Differences in weight stigma between gay, bisexual, and heterosexual men

Highlights

• Gay and bisexual men reported more weight self-stigma than heterosexual men.

• Bisexual men reported more weight stigma experiences than gay and heterosexual men.

• Sexual orientation did not moderate weight stigma and adverse outcome relationships.

• Weight stigma may compound the appearance pressures faced by sexual minority men.

• Sexual minority men should be included in weight stigma research and interventions.

Abstract

Gay and bisexual men may experience more weight stigma than heterosexual men; however, research is limited. We examined differences in experienced weight discrimination, weight bias, and internalized weight bias in two studies: the first comprising gay (n = 351), bisexual (n = 357), and heterosexual (n = 408) men, and the second comprising gay (n = 614) and bisexual (n = 123) men. In Study 1, bisexual men reported experiencing more weight discrimination than gay (r = .07) and heterosexual (r = .08) men. Bisexual (Glass’ Δ = 0.41) and gay (Δ = 0.37) men reported greater internalized weight bias than heterosexual men. Heterosexual men reported more weight bias than gay (Cohen’s d = 0.35) and bisexual (d = 0.46) men. In Study 2, gay men reported more internalized weight bias than bisexual men (d = 0.26). Sexual orientation did not moderate the relationships of weight stigma with either body dissatisfaction or psychological quality of life. Among gay and bisexual men, experiencing weight discrimination predicted diminished psychological quality of life through internalized weight bias and body dissatisfaction. Our research emphasizes the importance of assessing weight stigma among sexual minorities and suggests bisexual men might be particularly vulnerable to weight stigma.

Introduction

Weight stigma refers to negative attitudes, beliefs, and behaviours directed at individuals who deviate from societal body ideals – phenomena disproportionately experienced by people of higher body weights (Meadows & Calogero, 2018; Tomiyama et al., 2018). Weight stigma experiences and internalization are associated with negative mental health outcomes, including reduced psychological quality of life, body dissatisfaction, and disordered eating (Papadopoulos & Brennan, 2015; Pearl & Puhl, 2018). Increasing research has examined weight stigma among men (Hebl & Turchin, 2005; Himmelstein, Puhl, & Quinn, 2018; Himmelstein, Puhl, & Quinn, 2019; Lozano-Sufrategui, Carless, Pringle, Sparkes, & McKenna, 2016); however, little is known about weight stigma and its outcomes among sexual minority men (i.e., men who identify as gay, bisexual, or alternative non-heterosexual sexual orientations). Such focused investigations are warranted, as sexual minority men may be particularly vulnerable to weight stigma due to the heightened appearance pressures they face (Calzo et al., 2015; Jankowski, Fawkner, Slater, & Tiggemann, 2014).

Weight stigma is multifaceted, and existing literature uses interchangeable terms to refer to its components. For clarity, we use labels that correspond with the measures used in our research. We use experiences of weight discrimination to refer to individuals’ experiences of weight stigma (Hunger, Dodd, & Smith, 2020; Meadows & Calogero, 2018). We refer to the endorsement of negative weight stereotypes (e.g., the idea that people of higher weights are less likeable than others) as weight bias (Latner, O’Brien, Durso, Brinkman, & MacDonald, 2008). Individuals may internalize these stereotypes and subsequently feel negatively about their own body (e.g., “I hate myself for my weight”), a process hereon termed internalized weight bias (Pearl & Puhl, 2014).

These weight stigma phenomena are each associated with adverse mental health outcomes. For instance, internalized weight bias is one mechanism that may exacerbate the mental health outcomes associated with experiences of weight discrimination (e.g., anxiety and depression; Pearl & Puhl, 2018). However, experiences of weight discrimination and internalized weight bias also demonstrate unique contributions to mental health outcomes (Pearl & Puhl, 2016). Weight bias is primarily investigated as a factor underlying individuals’ perpetration of weight discrimination (Lee, Ata, & Brannick, 2014), but may also facilitate negative mental health outcomes for the person endorsing these attitudes (e.g., disordered eating; Puhl & Suh, 2015).

The heightened appearance pressures faced by sexual minority men may facilitate, or arise from, increased levels of weight stigma phenomena within communities of sexual minority men. For instance, the masculine body ideal is one of lean muscularity: a physique achieved through a combination of building muscle and reducing body fat, which together increase the visibility of an individual’s musculature (Griffiths, Murray, & Touyz, 2013). The pressure to attain this body ideal is greater among gay men – research indicates that gay men are more likely to idealize both high levels of muscularity and low levels of body fat, for both themselves and romantic partners (Calzo et al., 2015; Morrison, Morrison, & Sager, 2004; Strübel & Petrie, 2019). These pressures are perpetuated by the appearance-centric culture sexual minority men are embedded in – for example, magazines targeted at gay men emphasise idealized bodies more than those targeted at heterosexual men (Jankowski et al., 2014; Lanzieri & Cook, 2013). The heightened levels of body dissatisfaction and disordered eating evidenced among sexual minority men have been attributed (in part) to these appearance pressures (Martins, Tiggemann, & Kirkbride, 2007; Morrison et al., 2004; Tiggemann, Martins, & Kirkbride, 2007).

The centrality of body fat reduction to achieving the masculine body ideal, combined with the pressures that sexual minority men face to achieve this ideal, may engender heightened levels of weight bias, internalized weight bias, and by extension, experiences of weight discrimination among this population. Indeed, in addition to their heightened levels of general body dissatisfaction, several studies suggest that sexual minority men display a greater desire for a lean physique than heterosexual men (Smith, Hawkeswood, Bodell, & Joiner, 2011; Strübel & Petrie, 2019; Tiggemann et al., 2007), which may reflect a heightened devaluation of body fat among this population. Supporting this, Kaminski, Chapman, Haynes, & Own (2005) found that gay participants reported an increased fear of becoming fat than heterosexual participants. The heightened body dissatisfaction and desire for leanness evidenced among sexual minority men in comparison to their heterosexual counterparts suggests that weight stigma may also be a more substantial issue among this population.

