A mixed methods approach to understanding obesity risk among sexual minority women

PROJECT SUMMARY/ABSTRACT Obesity, a preventable and treatable condition, is associated with the leading causes of death in the United States and worldwide. Women who identify as sexual minorities (SMW; i.e., women with sexual orientations other than heterosexual) are up to twice as likely to have obesity compared to men and heterosexual women,

yet little is known about the mechanisms that confer heightened risk for these communities. The minority stress model, which posits that historically marginalized populations, such as SMW, are at increased risk for stress due to increased exposure to stigma and discrimination at the structural, interpersonal, and individual levels, can be

applied to help delineate potential factors that place SMW at greater risk for overweight and obesity. However, limitations in the literature hinder our ability to address obesity disparities. First, SMW are often treated as a homogeneous group, so we know little about risk factors for understudied subgroups of SMW (e.g., bisexual,

asexual, queer, pansexual, questioning). Second, among the limited research on obesity or the primary behavioral drivers of overweight and obesity (i.e., energy-balance behaviors such as diet, physical activity, and sedentary activity) among SMW, there is an overreliance on cross-sectional, retrospective self-report, or semi-

annual longitudinal designs. While these studies provide a foundation for understanding behavioral risk factors among SMW, these methods are limited in the data they can provide. Experience sampling methods (ESM) can advance our understanding by identifying temporally proximal risk factors for obesity (e.g., factors predicting

physical activity or high caloric intake) and disentangling risk factors from correlates. I will conduct a mixed methods study to delineate factors and mechanisms that may be associated with obesity risk among SMW, which is highly aligned with NIMHD’s focus on research that seeks mechanisms and pathways behind health

determinants that confer worse outcomes in health disparity populations. First, I will utilize a qualitative life history approach to identify preliminary factors associated with the development and maintenance of weight-related cognitions and behaviors (Aim 1). Second, I will use ESM to test the preliminary model identified in Aim 1 and

examine relationships between minority stressors and weight-related behaviors in real time in the natural environment among SMW from diverse sexual orientation identities (Aim 2). These aims support my training plan in which I will receive expert mentorship and training in: multi-level influences on SMW obesity outcomes

(Training Aim 1); qualitative data collection and analysis (Training Aim 2); ESM and advanced statistics for ESM data (Training Aim 3); and career development (Training Aim 4). Results will be used to inform a model of minority stress and obesity among SMW, which I will then test in a rigorous, large-scale, longitudinal trial

(R01). This K01 will equip me with the skills to become a leader in promoting SMW behavioral health.