Restricted accessResearch articleFirst published online 2026-4
Prevalence of Clinical Obesity Based on Updated Definitions Among Women by Sexual Identity: Results from 2001 to 2016 National Health and Nutrition Examination Survey
Previous work has consistently shown a higher prevalence of obesity based on body mass index (BMI) among lesbian women and, more recently, also among bisexual women. New recommendations on defining clinical obesity suggest the inclusion of other physical health measures related to physiological health and/or physical limitations. Therefore, the purpose of this study is to examine sexual identity-based differences in clinical obesity among women using updated definitions.
Methods:
2001–2016 National Health and Nutrition Examination Survey data were analyzed in 2024 to 2025. Body mass index, metabolic biomarkers, and physical functioning were used to estimate prevalence of clinical obesity for each sexual identity group (heterosexual n = 11,054; lesbian/gay n = 171; bisexual n = 464; something else n = 94; “not sure” n = 289). Logistic regression models were fit to assess sexual identity-based differences in clinical obesity. Covariates included age, race/ethnicity, income, education, and relationship status.
Results:
With metabolic biomarkers, there was no statistically significant difference in prevalence of clinical obesity between lesbian/gay and heterosexual women. With physical functioning only, prevalence was higher among lesbian/gay than heterosexual women (OR range: 2.0–2.5). Bisexual women consistently had higher prevalence of clinical obesity than heterosexual women (OR range: 1.2–2.1) across all definitions. There were no other sexual identity-based differences in clinical obesity.
Conclusion:
Based on updated recommendations, physical functioning may better capture clinical obesity among lesbian/gay and bisexual than heterosexual women with BMI ≥30 kg/m2 than metabolic biomarkers. However, bisexual women continued to have higher risk for clinical obesity, and additional work is needed to better understand the factors that contribute to this disparity.
BowenDJ, BalsamKF, EnderSR. A review of obesity issues in sexual minority women. Obesity (Silver Spring), 2008; 16(2):221–228; doi: 10.1038/oby.2007.34
2.
EliasonMJ, IngrahamN, FogelSC, et al.A systematic review of the literature on weight in sexual minority women. Womens Health Issues, 2015; 25(2):162–175.
3.
LickDJ, DursoLE, JohnsonKL. Minority stress and physical health among sexual minorities. Perspect Psychol Sci, 2013; 8(5):521–548.
4.
CaceresBA, BrodyAA, HalkitisPN, et al.Cardiovascular disease risk in sexual minority women (18-59 Years Old): Findings from the National Health and Nutrition Examination Survey (2001-2012). Womens Health Issues, 2018; 28(4):333–341; doi: 10.1016/j.whi.2018.03.004
5.
BeachLB, ElasyTA, GonzalesG. Prevalence of self-reported diabetes by sexual orientation: Results from the 2014 behavioral risk factor surveillance system. LGBT Health, 2018; 5(2):121–130; doi: 10.1089/lgbt.2017.0091
6.
CaceresBA, BrodyA, LuscombeRE, et al.A systematic review of cardiovascular disease in sexual minorities. Am J Public Health, 2017; 107(4):e13–e21; doi: 10.2105/AJPH.2016.303630
7.
CaceresBA, StreedCG, CorlissHL, et al.; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council. Assessing and addressing cardiovascular health in LGBTQ adults: A scientific statement from the American heart association. Circulation, 2020; 142(19):e321–e332; doi: 10.1161/CIR.0000000000000914
8.
GonzalesG, Henning-SmithC. Health disparities by sexual orientation: Results and implications from the behavioral risk factor surveillance system. J Community Health, 2017; 42(6):1163–1172; doi: 10.1007/s10900-017-0366-z
9.
BoehmerU, MiaoX, LinkletterC, et al.Health conditions in younger, middle, and older ages: Are there differences by sexual orientation? LGBT Health, 2014; 1(3):168–176; doi: 10.1089/lgbt.2013.0033
10.
CrawfordCA, CarsonIW, PolankaBM, et al.Associations between sexual orientation dimensions and cardiometabolic diseases: Data from the national epidemiologic survey on alcohol and related Conditions-III (NESARC-III). Psychosom Med, 2024; 86(9):774–780; doi: 10.1097/PSY.0000000000001349
11.
HaarmannL, FolkertsA-K, LiekerE, et al.Comprehensive systematic review and meta-analysis on physical health conditions in lesbian- and bisexual-identified women compared with heterosexual-identified women. Womens Health (Lond), 2023; 19:17455057231219610; doi: 10.1177/17455057231219610
12.
EliasonMJ, Sanchez-VaznaughEV, StupplebeenD. Relationships between sexual orientation, weight, and health in a population-based sample of California women. Womens Health Issues, 2017; 27(5):600–606; doi: 10.1016/j.whi.2017.04.004
13.
