Adult Body Mass Index Trajectories and Sexual Orientation

The Nurses' Health Study II


      Cross-sectional research has documented elevated prevalence of obesity in lesbian and bisexual women relative to heterosexual women, but little is known about disparities in longitudinal patterns in BMI change during adulthood.


      To examine sexual orientation–related disparities in individual BMI trajectories throughout adulthood.


      Data on BMI, sexual orientation, and sociodemographics were gathered prospectively from 1989 through 2005 from 90,713 U.S. women in the Nurses' Health Study II and examined in 2011 using general growth mixture modeling to identify BMI trajectories from ages 25 to 59 years. Multinomial logistic regression was used to determine whether sexual orientation was associated with BMI trajectory group membership.


      Four BMI trajectory groups were identified and labeled based on mean BMI within each group at baseline and final follow-up: Group 1: slow-weight-gain trajectory; Group 2: moderate-weight-gain trajectory; Group 3: rapid-weight-gain trajectory; and Group 4: obese-to-overweight trajectory. Lesbian and bisexual women showed consistently higher odds of membership in Groups 2–4 (adverse-weight-gain trajectories) versus Group 1 (the slow-weight-gain trajectory) relative to heterosexual women.


      Both lesbian and bisexual women were more likely than heterosexual women to experience adverse-weight-gain trajectories in adulthood. New research efforts are needed to understand and eliminate these pronounced disparities.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • Johnson C.L.
        Prevalence and trends in obesity among U.S. adults, 1999–2000.
        JAMA. 2002; 288: 1723-1727
        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • Curtin L.R.
        Prevalence and trends in obesity among U.S. adults, 1999–2008.
        JAMA. 2010; 303: 235-241
        • Mokdad A.H.
        • Ford E.S.
        • Bowman B.A.
        • et al.
        Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.
        JAMA. 2003; 289: 76-79
        • Wang Y.
        • Beydoun M.A.
        The obesity epidemic in the U.S.—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.
        Epidemiol Rev. 2007; 29: 6-28
        • Aaron D.J.
        • Markovic N.
        • Danielson M.E.
        • Honnold J.A.
        • Janosky J.E.
        • Schmidt N.J.
        Behavioral risk factors for disease and preventive health practices among lesbians.
        Am J Public Health. 2001; 91: 972-975
        • Austin S.B.
        • Ziyadeh N.J.
        • Corliss H.L.
        • et al.
        Sexual orientation disparities in weight status in adolescence: Findings from a prospective study.
        Obesity. 2009; 17: 1776-1782
        • Boehmer U.
        • Bowen D.J.
        Examining factors linked to overweight and obesity in women of different sexual orientations.
        Prev Med. 2009; 48: 357-361
        • Boehmer U.
        • Bowen D.J.
        • Bauer G.R.
        Overweight and obesity in sexual-minority women: evidence from population-based data.
        Am J Public Health. 2007; 97: 1134-1140
        • Case P.
        • Austin S.B.
        • Hunter D.J.
        • et al.
        Sexual orientation, health risk factors, and physical functioning in the Nurses' Health Study II.
        J Women's Health. 2004; 13: 1033-1047
        • Conron K.J.
        • Mimiaga M.J.
        • Landers S.J.
        A population-based study of sexual orientation identity and gender differences in adult health.
        Am J Public Health. 2010; 100: 1953-1960
        • Brigham and Women's Hospital/Harvard Medical School
        Nurses' Health Study.
        • Jun H.-J.
        • Rich-Edwards J.
        • Boynton-Jarret R.
        • Wright R.W.
        Intimate partner violence and cigarette smoking: association between smoking risk and psychological abuse with and without co-occurrence of physical and sexual abuse.
        Am J Public Health. 2008; 98: 527-535
