Abstract
Gay men’s subcultural identifications may help explain why certain groups of gay men are more at risk than other groups. One such subculture is the Bear community, a group that espouses that large-framed, hirsute men are attractive. To understand current health risks among the Bear community, a literature search was conducted using Medline, Psychinfo, CINAHL, and LGBT Life. A total of eight articles were found addressing health risks in the Bear community. There is a dearth of literature that focuses on the Bear community, but the current literature indicates that Bears are more likely to have a higher body mass index, lower self-esteem, and engage in risky sexual behaviors than other gay men. Suggestions for engaging and conducting research with the Bear community are provided. Last, clinical implications offer guidance for health care providers working with the Bear community to ensure that appropriate care is delivered to these men.
Introduction
Gay men are a vulnerable population that are at higher risk of experiencing increased levels of certain health issues like depression, sexually transmitted infection (STI)/HIV risk, and discrimination (Centers for Disease Control and Prevention, 2011). Research has noted that a gay man’s social network influences health risk factors (Peterson & Bakeman, 2006; Smith, Grierson, Wain, Pitts, & Pattison, 2006). Researchers have begun exploring the importance of gay men’s subcultural identification and the impact on health by highlighting the significant distinctions among each subcultural group (Gough & Flanders, 2009; Hennen, 2005; Lyons & Hosking, 2014; Manley, Levitt, & Mosher, 2007; Moskowitz, Turrubiates, Lozano, & Hajek, 2013; Prestage et al., 2015; Whitesel & Shuman, 2013; Willoughby, Lai, Doty, Mackey, & Malik, 2008). One such subgroup is the Bear community, a group that eroticizes and promotes large-framed, hirsute men as attractive in sharp contrast with the stereotypical image of gay men as youthful, thin, and smooth-skinned (Locke, 1997).
In 2010, it was estimated that 1.4 million Bears lived in the United States (Mann, 2010). Another estimate suggested that Bears comprise about 14% to 22% of the gay community (Moskowitz et al., 2013). The Bear community is an understudied sexual minority group that experiences health risks due to their lifestyle, such as anal sex without a condom (Willoughby et al., 2008), as well as due to weight-related stigma and discrimination (Gough & Flanders, 2009; Whitesel & Shuman, 2013). By conducting a literature review, this article will examine health risks among Bears as well as clinical implications for health care clinicians providing care to this subculture of gay men.
What Is a “Bear?”
In contrast with stereotypical images of mainstream heterosexual and gay notions of physical desirability, the Bear community has been able to promote an alternative form of attractiveness, one that emphasizes that large girth can be synonymous with handsomeness. Bears vary in size, shape, and skin tones, and the Bear community promotes inclusion of all types of people, but a stereotypical physical image of a Bear usually describes a man with a burly, hirsute body who has facial hair and dressed in blue collar clothing (Locke, 1997; Wright, 1997). These elements help emanate a sense of masculinity (Hennen, 2005).
Bears’ expression of masculinity is different than that of heterosexual males and the mainstream gay community’s expressions of masculinity. In fact, some Bears claim that ascribing to Bear culture is more about attitude than physical body traits like weight and hirsuteness (Hennen, 2005). Bears’ unique display of masculinity fosters a traditional masculine appearance while allowing for displays of affection, intimacy, and nurturance, which are typically understood as feminine (Manley et al., 2007; Suresha, 2009). Being able to show affection to another man does not cause a Bear to question his masculinity (Manley et al., 2007).
Further classification of Bears based on age, race, physical characteristics, and sexual interest is provided by the community itself. For example, a younger, large-framed, hirsute man who identifies with the Bear community is referred to as a “Cub” (Lyons & Hosking, 2014). Older Bears are called “Polar Bears” because of the physical trait of gray or white hair (Moskowitz et al., 2013). A Hispanic Bear is referred to as a “Brown Bear,” an Asian Bear is called a “Panda Bear,” and an African American Bear is termed a “Black Bear” (Moskowitz et al., 2013; Suresha, 2009). Thin, hairy men who identify with the Bear community are termed “Otters” (Moskowitz et al., 2013). Thin, hairless men who are attracted to any type of Bear are labeled “Admirers” or “Chasers” because these men “admire” the characteristics of Bears and often “chase” after them. “Leather Bears” are men who enjoy wearing leather and possibly engage in bondage/domination, or sadism/masochism. Table 1 presents a list of common terms used in the Bear community.
