority men. Internalized weight bias is a particularly promising intervention target.

Is weight stigma associated with physical activity? A systematic review

OBJECTIVE

Weight stigma is associated with impaired health, attributed in part to reductions in health-promoting behaviors. This review analyzed evidence of the association between weight stigma and physical activity (PA) in adults and youth.

METHODS

Three databases were searched for terms related to weight stigma and PA. Eligible studies reported the quantitative association between at least one measure of weight stigma and one behavioral measure of PA.

RESULTS

A total of 38 studies met eligibility criteria. Of the 29 studies of adults, 3 used objective PA measures, and 79% used an observational, cross-sectional design. Findings of the relationship between weight stigma and PA were mixed. Everyday weight discrimination and internalizing weight stigma were associated with reduced PA in most studies. Several studies found indirect, and not direct, effects of weight stigma on PA when analyses included other individual-level factors. In the nine studies of youth, two used objective PA measures, all were observational, and only one study was longitudinal. Most youth studies found a relationship between weight-based teasing and reduced PA.

CONCLUSIONS

Weight teasing, everyday discrimination, and internalization were associated with reduced PA. However, associations were inconsistent and often indirect. Future studies should include objective PA measures with larger samples and longitudinal assessments.

Androgen abuse among gay and bisexual men

PURPOSE OF REVIEW

Androgen abuse is more prevalent among gay and bisexual (i.e. sexual minority) men than heterosexual men. We review recent research about androgen abuse in sexual minority men and provide relevant social, cultural, and historical contexts.

RECENT FINDINGS

Androgen abuse among sexual minority men is shaped by the intersections of sexuality, desirability, masculinity, and race. Muscular male bodies are desired and - in erotic settings especially - prized as literal embodiments of masculinity. Racist stereotypes unjustly diminish the desirability and masculinity of sexual minority men who belong to racial minorities, especially those who are Asian or Black, and the higher rates of androgen abuse among these racial minorities may reflect a compensatory motivation for these diminishments. The historical context for sexual minority men - decades of subjugation alongside stereotypes of masculinity-compromising effeminacy - further complicate the intersections of sexuality with androgen abuse. Harm minimization efforts led by empathetic endocrinologists stand the best chance of achieving positive outcomes for sexual minority men who use androgens.

SUMMARY

More dedicated research on androgen abuse among sexual minority men is needed as this population requires thoughtfully designed research that is incorporative - at a minimum - of the complexities of sexuality, desirability, masculinity, and race.

Multiply marginalized: Linking minority stress due to sexual orientation, gender, and weight to dysregulated eating among sexual minority women of higher body weight

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.

The WOMBS Framework: A review and new theoretical model for investigating pregnancy-related weight stigma and its intergenerational implications

As the growing weight stigma literature has developed, one critically relevant and vulnerable population has received little consideration-pregnant and postpartum women. Because weight fluctuations are inherent to this life phase, and rates of prepregnancy overweight and obesity are already high, this gap is problematic. More recently, however, there has been a rising interest in pregnancy-related weight stigma and its consequences. This paper therefore sought to (a) review the emerging research on pregnancy-related weight stigma phenomenology and (b) integrate this existing evidence to present a novel theoretical framework for studying pregnancy-related weight stigma. The Weight gain, Obesity, Maternal-child Biobehavioral pathways, and Stigma (WOMBS) Framework proposes psychophysiological mechanisms linking pregnancy-related weight stigmatization to increased risk of weight gain and, in turn, downstream childhood obesity risk. This WOMBS Framework highlights pregnant and postpartum women as a theoretically unique at-risk population for whom this social stigma engages maternal physiology and transfers obesity risk to the child via social and physiological mechanisms. The WOMBS Framework provides a novel and useful tool to guide the emerging pregnancy-related weight stigma research and, ultimately, support stigma-reduction efforts in this critical context.

The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries

BACKGROUND/OBJECTIVES

Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries.