There are few studies investigating sexual orientation differences in weight stigma among men. Foster-Gimbel and Engeln (2016) examined sexual orientation differences in weight bias, revealing that gay men were significantly more likely than heterosexual men to expect a higher-weight man to be negatively evaluated by a potential romantic partner. Puhl, Himmelstein, Pearl, Wojtanowski, and Foster (2019) similarly found that gay men enlisted in a weight-loss program reported greater internalized weight bias than heterosexual men, but found no differences in experiences of weight discrimination. Conversely, one study assessing experiences of weight discrimination among adolescents revealed that, compared to heterosexual adolescents, sexual minority (including gay and bisexual) adolescents demonstrated a higher odds of experiencing weight-based teasing from peers and family members (Puhl, Himmelstein, & Watson, 2019). While these studies provide some evidence to suggest heightened weight stigma phenomena among sexual minority men, the varied samples and constructs they assess warrants further assessment of this potentially increased vulnerability.

The different experiences of gay and bisexual men are sometimes unaddressed in body image research, given their shared experience of attracting male partners (Brewster, Sandil, DeBlaere, Breslow, & Eklund, 2017). However, bisexual men likely face appearance pressures from both gay men and heterosexual women, which may engender variations in the nature of their experiences and internalization of weight stigma. Relatedly, bisexual men face increased stigmatization from both heterosexual and sexual minority individuals due to, in part, misconceptions surrounding their supposedly ‘ill-defined’ sexual identity (Helms & Waters, 2016; Mulick & Wright, 2002). The enhanced stigmatization of bisexual men may therefore encompass, or be compounded by, weight-related stigmatization. In sum, the distinct social pressures and stigma that gay and bisexual men experience highlight a need to investigate their unique weight stigma experiences and outcomes.

Increasing evidence suggests that experiences of weight discrimination among sexual minority men are commonplace and associated with negative mental health outcomes. In one qualitative study, higher-weight gay men described frequent experiences of weight discrimination both within and outside of the gay community, producing feelings of shame and low self-esteem (Whitesel, 2014). Similarly, Foster-Gimbel and Engeln (2016) revealed that approximately one-third of gay participants (recruited via social media advertisements and snowball sampling) had experienced weight bias; further, experiences of weight bias were positively associated with drive for muscularity, disordered eating, and body dissatisfaction. In their cross-sectional research, Griffiths, Brennan et al. (2018) found that sexual minority men who reported more frequent experiences of weight discrimination reported higher average body dissatisfaction, and through this, reduced psychological quality of life. While higher-weight sexual minority men disproportionately experienced weight discrimination, those with an ‘underweight’ body mass index (BMI) also experienced significantly more weight discrimination than their ‘normal weight’ BMI counterparts, perhaps reflecting the deviance of both groups from the visibly muscular ideal.

If sexual minority men are more likely to experience and internalize weight stigma, they may also face greater negative outcomes. To our knowledge, one study has investigated the moderating effects of sexual orientation on weight stigma-related outcomes, finding no moderating effects of sexual orientation on the relationships of experiences of weight discrimination and internalized weight bias with eating behaviours and health-related quality of life (Puhl, Himmelstein, Pearl et al., 2019). This study sample comprised adults recruited from a weight loss program with an average BMI of 32.99, which may have facilitated more experiences of weight discrimination and greater internalized weight bias irrespective of sexual orientation. Therefore, we sought to complement these findings by investigating the moderating effects of sexual orientation on weight stigma and its mental health outcomes among a more weight-diverse sample of men recruited from non-weight-loss settings.

Further, although several cross-sectional studies have revealed that internalized weight bias mediates the relationship between experiences of weight discrimination and mental health outcomes (e.g., Hayward, Vartanian, & Pinkus, 2018; O’Brien et al., 2016; Zuba & Warschburger, 2017), no literature has investigated these relationships among sexual minority men. Clarifying these relationships can determine whether weight stigma is one factor linked to the appearance pressures faced by sexual minority men, and to identify potential intervention targets to reduce weight stigma and its outcomes in this population.

We primarily aimed to examine sexual orientation differences in weight stigma and mental health outcomes among men. We hypothesized that (i) compared to heterosexual men, sexual minority men would display heightened levels of experiences of weight discrimination, weight bias, and internalized weight bias, and (ii) the strength of the relationships of experiences of weight discrimination and internalized weight bias with body dissatisfaction and psychological quality of life would be greater among sexual minority men than heterosexual men. Given the limited evidence surrounding potential differences in weight stigma between gay and bisexual men, no a priori hypotheses were proposed for these relationships.

Our secondary aim was to determine whether, consistent with models of weight stigma in alternative populations, the relationships of experiences of weight discrimination with mental health outcomes (namely, body dissatisfaction and psychological quality of life) among sexual minority men were mediated by internalized weight bias. We hypothesized that experiences of weight discrimination would predict diminished psychological quality of life through internalized weight bias and body dissatisfaction (see Fig. 1). We acknowledge that other models containing these constructs are plausible (e.g., reduced psychological quality of life predicting greater internalized weight bias). The main reason we used this model was to provide a theoretical basis for our primary aim, wherein we assessed if sexual orientation moderates the various relationships between weight stigma constructs and mental health outcomes.