Associations between Disordered Eating, Body Image and Sexual Risk among Gay and Bisexual Men

Background/Purpose

Gay and bisexual men (GBM) experience high levels of body dissatisfaction which is associated with both disordered eating risk (Wichstrøm, 2006) and sexual risk (Allensworth-Davies, et al., 2008). More research is needed that explores the connectedness between identity, disordered eating and the well-being of GBM. The objectives are:

1) Estimate the prevalence of disordered eating risk and sexual risk among a racially diverse sample of GBM attending Toronto's 2008 LGBT Pride Festival,

2) Identify demographic/psychosocial factors associated with these risks.

Methods:

Cross sectional data were collected using a survey from a convenience sample. Variables included demographics, HIV status, body mass (BMI), depression/anxiety, alcohol/illicit drug consumption, and body image (idealized and behavioral drive for muscularity). The variables of primary interest were disordered eating risk (EAT-26; Garner et al., 1982) and sexual risk (specifically sero-discordant unprotected anal intercourse - SDUAI).

Results:

510 men participated; 43.6% were men of color (16.7% Black, 19.2% Asian, 7.6% mixed race/other). Mean age was 34 years (SD = 12). More than half had some post-secondary education. The majority of respondents identified as exclusively homosexual (62.9%) and 56% were single. Positive HIV status was reported by 12.7% and unknown status by 6.7%. SDUAI was reported by 22.2%. Risk for disordered eating was reported by 14.4%.

Directly associated with disordered eating risk were Idealized Muscularity (p=.01), Behavioral Muscularity (p<.001), drug use (p=.03), and being younger (16-24; p=.007). An increase in SDUAI was associated with less education (p=.02), mixed race ( p<.01), being in a non-monogamous relationship (p=.04), unknown HIV status (p=.001), use of drugs (p<.01), and increased anxiety/depression (p<.01).

In multivariate analysis, eating risk was predicted by the following factors. In comparison to men 16-25, those between 31-40 were 73% less likely to report eating risk (OR 0.27, 95% CI .10, 0.72, p<.01), and those between 41-50 were 56% less likely to report risk for disordered eating (OR 0.44, CI 95% 0.20, 0.98, p<.05). Moreover, men over 50 were 83% less likely to report eating risk than the youngest age group (OR 0.17, CI 95% 0.04, 0.80, p<.05). Finally, increased behaviour devoted to gaining muscle predicted disordered eating risk (OR 1.13, CI 95% 1.07, 1.19, p<.001).

SDUAI was predicted by the following factors. Compared to White men, Asian men were less likely to report SDUAI (OR 0.44, 95% CI 0.21, 0.96, p<.05). Compared to HIV-negative men, HIV-positive men were almost twice as likely (OR 1.91, 95% CI 1.03, 3.56, p<.05) and HIV-unknown men were over three times as likely (OR 3.28, 95% CI 1.46, 7.40, p<.01) to report SDUAI. Men with some level of college education reported 43% less chance of SDUAI than men with no college (OR 0.57, 95% CI 0.57, .33, p=.046).

Conclusions/Implications:

GBM report high rates of disordered eating risk, but this does not appear to be associated with sexual risk. Yet targeted prevention programs for eating disorders among GBM are needed. Further research is required to understand the factors that influence the relationship between body image dissatisfaction, disordered eating and sexual risk among GBM.