1
|
Goldblatt AEA, Bankoff SM, Katz-Wise SL, Pantalone DW. A heavy burden: Associations between sexual minority status, mental health, and BMI in women. J Clin Psychol 2022; 78:2180-2196. [PMID: 35881947 DOI: 10.1002/jclp.23423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/20/2022] [Accepted: 07/10/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sexual minority women (SMW) are at increased risk of elevated body mass index (BMI) compared to heterosexual women, increasing their vulnerability to chronic diseases. Nonmonosexual SMW appear to be at additional risk for elevated BMI, likely due to unique sexual minority stressors. METHODS A total of 437 SMW and heterosexual women completed a cross-sectional, online survey including self-report measures of sexual orientation dimensions, weight, psychological distress, and eating behaviors. We investigated relations among these variables to better understand disparities in self-reported BMI based on sexual orientation and sexual orientation discordance (SOD). RESULTS SMW self-reported more psychological distress, more binge eating, and higher BMIs than their heterosexual peers, with nonmonosexual groups of SMW often reporting the highest values. SOD was positively associated with psychological distress. CONCLUSIONS SMW-particularly nonmonosexual SMW-are at increased risk for psychological distress, binge eating, and elevated BMI relative to heterosexual peers. Future research should further elucidate mechanisms for these disparities.
Collapse
Affiliation(s)
- Alison E A Goldblatt
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Sarah M Bankoff
- Behavioral Medicine Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Abstract
Purpose of Review Sexual and gender minority (SGM) adults experience significant cardiovascular health disparities, yet little is known about diet and food insecurity in this population. This review summarizes recent literature on diet and food insecurity in SGM adults and their contribution to cardiovascular disease (CVD) risk in this population. Recent Findings Existing evidence on diet and food insecurity disparities among SGM adults is inconclusive and research examining their link with CVD risk in SGM adults is limited. The majority of existing studies lack standardized and validated assessments of diet and food insecurity. Correlates of unhealthy diet and food insecurity among SGM adults are poorly understood. Summary Research examining the associations between diet and food insecurity with CVD risk in SGM adults is limited. Longitudinal studies are needed to investigate whether diet and food insecurity contribute to the cardiovascular health disparities observed in SGM adults. Supplementary Information The online version contains supplementary material available at 10.1007/s11883-022-00991-2.
Collapse
|
3
|
Ancheta AJ, Caceres BA, Zollweg SS, Heron KE, Veldhuis CB, VanKim NA, Hughes TL. Examining the associations of sexual minority stressors and past-year depression with overeating and binge eating in a diverse community sample of sexual minority women. Eat Behav 2021; 43:101547. [PMID: 34412003 PMCID: PMC8629849 DOI: 10.1016/j.eatbeh.2021.101547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023]
Abstract
Sexual minority stressors (e.g., stigma consciousness, internalized homophobia, discrimination) are posited to contribute to higher prevalence of overeating and binge eating among sexual minority women (SMW) relative to heterosexual women. Few studies have examined psychosocial mediators of the associations of minority stressors with overeating and binge eating in SMW. Using data from a diverse, community-based sample of SMW, we examined these associations, including the potential mediating effects of past-year depression. We also conducted exploratory analyses to determine if the associations of sexual minority stressors with overeating and binge eating differed by sexual identity or by race and ethnicity. The sample included 607 SMW (38.2% White, 37.1% African American, 24.7% Latina) with a mean age of 39.7 years. Approximately 17% and 9% of SMW reported overeating and binge eating, respectively, in the past 3 months. Greater stigma consciousness was associated with higher odds of overeating (AOR 1.31, 95% CI = 1.03-1.66). We found no significant associations between minority stressors and binge eating. Past-year depression did not mediate associations between minority stressors and overeating or binge eating. Although we found no sexual identity differences, stigma consciousness among Latina SMW was associated with higher odds of overeating relative to White SMW (AOR 1.95, 95% CI = 1.21-3.12) and African American SMW (AOR 1.99, 95% CI = 1.19-3.31). Findings highlight the importance of screening SMW for stigma consciousness as a correlate of overeating and considering racial and ethnic differences in overeating and binge eating in this population.
Collapse
Affiliation(s)
- April J Ancheta
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Sarah S Zollweg
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Kristin E Heron
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, 250 Mills Godwin Building, Norfolk, VA 23529, United States of America.
| | - Cindy B Veldhuis
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences University of Massachusetts Amherst, 406 Arnold House, Amherst, MA 01003, United States of America.
