National population-based studies have found that eating disorders affect 1–3% of women and less than 0.5% of men,1–3
except for binge eating disorder which was found to affect 2% of the men in the study by Hudson et al.3
Although anorexia and bulimia nervosa occur primarily in women, 5–20% of people with eating disorders are men.4–6
Studies suggest that a disproportionate number of these men are gay and bisexual. In both community7
samples of men with eating disorders, 14–42%—compared with about 3% of the U.S. male population10
—are gay or bisexual. Consistent with these findings, studies have found that compared with heterosexual men, gay and bisexual men have more behavioral symptoms indicative of eating disorders.8,9,11–18
For example, Strong et al.19
found that the proportion of gay and bisexual men with symptoms related to disordered eating was 10 times higher than among heterosexual men (10 and 1%, respectively).
One prominent explanation for the high prevalence of eating disorders among gay and bisexual men can be referred to as the sociocultural perspective.
The sociocultural perspective implicates social and cultural values and norms that advance notions of an ideal body image that are unobtainable by many,20
which can influence self-esteem and attitudes towards eating and food.21
Thus, the perspective posits that gay and bisexual men are affected by social norms and values that guide cultural notions of beauty. Gay and bisexual men aim to sexually attract men, and therefore, they are subject to similar pressures and demands as heterosexual women. For example, Siever13
suggested that gay and bisexual men are more likely than heterosexual men to view their bodies as sexual objects, and therefore, like heterosexual women, may be more vulnerable to experiencing body dissatisfaction. Gay culture and the gay community have also been implicated in this hypothesis. It has been suggested that values and norms in the gay male community place a heightened focus on physical appearance to which men may feel pressured to conform.16,22,23
Others, however, have suggested that participation in the gay community (e.g., attending gay-affirmative events like “Pride”) provides support that may protect
men from developing eating disorders.24
Applying the sociocultural perspective to lesbian and bisexual women, researchers have proposed that they may be less
prone to eating disorders because they do not share with heterosexual women the standards of feminine beauty espoused by Western culture. In support, some studies have shown that lesbians and bisexual women have lower levels of body dissatisfaction than heterosexual women,13,25,26
and that lesbians who are socially more involved with other lesbians have a more positive body image.27,28
Other studies, however, found no differences between lesbians and heterosexual women in body dissatisfaction.22,27,29
Similarly, some studies found that lesbians and bisexual women had fewer symptoms of eating disorders than heterosexual women,12,13,19,30
but others found no differences between lesbian and bisexual women and heterosexual women.31
Finally, one study found higher levels of eating disorders in lesbians compared with heterosexual women.18
Despite the interest in the question of eating disorders in lesbians, gay men, and bisexuals (LGB) and the relevance of this question to the study of health disparities related to sexual orientation,32
existing studies have serious limitations. First, to date no study has assessed the prevalence of eating disorders in LGB populations using DSM criteria. Instead, studies have used measures of body dissatisfaction22
or symptoms of eating disorders11
that may suggest the presence of an eating disorder, but do not provide evidence of a clinical diagnosis. Exceptions are Herzog et al.8
and Carlat et al.9
who used DSM criteria to diagnose participants with eating disorders, but these used clinical samples that cannot provide population prevalence estimates.
Second, existing studies have used primarily two types of samples: college students30
and clinical samples.9
Both types of samples are likely to be biased. The former typically recruits volunteers by describing the study’s focus on disordered eating and body satisfaction. Such samples may overrepresent volunteers whose interest in the topic is motivated by having greater difficulties around eating disorders than nonvolunteers. The latter, clinical samples, may overestimate disorder prevalence in gay and bisexual men if they are more likely then heterosexual men to be treated for mental disorders—something that has been documented in numerous studies.33
Third, to date no study has assessed racial/ethnic variability in eating disorders among LGB subpopulations. Assessing racial/ethnic variation in eating disorders is important because, although inconclusive, recent research among heterosexual women has suggested that there are fewer differences among racial groups in levels of eating disordered behavior than was previously thought.34,35
The current study fills gaps in our knowledge of eating disorders in LGB populations. It is the first study to assess DSM-IV diagnostic categories in a community-based sample and to report on variation in eating disorders among white, black, and Latino LGB individuals. We tested the hypotheses that gay and bisexual men have a higher prevalence of eating disorders than heterosexual men, and lesbian and bisexual women have a lower prevalence of eating disorders than heterosexual women. We also tested differences in the prevalence of eating disorders among LGB individuals across the dimensions of race, age, and sexual identity.
Finally, following the sociocultural perspective, we hypothesized that among gay and bisexual men, participation in body or appearance focused organizations in the gay community is associated with increased risk for eating disorders. Therefore, men who participate in organizations that emphasize physical appearance (e.g., a gay gym or sports team) will have a higher prevalence of eating disorders than men who are not affiliated with such organizations in the gay community.