Perceived Weight Gain and Eating Disorder Symptoms among LGBTQ+ Adults during the COVID-19 Pandemic: A Convergent Mixed-Method Study

Abstract

BackgroundIn this study, we seek to further explore the role of COVID-19 pandemic-related stress, social support, and resilience on self-reported eating disorder symptoms (using the EDE-QS) and perceived weight gain among lesbian, gay, bisexual, transgender and/or queer (LGBTQ+ adults) in the US context during the COVID-19 pandemic. MethodsEmploying a convergent mixed method design, we surveyed 411 individuals, and conducted qualitative semi-structured follow-up interviews with 43 LGBTQ+-identifying survey respondents. Using OLS regression and multinomial logistic regression, we modeled eating disorder symptoms and perceived weight gain among LGBTQ+ individuals (n=120) and cisgender and heterosexual-identifying women (n=230), to cisgender and heterosexual-identifying men (n=61). We also explored complementary interview narratives among LGBTQ+ people by employing selective coding strategies. ResultsStudy results suggest that LGBTQ+ individuals are likely experiencing uniquely high levels of pandemic-related stress, and secondly, that pandemic-related stress is associated with elevated eating disorder symptoms and higher risk of perceived weight gain. Nearly 1 in 3 participants reported eating disorder symptoms of potentially clinical significance. Social support, but not resilient coping, was found to be protective against increased eating disorder symptoms. Qualitative analyses revealed that LGBTQ+ individuals situated physical exercise constraints, challenging eating patterns, and weight concerns within their pandemic experiences. ConclusionsClinicians of diverse specialties should screen for eating disorder symptoms and actively engage patients in conversations about their COVID-19 related weight gain and eating behaviors, particularly with LGBTQ+-identifying adults.

A mixed‐studies systematic review of the experiences of body image, disordered eating, and eating disorders during the COVID‐19 pandemic

“…Overall, findings indicate that pandemic‐related stress was associated with ED symptoms and perceived weight gain, and this association was stronger in women and individuals who identified as LGBTQ+ compared to cisgender and heterosexual men (Tabler et al, 2021 ). Although findings regarding the impact of the COVID‐19 pandemic on BI and eating outcomes generally mirrored those discussed above, individuals who identified as LGBTQ+ discussed challenges of COVID‐19 through a lens of gender identity and sexuality.…”

“…Multiple factors were also identified that were associated with more positive and less negative BI and eating outcomes during the pandemic, including personal characteristics, such as adaptive coping mechanisms (e.g., Baenas et al, 2020 ), self‐compassion (e.g., Swami, Todd, et al, 2021 ), emotion regulation (e.g., reappraisal; Giel et al, 2021 ), sense of coherence (e.g., Giel et al, 2021 ), and higher perceived control (e.g., Branley‐Bell & Talbot, 2020 ); social characteristics, such as emotional and social support from others (e.g., Tabler et al, 2021 ), virtual social contact with friends and family (e.g., Schlegl, Meule, et al, 2020 ), and more time spent with family and improved family relationships (e.g., Vuillier et al, 2021 ); and individual behaviors, such as mild physical activity (e.g., Schlegl, Meule, et al, 2020 ), taking part in enjoyable activities (e.g., Schlegl, Maier, et al, 2020 ; Schlegl, Meule, et al, 2020 ), maintaining daily routines (e.g., Schlegl, Maier, et al, 2020 ), and day planning (e.g., Schlegl, Maier, et al, 2020 ).…”

“…Of note, the majority of the included studies did not specify whether they assessed sex assigned at birth, gender, or gender identity, and many used “sex” and “gender” interchangeably. In addition, most studies included predominantly cisgender and heterosexual participants, apart from Quathamer and Joy ( 2021 ), who specifically explored the impact of the COVID‐19 pandemic on BI among LGBTQ+ individuals in Canada, and Tabler et al ( 2021 ), who investigated the impact of COVID‐19 on self‐reported ED symptoms and perceived weight gain among LGBTQ+ adults in the United States. None of the studies included in this review directly investigated the unique experiences of BI, DE, or EDs during COVID‐19 among individuals who identified as nonbinary or transgender.…”

“…In addition, one study grouped all participants who identified as LGBTQ+ in their analyses. Indeed, even in studies that specifically targeted LGBTQ+ samples (Quathamer & Joy, 2021 ; Tabler et al, 2021 ), the majority of participants identified as cisgender. As such, findings across all participants who identified as LGBTQ+ are presented together in this review, while we acknowledge the possible differences in experiences across various identities.…”

“…There is some evidence showing that participants who identify as LGBTQ+ and/or BIPOC are more at risk of reporting adverse mental health, body image, and eating outcomes during COVID‐19 (e.g., Christensen, Forbush, et al, 2021 ; S. Kim, Wang, et al, 2021 ; Tabler et al, 2021 ; Quathamer & Joy, 2021 ).…”