Perceived weight gain and eating disorder symptoms among LGBTQ plus adults during the COVID-19 pandemic: a convergent mixed-method study

Background In this study, we 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. Methods Employing 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. Results Study 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. Conclusions Clinicians 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. Plain English summary The COVID-19 pandemic has uniquely shaped the mental health of individuals globally. Adults, particularly those identifying as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+), may be at risk of engaging in disordered eating behaviors (eating disorder symptoms) due to pandemic-related stress. This study explores correlates of eating disorder symptoms and perceived weight gain among adults during the COVID-19 pandemic. We surveyed 411 US-residents, and engaged in follow-up semi-structured interviews with 43 LGBTQ+ -identifying survey respondents to better establish the unique pandemic-related experiences and mental health challenges of LGBTQ+ adults. We quantitatively found that LGBTQ+ individuals experienced uniquely high levels of pandemic-related stress, and secondly, that pandemic-related stress was associated with increased eating disorder symptoms and perceived weight gain. Qualitative narratives complemented quantative findings and suggested that eating concerns, physical exercise constraints, and weight concerns were important to LGBTQ+ people's perceived health challenges during the pandemic. These findings highlight the need to screen for any persistent eating disorder symptoms or weight concerns, particularly among LGBTQ+ adults.