The purpose of this analysis was to examine the correlates of obesity in a large community-based sample of lesbian and heterosexual women. Specifically, we assessed whether sexual orientation and history of sexual abuse were associated with obesity after adjusting for demographic and mental health variables.
We found that a lesbian sexual orientation was independently related to adulthood obesity after accounting for significant covariates. These results are consistent with the literature concluding that lesbians have higher rates of obesity than heterosexual women.16–18,21
All SA measures were associated with obesity in unadjusted analyses. When obesity was adjusted for sexual orientation and each SA variable separately, lifetime SA (p
0.037), intrafamilial CSA (p
=0.0001) and extrafamilial CSA (p
0.029) were significantly related to obesity. In multivariate analysis that included other relevant demographics and previous mental health diagnosis, intrafamilial CSA was the only SA item independently associated with obesity (p
0.014). Other published reports suggest that there is an association between CSA and obesity among women; however, these prior studies did not distinguish between intrafamilial and extrafamilial CSA.8–11,22
Our findings stress that the relationship of the perpetrator to the CSA victim could help explain the association between CSA and adulthood obesity. The nonsignificant association between ASA and obesity may explain the lack of published literature on this topic. Further investigation is needed to understand the relationship between ASA and obesity.
Other results were consistent with those of previous studies, in that race,1,3,6,23
socioeconomic status (years of education and household income),23,24
and mental health history22
were independently associated with obesity. Our analysis found that women who reported a household income of at least $75,000 or had a graduate degree were less likely to be obese. African American women and women who reported a history of a mental health diagnosis were more likely to be obese than Caucasian women or women who were never given a mental health diagnosis. We did not find an association between relationship status and obesity. Other studies have produced mixed results on the association between obesity and relationship/marital status.25,26
Although age is a known risk factor for obesity,23
we did not find an association, which may be explained by the restricted age range of our sample (35–65 years).
Comparing the relationship of SA history, lesbian sexual orientation, and adulthood obesity across studies is complex, largely because of varying definitions of SA and lesbian sexual orientation. Our findings related to SA are based on responses to two questions that asked about self-perceived SA by family and nonfamily members during childhood and one question about unwanted sexual experiences at age 18 or later. Interpretation of experiences during childhood and adulthood likely varied among participants. On the one hand, the relatively broad definition of SA used in the study may have led to inflated estimates of SA. On the other, it is possible that SA (especially CSA) may have been underreported because some women may not define their experience as abuse. Future research using more stringent definitions of SA, including more comprehensive indicators of severity (e.g., age of onset, duration of abuse), is needed. Despite the use of these broad questions to measure SA, it can be argued that if a woman reported SA in her lifetime, no matter the severity or duration of SA, her reported SA events may have some impact on her mental and physical health. Another bias, common across SA studies, is that not all women who have experienced SA may have felt comfortable reporting abuse, which means the prevalence of SA may actually be higher in this sample and the true relation of SA to obesity among women may be underestimated. Further research is needed to determine if exposure to nonsexual abuse in childhood (physical and verbal abuse, physical and emotional neglect) is also associated with obesity in adulthood.
The mental health assessment also had limitations. Those who reported having a mental health diagnosis (history of being diagnosed with depression or anxiety) represent individuals who have access to and use the healthcare system. The mental health assessment may have underestimated the rate of those with a history of a mental health diagnosis because individuals could have attained medication for depressive or anxious symptoms from their primary care physicians and may not consider themselves to be diagnosed with anxiety or depression. Furthermore, because not all people who have depression or anxiety are diagnosed, our results may underestimate the association between having a mental health diagnosis of depression or anxiety and obesity.
Several other important limitations should be considered when interpreting our findings. This analysis did not include information about lifetime history of obesity or when obesity developed in relation to SA. Longitudinal studies are needed to further explore the association between obesity and related factors over time. It is important to acknowledge that lesbians represented in this analysis are out to some degree; results describe women comfortable with reporting their sexual orientation. Conclusions are also limited to lesbian and heterosexual women; therefore, they do not represent women with questioning or bisexual sexual identities. Lastly, this sample mainly represents older adult women who are well educated and primarily Caucasian.