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| |
Collapse
|
4
|
Panza E, Olson K, Selby EA, Wing RR. State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women. Body Image 2021; 36:107-116. [PMID: 33279785 PMCID: PMC7987775 DOI: 10.1016/j.bodyim.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 01/20/2023]
Abstract
This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.
Collapse
Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, 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, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| |
Collapse
|
5
|
Pachankis JE, Mahon CP, Jackson SD, Fetzner BK, Bränström R. Sexual orientation concealment and mental health: A conceptual and meta-analytic review. Psychol Bull 2020; 146:831-871. [PMID: 32700941 PMCID: PMC8011357 DOI: 10.1037/bul0000271] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
6
|
Parker LL, Harriger JA. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord 2020; 8:51. [PMID: 33088566 PMCID: PMC7566158 DOI: 10.1186/s40337-020-00327-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM). MAIN This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals). CONCLUSION LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.
Collapse
Affiliation(s)
- Lacie L Parker
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Suite 106, Loma Linda, CA 92350 USA
| | | |
Collapse
|
7
|
The relationship between minority stress and biological outcomes: A systematic review. J Behav Med 2019; 43:673-694. [PMID: 31863268 DOI: 10.1007/s10865-019-00120-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023]
Abstract
Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.
Collapse
|
8
|
Goldhammer HB, Maston ED, Keuroghlian AS. Addressing Eating Disorders and Body Dissatisfaction in Sexual and Gender Minority Youth. Am J Prev Med 2019; 56:318-322. [PMID: 30554976 DOI: 10.1016/j.amepre.2018.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Hilary B Goldhammer
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Essence D Maston
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Alex S Keuroghlian
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
9
|
O'Neill T, Wakefield J. Fifteen-minute consultation in the normal child: Challenges relating to sexuality and gender identity in children and young people. Arch Dis Child Educ Pract Ed 2017; 102:298-303. [PMID: 28495667 DOI: 10.1136/archdischild-2016-311449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/28/2017] [Accepted: 04/02/2017] [Indexed: 11/04/2022]
Abstract
Lesbian, gay, bisexual and transgender (LGBT+) young people face several challenges in their daily lives, including specific healthcare inequalities. Negative societal attitudes towards sexual and gender minorities, and the effects of regular experiences of bullying and homophobia/transphobia exacerbate the normal trials and tribulations of childhood and adolescence. Barriers to accessing healthy activities, such as sport, are created by perceived stigma and real-life experiences. Healthcare environments are by default heteronormative and contribute to the isolation and exclusion of LGBT+ young people. Paediatricians are well placed to act on these healthcare inequalities and to advocate for LGBT+ youth, through simple changes to individual practice as well as system-wide improvements.
Collapse
Affiliation(s)
- Thomas O'Neill
- Children's Clinical Research Facility, Royal Hospital for Sick Children, Edinburgh, UK
| | - Justin Wakefield
- Child and Adolescent Mental Health Service (CAMHS), East London NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Calzo JP, Blashill AJ, Brown TA, Argenal RL. Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations. Curr Psychiatry Rep 2017; 19:49. [PMID: 28660475 PMCID: PMC5555626 DOI: 10.1007/s11920-017-0801-y] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW This review summarized trends and key findings from empirical studies conducted between 2011 and 2017 regarding eating disorders and disordered weight and shape control behaviors among lesbian, gay, bisexual, and other sexual minority (i.e., non-heterosexual) populations. RECENT FINDINGS Recent research has examined disparities through sociocultural and minority stress approaches. Sexual minorities continue to demonstrate higher rates of disordered eating; disparities are more pronounced among males. Emerging data indicates elevated risk for disordered eating pathology among sexual minorities who are transgender or ethnic minorities. Dissonance-based eating disorder prevention programs may hold promise for sexual minority males. Continued research must examine the intersections of sexual orientation, gender, and ethnic identities, given emergent data that eating disorder risk may be most prominent among specific subgroups. More research is needed within sexual minorities across the lifespan. There is still a lack of eating disorder treatment and prevention studies for sexual minorities.
Collapse
Affiliation(s)
- Jerel P Calzo
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182-4162, USA.
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA, USA.
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, CA, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Tiffany A Brown
- Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego, CA, USA
| | - Russell L Argenal
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182-4162, USA
| |
Collapse
|