Abstract
Purpose
To investigate the relationship between selected disordered eating behaviors and self-reported sexual minority status (gay/lesbian, bisexual, and unsure) among a representative sample of high school adolescents.
Methods
The 2013 Centers for Disease Control and Prevention (CDC)-sponsored Connecticut Youth Risk Behavior Survey was utilized (N = 2242). Unadjusted and adjusted logistic regression analyses, separated by gender, examined sexual minority adolescents (gay/lesbian, bisexual, and unsure) and selected eating behaviors. Analyses adjusted for race, age, cigarette use, binge drinking, organized school activity participation, body mass index (BMI), and depression.
Results
Gay males were significantly more likely to report exercising or eating less to lose weight in the unadjusted models (p < 0.05) and fasting, vomiting, and taking diet pills in both adjusted (p < 0.05) and unadjusted models (p < 0.01) when compared to the referent heterosexual males. Bisexual females were significantly more likely to report fasting, vomiting, and taking diet pills in the unadjusted model (p < 0.05) when compared to the referent heterosexual females and significantly less likely to report exercising or eating less to lose weight in the adjusted models (p < 0.05).
Conclusions
Although additional studies are needed owing to small sample sizes, preliminary findings support previous research suggesting that high school-aged sexual minority youth subgroups are a priority target population for increased efforts to prevent disordered eating.
Similar content being viewed by others
References
Valois RF, Kerr JC, Kammermann SK (2014) Life satisfaction and adolescent health risk behaviors. In: Sarracino F, Mikucka M (eds) Life satisfaction: perceptions, social influences and implications for long-term health. Nova Science Publishers, Hauppauge, pp 21–29
Valois RF (2003) Promoting adolescent and school health: perspectives and future directions. Am J Health Educ 34:314–328. doi:10.1080/19325037.2003.10603572
Dryfoos JG (1991) Preventing high risk behavior. Am J Public Health 81:157–158. doi:10.2105/AJPH.81.2.157
Crow S (2005) Medical complications of eating disorders. In: Wonderlich S, Michell J, de Zwaan M (eds) Eating disorders review, Part 1. Radcliffe Publishing Ltd, Abingdon, pp 127–136
Hudson JI, Hiripi E, Pope Jr HG et al (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61:348–358. doi:10.1016/j.biopsych.2006.03.040
Herzog DB, Hopkins JD, Burns CD (1993) A follow-up study of 33 subdiagnostic eating disordered women. Int J Eat Disord 14:261–267. doi:10.1002/1098-108X(199311)14:3%3C261::AID-EAT2260140304%3E3.0.CO;2-N
King MB (1989) Eating disorders in a general practice population: prevalence, characteristics and follow-up at 12–18 months. Psychol Med 14:1–34. doi:10.1017/S0264180100000515
Kann L, Kinchen S, Shanklin S et al (2014) Youth risk behavior surveillance: United States, 2013. MMWR Surveill Summ 63:40–41. http://files.eric.ed.gov/fulltext/ED566383.pdf
Croll J, Neumark-Sztainer D, Story M, Ireland M (2002) Prevalence and risk and protective factors related to disordered eating behaviors among adolescents: relationship to gender and ethnicity. J Adolesc Health 31:166–175. doi:10.1016/S1054-139X(02)00368-3
Austin SB, Nelson LA, Birkett MA et al (2013) Eating disorder symptoms and obesity at the intersections of gender, ethnicity, and sexual orientation in US high school students. Am J Public Health 103:16–22. doi:10.2105/AJPH.2012.301150
Feldman MB, Meyer IH (2007) Eating disorders in diverse lesbian, gay, and bisexual populations. Int J Eat Disord 40:218–226. doi:10.1002/eat.20360
Russell CJ, Keel PK (2002) Homosexuality as a specific risk factor for eating disorders in men. Int J Eat Disord 31:300–306. doi:10.1002/eat.10036
Ackard DM, Fedio G, Neumark-Sztainer D et al (2008) Factors associated with disordered eating among sexually active adolescent males: gender and number of sexual partners. Psychosom Med 70:232–238. doi:10.1097/PSY.0b013e318164230c
French SA, Story M, Remafedi G, Blum RW (1996) Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: a population-based study of adolescents. Int J Eat Disord 19:119–126. doi:10.1002/(SICI)1098-108X(199603)19:2<119:AID-EAT2>3.0.CO;2-Q
