During the past 18 months, I have worked on the federally funded Doing It For Ourselves project, targeting older women of size for nutrition, physical activity, and stress reduction activities. It has been an interesting process that has challenged my own assumptions in so many ways. I wrote about my own experiences as a researcher and group facilitator last month, but this month I’d like to talk about a more cognitive “aha” movement I had during the research gathering phase of this study.
One of the first activities we did as a cross-site team was to do a critical review of the literature on weight among sexual minority women. Not surprisingly, of the 35 articles we reviewed, about 65% of them found a statistically significant difference with lesbians and often bisexual women, being heavier than heterosexual women. But the magnitude of the difference was not huge…probably about a 4-5 pound difference overall. I was tasked with lead author on this paper, and I felt that we could not leave the paper as only a review of the weight studies. I needed to know whether that weight difference was associated with any health risks. All the biomedical literature available today tries to convince us that obesity is related to higher rates of diabetes, heart disease, hypertension, and some cancers. I knew that many studies in the past 20 years have reported that lesbians are at high risk for breast cancer. A researcher at a lecture I attended in the past year said lesbians were nine times more likely to get breast cancer, but reported no sources.
So I conducted a review of the literature. Finally, because of the addition of sexual orientation questions to some of the big health surveillance instruments, there is some population-based data on frequency of health problems. Here is what I found:
• Diabetes: 8 studies, none found a significant difference
• Hypertension: 10 studies, none found a significant difference
• Heart Disease: 2 studies found a small difference with lesbians having higher rates; 8 studies found no differences
• Breast Cancer: 2 studies found lesbians with higher rates and 5 studies found no differences.
I got to wondering about what effect the rhetoric about risk might have in our communities and recalled some of the reactions women had at lectures, classes, or conferences I had attended in the past. Some women had seemed to adopt a fatalistic response. They seemed to think that the problem of stigma was too large to address, so they were inevitably going to get some of these disorders. Others seemed to have their heads in the sand…they did not want to hear this information. I wondered if they would also avoid screening tests like mammograms because of this avoidance. I don’t know if there is research on this issue of the unintended consequences of disseminating information about risk factors, and I will look into this when I have some time. But for now, what do you think? Should we be developing materials to alert LGBT people about risks, or should we consider other strategies to promote health?
Interesting, Mickey! 8)
I am also based in a research university. I find that when I’m educating health professionals and health professions students about LGBTQ populations that I must lead with the “higher risks” argument in order to justify the importance of whatever I’m supposed to be speaking about. If, despite the many inequities facing LGBTQ pops inside and outside of health care, we are at no higher risks for anything then why should current and future health professionals give a hoot? Once some systematic reviews supporting your findings are published then I’ll need to rethink my hook. Thanks for the post!
Rutgers School of Nursing at RBHS
Wendy, I agree that we need to lead with the risk discourse with health professionals and potential funders. That is the language that is understood. They do not as readily understand the need for sensitive language, respect for partners/families, and the more subtle micro-aggressions, so they need the numbers to justify LGBTQ education. I am wondering if we need a different strategy when we do education within LGBTQ populations, though. When my review is published (should be soon!), I’ll post the link here.
Great discussion on a very interesting issue! And thanks for your comment on this, Wendy. I am wondering about the potential for research that shows the strengths that LGBTQ people and families have/develop/nurture to offset the risks that we know derive from stigma? I think that it is possible that instead of concluding that LGBTQ people are just like everyone else and have no significant differences (and perhaps no greater risk) that the conclusion might be instead that we have developed exceptional strength that mitigates the risks?? It seems to me that if we are focused on rooting health, that investigations from this perspective could be vitally important!