Exploring lesbian health disparities: social and structural predictors of adiposity and the metabolic syndrome

Lesbians in the U.S. are disproportionately affected by overweight and obesity compared to heterosexual women. However, there is little public health research examining the possible explanations for the disparity. In addition, there are few studies that have examined the related sequelae of obesity, such as metabolic syndrome. Three studies were conducted using the Epidemiologic Study of HEalth Risk Among Women (ESTHER), a cross-sectional cardiovascular risk study of lesbian and heterosexual women from Pittsburgh, PA and surrounding areas. Study 1 examined the influence of gender nonconformity on body image and satisfaction as well as weight. Butch lesbians reported a smaller difference between their current and ideal figure compared to femme lesbians, lesbians who were “neither” butch nor femme, and heterosexual women, although we did not note any significant differences between the lesbian subgroups in terms of ideal figure. Butch lesbians had significantly higher odds of both overweight and obesity (AOR = 2.15 and 5.57, respectively). Study 2 explored predictors of waist-to-hip ratio (WHR) and BMI status. We did not find any difference between lesbians and heterosexuals in terms of WHR. The odds of lesbians being obese compared to normal weight were 1.63 times higher than the odds of heterosexuals being obese compared to normal weight (p=0.013). Being in a committed relationship was associated with significantly lower odds of overweight and obesity for heterosexual women but not for lesbians. Importantly, lesbians who reported gender discrimination had over three times higher odds of being obese (AOR = 3.122, p < 0.001). Study 3 extended the lesbian health disparities literature by quantifying the differential risk of the metabolic syndrome between lesbians and heterosexuals. After controlling for several factors, lesbians had a 44% higher risk of having the metabolic syndrome than heterosexuals. Future research is needed to examine potential mediators and additional moderators of the relationship between gender nonconformity, sexual orientation, and obesity and the metabolic syndrome. Given the serious public health consequences of both obesity and the metabolic syndrome, public health should commit greater resources to studying these health disparities among lesbians