Common Terms Used in the Bear Community.
Note. Table compiled from terms in Hennen (2005); Lyons and Hosking (2014); Manley et al. (2007); Moskowitz et al. (2013); and Suresha (2009).
Today, there are many resources for Bears to interact with others. Readers interested in Bear history and culture can read The Bear Book I, The Bear Book II, Bears on Bears, The Bear Handbook, and The Guide for the Modern Bear. Regional Bear clubs, like the Bears of South Florida, allow Bears to congregate for monthly gatherings. Annual events, like Texas Bear Round-Up, attract a global group of Bears to socialize. Technology plays an important role in communication among Bears. Some social media groups are centered on Bear interests, displaying images of men who identify as Bears and informing Bears of upcoming events. A phone app exists that allows users to identify Bears based on proximity.
Methodology
To determine the health risks of Bears, a literature search was performed using Medline, PsychInfo, CINAHL, and LGBT life in May 2015. The search terms were “Gay OR MSM” and “Bear OR Bears.” No time limitation was placed on the search in order to acquire as many articles as possible. The search yielded a total of 117 articles. Eight of these articles mentioned Bears in the title or abstract. From these eight works, six mentioned health risk. Works highlighting health benefits were removed from the literature review since the focus was on health risks. The authors reviewed the reference lists of these articles to find any other relevant sources on Bears. By exploring the reference section, two textbooks, The Bear Book I and The Bear Book II, and a book of interviews, Bears on Bears, were discovered. The researchers looked for articles and interviews related to health risk in these books. One article (Mass, 2001) and an interview (Suresha, 2009) were obtained from these books, for a total of eight works analyzed.
Health-Related Research on Bears
There is a dearth of research regarding the Bear community and health-related issues. The research that has been conducted has generated more research questions to help better understand this subculture. Very few articles focus on the physical health aspects of being a Bear, while many articles focus on the mental health of Bears.
A health survey was conducted in New York by Steve Albert, who published the results in the November 1998 issue of Metropolitan Bears, a monthly newsletter of the NYC Metrobears, a Bear club. He asked less than 100 Bears what they considered to be their greatest health concerns. The results stated that eating disorders was the top concern, followed by depression, HIV/AIDS, insurance issues, and stress (Mass, 2001).
In an interview with Mass, Suresha (2009) discusses health risks that face overweight and obese Bears, highlighting the risks of obesity like hypertension, diabetes, heart attack, and stroke. Some Bears associate large-framed bodies with masculinity and attraction. While girth might attract Bears, the realization that obesity leads to many health problems must be recognized. Compulsive eating can be caused by issues of self-esteem. To address these problems, diet, exercise, and group-counseling therapy are recommended, yet the authors realize that some Bears may not seek help and are content with their body size.
In an attempt to understand Bears’ physical, behavioral, and psychological traits, Moskowitz et al. (2013) conducted a quantitative study of Bears. There were two parts to this study: an online survey and an in-person survey. Based on the responses of 1,598 non-Bears and 469 self-identified Bears, Moskowitz et al. concluded that Bears were more likely than non-Bears to be shorter, heavier, and hairier. Bears wanted partners who were also hirsute and heavy. Bears were less likely to reject sexual partners. Regarding psychological traits, when compared to non-Bears, Bears had a lower self-esteem, but reported a higher degree of masculinity. Bears were more likely to engage in diverse sexual acts like receptive and insertive anilingus, fisting, urination, voyeurism, and exhibitionism. Bears may engage in these behaviors to demonstrate masculinity or as a result of lower self-esteem (Moskowitz et al., 2013).
Examining a younger group of gay men, Lyons and Hosking (2014) explored physical, mental, and sexual health among Cubs and other gay men. Cubs are typically younger, gay men who identify with the Bear community. Using an online survey, the researchers surveyed 1,034 men between 18 and 39 years. From this sample, 92 (9%) identified as Cubs. The researchers determined that Cubs had a lower self-esteem score when compared to nonidentified men after adjusting for age. This lower self-esteem could be related to discrimination. Also, Cubs were more likely to get tested for STIs. Like Moskowitz et al. (2013), Lyons and Hosking (2014) reported that there are differences based on identification with a particular gay group. Reasons for these particular results need to be researched further to determine how Cubs perceive discrimination and what contributes to their lower self-esteem.
