American researchers found that overweight lesbians with identified heart risks were keen to take part in culturally sensitive programmes to improve their health, but very unhappy with healthcare professionals who focused purely on their Body Mass Index (BMI).
The study revealed important generational differences in the women's attitudes towards their weight, and being overweight, together with an overall greater tolerance of different body shapes. It also showed that homophobia and social exclusion could lead to stress, anxiety and depression, creating barriers to changing unhealthy behaviour.
Twenty-five lesbians aged between 22 and 60 took part in a series of focus groups to explore their attitudes and beliefs about the links between being overweight and heart risk. The discussion formed part of a larger study on coronary heart disease and lesbians.
Three-quarters of the women who took part were overweight and all had at least one risk factor for cardiovascular disease, such as a family history of cardiovascular disease, diabetes, high blood pressure or high cholesterol.
"The women felt angry that healthcare professionals focused on lowering their BMI, rather than improving their general health and many had been told to lose weight without any advice or support on the best way to do it" says lead author Professor Susan J Roberts from the Northeastern University School of Nursing in Boston. "Barriers to weight loss included feeling self conscious about exercising with normal weight people and lack of gym facilities that provide joint membership, or a comfortable welcoming environment, for same-sex couples."
Younger lesbians felt they had the same attitudes to weight and appearance as heterosexual women. As one of the study participants explained: "My mother, my grandmother, we all have to deal with it [being overweight]. I don't think they feel different than I do".
But some women over 40 felt that lesbians were more likely to reject the social norms for women's appearance, body type and weight. "I think that older lesbians have different perspectives around weight and body changing and accept that that happens."
There was general agreement that lesbians were more accepting of a variety of body images and a number of women acknowledged that this could be detrimental to their health. "We're more apt to accept each other for who and what we are, so if we gain a little weight so what? In the male-female community it's more of a threat."
Others suggested that while some lesbians criticised people who were overweight, some positively championed it. "Maybe at women's festivals or something there'd be like fat lesbians who want their own group."
Depression was common, as many of the women felt that being a lesbian and being overweight gave them a double disadvantage. "I do think depression is a big factor in being overweight and especially with lesbians."
Being depressed led to unhealthy stress-related behaviour, such as smoking and drinking, and homophobia and sometimes having to hide their sexuality led to feelings of anger, loneliness and isolation. "...it comes and goes because you can be out in some places and not in others."
A consistent theme to come out of the focus groups was that being a lesbian added to general work and life stress. "You are always under stress and then you choose a lifestyle which is unacceptable...it just adds to it."
A number of the women also talked about the need for constant vigilance. "I think there's a kind of gnawing stress of keeping a part of yourself hidden."
"The women who took part in our focus groups were aware of the health consequences of being overweight or obese and most expressed a desire to lose weight to improve their health and fitness" says Professor Roberts.
"A unique finding of this study is that there are generational difference in the way lesbians view weight and being overweight. We feel that their wider acceptance of different body shapes is also particularly noteworthy."
The authors are calling for culturally sensitive initiatives that help lesbians at risk of heart disease to improve their overall health and weight.
"Although these interventions may improve the general health of lesbians, and help to lower the risk of heart disease, the overall challenge is to raise sensitivity in healthcare professionals" concludes Professor Roberts.
"This study revealed that the anxiety and depression these women felt was related to being part of a stigmatised minority whose needs are often invisible to healthcare providers."