CaceresBA, AnchetaAJ, DorsenC, et al.A population-based study of the intersection of sexual identity and race/ethnicity on physiological risk factors for CVD among U.S. adults (ages 18–59). Ethn Health, 2022; 27(3):617–638; doi: 10.1080/13557858.2020.1740174
14.
MaysVM, JusterR-P, WilliamsonTJ, et al.Chronic physiologic effects of stress among lesbian, gay, and bisexual adults: Results from the national health and nutrition examination Survey. Psychosom Med, 2018; 80(6):551–563; doi: 10.1097/PSY.0000000000000600
15.
CorlissHL, VanKimNA, JunH-J, et al.Risk of type 2 diabetes among lesbian, bisexual, and heterosexual women: Findings from the nurses’ health study II. Diabetes Care, 2018; 41(7):1448–1454; doi: 10.2337/dc17-2656
16.
RubinoF, CummingsDE, EckelRH, et al.Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol, 2025; 13(3):221–262; doi: 10.1016/S2213-8587(24)00316-4
17.
RothblumED. Commentary: Lesbians should take the lead in removing the stigma that has long been associated with body weight. Psychol Sex Orientat Gend Divers, 2014; 1(4):377–382; doi: 10.1037/sgd0000065
18.
PenneyTL, KirkSFL. The health at every size paradigm and obesity: Missing empirical evidence may help push the reframing obesity debate forward. Am J Public Health, 2015; 105(5):e38–e42; doi: 10.2105/AJPH.2015.302552
19.
McPhailD, BombakAE. Fat, queer and sick? A critical analysis of ‘lesbian obesity’ in public health discourse. Crit Public Health, 2015; 25(5):539–553; doi: 10.1080/09581596.2014.992391
20.
Institute of Medicine. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Institute of Medicine: Washington, DC; 2011.
21.
McElroyJA, GilbertT, HairEC, et al.Obese but fit: The relationship of fitness to metabolically healthy but obese status among sexual minority women. Womens Health Issues, 2016; 26 (Suppl 1):S81–S86; doi: 10.1016/j.whi.2015.09.014
22.
ZpifG, ChiappaM, PorterKS, et al.National Health and Nutrition Examination Survey: Plan and Operations, 1999–2010. Vital Health Statistics. National Center for Health Statistics; 2013.
23.
TerryA, ChiappaM, McAllisterJ, et al.Plan and Operations of the National Health and Nutrition Examination Survey, August 2021–August 2023. In: Vital Health Statistics. National Center for Health Statistics (U.S.): Hyattsville, MD; 2024.; doi: 10.15620/cdc/151927
24.
Anonymous. Summary of revisions for the 2010 clinical practice recommendations. Diabetes Care, 2010; 33(Supplement_1):S3; doi: 10.2337/dc10-S003
25.
JusterR-P, SmithNG, OuelletÉ, et al.Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosom Med, 2013; 75(2):103–116; doi: 10.1097/PSY.0b013e3182826881
26.
LiuX, HuangY, FuJ, et al.Associations of arthritis with functional disability and depressive symptoms in general US adults: NHANES 1988–1994 and 1999–2018. Aging Med (Milton), 2024; 7(6):705–716; doi: 10.1002/agm2.12379
27.
Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey. Analytic Guidelines, 1999-2010. n.d. Available from: https://stacks.cdc.gov/view/cdc/21305 [Last accessed: March19, 2023].
28.
CaseP, Bryn AustinS, HunterDJ, et al.Sexual orientation, health risk factors, and physical functioning in the nurses’ health study II. J Womens Health (Larchmt), 2004; 13(9):1033–1047; doi: 10.1089/jwh.2004.13.1033
29.
Fredriksen-GoldsenKI, KimH-J, BarkanSE. Disability among lesbian, gay, and bisexual adults: Disparities in prevalence and risk. Am J Public Health, 2012; 102(1):e16–e21; doi: 10.2105/AJPH.2011.300379
30.
GonzalesG, PrzedworskiJ, Henning-SmithC. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: Results from the national health interview survey. JAMA Intern Med, 2016; 176(9):1344–1351; doi: 10.1001/jamainternmed.2016.3432
31.
FeinsteinBA, DyarC. Bisexuality, minority stress, and health. Curr Sex Health Rep, 2017; 9(1):42–49; doi: 10.1007/s11930-017-0096-3
32.
WestBT, EngstromCW, SchepisTS, et al.How a “Something Else” response option for sexual identity affects national survey estimates of associations between sexual identity, reproductive health, and substance use. Arch Sex Behav, 2024; 53(1):107–126; doi: 10.1007/s10508-023-02710-7
33.
EliasonMJ, RadixA, McElroyJA, et al.The “Something Else” of sexual orientation: Measuring sexual identities of older lesbian and bisexual women using national health interview survey questions. Womens Health Issues, 2016; 26:S71–S80; doi: 10.1016/j.whi.2016.03.012
