Overlooked Assets: Body Size, Body Image, and Sexual Minority Women.

Abstract

While public health literature indicates sexual minority women (SMW) are at risk for obesity, psychological literature suggests SMW possess the health advantage of positive body image. In this dissertation, I bring these two lines of research together to create a more complete picture of SMW’s health. First, I conducted a purposeful literature review to identify influential papers in the health sciences that focus on SMW, body size, and health status. Articles in the final analytic sample contained key gaps in the operationalization of body size and its relationship to health. The majority demonstrated a bias towards understanding body size as a marker of disease, ignoring scholarship questioning the link between body size and health. Body image was missing from half the articles, suggesting a privileging of medical metrics like BMI over SMW’s beliefs about the status of their bodies. Then, using quantitative survey data from the Michigan Smoking and Sexuality Survey (M-SASS), a cross-sectional study of SMW between the ages of 18 and 24, I conducted two sets of analyses. (1) I evaluated whether aspects of SMW’s identities where they departed from heteronormative social roles (i.e., non-traditional gender roles, sexual identity, connection to LGBTQ community) were associated with dimensions of body esteem (i.e., body weight, body attribution, and body shame). The results indicated that connection to the LGBTQ community increased positive feelings about body weight and reduced feelings of body shame. These relationships were amplified among masculine-identified SMW. (2) I assessed whether positive body image can be understood as a psychological asset available to SMW facing size discrimination. I tested three theoretically informed resilience models of body size, size discrimination, body image, and mental health (i.e., depressive symptoms, self-esteem) and found that SMW who experienced more size discrimination reported more depressive symptoms. Conversely, positive body image was associated with fewer depressive symptoms and more self-esteem. By examining body size and body image in relationship to each other and to mental health, this dissertation underscores that viewing the health of SMW solely through the lens of obesity is limiting and that SMW may have access to unique processes of resilience.