Abstract
Background
Lesbian and bisexual women are at greater risk of being obese than heterosexual women;
however, there is little research on dietary intake among lesbian and bisexual women.
Objective
This study estimated differences in dietary quality and intake during adulthood comparing
heterosexual women to lesbian and bisexual women.
Design
Biennial mailed questionnaires were used to collect data from a cohort between 1991
and 2011. Heterosexual-identified women were the reference group.
Participants/setting
More than 100,000 female registered nurses in the United States, aged 24 to 44 years,
were recruited in 1989 to participate in the Nurses’ Health Study II. More than 90%
of the original sample are currently active in the study. About 1.3% identified as
lesbian or bisexual.
Main outcome measures
Dietary measures were calculated from a 133-item food frequency questionnaire administered
every 4 years. Measures included diet quality (Alternative Healthy Eating Index-2010
and Dietary Approaches to Stop Hypertension); calorie, fat, and fiber intake; and
glycemic load and index.
Statistical analyses
Multivariable adjusted repeated measures linear regression models were fit.
Results
On average, lesbian and bisexual women reported better diet quality (P<0.001) and diets lower in glycemic index (P<0.001) than heterosexual women. In the whole cohort, diet quality scores increased
as participants aged, and were lower among women living in rural compared to urban
regions. Comparisons in dietary intake across sexual orientation groups were generally
similar across age and rurality status. However, differences between lesbian and heterosexual
women in Alternative Healthy Eating Index-2010 were larger during younger compared
to older ages, suggesting that diet quality estimates among sexual orientation groups
converged as women aged.
Conclusions
Lesbian and bisexual women reported higher diet quality than heterosexuals. More research
examining how diet affects risk for chronic conditions, such as diabetes, among sexual
minorities is needed. Physical activity, sedentary behavior, disordered eating behaviors,
and psychosocial and minority stress should be explored as potential contributors
to higher rates of obesity among sexual minority women.
Keywords
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References
- A population-based study of cardiovascular disease risk in sexual minority women.Am J Public Health. 2013; 103: 1845-1850
- Health and health risks among sexual minority women: An examination of three subgroups.Am J Public Health. 2014; 104: 1045-1047
- Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study.Am J Public Health. 2013; 103: 1802-1809
- Adult health behaviors over the life course by sexual orientation.Am J Public Health. 2012; 102: 292-300
- A population-based study of sexual orientation identity and gender differences in adult health.Am J Public Health. 2010; 100: 1953-1960
- Demonstrating the importance of feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest.Am J Public Health. 2009; 99: 1-8
- Sexual-orientation disparities in cigarette smoking in a longitudinal cohort study of adolescents.Nicotine Tob Res. 2013; 15: 213-222
- Sexual orientation disparities in longitudinal alcohol use patterns among adolescents: Findings from the Growing Up Today Study.Arch Pediatr Adolesc Med. 2008; 162: 1071-1078
- Disparities in health-related quality of life: A comparison of lesbians and bisexual women.Am J Public Health. 2010; 100: 2255-2261
- Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States.Am J Public Health. 2010; 100: 468-475
- Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States.J Consult Clin Psychol. 2003; 71: 53-61
- Overweight and obesity in sexual-minority women: evidence from population-based data.Am J Public Health. 2007; 97: 1134-1140
- Examining factors linked to overweight and obesity in women of different sexual orientations.Prev Med (Baltim). 2009; 48: 357-361
- Weight status and sexual orientation: Differences by age and within racial and ethnic subgroups.Am J Public Health. 2014; 104: 103-109
- Disparities in weight and weight behaviors by sexual orientation in college students.Am J Public Health. 2015; 105: 111-121
- Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II.J Women’s Heal. 2004; 13: 1033-1047
- Disability among lesbian, gay, and bisexual adults: Disparities in prevalence and risk.Am J Public Health. 2012; 102: e16-e21
- Sexual orientation and sex differences in adult chronic conditions, health risk factors, and protective health practices: Oregon 2005-2008.Prev Chronic Dis. 2014; 11: E136
- Hispanic lesbians and bisexual women at heightened risk for health disparities.Am J Public Health. 2012; 102: e9-e15
- Sexual Orientation and Health Among U.S. Adults: National Health Interview Survey, 2013.(National Health Statistics Reports, No. 77) National Center for Health Statistics, Hyattsville, MD2014
- A review of obesity issues in sexual minority women.Obesity. 2008; 16: 221-228
