Certain sexual identity changes may improve weight and physical activity behavior; the direction of sexual identity change matters more for men than for women

Sexual fluidity and BMI, obesity, and physical activity. Julie Fricke, Maria Sironi. SSM - Population Health, Volume 11, August 2020, 100620. https://doi.org/10.1016/j.ssmph.2020.100620

Highlights
• Links between sexual fluidity and weight and physical activity are analyzed.
• Certain sexual identity changes may improve weight and physical activity behavior.
• The direction of sexual identity change matters more for men than for women.

Abstract: Analyzing reported changes in sexual identity over time is necessary for understanding young adult health risks. Utilizing waves 3 and 4 of the National Longitudinal Study of Adolescent to Adult Health, this paper studies the relationships between sexual identity changes and BMI, obesity, and physical activity among young adults in the U.S (N = 11,349). The results show that men who report a change toward a more homosexual identity have a significantly lower BMI and participate in more physical activity, while men who report a change toward a more heterosexual identity participate in less physical activity and have a higher BMI compared to those who did not report a change. For women, a change toward a more homosexual identity is significantly associated with more physical activity and lower odds of being obese compared to no change. The results suggest that specific sexual identity changes may also be linked to improvements in health.

Keywords: Sexual identityFluidityBMIObesityPhysical activity

4. Discussion

Analyzing reported changes in sexual identity over time is necessary for understanding young adult health risks, as sexual fluidity has been associated with various health-related consequences (B. Everett, 2015; Fish & Pasley, 2015; Ott et al., 2013). This work extends that current body of literature by arguing that specific sexual identity trajectories are associated with a lower BMI and obesity prevalence and increases in physical activity, which provides evidence that sexual fluidity may also be linked to improvements in health, in addition to the documented consequences. As such, particular findings of this work contradict our proposed hypothesis that characterize sexual identity change as a stressful life event that may negatively influence weight and physical activity for those who change toward more homosexual identities.

More specifically, results indicate that men who report a change toward a more homosexual identity have a significantly lower BMI on average compared to those who report no change and to those who report a change toward a more heterosexual identity. And post hoc analyses revealed that they are also less likely to be obese than those who report a change toward a more heterosexual identity. This is coherent with previous findings that sexual minority males are less likely to be overweight than heterosexual males (Conron, Mimiaga, & Landers, 2010). Similarly, men who report a change toward a more homosexual identity have a significantly greater average number of physical activities per week compared to those who do not report a change. While in contrast, men who report a change toward a more heterosexual identity report a significantly lower average number of physical activities per week than those who do not report a change.

These findings suggest that the direction of sexual identity change matters for men in regards to BMI and physical activity behavior, such that a change toward a more homosexual identity may be beneficial, while a change toward a more heterosexual identity may be harmful. This implies that body size and shape are at least as important to sexual minority men as compared to heterosexual men, which points to a growing body of literature that describes gay men as followers of the traditional masculinity ideology (Wade & Donis, 2007). It has been argued that sexual minority men aim to develop a muscular body to counteract memories of having a less athletic, or feminine, appearance during their childhood and adolescence (Rubinstein, 2003), or even to avoid harassment for violating masculine appearance norms (Watson & Dispenza, 2015). These results contradict our proposed hypothesis that a change toward a more homosexual identity has negative implications for BMI and physical activity. Further, these results for men partially confirm our hypothesis that a change in sexual identity is a stressful life event that adversely influences BMI, obesity, and physical activity. Future research should investigate why sexual identity change may present more of a challenge for men who change toward a more heterosexual identity.

For women, results indicate that those who report a change toward a more homosexual identity report a significantly greater average number of physical activities per week compared to those who do not report a change. Further, women who report a change toward a more homosexual identity are less likely to be obese, which is inconsistent with previous literature that repeatedly argues that sexual minority women are more likely to be obese than heterosexual women (Bowen, Balsam, Diergaarde, Russo, & Escamilla, 2006). However, post hoc analyses revealed that there is no difference among women who report a change toward a more heterosexual identity and those who report a change toward a more homosexual identity.

Results for women contradict our hypothesis that a change toward a more homosexual identity is a stressful life event that adversely influences obesity and physical activity. It may be the case that such a change is indeed a stressful life event, but the experienced mental health challenges do not impede physical activity behavior or actions to prevent obesity among women. Instead, they may motivate individuals to exercise, whereby exercise acts as a type of coping mechanism (Frederick & Ryan, 1993). Alternatively, as women are more likely than men to change their sexual identity (Diamond, 2015; Dickson et al., 2003; Ott et al., 2011) and are argued to be more comfortable with their self-concept and related expression (Baumeister, 2000; Savin-Williams & Cohen, 2004), a change in sexual identity may be considered “liberating” as opposed to stressful, thereby encouraging women to engage in positive health behaviors. Further, it may result in gaining community, social status, and social or emotional resources, as opposed to losing them. An additional explanation could be that sexual minority women in this sample may not have experienced minority stress (e.g. discrimination and harassment) in physical activity settings, thus encouraging them to exercise (the same can be said for men who change toward a more homosexual orientation).

The inclusion of depression as a control variable did not change our results in any of the regression analyses, which indicates that depression does not explain the negative associations between changing toward a more heterosexual identity and BMI and physical activity for men. This suggests that a different mental health mechanism (or different mechanism altogether) may be at work that accounts for the undesirable BMI and physical activity results. Possible other mechanisms may focus on social factors (e.g. social support), as changes in sexual identity are associated with loss of community, loss of social status, and decreased access to social or emotional resources (Ott et al., 2011). Future research should aim to identify these other mechanisms.

In regards to limitations, this analysis relies purely on self-reported sexual identity and physical activity, BMI, and obesity information, and self-report measures have limitations in accuracy and can be prone to certain biases, such as social-desirability bias (Wolfson et al., 2003). But Add Health respondents answer sensitive questions by computer (computer-assisted personal interviewing, ‘CAPI’), which may limit this. Add Health is one of the few datasets that allows for an analysis of sexual identity change, as it asks about sexual identity at multiple time points. However, as of now, the data only allows for the consideration of one change. If possible, future research should investigate whether results vary when more than one change in identity occurs. Additionally, due to the small sample sizes of the subgroups that experienced specific changes, we settled for a dichotomous conceptualization of fluidity, which disregards the starting point from which the change originated and the health implications for non-sexual individuals (e.g. those who move from mostly straight to bisexual). However, future research (if feasible) should take into account the more nuanced categories of sexual orientation, including bisexuality, because recent work recognizes that it is often those categories that have worse health outcomes (Lindley et al., 2012; Mereish, Katz-Wise, & Woulfe, 2017).