College Women's Weight-related Behavior Profiles Differ by Sexual Identity.

Existing research suggests that lesbian, gay, and bisexual (LGB) adult women are more likely to be obese than heterosexual women.1–8 Findings for disparities in diet and physical activity across sexual orientation among women mostly have been mixed, and measurement of these behaviors has been inconsistent.3,5,6,9–15 These disparities exist even during emerging adulthood (typically defined as 18–25 years), when independence is generally established and new responsibilities, life skills, and identities are negotiated and formed.16 In studying weight-related health, particularly across sexual orientation, it is important to consider age.7,9 Research has suggested that weight-related health generally declines during emerging adulthood, with noted weight gain, deterioration of diet quality and physical activity, and increasing sedentary behaviors.17–25 Some studies have indicated that during emerging adulthood, health disparities widen.26–28 Given that adolescence and emerging adulthood is also a period for sexual development and exploration,29–31 this period in the life-course may be a critical time where individual trajectories can have an adverse impact on weight-related health disparities. Nearly half of emerging adults attend college, representing a large proportion of this age group and an accessible population in which to study emerging adult disparities and to design and deliver interventions to address these disparities.32 In our previous work on weight-related disparities among emerging adults, findings suggested that among women, differences exist across sexual orientation for breakfast, fast food, and restaurant food consumption, physical activity, unhealthy weight control behaviors (such as vomiting, taking diet pills or laxatives), and binge eating.33 Other studies using longitudinal cohort data also found disparities across sexual orientation in unhealthy weight control behaviors and physical activity from adolescence into emerging adulthood.15,34 However, none of these studies has explored the patterning of weight-related behaviors. Patterning of weight-related behaviors is complex, and traditional methods of analysis, such as regression, may not be sufficient in modeling of relationships among multiple behaviors. This is particularly relevant for weight-related factors, where eating habits, sedentary behaviors, and physical activity, might not consistently track together. It is likely that in these instances, a more holistic analytic approach might better capture the heterogeneity in a population. It is this heterogeneity that might improve understanding of the differences observed in weight-related health disparities across sexual orientation that can then be used to target and tailor interventions. For example, in a study of female college students by Laska et al,35 the authors were able to identify 4 subgroups of women based on a wide-range of health behaviors, including physical activity and nutrition. “Poor lifestyle, low risk” had the highest membership (40% of students), highlighting a large proportion of the female student population for which to address health-related programming targeting wellness behaviors (eg, physical activity and nutrition) with a concurrent focus on other risky behaviors (eg, alcohol and tobacco use).35 Further, the findings from the Laska et al study,35 as well as other studies, highlight that important differences in weight-related behaviors across sex exist, likely due to factors such as varying social norms.4,5,34,35 Therefore, we are including only women in this paper. The purpose of this study was to identify and describe homogenous profiles of female college as students based on patterning of healthful weight-related behaviors (eg, eating habits, physical activity, weight control behaviors), and to examine differences across 5 sexual orientation groups. We hypothesized that there are distinct classes that share common patterns of weight-related behaviors, and for whom interventions can be developed and tailored. In addition, we hypothesized that differences in proportions of classes and patterning of weight-related behaviors exist across sexual orientation groups, with greater proportions of LGB women in unhealthy classes and exhibiting unhealthier patterns than heterosexual women.