Lesbian and bisexual women are disproportionately overweight in comparison with heterosexual women. But if doctors offered more targeted health guidance, could it help?
To try to answer that question, researchers enrolled women who self-identified as both overweight and lesbian or bisexual in a study in which doctors stressed health care interventions specifically tailored to them. Focus groups suggested, for instance, that lesbian and bisexual women generally did not respond well to weight-loss appeals emphasizing appearance or body size. The study was published in Women’s Health Issues.
Instead, the doctors designed programs that included helping the women develop mindfulness; providing opportunities to use a gym or personal training; and using a pedometer to count their steps. The programs included a support group component, and took place in community centers or other locations familiar and comfortable to the participants.
The researchers found that 95 percent of the women participating in the study improved their health habits in one way or another.
“Most of our participants made changes in physical activity, fruit and vegetable consumption, and improved weight,” said lead researcher Jane McElroy, associate professor of community medicine at the University of Missouri School of Medicine.
The study included 266 participants, all of them age 40 or older.
Nearly 60 percent of them increased the time they spent on physical activity each week by 20 percent. And while 29 percent decreased their waist-to-height ratio, they often resisted that standard as a measure of their success.
“Women in the bisexual and lesbian community have different standards of beauty,” said Jacquetta Brooks, a counselor at one of the study sites. “Thin and athletic are not necessarily priorities for them. Their motivations were more health-related, instead of aesthetic.”
This was one of the points emphasized in an additional report, where researchers outlined cultural awareness for health care professionals treating women in the LGBT community.
“If a patient is a lesbian, the health care provider needs to know how to ask questions about sexual practices,” Brooks added. “They need to know which words to use, and how to build rapport.”
One way to build good relationships with lesbian and bisexual female patients, researchers said, was to take a healthy-at-any-size approach. For a small subgroup of study participants, obesity did not have the expected negative effects on their health. The research team discovered this fact when participants at one site had their blood drawn and tested. Those findings are included in a supplemental report on the study.
“We had about a third of those participants who were metabolically healthy,” said McElroy. “We found a group of obese women whose blood sugar was fine, cholesterol was fine, and their triglycerides and blood pressure were all in normal ranges.”
McElroy admitted that the study group was small, and that it’s unclear whether these women will remain healthy in the long run. But she thinks the finding offers another possible way for doctors to look at the relationship between weight and health.
“You go to the doctor and they say you need to lose weight,” she said. “But we found that fitness level is a real factor. If you’re working out and eating healthy, you can be healthy even if you’re overweight.”
June Stevens, a professor of nutrition and epidemiology at the University of North Carolina at Chapel Hill who was not involved in the study, was skeptical. Obesity, she said, is still a health risk.
“There are some conditions that don’t work through metabolic pathways,” said Stevens. “Osteoarthritis causes disability, resulting in hip replacements and other problems. And the condition is exacerbated by carrying extra weight over a long period of time.”
“As an advocate of public health, I’m glad that not every obese person becomes unhealthy,” she added. “But you still have four to five times the risk of cardiovascular disease of someone who is metabolically healthy and of normal weight.”