METHODS

Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors.

RESULTS

Among participants who reported a history of weight stigma (56-61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries.

CONCLUSIONS

Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.

"What can her body do?" Reducing weight stigma by appreciating another person's body functionality

OBJECTIVE

Weight stigma is prevalent across multiple life domains, and negatively affects both psychological and physical health. Yet, research into weight stigma reduction techniques is limited, and rarely results in reduced antipathy toward higher-weight individuals. The current pre-registered study investigated a novel weight stigma reduction intervention. We tested whether a writing exercise focusing on body functionality (i.e., everything the body can do, rather than how it looks) of another person leads to reductions in weight stigma.

METHOD

Participants were 98 women (Mage = 23.17, Range = 16-63) who viewed a photograph of a higher-weight woman, "Anne," and were randomised to complete a writing exercise either describing what "Anne's" body could do (experimental group) or describing her home (active control group). Facets of weight stigma were assessed at pretest and posttest.

RESULTS

At posttest, the experimental group evidenced higher fat acceptance and social closeness to "Anne" compared with the active control group. However, no group differences were found in attribution complexity, responsibility, and likeability of "Anne".

CONCLUSIONS

A brief body functionality intervention effectively reduced some, but not all, facets of weight stigma in women. This study provides evidence that functionality-focused interventions may hold promise as a means to reduce weight stigma.

Differences in weight stigma between gay, bisexual, and heterosexual men

Gay and bisexual men may experience more weight stigma than heterosexual men; however, research is limited. We examined differences in experienced weight discrimination, weight bias, and internalized weight bias in two studies: the first comprising gay (n = 351), bisexual (n = 357), and heterosexual (n = 408) men, and the second comprising gay (n = 614) and bisexual (n = 123) men. In Study 1, bisexual men reported experiencing more weight discrimination than gay (r = .07) and heterosexual (r = .08) men. Bisexual (Glass' Δ = 0.41) and gay (Δ = 0.37) men reported greater internalized weight bias than heterosexual men. Heterosexual men reported more weight bias than gay (Cohen's d = 0.35) and bisexual (d = 0.46) men. In Study 2, gay men reported more internalized weight bias than bisexual men (d = 0.26). Sexual orientation did not moderate the relationships of weight stigma with either body dissatisfaction or psychological quality of life. Among gay and bisexual men, experiencing weight discrimination predicted diminished psychological quality of life through internalized weight bias and body dissatisfaction. Our research emphasizes the importance of assessing weight stigma among sexual minorities and suggests bisexual men might be particularly vulnerable to weight stigma.

Characterizing Lifetime and Daily Experiences of Weight Stigma among Sexual Minority Women with Overweight and Obesity: A Descriptive Study

Sexual minority women are disproportionately impacted by obesity yet are underrepresented in weight stigma research. This Ecological Momentary Assessment (EMA) study is a secondary analysis that aimed to elucidate the frequency and contextual characteristics of perceived experiences of lifetime and momentary weight stigma among sexual minority women with overweight/obesity. Participants were 55 sexual minority women ages 18-60 with a body mass index ≥25 kg/m2. Perceived lifetime weight stigma events were assessed at baseline. For the subsequent five days, participants used a smartphone to complete five daily, random EMA prompts assessing the frequency/characteristics of perceived weight stigma events in daily life. All participants reported at least one lifetime weight stigma event. During the EMA period, participants reported 44 momentary weight stigma events (M = 0.80), with 24% of participants reporting at least one event. During most instances of weight stigma, women perceived the stigma's cause to be their weight and another minority identity (e.g., sexual orientation). Findings showing high rates of perceived lifetime weight stigma in this sample and frequent co-occurrence of perceived weight stigma with stigma due to other marginalized identities in daily life underscore the need for future, larger studies investigating weight stigma through an intersectional lens in sexual minority women with overweight/obesity.

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

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