To further understand the Bear movement, Gough and Flanders (2009) conducted interviews with 10 self-identified Bears to explore understanding and beliefs about weight and health, as well as the importance of association with the Bear community. The participants reported being verbally chastised and teased because of their weight, which had a negative impact on their self-esteem and self-worth. Affiliation with other Bears resulted in the participants viewing the Bear community as a place where size was not ridiculed, but rather celebrated and eroticized, allowing men to promote a more positive body image. When comparing themselves to other subcultures in the gay community, Bears contended that thinner men were less happy and healthy than Bears. Bears also discussed that they would not feel comfortable if their body mass index (BMI) was within normal limits, but did state they would be willing to lose some weight for certain reasons. Bears discussed that the health care system does not address health needs in a realistic fashion. Doctors counsel Bears to lose weight according to health guidelines, not recognizing the impossible nature of the task being asked. Bears also acknowledged increased weight is a personal choice and believed that increased weight was positive because it promoted desirability, strength, confidence, and contentment.
Examining health risk behaviors like unprotected sex, drug and alcohol use, and steroid use, Willoughby et al. (2008) surveyed different sectors of the gay community to determine if association with a particular group affected the rates at which men engage in these behaviors. For Bears, there were no significant results with regard to steroid use and substance use, but there were significant results regarding anal sex without a condom. When compared with other groups, Bears were reported to engage in anal sex with casual partners without a condom more often. Willoughby et al. linked this behavior to displays of masculinity. Understanding the reasons why Bears engage in anal sex without a condom is critical to preventing HIV/STI transmission. A qualitative study interviewing Bears who engage in anal sex without a condom would help determine reasons why Bears engage in anal sex without a condom. Equally important in this article were the indications that Bears did not abuse drugs and alcohol. This may not be a problem for the Bears surveyed, but it is important to continue the research in this area because there are Bears who do have problems with substances, finding it difficult to associate with the community because many events serve alcohol (Egan, 2003).
Interested in HIV prevention, Prestage et al. (2015) explored differences in condom usage among gay subcultures through a cross-sectional survey conducted in Australia. The results indicated that, compared with other gay subgroups, Bears were more likely to engage in anal sex without a condom with casual partners in the previous 6 months, have more sex partners, and more likely to be HIV-infected. No rationale was provided to explain why Bears engaged in anal sex without a condom more often than other gay subcultures.
Lin (2014) conducted a study of men living in China who identified as Bears. Like other studies, Lin indicated that Chinese Bears had a higher BMI than other gay men and felt more comfortable interacting with other Bears because of a lack of perceived discrimination from other men. Chinese Bears’ self-esteem was not significantly lower than other gay men. Unlike Bears in other geographic locations, Chinese Bears are not inclusive, unwelcoming of those who do not fit the stereotypical image of the Bear into their subculture.
Health wise, not enough research has been done to identify and manage the health needs and concerns of the Bear community. While the research that has been conducted provides a great foundation, future research needs to determine what Bears consider to be major health problems, enabling health care providers to address health care issues pertinent to Bears.
Critical Review of Literature
The current health research on the Bear community is still in its infancy with many gaps in the literature and limitations to the current studies. The research conducted on Bears has been conducted using exploratory, descriptive qualitative and quantitative research designs (Gough & Flanders, 2009; Lin, 2014; Lyons & Hosking, 2014; Moskowitz et al., 2013; Prestage et al., 2015; Willoughby et al., 2008). Despite the use of both quantitative and qualitative methodologies to study this population, the designs selected have weaknesses. For example, descriptive studies do not provide a causal relationship to the results (Creswell, 2014). While it is reported that Bears have higher BMI (Lin, 2014; Lyons & Hosking, 2014; Moskowitz et al., 2013), it is unknown whether Bears have a higher BMI prior to associating with the Bear community or whether these men gain weight from association with the Bear community to conform to images promulgated throughout the Bear community.
