Risky weight loss behavior more prevalent in lesbian and bisexual women

One in three sexual minority women abuse laxatives and diet pills or induce vomiting.

Eating disorders have been on the rise for decades in the United States. However, a new study has discovered that one group is particularly vulnerable to disordered eating and the abuse of weight loss products – sexual minority women. S. Bryn Austin from the Boston Children’s Hospital explains why this is the case, and what she believes needs to change to stop the increase in disordered eating.  

ResearchGate: Do you know why sexual minority women are more likely to use laxatives?

Bryn Austin: Sexual minority youth of all genders growing up in our society face stigma and harassment related to having a minority sexual orientation. The stigma, social rejection, and sometimes violence can be especially harsh for teens, occurring at school, in the community, and even at home. The psychological stress caused by this stigma can lead to depression and anxiety and can also put young people at risk for unhealthy coping behaviors such as disordered weight control behaviors, including abuse of laxatives and diet pills or self-induced vomiting.

While youth of all genders may use disordered weight control behaviors, we know that girls are more at risk than boys and we also know that sexual minority girls are at even more risk. In a recent study we conducted with high school girls from across the U.S., we found that one in three sexual minority girls engaged in abuse of laxatives or diet pills or self-induced vomiting to control their weight in the past month compared to fewer than one in ten heterosexual girls.

These behaviors are harmful enough on their own, but when youth do not receive the help they need in time, these problems can escalate into a full-blown eating disorder. In the U.S., eating disorders have the highest death rate compared to any other psychiatric disorder, and young women with an eating disorder have ten times the risk of dying compared to peers their age without an eating disorder.

RG: What lead you to research laxative usage in women?

Austin: Though laxatives do have a medically indicated use, they are widely abused in misguided attempts to lose weight. They do not lead to healthy weight loss, though, and instead, when abused, can damage the digestive system, cause dangerous dehydration and electrolyte imbalances, disrupt normal heart rhythms, and even lead to death. Laxative abuse is part of the larger problem of eating disorders and disordered weight control behaviors. 30 million Americans will suffer from an eating disorder in their lifetime, and dangerous and debilitating disordered weight control behaviors, including laxative abuse, are even more common.

Companies that sell these products are well aware of how widespread abuse is. For instance, it is not uncommon for dietary supplements promising weight loss or “cleansing” to include ingredients with laxative effects. They are basically selling an eating disordered behavior, but marketing it as “healthy” to their customers, most of whom are teen girls and women.

RG: What other factors impact whether a woman struggles with body image?

Austin: Weight stigma is deeply ingrained in our culture, and false and damaging misconceptions about people living in larger bodies are widely held. These negative beliefs are harmful to people who are overweight and contribute to widespread discrimination in the workplace, education, healthcare systems, and elsewhere and frequent harassment and social exclusion. But weight stigma does not only affect people who are overweight: People of all sizes are keenly aware of the social costs of being seen as overweight, and these costs are particularly harsh on girls and women. The pressures on girls and women especially to continually battle their own bodies to stay thin or become thin are overwhelming for many people, and for some, create conditions that lead to increasingly dangerous attempts to control their weight and debilitating shame and body dissatisfaction.

RG: We have seen the rates of eating disorders in women increase steadily over the past years. Do you see this trend continuing?

Austin: In the United States, we saw a rise in eating disorders in girls and women over several decades, but whether it is still increasing is not clear. Among teenage boys, we do have evidence of increasing rates of eating disorders symptoms over the past ten years or so. We have also seen an increase since at least 1999 in the number of hospitalizations for eating disorder treatment, which may relate to better identification of people needing treatment or just improved documentation by hospitals that an eating disorder was the reason for hospitalization.

RG: In your opinion, what factor would have the biggest impact on preventing women from developing eating disorders?

Austin: Our toxic environment, meaning the pervasive weight stigma and unrealistic standards of thinness in our society, especially for girls and women, is a prime culprit in eating disorders and the wider problem of disordered and dangerous weight and shape control behaviors. The media and fashion industries promote distorted ideals of thinness and undermine girls’ – and increasingly, boys’ – sense of self with constant messages that physical appearance is more important than anything else about who a person is and what they accomplish. And other industries are quick to profit from the body insecurities our society instills in young people, selling diet pills, laxatives, diuretics, and dietary supplements promising weight loss or muscle building in hopes of obtaining the idealized body. Consumers, community leaders, and youth have organized to change these forces, and there have been successes, but there is so much more to be done to clean up our toxic environment and make our world a place where all girls and boys can grow up at home in their own bodies.

Image credit Jared Earle