Calzo JP, Corliss HL, Blood EA et al (2013) Development of muscularity and weight concerns in heterosexual and sexual minority males. Health Psychol 13(32):42–51. doi:10.1037/a0028964
Austin SB, Ziyadeh N, Kahn JA et al (2004) Sexual orientation, weight concerns, and eating-disordered behaviors in adolescent girls and boys. J Am Acad Child Adolesc Psychiatry 43:1115–1123. doi:10.1097/01.chi.0000131139.93862.10
Fredrickson BL, Roberts T-A (1997) Objectification theory: Toward understanding women's lived experiences and mental health risks. Psychol Women Q 21:173–206. doi:10.1111/j.1471-6402.1997.tb00108.x
Hospers HJ, Jansen A (2005) Why homosexuality is a risk factor for eating disorders in males. J Soc Clin Psychol 24:1188–1201. doi:10.1521/jscp.2005.24.8.1188
Meyer IH (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129:674–697. doi:10.1037/0033-2909.129.5.674
Shearer A, Russon J, Herres J, Atte T, Kodish T, Diamond G (2015) The relationship between disordered eating and sexuality amongst adolescents and young adults. Eat Behav 19:115–119. doi:10.1016/j.eatbeh.2015.08.001
Guille C, Chrisler JC (1999) Does feminism serve a protective function against eating disorders? J Lesbian Stud 3:141–148. doi:10.1300/J155v03n04_18
Siever MD (1994) Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders. J Consult Clin Psychol 62(2):252–260. doi:10.1037/0022-006X.62.2.252
Brand PA, Rothblum ED, Solomon LJ (1992) A comparison of lesbians, gay men and heterosexuals on weight and restrained eating. Int J Eat Disord 11:253–259
Heffernan K (1996) Eating disorders and weight concern among lesbians. Int J Eat Disord 19(2):127–138. doi:10.1002/(SICI)1098-108X(199603)19:2<127:AID-EAT3>3.0.CO;2-P
Moore F, Keel PK (2003) Influence of sexual orientation and age on disordered eating attitudes and behaviors in women. Int J Eat Disord 34:370–374. doi:10.1002/eat.10198
Share TL, Mintz LB (2002) Differences between lesbians and heterosexual women in disordered eating and related attitudes. J Homosex 42:89–106. doi:10.1300/J082v42n04_06
Austin SB, Ziyadeh NJ, Corliss HL, Rosario M, Wypij D, Haines J et al (2009) Sexual orientation disparities in purging and binge eating from early to late adolescence. J Adolesc Health 45:238–245. doi:10.1016/j.jadohealth.2009.02.001
Hadland SE, Austin SB, Goodenow CS, Calzo JP (2014) Weight misperception and unhealthy weight control behaviors among sexual minorities in the general adolescent population. J Adolesc Health 54:296–303. doi:10.1016/j.jadohealth.2013.08.021
Robin L, Brener ND, Donahue SF, Hack T, Hale K, Goodenow C (2002) Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students. Arch Ped Adolesc Med 156:349–355. doi:10.1001/archpedi.156.4.349
Wichstrøm L (2006) Sexual orientation as a risk factor for bulimic symptoms. Int J Eat Disord 39:448–453. doi:10.1002/eat.20286
Boehmer U, Bowen DJ, Bauer GR (2007) Overweight and obesity in sexual-minority women: evidence from population-based data. Am J Public Health 97(6):1134–1140. doi:10.2105/AJPH.2006.088419
Williams T, Connolly J, Pepler D, Craig W (2005) Peer victimization, social support, and psychosocial adjustment of sexual minority adolescents. J Youth Adolesc 34:471–482. doi:10.2015/AJPH.2006.088419
Zhao Y, Montoro R, Igartua K, Thombs BD (2010) Suicidal ideation and attempt among adolescents reporting “unsure” sexual identity or heterosexual identity plus same-sex attraction or behavior: forgotten groups? J Am Acad Child Adolesc Psychiatry 49:104–113. doi:10.1016/j.jaac.2009.11.003
Sorosiak D, Frassinelli J, Edmondson BJ (2013) Connecticut Youth Risk Behavior Survey: Component of the Connecticut School Health Survey. Connecticut Department of Public Health in collaboration with the Connecticut State Department of Education. http://www.ct.gov/dph/lib/dph/hisr/pdf/cshs_ybc2013_report.pdf. Accessed 12 June 2015
Brener ND, Kann L, McManus T, Kinchen SA, Sundberg EC, Ross JG (2002) Reliability of the 1999 Youth Risk Behavior Survey questionnaire. J Adolesc Health 31:336–342. doi:10.1016/S1054-139X(02)00339-7
Matthews-Ewald MR, Zullig KJ, Ward RM (2014) Sexual orientation and disordered eating behaviors among self-identified male and female college students. Eat Behav 15:441–444. doi:10.1016/j.eatbeh.2014.05.002
King M, Semlyen J, Tai SS et al (2008) A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 8:70. doi:10.1186/1471-244X-8-70