The majority of the research studies included in this literature review used snowball sampling (Gough & Flanders, 2009; Lin, 2014; Prestage et al., 2015; Willoughby et al., 2008) and venue-based sampling (Gough & Flanders, 2009; Lin, 2014; Lyons & Hosking, 2014; Moskowitz et al., 2013) to recruit and sample participants. Both these sampling strategies have weaknesses that may influence the study’s findings. Snowball sampling may result in a sample that is too homogenous with little variation among participants. Venue-based sampling only allows participants at a particular site to be sampled, thereby missing potential participants who are not present at the time of data collection (Creswell, 2014). Despite the identified weaknesses of the selected sampling strategies, these are necessary to recruit hard-to-reach populations such as members of the Bear community.
The Bear community is a heterogeneous group, but the majority of research conducted does not reflect the experiences of racial minorities who identify with the Bear community. Most of the research has used a majority of White men as the sample and has not identified differences between different racial groups (Gough & Flanders, 2009; Lyons & Hosking, 2014; Moskowitz et al., 2013; Willoughby et al., 2008). Lin (2014) used a Chinese sample of men and reported that Bear identity for Chinese men is different than for White men. Acquiring diverse samples of Bears allows researchers to determine if identifying as a Bear has different meanings and risks for different races.
Some men choose to identify as a Bear based on physical appearance and weight (Hennen, 2005). Research indicates that Bears have a higher BMI, which is used as a rough indicator of obesity, compared to other gay men (Lin, 2014; Lyons & Hosking, 2014; Moskowitz et al., 2013). Studies of Bears have yet to examine other important biomarkers in this community like blood pressure, blood glucose, cortisol, cholesterol, and triglycerides to obtain a better understanding of Bears’ physical health. These biomarkers can be used to identify health conditions like heart disease and diabetes, and ultimately investigate the prevalence of these health conditions related to obesity within the Bear community.
Despite the small sample sizes, a restricted range of research designs, a focus on Caucasian participants, and a lack of biomarkers to document health, the available research provides a foundation for further work. It is obvious that research conducted with Bears has been approached largely from a psychosocial perspective, often ignoring health implications associated with the Bear lifestyle. Opportunities for future research are available to explore both the positive and negative impacts of association with the Bear community on the physical health of its community members.
Engaging and Conducting Research in the Bear Community
Researchers have used several ways to engage the Bear community in order to conduct research. Some researchers have explained the value of having a researcher who identified with the community because it facilitated easier access to the Bear community and its members (Gough & Flanders, 2009; Hennen, 2005; Manley et al., 2007) because Bears may feel more comfortable speaking to other Bears. Moskowitz et al. (2013) surveyed Bears at two gay events. Other techniques included snowball sampling (Lyons & Hosking, 2014; Manley et al., 2007), visiting or advertising at LGBT centers or social media sites likes Facebook (Lin, 2014; Lyons & Hosking, 2014), and the use of listservs and chatrooms (Manley et al., 2007; Willoughby et al., 2008).
While the above-mentioned methods were effective in obtaining a sample of Bears alternative methods exist for recruitment that are more specific to Bears. Bear clubs like Bears LA in California, Bears of South Florida, and Bear Albany in New York are regional clubs that hold engagements for local Bears. Annual events that are organized by Bears and tailored to the Bear community like Bear Pride in Chicago, Provincetown Bear Week in Massachusetts, and Texas Bear Round-Up are frequented by large groups of Bears from around the world. These venues might be useful to gather larger samples of Bears.
Newer forms of technology may be used to obtain a sample of Bears. Many Bear clubs have social media pages that could be used as a way to recruit participants. A social media app has been created that allows Bears to connect with others using cell phones. A feature of these social media apps allows users to create a message and send it out to other users of the app within a 5-, 10-, or 20-mile radius. The use of social media pages and apps may allow researchers to locate, recruit, and survey larger samples.
