Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades

Abstract

Objective Sexual minority (SM) groups (e.g., those who identify as lesbian, gay, bisexual, questioning, queer, asexual, or those who feel their sexual orientation identity cannot be captured with existing terminology [LGBQA+] and those who report same‐sex or same‐gender attraction and/or behavior) are at elevated risk for eating disorder (ED) symptoms and behaviors. However, the ways in which this risk varies across SM is less clear, and findings are not fully convergent. Evolution in the definition and assessment of SM status may contribute to this divergence. The aim of this study was to systematically review how sexual orientation and SM status have been assessed in the ED literature and how this may relate to patterns of associations between SM status and ED symptoms. Methods A systematic review of the literature focused on ED symptoms and behaviors and SM groups was conducted, yielding 182 studies. Results Five categories were created reflecting SM status assessment: identity only (n = 105), attraction only (n = 8), behavior only (n = 4), combinations of identity, behavior, or attraction (n = 58), and articles with unclear or insufficient information about SM status assessment (n = 7). SM status operationalizations varied across studies, with more inclusive assessments in more recent work. Findings revealed persistent conflicting patterns of disordered eating symptomatology for some SM groups. In addition, decisions to selectively combine SM participants in some studies, most often to increase power, decreased the specificity of their results in relation to differential risk and protective factors within specific LGBQA+ groups. Discussion Findings highlight the importance of inclusive assessments of sexual orientation in the ED literature and research focused on underrepresented groups with intersecting identities. Identifying modifiable targets for intervention is a critical next step. Public Significance Sexual minority (SM) groups have been identified as presenting elevated risk for eating disorder symptoms and behaviors. Our findings suggest that the level of risk is variable across SM groups and points to the need for multi‐dimensional assessments of SM status, and increased focus on the function of disordered eating behaviors and different profiles that might emerge related to efforts to modify physical appearance or to regulate emotion.

Eating Disorders and Dietary Supplements: A Review of the Science

“…There is some evidence to suggest a potential link between the use of some products and a later eating disorder diagnosis. However, this appears to be more of a symptom or associated behavior potentially valuable as a screening tool as opposed to demonstrating causality [11]. Therefore, it may be reasonable to state that the abuse, not use, of certain supplements may be associated with an eating disorder rather than being a risk factor.…”

“…A risk factor occurs before the associated outcome; it is a characteristic associated with an increased likelihood of the outcome being studied. It can be used to determine highrisk and low-risk subgroups [11]. It should not be confused with symptoms or behaviors associated with the disease itself.…”

“…According to the DSM-V, dependence on enteral feeding or nutritional supplements taken orally is a symptom or warning sign of an eating disorder, specifically Avoidant/ Restrictive Food Intake Disorder (ARFID) [4]. This should not be confused with a risk factor; as mentioned above, a risk factor occurs before the behavior [11]. It is reasonable to state that the abuse, not use, of some supplements may be a sign or symptom of an eating disorder, not a risk factor.…”

A feminist approach to eating disorders in China: a qualitative study

“…In addition, the research attracted a number of university educated students who were studying gender—a pursuit which may be more associated with marginalized communities in the Chinese context. Western studies have explored how occupying a sexual minority identity may increase the risk for EDs (although the results are uneven and there is more work on males) [ 51 ], and how experiences of sexual marginalization can shape the political and personal meanings of eating/body distress [ 36 ]. Nevertheless, the participants in the study who identified as pan/bi/lesbian did not refer to issues of sexuality in interview, whether explicitly or implicitly.…”

The role of minority stress in disordered eating: a systematic review of the literature

“…People that are part of Sexual and Gender Minorities (SGMs) seem to be particularly at risk—that is, people who have either a sexual orientation other than heterosexual (e.g., gay, lesbian, bisexual, pansexual 1 ) or a gender identity that is not consistent with one’s assigned gender at birth (e.g., trans, non-binary, gender non-conforming). The prevalence of disordered eating has been found to be higher in SGMs when compared to heterosexual or cisgender people [ 6 – 9 ]. SGMs have also been found to be at significant risk for body image concerns, such as increased body dissatisfaction [ 10 , 11 ], weight bias [ 12 ] and weight dissatisfaction [ 13 , 14 ], which are closely linked to disordered eating.…”