WVU study finds vulnerabilities among sexual minorities seeking weight-loss surgery

MORGANTOWN, WV – West Virginia University researchers have found that gay and bisexual adults seeking bariatric surgery are more likely to binge eat and believe derogatory weight-related stereotypes apply to them, making it less likely they will follow through with the procedure. The study suggests the reason could have to do with stress related to identifying as a sexual minority. 

Numerous studies show bariatric surgery is currently the most effective long-term treatment for obesity, yet only about 1% of people who qualify based on their body mass index go through with the operation. Additional research shows sexual minorities and people who binge eat are at increased risk for dropping out of the screening process before receiving surgery.

WVU researchers were trying to identify new factors that influence the ones they already understood as reasons sexual minority patients drop out of the program prior to having surgery.

“We wanted to understand to what extent internalized weight bias – the way people feel about themselves based on their weight – impacts binge eating, depression and anxiety and if that relationship differed depending on a person’s sexual orientation,”  said Laura Aylward, assistant professor in the Department of Behavioral Medicine and Psychiatry in the WVU School of Medicine and the study’s principal investigator. “We found the relationship between internalized weight bias and binge eating was stronger for the patients who identified as sexual minorities compared to heterosexual patients.”

Researchers think that’s where sexual minority stress, which is based on sources of stigma and prejudice as well as societal structure, comes into play.

“As a minority, there’s additional stress and burden that someone experiences,” Aylward said. “We think that helps explain the relationship for how people who are not straight think about their bodies and binge eating and how those are much more tied together.” 

The study, published in Surgery for Obesity and Related Diseases, found no significant results linking internalized weight bias with depression and anxiety.

Aylward is one of two psychologists at the WVU Medicine Medical and Surgical Weight-Loss Center that also includes a team of nurses, dietitians and surgeons that provides pre-surgery education and post-operative success plan.

She explained that, as a standard of care, most hospitals require weight-loss surgery candidates to undergo a psychological evaluation. Internalized weight bias and a patient’s self-esteem play roles in the success of the surgical process and maintaining positive results afterward.

“Part of what can help someone be successful with the surgical process and maintaining good results afterwards is the way that they are thinking about the surgery,” Aylward said. “Are they thinking it’s something they’re excited about that’s going to give them new opportunities and improve quality of life? Or do they feel like the surgery is a last resort or a punishment?”

Aylward said findings from the study can help health care providers become more vigilant and intervene earlier which in turn could improve the bariatric surgery success rates among sexual minorities.

“As a bariatric team we know that sexual minorities are a population that are particularly underserved within medical research and especially within bariatrics which is a relatively new field,” she said. “Those folks are ones who could benefit from additional attention. As a team we want to lift them up and help them cross the finish line.”

For the study, researchers used data from collected from 811 adult patients at WVU Medicine Medical and Surgical Weight-Loss Center responding to standard questionnaires presented during routine pre-surgical psychological evaluations.

Aylward pointed out that the study focused on binge eating behavior as opposed to a clinical diagnosis of the disorder.

“We were looking at binge eating severity by asking people to self-report information as to what extent that was true from them,” she said.

Researchers also used the Weight Bias Internalization Scale, a self-report measure that asks participants whether they believe negative statements and stereotypes about overweight and obese people apply to themselves.

While the research team doesn’t have plans for a future study, they hope to eventually follow up with work that can provide more answers.

“Since we are understanding that there is this relationship between internalized weight bias and binge eating for sexual minorities, what we don't know yet is the direction of that relationship,” Aylward said. “Does internalized weight bias cause binge eating or does binge eating come first? It’s kind of like the chicken or the egg question. The natural next step is trying to understand the direction of that relationship.”