Saules KK, Pomerleau CS, Snedecor SM et al (2004) Relationship of onset of cigarette smoking during college to alcohol use, dieting concerns, and depressed mood: results from the Young Women’s Health Survey. Addict Behav 29:893–899. doi:10.1016/j.addbeh.2004.02.015
Kann L, Olsen EO, McManus T, Kinchen S, Chyen D, Harris WA, Wechsler H (2011) Sexual identity, sex of sexual contacts, and health risk behaviors among students in Grades 9–12-Youth Risk Behavior Surveillance, Selected Sites, United States, 2001–2009. MMWR 2011:60;1–133 http://www.cdc.gov/mmwr/pdf/ss/ss60e0606.pdf. Accessed 15 March 2016
Baumeister RF (2000) Gender differences in erotic plasticity: the female sex drive as socially flexible and responsive. Psychol Bull 126:347–374. doi:10.1037/0033-2909.126.3.347
Peplau LA (2000) Human sexuality: how do men and women differ? Curr Dir Psychol Sci 12:37–40. doi:10.1111/1467-8721.01221
Crow S, Peterson CB (2003) The economic and social burden of eating disorders: a review. In: Maj M, Halmi K, Lopez-Ibor JJ, Sartorius N (eds) Eating Disorders. John Wiley & Sons Ltd, Hoboken, pp 383–396
Franko DL, Keel PK (2006) Suicidality in eating disorders: occurrence, correlates, and clinical implications. Clin Psychol Rev 26:769–782. doi:10.1016/j.cpr.2006.04.001
Savin-Williams RC, Diamond LM (2009) Sexual identity trajectories among sexual-minority youths: gender comparisons. Arch Sex Behav 29:607–627. doi:10.1023/A:1002058505138
Brand PA, Rothblum ED, Solomon LJ (1992) A comparison of lesbians, gay men and heterosexuals on weight and restrained eating. Int J Eat Disord 11:253–259
Herzog DB, Newman KL, Warshaw M (1991) Body image dissatisfaction in homosexual and heterosexual males. J Nerv Ment Dis 170:356–359
Wiseman MC, Moradi B (2010) Body image and eating disorder symptoms in sexual minority men: a test and extension of objectification theory. J Counsel Psychol 57:154–166. doi:10.1037/a0018937
Ruuska J, Kaltiala-Heino R, Kovisto AM, Rantanen P (2003) Puberty, sexual development and eating disorders in adolescent outpatients. Eur Child Adolesc Psychiatry 12:214–220. doi:10.1007/s00787-003-0340-4
Brewster ME, Moradi B (2010) Perceived experiences of anti-bisexual prejudice: instrument development and evaluation. J Counsel Psychol 57:451–468. doi:10.1037/a0021116
Walters ML, Chen J, Breiding MJ (2013) The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 findings on victimization by sexual orientation. Atlanta, Georgia: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/ViolencePrevention/pdf/NISVS_SOfindings.pdf. Accessed 1 May 2017
Thompson KM, Wonderlich SA, Crosby RD, Mitchell JE (2001) Sexual violence and weight control techniques among adolescent girls. Int J Eat Disord 29:166–176. doi:10.1002/1098-108X(200103)29:2%3C166::AID-EAT1006%3E3.0.CO;2-3
Gonsalves D, Hawk H, Goodenow C (2014) Unhealthy weight control behaviors and related risk factors in massachusetts middle and high school students. Matern Child Health J 18:1803–1813. doi:10.1007/s10995-013-1424-5
Matthews M, Zullig K, Ward R et al (2012) An analysis of specific life satisfaction domains and disordered eating among college students. Soc Indic Res 107:55–69. doi:10.1007/s11205-011-9826-5
Forman-Hoffman V (2004) High prevalence of abnormal eating and weight control practices among US high-school students. Eat Behav 5:325–336. doi:10.1016/j.eatbeh.2004.04.003
Atkins L, Sharp SF, Watt TT (2002) Personal control and disordered eating patterns among college females. J Appl Soc Psychol 32:2502–2512
Sherer M, Maddux JE, Mercandante B et al (1982) The self-efficacy scale: construction and validation. Psychol Rep 51:663–671. doi:10.2466/pr0.1982.51.2.663
Bandura A (1997) Self-efficacy: the exercise of self-control. Freeman, New York
Buckley M, Storino M, Saarni C (2003) Promoting emotional competence in children and adolescents: implications for school psychologists. Sch Psych Q 18:177–191. doi:10.1521/scpq.18.2.177.21855
Saarni C, Campos JJ, Camras LA et al (1998) Emotional development: action, communication, and understanding. Handb Child Psychol. doi:10.1002/9780480147658.chpsy0305
Halberstadt AG, Denham SA, Dunsmore JC (2001) Affective social competence. Soc Dev 10:79–119. doi:10.1111/1467-9507.00150
