A Systematic Review of Sexual Orientation Disparities in Disordered Eating and Weight-Related Behaviors Among Adolescents and Young Adults: Toward a Developmental Model

Abstract

Adolescence is a sensitive period for the development of disordered eating and weight-related behaviors, and sexual minorities may be particularly at risk due to heightened minority stress and challenges related to sexual identity development. This review synthesized findings from 32 articles that examined sexual orientation disparities (each with a heterosexual referent group) in four disordered eating behaviors (binging, purging, restrictive dieting, diet pill use) and four weight-related behaviors (eating behaviors, physical activity, body image, and Body Mass Index [BMI]). Potential variations by outcome, sex, race/ethnicity, and developmental stage were systematically reviewed. Evidence supporting sexual orientation disparities in disordered eating and weight-related behaviors was more consistent among males than females. Among females, sexual orientation disparities in disordered eating behaviors appeared to be more pronounced during adolescence than in young adulthood. Sexual minority females generally reported more positive body image than heterosexual females but experienced disparities in BMI. Sexual orientation differences in eating behaviors and physical activity were especially understudied. Incorporating objectification and minority stress theory, a developmental model was devised where body image was conceptualized as a key mechanism leading to disordered eating behaviors. To advance understanding of sexual orientation disparities and tailor intervention efforts, research in this field should utilize longitudinal study designs to examine developmental variations and incorporate multi-dimensional measurements of sexual orientation and body image.

The role of peer victimization, sexual identity, and gender on unhealthy weight control behaviors in a representative sample of Texas youth

“…Results showed a higher prevalence of UWCB among SMM. This finding is consistent with previous studies that show that SMM adolescents are especially at risk for disordered eating behaviors and weight‐related concerns (see Miller & Luk, for a review). Descriptive statistics also showed significant disparities on indicators that are typically associated with patterns of UWCB.…”

“…Descriptive statistics also showed significant disparities on indicators that are typically associated with patterns of UWCB. Consistent with previous research (Miller & Luk, ), we found no differences between SMM and heterosexual males on BMI and physical activity, while SMF are more likely to be obese and less likely to physically active compared to heterosexual females.…”

The relationship between body mass index, body dissatisfaction, and eating pathology in sexual minority women

“…Few studies have examined the mediating role of body dissatisfaction on the association between BMI and eating pathology among sexual minority women (i.e., same‐sex attracted). Similar to Black women, studies indicate that sexual minority women have higher BMIs and report less body dissatisfaction than heterosexual women on average (Eliason et al, ; Laska et al, ; Miller & Luk, ). Recent reviews present conflicting results on the prevalence of eating pathology among sexual minority women (Calzo, Blashill, Brown, & Argenal, ; Meneguzzo et al, ).…”

Sexual Minority Status and Adolescent Eating Behaviors, Physical Activity, and Weight Status

“…1,2 While sexual minority adolescents experience more disordered eating behaviors, empirical evidence on sexual orientation disparities in eating behaviors, physical activity, and weight-related constructs is relatively limited. 3 Moreover, despite the importance of parental and peer influences on healthy development among sexual minority adolescents, 4 these factors have not been tested as moderators of sexual orientation disparities in physical health, which is needed to inform prevention and translational research. 5 The present study examined parental and peer influences on sexual orientation disparities in eating behaviors, physical activity, and BMI in a nationally representative sample of male and female adolescents.…”

“…6 Past studies on sexual orientation disparities in various eating behaviors have yielded mixed findings. 3 Among adolescents in the Growing Up Today Study (GUTS), sexual minority females had higher rates of fast food consumption than heterosexual females, whereas sexual minority males had lower rates of fast food consumption than heterosexual males. 7 Findings from the 2005 and 2007 Youth Risk Behavior Surveys (YRBS) indicated that male and female sexual minority adolescents consumed more fruits and vegetables relative to heterosexual peers, 8 but this finding was not replicated in a female college student sample.…”