The purpose of this study is to assess the differences in obesity and physical activity between sexual minority identified women and heterosexual identified women.

1. A Population-Based Study of Body Mass Index
and Physical Activity Disparities Among
Sexual Minority Identified Women
Sarah M. Piperato & Melinda Forthofer

2. Presenter Disclosures
Sarah M. Piperato
No relationships to disclose

3. Quick Overview
• Background: Current Literature
• Methods
• Results
• Conclusions
• Questions

4. Sexual Minority Identified Women
• Self-identification as a sexual minoritized
person
• Prior research has categorized as: sexual
minority, sexual orientation, sexual behavior
• Sexual identity relates to one’s lived
experiences interacting with society

5. Background
- Sexual minority identified women experience higher rates of
obesity compared to heterosexual identified women (Eliason, et
al., 2015)
- Participate in risky health behaviors at higher rates than
heterosexual identified women (Farmer, et al., 2013; Jabson, et al., 2014;
Operario, et al., 2015)
- No association between energy intake and BMI among sexual
minority identified women (Boehmer & Bowen, 2009)

6. Physical Activity
• Caloric Balance
• Inconsistent results of prior physical activity
studies(Austin & Irwin, 2010; Blosnich, et al., 2010; Boehmer & Bowen,
2009; McElroy & Jordan, 2014)
• Use population based sample

7. Purpose
The purpose of this study is to assess the
differences in obesity and physical activity
between sexual minority identified women and
heterosexual identified women

8. • National Health and Nutrition Examination
Survey 2007-2014
• 6,797 Women
– 455 Sexual minority identified
– 6,342 Heterosexual identified
Methods: Data

9. • Sexual Identification
– “How do you describe yourself”
– Grouped lesbian, bisexual, and other as sexual
minority identified
• Body Mass Index
– Height and weight measured by NHANES staff
– Kg/m2
Methods: Measures

10. Methods: Measures
• Physical Activity
– Self-report recreational physical activity
– Calculated average metabolic equivalents (METS)
of moderate and vigorous physical activity per
week
– Categorized as meeting physical activity
recommendation if >500 Met minutes of physical
activity per week

11. • Descriptive statistics calculated for covariates,
stratified by sexual identity
• Multivariable logistic regression models used
for each outcome; BMI, MPA, VPA, meets PA
recommendations
• Backward stepwise elimination used to
remove covariates for final models
Methods: Statistical Analysis

12. Results: Demographics
• Predominantly White, college educated, self-
rated health “good”
• Sexual minority identified women
– Less likely to have health insurance
– More likely to consume alcohol, smoke cigarettes,
have a history of illicit drug use

13. Results: BMI
Multivariate Adjusted Logistic Regression Analysis of
Associations Between Body Mass Index and Sexual Identity
Sexual Minority Identified Compared to
Heterosexual Identified
Body Mass Index Adjusted Odds
Ratio
95% Confidence
Interval
P-value
Underweight 1.38 (0.59, 3.23) 0.4541
Healthy Weight REF - -
Overweight 1.01 (0.65, 1.54) 0.9825
Obese 1.81 (1.23, 2.65) 0.0032*
Multivariate logistic regression analyses for BMI are adjusted for age, physical activity recommendation, race, marital
status, health insurance status, alcohol use, marijuana or hashish use, cocaine/methamphetamine use and cigarette
smoking. *p-value <.05

14. Results: Physical Activity
Multivariate Adjusted Logistic Regression Analyses of
Associations Between Recreational Physical Activity and
Sexual Identity
Sexual Minority Identified Compared to
Heterosexual Identified
Participation in
Recreational PA
Adjusted Odds
Ratio
95% Confidence
Interval
P-value
Moderate Activity 0.85 (0.67,1.08) 0.1854
Vigorous Activity 1.18 (0.82, 1.70) 0.3622
Meets Recommendations 0.92 (0.68, 1.25) 0.5924
MPA adjusted for BMI, age, race, education, self-rated health, alcohol use,
cocaine/methamphetamine use and cigarette use. VPA adjusted for BMI, age, marital status,
education, self-rated health and alcohol use. Physical activity recommendations adjusted for BMI,
age, race, marital status, education, self-rated health and alcohol use.

15. Discussion
• Consistent with previous literature, sexual
identity is significantly associated with obesity
(Eliason, et al., 2015)
• No association between sexual identity and
physical activity (Blosnich, et al., 2014; Boehmer & Bowen, 2009)
• Lower physical activity levels may not be
underlying cause of higher prevalence of
obesity

16. Limitations
• Small sample size
• Limited options for sexual identification
• Cross-sectional design
• Social acceptability bias
• Subjective physical activity measures

17. Conclusions
• Physical activity does not appear to be driving
the weight disparity between sexual minority
identified women and heterosexual identified
women

18. Future Directions
• Consider socio-cultural impacts on weight
• Intentional in categorization of sexual identity
• Consider sampling frameworks when
designing studies with sexual minoritized
individuals

19. Acknowledgements
• This presentation was made possible in part
by Grant Number T32-GM081740 from NIH-
NIGMS

20. References
• Austin, E. L. & Irwin, J. A. 2010. Health behaviors and health care utilization of southern
lesbians. Women’s Health Issues 20: 178–184.
• Blosnich, J. R., Farmer, G. W., Lee, J. G., et al. 2010. Health inequalities among sexual minority
adults: Evidence from 10 U.S. states, 2010. American Journal of Preventive Medicine 46: 337–
349.
• Boehmer, U. & Bowen, D. J. 2009. Examining factors linked to overweight and obesity in
women of different sexual orientations. Preventive Medicine 48: 357–361.
• Eliason, M. J., Ingraham, N., Fogel, S. C., et al. 2015. A systematic review of the literature on
weight in sexual minority women. Women’s Health Issues 25: 162-175.
• Farmer, G. W., Jabson, J. M., Bucholz, K. K., et al. 2013. A population-based study of
cardiovascular disease risk in sexual-minority women. American Journal of Public Health 103:
1845-1850.
• Jabson, J. M., Farmer, G. W., & Bowen, D. J. 2014. Stress mediates the relationship between
sexual orientation and behavioral risk disparities. BMC Public Health 14: 1-8.
• McElroy, J. A. & Jordan, J. 2014. Disparate perceptions of weight between sexual minority and
heterosexual female college students. LGBT Health 1: 122–130.