DiClemente RJ, Crittenden CP, Rose E et al (2008) Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn’t work? Psychosom Med 70:598–605. doi:10.1097/PSY.0b013e3181775edb
Hennessy M, Romer D, Valois RF et al (2013) Safer sex media messages and adolescent sexual behavior: 3-year follow-up results from Project iMPPACS. Am J Public Health 103:134–140. doi:10.2105/AJPH.2012.300856
Hessler DM, Katz LF (2010) Brief report: associations between emotional competence and adolescent risky behavior. J Adolesc 33:241–246. doi:10.1016/j.adolescence.2009.04.007
Balis T, Postolache TT (2008) Ethnic differences in adolescent suicide in the United States. Int J Child Health Hum Dev 1:281–296. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845977/pdf/nihms-86201.pdf
van den Bree MM, Pickworth WB (2005) Risk factors predicting changes in marijuana involvement in teenagers. Arch Gen Psychiatry 62:311–319. doi:10.1001/archpsyc.62.3.311
Borowsky IW, Ireland M, Resnick MD (2001) Adolescent suicide attempts: risks and protectors. Pediatrics 107:485–493. http://pediatrics.aappublications.org/content/pediatrics/107/3/485.full.pdf
Belfield C, Bowden B, Klapp A (2015) Economic value of social and emotional learning. Center for Benefit-Cost Studies in Education. Teachers College, Columbia University, New York, http://www.casel.org/s/Belfield-etal-The-Economics-of-SEL-Feb-2015.pdf. Accessed 26 June 2016
Ragozzino K, Utne O’Brien M (2009) Social and emotional learning and bullying prevention. Collaborative for Academic, Social, and Emotional Learning (CASEL). http://casel.org/downloads/2009_bullyingbrief.pdf. Accessed 22 June 2017
Guerra NG, Bradshaw CP (2008) Linking the prevention of problem behaviors and positive youth development: core competencies for positive youth development and risk prevention. New Dir Child Adolesc Dev 122:1–17. doi:10.1002/cd.225
Greenberg M, Weissberg R, O’Brien M (2003) Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. Am Psychol 58:466–474. doi:10.1037/0003-066X.58.6-7.466
Hawkins JD, Smith BH, Catalano RF (2004) Social development and social and emotional learning. In: Zins JE, Weissberg RP, Wang MC, Walberg HJ (eds) Building academic success on social and emotional learning: What does the research say? Teachers College Press, New York, pp 135–150
Zins JE, Weissberg RP, Wang MC (2004) Building academic success on social and emotional learning: what does the research say?. Teachers College Press, New York
Durlak JA, Weissberg RP, Dymnicki AB, Taylor RD, Schellinger KB (2011) The impact of enhancing students’ social and emotional learning: a meta-analysis of school-based universal interventions. Child Dev 82:405–432. doi:10.1111/j.1467-8624.2010.01564.x
Payton JW, Wardlaw DM, Graczyk PA, Bloodworth MR, Tompsett CJ, Weissberg RP (2000) Social and emotional learning: a framework for promoting mental health and reducing risk behavior in children and youth. J Sch Health 70:179–185. doi:10.1111/j.1746-1561.2000.tb06468.x
Brown EC, Low S, Smith BH (2011) Outcomes from a school-randomized controlled trial of steps to respect: a school bullying prevention program. Sch Psychol Rev 40(3):423–443. http://search.proquest.com/docview/901135827?pqorigsite=gscholar
Frankowski BL (2004) Sexual orientation and adolescents. Pediatrics 113:1827–1832. doi:10.1542/peds.113.6.1827
Neumark-Sztainer D (2009) Preventing obesity and eating disorders in adolescents: what can health care providers do? J Adolesc Health 44:206–213. doi:10.1016/j.jadohealth.2008.11.005
Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159:1284–1293. doi:10.1176/appi.ajp.159.8.1284
Steinhausen HC, Rauss-Mason C, Seidel R (1991) Follow-up studies of anorexia nervosa: a review of four decades of outcome research. Psychol Med 21:447–454. doi:10.1017/S0033291700020559
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest associated with this research study.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study data utilized by the authors of this study were de-identified for analysis; thus, for this type of study formal consent is not required.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Zullig, K.J., Matthews-Ewald, M.R. & Valois, R.F. Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents. Eat Weight Disord 24, 565–573 (2019). https://doi.org/10.1007/s40519-017-0389-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-017-0389-6