A Systematic Review of Sexual Orientation Disparities in Disordered Eating and Weight-Related Behaviors Among Adolescents and Young Adults: Toward a Developmental Model

Adolescence is a sensitive period for the development of disordered eating and weight-related behaviors, and sexual minorities may be particularly at risk due to heightened minority stress and challenges related to sexual identity development. This review synthesized findings from 32 articles that examined sexual orientation disparities (each with a heterosexual referent group) in four disordered eating behaviors (binging, purging, restrictive dieting, diet pill use) and four weight-related behaviors [eating behaviors, physical activity, body image, and body mass index (BMI)]. Potential variations by outcome, sex, race/ethnicity, and developmental stage were systematically reviewed. Evidence supporting sexual orientation disparities in disordered eating and weight-related behaviors was more consistent among males than females. Among females, sexual orientation disparities in disordered eating behaviors appeared to be more pronounced during adolescence than in young adulthood. Sexual minority females generally reported more positive body image than heterosexual females but experienced disparities in BMI. Sexual orientation differences in eating behaviors and physical activity were especially understudied. Incorporating objectification and minority stress theory, a developmental model was devised where body image was conceptualized as a key mechanism leading to disordered eating behaviors. To advance understanding of sexual orientation disparities and tailor intervention efforts, research in this field should utilize longitudinal study designs to examine developmental variations and incorporate multi-dimensional measurements of sexual orientation and body image.