        • Bell R.Q.
        Convergence: An accelerated longitudinal approach.
        Child Dev. 1953; 24: 145-152
        • Duncan S.C.
        • Duncan T.E.
        • Strycker L.A.
        • Chaumeton N.R.
        A cohort-sequential latent growth model of physical activity from ages 12 to 17 years.
        Ann Behav Med. 2007; 33: 80-89
        • Muthén L.K.
        • Muthén B.O.
        Mplus user's guide.
        5th edition. Muthén & Muthén, Los Angeles, CA1998–2007
        • Muthén B.
        Latent variable analysis: Growth mixture modeling and related techniques for longitudinal data.
        in: Handbook of quantitative methodology for the social sciences. Sage Publications, Newbury Park CA2004: 345-368
        • Little R.
        • Rubin D.
        Statistical analysis with missing data.
        Wiley, New York NY2002
        • Raftery A.
        Bayesian model selection in social research.
        Sociol Method. 1995; 25: 111-163
        • Schwarz G.
        Estimating the dimension of a model.
        Annal Stat. 1978; 6: 461-464
        • Lubke G.
        • Neale M.C.
        Distinguishing between latent classes and continuous factors: resolution by maximum likelihood?.
        Multivariate Behav Res. 2006; 41: 499-532
        • Nagin D.
        • Tremblay R.
        Analyzing developmental trajectories of distinct but related behaviors: a group-based method.
        Psychol Methods. 2001; 6: 18-34
        • Bowen D.J.
        • Balsam K.F.
        • Ender S.R.
        A review of obesity issues in sexual minority women.
        Obesity (Silver Spring). 2008; 16: 221-228
        • Vahratian A.
        Prevalence of overweight and obesity among women of childbearing age: results from the 2002 National Survey of Family Growth.
        Matern Child Health J. 2009; 13: 268-273
        • Meyer I.H.
        Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.
        Psychol Bull. 2003; 129: 674-697
        • Austin S.B.
        • Ziyadeh N.J.
        • Corliss H.L.
        • et al.
        Sexual orientation disparities in purging and binge eating from early to late adolescence.
        J Adolesc Health. 2009; 45: 238-245
        • Feldman M.B.
        • Meyer I.H.
        Eating disorders in diverse lesbian, gay, and bisexual populations.
        Int J Eat Disord. 2007; 40: 218-226
        • Roberts A.L.
        • Austin S.B.
        • Corliss H.L.
        • Morris A.
        • Koenen K.
        Pervasive trauma exposure among U.S. sexual orientation minority adults linked to posttraumatic stress disorder risk.
        Am J Public Health. 2010; 100: 2433-2441
        • Rosario M.
        • Schrimshaw E.W.
        • Hunter J.
        • Gwadz M.
        Gay-related stress and emotional distress among gay, lesbian, and bisexual youths: a longitudinal examination.
        J Consult Clin Psychol. 2002; 70: 967-975
        • Saewyc E.M.
        • Skay C.L.
        • Pettingell S.L.
        • et al.
        Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the U.S. and Canada.
        Child Welfare. 2006; 85: 195-213
        • Bordo S.
        Unbearable weight: feminism, Western culture and the body.
        University of California Press, Berkeley CA1993
        • Rodin J.
        • Silberstein L.
        • Striegel-Moore R.
        Women and weight: A normative discontent.
        Nebr Symp Motiv. 1984; 32: 267-307
        • McConaghy N.
        • Zamir R.
        Sissiness, tomboyism, sex-role, sex identity, and orientation.
        Aust N Z J Psychiatry. 1995; 29: 278-283
        • Whitman F.L.
        • Mathy R.M.
        Childhood cross-gender behavior of homosexual females in Brazil, Peru, the Philippines, and the U.S..
        Arch Sexual Behav. 1991; 20: 151-170
        • Stommel M.
        • Schoenborn C.A.
        Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES and NHIS 2001-2006.
        BMC Public Health. 2009; 9: 1-10
      1. Richmond TK, Walls CE, Austin SB. Is sexual orientation linked to bias in self-reported BMI? In press.