One Size Does Not Fit All
Ed. note: This blog is cross-posted from health.gov. The original post date was September 28, 2016. Read the original post.
Many women in the United States feel pressure to conform to society's expectations, particularly around weight. But cultural acceptance of higher weights in the LGBT community challenges the expectations of typical weight loss programs. Lesbian and bisexual women are more likely to be obese than heterosexual women, but less likely to consider themselves overweight or want to lose weight. When it comes to the ways we talk about overweight and obesity, we often don't take the cultural context of lesbian and bisexual women's lives into account. Thanks to current research funded by OWH we know that lesbian and bisexual women are more interested in improving their physical health than in losing weight — they want to feel healthy and be more active rather than lose weight for its own sake.
This knowledge helped guide the research as we set out on our new study: Healthy Weight in Lesbian and Bisexual Women (HWLB). The OWH goal was to develop nutrition and physical activity interventions tailored to lesbian and bisexual women 40 and older. Working with five research organizations who partnered with LBGT community organizations, we were able to reach 333 women in 10 cities across the United States. We used the healthy weight approach used in other settings, with the goal of helping older overweight and obese women reach a healthy weight, which would mean a reduced risk for health problems and improved mental health status.
The Healthy Weight program focused on activities that would help lesbian and bisexual women get 20% more exercise, eat 50% more fruits and vegetables, cut back by half on sugar-sweetened and alcoholic drinks, and improve their overall physical and mental health for better quality of life. Weight loss and decrease in waist-to-height ratio by 5% were secondary goals for the researchers and were not emphasized with the participants.
How the OWH projects presented the healthier options to participants was just as important as the changes themselves, and OWH wanted the interventions to be culturally sensitive. To that end, programs were named using slogans that would appeal to lesbian and bisexual women, such as "SHE — Strong, Healthy, and Energized." Interventions chose lesbian and bisexual women-oriented images during recruiting and used LGBT friendly meeting locations and gyms. They also matched the participants with group leaders who also identified as lesbian or bisexual, whenever possible. The participants chose which changes they wanted to work on first.
The results were astounding. Ninety-five percent of the participants achieved at least one of the objectives. Fifty-seven percent of women reached their physical activity goals; 51% met their goals for increasing fruits and vegetables; 41% reduced their alcohol intake to one drink a day; and 39% decreased their intake of sugar-sweetened sodas. These results translated into weight change as well. Fifty-eight percent of participants lost some weight, and 19% lost 5% of their weight, the minimum loss needed to put them into normal ranges for physical health risks and conditions. Sixty-four percent saw some decrease in waist-to-height ratio, and 28% reached the 5% reduction level.
This is the first large-scale study to test healthy weight interventions in lesbian and bisexual women 40 and older — in fact, it's one of only a few public health interventions focusing on lesbian and bisexual women at all — but I hope it won't be the last. Using tailored education and support and encouraging changes in nutrition, physical activity, and quality of life could have a huge impact on the health of women in this community. I hope the study will be replicated in other locations, with other racial and ethnic groups, and tailored separately for lesbian, bisexual, and transgender women.