Clinical Implications
Health and health care access is an important issue for gay men. Researchers have reported that gay men experience more barriers to health care when compared with heterosexual men (McKirnan, DuBois, Alvy, & Jones, 2012). This may be due to the fact that gay men are less likely to have health insurance and are more likely to have unmet health care needs when compared with heterosexual men (Bunchmueller & Carpenter, 2010). These issues result in an overall poor general health status of gay men (Lick, Durso, & Johnson, 2013).
Regardless of the large amount of research that has been conducted on the general health of gay men, and the smaller amount of research on the Bear community, evidence-based guidelines to address health issues and disparities among this subgroup of gay men does not exist. There are, however, evidence-based guidelines developed by the Institute of Medicine (2011) and the Fenway Institute (Makadon, Mayer, Potter, & Goldhammer, 2015) that provide guidelines on health status across the lifespan, addressing inequities in health, aging, obesity, mental health, substance abuse, sexual health, and HIV prevention, as well as gaps in provider knowledge. Although neither of these sources mention the Bear community specifically, interventions can be applied to the health of this group of men as a foundation to address health disparities among the Bear community.
Health care providers play a vital role in addressing the health concerns of any client’s health. When compared with heterosexual counterparts, gay men have worse health outcomes and engage in more risky behavior such as substance abuse and high rates of HIV, leading to poorer health (Institute of Medicine, 2011). Health care providers have difficulty discussing sexuality and typically do not assess client’s sexual behavior, resulting in gay men not disclosing their sexual orientation status (Klitzman & Greenberg, 2002). Further complicating the issue, many gay men do not disclose their sexual orientation to their health care providers because they fear mistreatment, do not believe it is relevant to health care, and privacy concerns (Durso & Meyer, 2013). This creates a situation where health care providers do not address sexual orientation and clients do not disclose, leaving the subject unaddressed. To remedy this issue, health care providers need to be educated in cultural sensitivity to work with this population, understanding that the gay community is a heterogeneous one (Durso & Meyer, 2013).
For the Bear community, health care providers should understand the role weight plays in identification for some Bears. Statistically, Bears were reported to have a higher BMI than non-Bears (Lyons & Hosking, 2014; Moskowitz et al., 2013). Men who are overweight or obese are at higher risk for diabetes, arteriosclerosis, heart disease, and stroke (Mass, 2001). Yet some Bears discussed the possibility of losing some weight while maintaining their Bear identity (Gough & Flanders, 2009). When discussing weight-related issues, Bears were not receptive to health care providers who delivered a rote, untailored message about the importance of losing weight. To successfully communicate with the Bear population, health care providers need to give culturally sensitive or Bear-specific information about weight without judgment. If the client wishes to lose weight, the health care provider can appropriately assist in achieving this goal. If the client does not seek to lose weight, the health care provider can help manage health issues related to weight like increased blood pressure and diabetes with medications.
When compared with heterosexual counterparts, gay men are at a greater risk for a variety of mental health issues including depression, anxiety, and suicide (Herek & Garnets, 2007; King et al., 2008). Mental health issues arise due to the coming-out experience, homophobia, discrimination, and self-image concerns (Dean et al., 2000). Furthermore, Bears were identified to have lower self-esteem than other gay communities (Moskowitz et al., 2013). As part of the annual check-up, health care providers should assess the mental health of their gay clients, using a routine depression screening (Gee, 2006). Some Bears have experienced weight-related criticism, leading to decreased self-esteem (Gough & Flanders, 2009).
Bears were reported to engage in more high-risk and diverse sexual behaviors than other gay men (Moskowitz et al., 2013; Prestage et al., 2015; Willoughby et al., 2008). High-risk sexual behaviors increase the susceptibility to STIs and HIV infection (Gee, 2006). Health care providers can facilitate an open dialogue with clients by asking how they protect themselves and their partners when engaging in sexual behaviors. Open-ended questions allow practitioners to assess the sexual practices of the client and provide knowledge about risks and protection, if necessary.
Conclusion
The Bear community is part of the larger gay community, accounting for approximately 14% to 22% of the gay community. Bears have developed a unique language and a global network for the community. Minimal research has been conducted concerning this community. However, opportunities to meet the distinctive health care needs of this population must be addressed. In addition, there are numerous research opportunities to further the state of the science by specifically advancing knowledge on this subgroup, recognizing similarities and highlighting differences from the larger gay community.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.