- A systematic review of the literature on weight in sexual minority women.Women’s Heal Issues. 2015; 25: 162-175
- Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—The evidence report. National Institutes of Health.Obes Res. 1998; 6: 51S-209S
- The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.Institute of Medicine, Washington, DC2011
- College women’s weight-related behavior profiles differ by sexual identity.Am J Health Behav. 2015; 39: 461-470
- Adult body mass index trajectories and sexual orientation: The Nurses’ Health Study II.Am J Prev Med. 2012; 42: 348-354
- A national study of obesity prevalence and trends by type of rural county.J Rural Heal. 2005; 21: 140-148
- Obesity and physical inactivity in rural America.J Rural Heal. 2004; 20: 151-159
- Prevalence of obesity among adults from rural and urban areas of the United States: Findings from NHANES (2005-2008).J Rural Heal. 2012; 28: 392-397
- Crone songs: Voices of lesbian elders on aging in a rural environment.Affilia. 2004; 19: 418-436
- Health behaviors and health care utilization of southern lesbians.Women’s Heal Issues. 2010; 20: 178-184
- “Quite Frankly, i have doubts about remaining”: Aging-in-place and health care access for rural midlife and older lesbian, gay, and bisexual individuals.J LGBT Health Res. 2009; 5: 10-21
- An examination of past and current influences of rurality on lesbians’ overweight/obesity risks.LGBT Heal. 2015; 2: 154-161
- The Nurses’ Health Study: Lifestyle and health among women.Nat Rev Cancer. 2005; 5: 388-396
- Disclosure of sexual orientation and behavior in the Nurses’ Health Study II: Results from a pilot study.J Homosex. 2006; 51: 13-31
- The use of a self-administered questionnaire to assess diet four years in the past.Am J Epidemiol. 1988; 127: 188-199
- Alternative dietary indices both strongly predict risk of chronic disease.J Nutr. 2012; 142: 1009-1018
- Adherence to the DASH Diet is inversely associated with incidence of type 2 diabetes: The insulin resistance atherosclerosis study.Diabetes Care. 2009; 32: 1434-1436
- Ethnicity, obesity, and risk of type 2 diabetes in women: A 20-year follow-up study.Diabetes Care. 2006; 29: 1585-1590
- Diet and risk of type II diabetes: The role of types of fat and carbohydrate.Diabetologia. 2001; 44: 805-817
- Carbohydrates, dietary fiber, and incident type 2 diabetes in older women.Am J Clin Nutr. 2000; 71: 921-930
- Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.Am J Clin Nutr. 2004; 10: 348-356
- Dietary fibre intake and risk of cardiovascular disease: Systematic review and meta-analysis.BMJ. 2013; 347: f6879
- Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.N Engl J Med. 2001; 345: 790-797
- Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus.Arch Intern Med. 2012; 172: 1566-1572
SAS software [computer program]. Version 9.3. Cary, NC: SAS Institute, Inc; 2010.
- Sexual orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: Pooled Youth Risk Behavior Surveys.Am J Public Health. 2014; 104: 245-254
- Healthy eating, exercise, and weight: Impressions of sexual minority women.Women Health. 2008; 44: 79-93
VanKim NA, Porta CM, Eisenberg ME, Neumark-Sztainer DR, Laska MN. Lesbian, gay, and bisexual college student perspectives on weight-related behaviors: A qualitative analysis. J Clin Nurs. In press.
- Rural-urban differences in obesity.Rural Sociol. 1996; 61: 289-305
- Obesity and health status in rural, urban, and suburban southern women.South Med J. 2002; 95: 666-671
- Determinants of obesity-related underreporting of energy intake.Am J Epidemiol. 1998; 147: 1081-1086
- Sexual Behavior, Sexual Attraction, and sexual Identity in the United States: Data from the 2006-2008 National Survey of Family Growth.US Department of Health and Human Services, Hyattsville, MD2011
Biography
N. A. VanKim is an assistant professor, Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst; at the time of the study, she was a postdoctoral fellow with the Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA.
Biography
S. B. Austin is a professor, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, director of fellowship research training, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, and professor of pediatrics, Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
Biography
H.-J. Jun is an adjunct assistant professor, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA.
Biography
H. L. Corliss is a professor, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA.
Biography
F. B. Hu is a professor, Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, and professor of medicine, Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.
Article info
Publication history
Published online: November 23, 2016
Accepted:
September 26,
2016
Received:
January 5,
2016
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was supported by Award No. DK099360, DK58845, and UM1CA176726 from the National Institutes of Health.
Identification
Copyright
© 2017 by the Academy of Nutrition and Dietetics.
