Between Pressure and Acceptance: A Qualitative Study of How LGBTQ+ Identity May Shape Eating Patterns, Disordered Eating, and Body Image

Abstract Background Prior research has consistently found connections between LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other) identity, body image disturbances, and disordered eating, including a higher prevalence of such concerns in people who identify as part of a gender and/or sexual minority. Factors that may contribute to these connections include increased stress, higher risk for psychiatric conditions, and discriminatory experiences. However, most prior research has quantitatively analyzed self-report questionnaires, which may not illuminate the entirety of individuals’ lived experiences. Methods In this study, interviews were conducted to explore how sexual and/or gender identity may both positively and negatively impact eating patterns, disordered eating, and body image. Participants (N = 18) self-identified as LGBTQ+, experienced binge eating, and were interested in intervention. They were invited to design sessions as part of a larger research study optimizing a mobile app intervention for binge eating and weight-related health behaviors. Semi-structured interviews were analyzed using the principles of reflexive thematic analysis. Results Three themes were identified. First, participants, especially gay men, expressed experiencing added pressures by other individuals in their community to fit certain ideals, which contributed to decreased body satisfaction and unhealthy eating behaviors. Second, past negative experiences with bullying, discrimination, and pressure to conform to cisgender-heterosexual societal norms often had similar impacts. Third, self-acceptance of identity and feelings of freedom from societal expectations appeared to have largely protective effects on body image, promoting healthier eating patterns. Feelings of belonging and acceptance within the LGBTQ+ community also were positively impactful. Conclusions Taken together, these findings suggest there are protective and risk factors unique to LGBTQ+ individuals that may shape body image and eating behaviors, which could affect this population’s susceptibility to eating disorders. Recognition of this susceptibility, by both clinicians and researchers, will allow for a more holistic approach to addressing eating- and body-related conditions that encourages the acceptance and affirmation of LGBTQ+ identities.