Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity.

BACKGROUND: Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. METHODS: A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. RESULTS: Participants of lower SES had 1.27 (95% CI 1.25-1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. CONCLUSIONS: Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.

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

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.

OBJETIVO: Los grupos de minorías sexuales (SM) tienen un riesgo elevado de síntomas y comportamientos de trastornos de la conducta alimentaria. Sin embargo, las formas en que este riesgo varía entre SM son menos claras. La evolución en la definición y evaluación del estatus de SM puede contribuir a esta divergencia. El objetivo de este estudio fue revisar sistemáticamente cómo se han evaluado la orientación sexual y el estado de SM en la literatura sobre trastornos de la conducta alimentaria y cómo esto puede relacionarse con los patrones de asociaciones entre el estado de SM y los síntomas del trastorno alimentario. MÉTODOS: Se realizó una revisión sistemática de la literatura centrada en los síntomas y comportamientos del trastorno de la conducta alimentaria y los grupos de SM, que arrojó 182 estudios. RESULTADOS: Se crearon cinco categorías que reflejan la evaluación del estado de SM: solo identidad (n = 105), solo atracción (n = 8), solo comportamiento (n = 4), combinaciones de identidad, comportamiento o atracción (n = 58) y artículos con información poco clara o insuficiente sobre la evaluación del estado de SM (n = 7). Las operacionalizaciones del estado de SM variaron entre los estudios, con evaluaciones combinadas más inclusivas en el trabajo más reciente. Los hallazgos revelaron patrones persistentes y conflictivos de sintomatología alimentaria disfuncional para algunos grupos de SM. Además, las decisiones de combinar selectivamente a los participantes de SM en algunos estudios, con mayor frecuencia para aumentar el poder, disminuyeron la especificidad de sus resultados en relación con el riesgo diferencial y los factores de protección dentro de grupos LGBQA+ específicos. DISCUSIÓN: Los hallazgos resaltan la importancia de las evaluaciones inclusivas de la orientación sexual en la literatura sobre trastornos alimentarios y la investigación centrada en grupos subrepresentados con identidades que se cruzan. Identificar objetivos modificables para la intervención como recursos es un siguiente paso crítico.

Body image and associated factors among sexual minority men: A systematic review.

Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.

A biopsychosocial model of body image, disordered eating, and breastfeeding among postpartum women.

BACKGROUND: The aim of the current study was to test a biopsychosocial model of body image, eating, and feeding attitudes among postpartum women. Specifically, the model predicted that desired weight-loss, depressive symptoms, and body surveillance would predict body dissatisfaction and appearance-related barriers to breastfeeding, which in turn would predict maternal disordered eating and breastfeeding self-efficacy. METHODS: Data from 151 women, mean age = 32.77 (4.47) years, who provided complete data in response to an online survey were analyzed. RESULTS: Path analysis revealed that after minor modifications, the biopsychosocial model was a good fit to the data. Desired weight-loss, depressive symptoms, and body surveillance were associated with higher levels of disordered eating and lower levels of breastfeeding self-efficacy directly, as well as indirectly through body dissatisfaction and appearance-related barriers to breastfeeding. CONCLUSION: Findings provide support for an integrated biopsychosocial model of body image concerns, and eating and feeding attitudes among postpartum women as well as highlighting the need for additional support around body image, eating, and breastfeeding following childbirth. Our study has clinical implications for healthcare providers working with new mothers and can be used to inform postpartum psychoeducation efforts addressing breastfeeding, weight loss expectations and body image concerns.