By Avichai Scher
Lesbian and bisexual women in the United Kingdom are 14 percent more likely to be overweight or obese than their heterosexual counterparts, according to a new study published in the Journal of Public Health.
Researchers pooled data from 12 national health surveys in the U.K. comprising more than 93,000 participants, to look at the relationship between sexual orientation and body mass index, or BMI. The data goes back as far as 2008, when the U.K. began tracking sexual orientation in its health surveys.
Joanna Semlyen, a senior lecturer in psychology at Norwich Medical School in England and the study’s lead author, said she hopes that rather than stigmatizing lesbian and bisexual women, the study will raise awareness about health disparities.
“People working in health care should bear in mind the particular needs of sexual minorities and make needed care more accessible,” she told NBC News.
Semlyen’s report is the first of its kind in the U.K., but its findings are similar to those in previous U.S.-based studies. And like its predecessors, this latest report does not look behind the numbers at why sexual minority women are more at risk of being overweight and what their unique health care needs may be.
“These findings are not a surprise,” Jane McElroy, an associate professor at the University of Missouri’s School of Medicine, said of the U.K. study. “What we need is research into why, which we don’t really have.”
McElroy, who has researched weight in the LGBTQ community, said based on her limited research and anecdotal experience, one main cause of the weight disparity is that lesbian and bisexual women often view being thin as conforming to mainstream beauty ideals, which are, “made by men, for men.” She suggested health practitioners consider the pride that patients may have in rejecting those ideals.
“Doctors should ask, ‘How do you feel about your weight?’” McElroy said, “and not assume their patients want to lose weight, or that they’re unhealthy simply because their BMI says they’re overweight.”
For Alysse Dalessandro, 31, it took many years to accept being “plus size.” She identifies as queer and writes about body image and fashion on her blog, Ready to Stare, as well as on her body-positive Instagram account, which has almost 100,000 followers.
She’s been plus size since she was a child and struggled through many diets. But when she came out publicly as queer at 29, it helped her accept her size, as well.
“In society, for some people, it’s still unacceptable to identify as queer. The same goes for being plus size,” she said. “But I’m queer, and I love my body. Society is not OK with that, but I realized I didn’t have to accept what society wanted of me.”
She said when she dated men, they often fetishized her body. When she started dating women and transgender men (she’s currently engaged to trans activist Giovonni Santiago), she said she was appreciated as a whole person.
“I felt objectified by men who liked curvy women,” she said. “With women and trans men, I was more than just my body.”
Dalessandro stressed that people should not make assumptions about her health because of her size. “That’s between me and my doctor,” she said.
Mickey Eliason, a professor at San Francisco State University who studies LGBTQ health, agreed. She said health care providers need to first determine if a patient’s weight is a threat to their health and not reflexively blame health problems on weight.
“It might be an overblown problem,” Eliason said of sexual minority women and obesity. “Almost all of the studies find higher weight. But, among sexual minority women, there’s no conclusive evidence of higher rates of the health disorders that come with being overweight, such as (type II) diabetes.”
However, she said, weight loss can be needed for health, especially as women age. That’s when social norms in lesbian culture around weight can present a challenge.
To address this, McElroy and Eliason both led trial groups in a multicity study that aimed to improve the health of lesbian and bisexual women. The trial was for women over 40, with most women in their 50s and 60s. Both researchers said that in their groups, the women wanted to talk about health, not weight loss.
Jana Rickerson participated in Eliason’s group in San Francisco. She said she’d wanted to lose weight in the past but was frustrated by “gimmicky,” trendy diets that focused only on being skinny.
She found Eliason’s program, “Doing It for Ourselves,” liberating, because it focused on a personal definition of health and on building community. Meetings addressed issues, such as stress from experiencing homophobia, as well as stigma — for weight and sexuality — at the doctor’s office.
The program set goals such as gentle exercise, identifying the difference between real hunger and stress eating, and also gave participants the freedom to set their own goals.
Eliason said that in her initial 12-week trial group of 160 women, the weight loss numbers weren’t high. About a third lost roughly five pounds and most others stayed the same. “Where we saw the big change was women reporting they felt better,” she said.
Rickerson lost about 10 pounds over two rounds of the program, but she was more excited that she felt better overall and about building community.
“Doing this with other lesbians, it was like coming home,” she said. “There’s an additional level of stress we experience, and it was nice to see we weren’t alone.”
McElroy said that while the group study was useful for insight into how to help sexual minority women improve health, it’s only one piece of the puzzle. She said the conclusion the study provided was limited, because it tracked the women over a short time span and only looked at older women.
She and Eliason also said studies are needed to examine the root causes of weight gain among sexual minority women. While they cited possible factors that they’ve come across — including weight gain to deflect unwanted attention from men, a history of sexual abuse and eating disorders during youth — they said the topic should be studied further.
“None of the studies so far have parsed the relationship between stress and stigma causing higher rates of weight,” Eliason said. “There’s a lot more research to do.”