Gender expression associated with BMI in a prospective cohort study of US adolescents

Abstract

Objective To examine the relationship between gender expression (GE) and BMI in adolescence. Methods Repeated measures of weight-related behaviors and BMI were collected 1996-2011 via annual/biennial self-report surveys from youth ages 10 to 23 years (6,693 females, 2,978 males) in the longitudinal Growing Up Today Study. GE (very conforming [referent], mostly conforming, nonconforming) was assessed in 2010/11. Sex-stratified, multivariable linear models estimated GE group differences in BMI and the contribution of sexual orientation and weight-related exposures to group differences. Models for males included interaction terms for GE with age. Results In females, mostly conforming youth had 0.53 kg/m2 and nonconforming had 1.23 kg/m2 higher BMI; when adding adjustment for sexual orientation and weight-related exposures, GE-group estimates were attenuated up to 8% and remained statistically significant. In males, mostly conforming youth had −0.67 kg/m2 and nonconforming had −1.99 kg/m2 lower BMI (age [in years] interactions were between −0.09 to −0.14 kg/m2; when adding adjustment for sexual orientation and weight-related exposures, GE-group estimates were attenuated up to 11% and remained statistically significant. Conclusions GE is a strong independent predictor of BMI in adolescence. Obesity prevention and treatment interventions with youth must address ways that gender norms may reinforce or undermine healthful behaviors.

Relationship between weight‐related behavioral profiles and health outcomes by sexual orientation and gender

“…Sexual minorities may experience greater chronic stress resulting from stigma and discrimination (known as minority stress) which can negatively impact weight‐related health, particularly during the sensitive developmental period of emerging adulthood. During this time, we see greater risk for overweight and obesity, poor eating habits, insufficient physical activity, and disordered eating among emerging adult sexual minorities . Nearly half of emerging adults attend college , making college campuses a viable setting for interventions addressing weight‐related health disparities among emerging adult sexual minorities.…”

Overweight and obesity in sexual and gender minority adolescents: A systematic review

“…and M.E.B.) rated 18 studies as “good.” Three studies were rated as “fair” for the following reasons: lack of adjustment for confounding variables in statistical analyses; greater than 20% lost to follow‐up after baseline; and exposure of interest not measured prior to outcomes . Information on the quality assessment ratings for all studies is included in Table .…”

“…The preponderance of the studies (n = 16) were published between 2014 and 2018, whereas five were published between 2009 and 2013 . Of the 21 studies reviewed, 13 were cross‐sectional, six were longitudinal, and two were retrospective . Fourteen studies used nationally representative samples, six used community samples, and one used a clinical sample .…”

“…As summarized in the 2011 report by the Institute of Medicine on the health of SGM populations, further systematic investigation of the prevalence of overweight and obesity is warranted in order to enhance health equity among SGM individuals . Extant longitudinal data indicate that SGM youth may be at increased risk for overweight and obesity compared with cisgender, heterosexual youth and differences may exist across sexual orientation and gender identity . However, no studies, to our knowledge, have systematically reported on weight disparities in this population nor explored differential risk for overweight and obesity by SGM subgroup across studies.…”

Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults

“…Among young women, higher adherence to masculine role norms (which includes socially assigned gender nonconformity) has been associated with higher body mass index (BMI) relative to women who adhere to feminine role norms [58], and high BMI may be linked to poorer HRQOL [59]. Greater gender nonconformity among women could also predict greater participation in stereotypically masculine occupations involving physical labor or in sports-related activities, all of which could increase risk of injury [31, 60, 61], causing problems with pain and mobility.…”