In 2011, the Institute of Medicine released a report on the health of LGBT Americans which noted that lesbian and bisexual women “may be at greater risk of obesity” than their heterosexual counterparts.
In response, the Office on Women’s Health, which is part of the U.S. Department of Health and Human Services, launched its Healthy Weight in Lesbian and Bisexual Women (HWLB) program the following year.
Now, a team of researchers has tested the HWLB program in over 250 participants ages 40 and older across 10 cities. Not only is their study in Women’s Health Issues the first of its kind, a full 95 percent of the women in these pilot programs achieved at least one of the program’s goals.
In an interview with The Daily Beast, Dr. Jane McElroy, a professor of family and community medicine at the University of Missouri and lead author on the report of the study’s results, called it a “landmark study” and a “pretty amazing accomplishment.”
Researchers do not know exactly why lesbian and bisexual women are more likely to be overweight than straight women. As the 2011 Institute of Medicine report noted, current theories include “an association with the impact of minority stress, more positive body images, different exercise patterns, and childhood sexual abuse.”
Several studies have found that lesbian women tend to be more satisfied with their bodies than straight women, which could help explain the difference.
“There’s a culture within the community that has acceptance of a larger body size,” Dr. McElroy explained. “And this seems to also occur with better body image and self-esteem.”
As a result of these cultural differences, lesbian and bisexual women have “unique concerns” when it comes to weight interventions, the study noted.
Specifically, previous research has shown that lesbian and bisexual women want a “sense of community,” a “recognition of the specific stressors” LGBT people face, a “safe environment” in which they can talk openly about their partners without fear of discrimination, and “a focus on achieving health and physical fitness rather than thinness.”
“The whole point of this study was not to look at changing body size but to work on a healthy weight,” said McElroy.
What that means is that the HWLB program does not target a specific measurement on the Body Mass Index (BMI), which has long been contested as a bodily ideal. Instead, it focuses on helping lesbian and bisexual women work toward individual cardiovascular and metabolic health, first and foremost.
“A lot of women are OK with their body sizes,” McElroy explained. “They don’t really feel like they need to be look like they did when they were 16; they just want to be healthy at the weight they are.”
For instance, health objectives in the pilot programs included eating more fruits and vegetables, drinking fewer sugar-sweetened beverages, consuming less alcohol, and being more physically active. In other words: The goal isn’t a number on a scale but a healthy body.
The pilot programs were surprisingly successful. Almost 60 percent of HWLB program participants spent 20 more minutes per week being physically active. Half ate more fruits and vegetables ten percent more frequently. And 58 percent met three or more of the health objectives.
All of the pilot programs were run in partnership with LGBT community organizations, which helped the women feel more comfortable participating.
Making a change to diet and exercise habits is hard enough without having to hide your sexual orientation, McElroy explained.
“Our messaging and our interventions happened in places that were safe for the women,” she noted.
The researchers did measure weight and body size—and an impressive 29 percent of HWLB participants experienced a five percent drop in their waist-to-height ratios—but as McElroy and her co-authors noted in the study, these measurements were “met with resistance or refusal by some participants.”
That refusal, McElroy explained to The Daily Beast, did not stem from dissatisfaction with the programs’ overall focus—“that was, I think, well-received by everybody,” she recalled—but from a feeling that the specific measurements were not personally relevant.
McElroy summarized the sentiment that the researchers sometimes encountered as follows: “I don’t want to get on the scale and be measured because my weight is not what’s important to me—it’s that I feel healthy.”
Although the HWLB program was focused on lesbian and bisexual women, McElroy believes that its core principles have a far-reaching appeal. For example, she and her co-authors observed astonishing diversity in how the participants chose to participate in the pilot programs.
Some women took more steps per day, some cut down on sweet drinks, others did both and more. “I think that’s a take-home for any healthy weight intervention is to not make it so narrowly-focused that it doesn’t allow people to have that autonomy,” said McElroy.