"Lesbians had a significantly higher body mass index, waist circumference, and waist-to-hip ratio than their sisters," say Stephanie A. Roberts, M.D., and colleagues. This pattern of extra abdominal weight is one element of the metabolic syndrome, a group of symptoms that increase risk for cardiovascular disease.
Other risk factors, like smoking and exercise frequency, were similar in the two groups of women. Diet did not vary significantly between the lesbians and their sisters, except that the lesbians ate less red meat. Roberts suggests that attitudes about weight may partially explain the differences but also may complicate weight reduction efforts.
Roberts, a physician in private practice, and her colleagues from the School of Nursing at the University of California, San Francisco, surveyed 324 lesbians living in California and an equal number of their heterosexual sisters closest in age. Their work reflects previous studies that show lesbians have a higher body mass index (a ratio of weight to height used to define overweight and obesity) and are less concerned about weight issues than heterosexual women.
In general, Roberts found that the lesbians surveyed were about a year older (49.7 years vs. 48.9 years), more educated (17.5 years vs. 15.4 years) and more likely to be employed fulltime (70 percent vs. 56 percent), compared to their sisters.
On average, neither group fell into the ideal weight range. Both lesbians and their sisters had body mass indexes over 25, a level that is associated with increased risk for high blood pressure, coronary heart disease and severe chest pain.
The lesbians' waist circumference measurements and waist-to-hip ratios were near or above cutoff marks for cardiovascular risk, says Roberts. They also had a higher rate of weight cycling -- gaining, losing and regaining weight.
"Weight cycling has been associated with increased risk for cardiovascular disease," says Roberts.
The origin of these differences is unclear. Previous research has shown that in addition to being less concerned about weight, lesbians are less likely to perceive themselves as overweight, even when they are.
Roberts and her colleagues drew two conclusions from their study. They recommend a second round of research that would include not just self-performed measurements of height, weight and waist size, but also an unbiased observer's measurements of those factors, as well as of blood pressure, triglyceride, HDL and LDL cholesterol, and glucose levels. Tracking these diagnostic factors might provide insight into lesbians' vulnerability to the metabolic syndrome.
They also suggest that programs designed to reduce cardiovascular risk among lesbians should focus on decreasing their added weight around the middle of the body. Since heterosexual and lesbian women differ in their attitudes toward weight, generalized educational messages might be seen as irrelevant by lesbians. A more specific strategy may be needed, they say. This might begin by understanding how lesbians view the issue of overweight.
"Weight control is often perceived as a conventionally feminine behavior," says Roberts. "A strategy that de-emphasizes traditional feminine values may be the most effective for lesbians."
Funding for this study came from the California Breast Cancer Research Program of the University of California, and the Lesbian Health Research Center at the University of California, San Francisco.
BY AARON LEVIN, SCIENCE WRITER
HEALTH BEHAVIOR NEWS SERVICE
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