Lesbian, gay, bisexual and questioning youth (LGBQ) are more likely to develop type 2 diabetes, be obese and engage in a less amount of physical activity and more sedentary activities than heterosexual youth, a new Northwestern Medicine study has found.
The study is among the first of its kind to examine how health behaviors linked to minority stress – the day-to-day stress faced by stigmatized and marginalized populations – may contribute to the risk of poor physical health among LGBQ youth.
“The American public should take note of this study because the study findings have implications not only on LGBQ youth, but for the health of the overall American population,” says lead study author Dr. Lauren Beach, a postdoctoral research fellow at Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing.
“[Our research] shows that 11.6% of high school aged youth in the U.S. – or approximately one out of every 9 youth – identify as non-heterosexual. As the percentage of LGBQ people in the general population who identify as LGBQ increases, U.S. population health is increasingly tied to the health and wellbeing of LGBQ people,” she explains in an e-mail to dLife.
Additionally, she indicates, studies have found that diabetes is increasing among both adult and youth U.S. populations. To date, however, no federal government public health agencies report upon diabetes prevalence by sexual orientation.
Beach’s study is the largest study to date to report differences in levels of physical activity, sedentary behavior, and obesity by sex and sexual orientation among high-school-aged students. The authors used national data from 350,673 United States high-school students, predominantly ranging between 14 and 18 years old, collected by the Centers for Disease Control and Prevention as part of the Youth Risk Behavior Survey (YRBS) to detect disparities in diabetes risk factors by sexual orientation.
Key study findings:
- On average, sexual minority and questioning students were less likely to engage in physical activity than heterosexual students. They reported approximately one less day per week of physical activity and were 38 to 53% less likely to meet physical activity guidelines than heterosexual students.
- The number of hours of sedentary activity among bisexual and questioning students was higher than heterosexual students (an average of 30 minutes more per school day than heterosexual counterparts).
- Lesbian, bisexual and questioning female students were 1.55 to 2.07 times more likely to be obese than heterosexual female students.
Image: Northwestern University
What Do the Findings Mean?
Beach says the findings showed be viewed as an opportunity to improve the health of sexual minority and questioning youth.
“My study’s findings that diabetes risk factors are higher among LGBQ vs. heterosexual youth should send a wake-up call to researchers, clinicians, and policymakers that we must invest in efforts to improve not only the mental health but also the physical health of LGBQ youth,” Beach says.
She says teachers, parents, and physicians should work together to ensure these youth have the tools they need to stay healthy. Family support and identity affirmation – developing positive feelings and a strong attachment to a group – have been consistently linked to better health among LGBQ youth.
What Should Parents Do?
In addition to providing an overall supportive environment, parents should consider asking their children, “Have you been physically active today? Are you active in gym class? Can we do something today to be active together?” And parents should be proactive at doctor appointments and ask the doctor to screen for physical activity, screen time, diet and their child’s weight, Beach explains.
Previous studies have examined diabetes and cardiovascular health among LGBTQ people, but that research has largely focused only on adults.
Beach says her study ultimately winds up generating more questions than it answers about why LGBQ youth may be more at risk for the future development of diabetes than their heterosexual peers.
“We know from other research that minority stress – or the day-to-day stress faced by stigmatized and marginalized populations at the individual, interpersonal, and structural levels – contributes broadly to worse health outcomes among LGBQ people,” she says. “There are also many biological studies that have shown higher stress levels lead to increased diabetes risk.”
She says more research is needed to determine with greater certainty what is causing the disparities observed in her study. “As a researcher, investigating if higher stress levels tied to anti-LGBQ stigma can help explain heightened diabetes risk factors (e.g., BMI, physical activity, sedentary behavior) should definitely be a priority,” she states. “Given that stigma operates broadly across multiple levels, studies investigating how environmental and cultural factors may affect the diabetes risk of LGBQ youth differently will also be important.”
Are Interventions in Place?
Currently, no evidence-based interventions exist to decrease diabetes risk factors among LGBQ youth, according to Beach, who is a pioneer in this area of research.
“We know from other research, however, that family acceptance and support can broadly lead to better health outcomes among LGBQ youth,” she says. “Targeted interventions to increase physical activity shown to be effective among other youth populations may also be helpful.”
The effectiveness of these interventions, however, has not been evaluated among LGBQ youth. Beach points out as interventions are developed and vetted to prevent and treat diabetes among LGBQ youth populations, it will also be critically important that health care providers get the training they need to provide culturally competent, affirming diabetes care to these youth.
Gregory Phillips II, assistant professor of medical social sciences and preventive medicine at Feinberg, was senior author on the study. Dylan Felt, Rachel Marro and Blair Turner of Northwestern were co-authors. The study was published in the journal Pediatric Diabetes.