A Heavy Burden: Associations Between Sexual Minority Status, Mental Health, and BMI in Women

Sexual minority women (SMW) are at increased risk of elevated body mass index (BMI) compared to heterosexual women, which increases their vulnerability to a variety of chronic diseases. This increased risk of elevated BMI is likely due to unique minority stressors faced by sexual minority individuals, such as internalized heterosexism and discrimination. Minority stressors are associated with poorer mental and physical health among SMW, and SMW may engage in unhealthy coping strategies, like binge eating, to cope with these minority stressors. Research suggests that bisexual women, and other women with non-monosexual orientations, face elevated risks to their physical and psychological health compared to women with monosexual orientations, possibly related to unique minority stressors (e.g., bi-negativity, anti-bisexual discrimination) and unique responses to minority stressors. We recruited a sample of 437 primarily cisgender women, ages 18-65 years (M = 26.38; SD = 8.11), of all sexual orientations to complete a cross-sectional, online survey including self-report measures of sexual orientation, weight status, psychological distress, and eating behaviors. We investigated relations among these variables to better understand BMI disparities, both between SMW and heterosexual women and within SMW. Specifically, we examined how sexual orientation discordance (i.e., differences between dimensions of sexual orientation), psychological distress, eating behaviors, and BMI were related, and how different elements of sexual orientation influenced these associations. We found that the attraction and identity dimensions of sexual orientation were associated with symptoms of poorer mental and physical health among SMW. SMW reported more psychological distress, more binge eating, and elevated BMI than their heterosexual peers. Non-monosexual SMW reported the most psychological distress, binge eating, and highest BMIs, compared to all monosexual peers (i.e., heterosexual and lesbian). Clinicians should educate themselves, and their clients, about how risk factors may differ based on various aspects of sexual orientation (including sexual orientation discordance). They should provide culturally competent interventions at the first sign of either psychological distress, disordered eating, or elevated BMI. Future research should help to inform clinical practice by elucidating mechanisms by which mental and physical health symptoms contribute to each other, and how this may differ for distinct groups of women