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. Author manuscript; available in PMC: 2020 Jul 1.
Published in final edited form as: Pediatr Obes. 2019 Feb 6;14(7):e12514. doi: 10.1111/ijpo.12514

Weight-based Victimization Among Sexual and Gender Minority Adolescents: Findings from a Diverse National Sample

Rebecca M Puhl a,b, Mary S Himmelstein b, Ryan J Watson a
PMCID: PMC7183795  NIHMSID: NIHMS1581771  PMID: 30729734

Abstract

Objectives

Children and adolescents with overweight and obesity are vulnerable to weight-based victimization. Research on weight-based victimization and sexual identity have been largely isolated from one another; little is known about the nature of weight-based victimization in sexual and gender minority (SGM: e.g., lesbian, gay, bisexual and transgender) youth. Our study is the first to examine the nature, extent, and sources of weight-based victimization in a large sample of SGM adolescents.

Methods

This study utilized data from the 2017 LGBTQ National Teen Survey, a comprehensive online survey assessing victimization, school experiences, health behaviors, and sexuality-specific experiences of SGM adolescents across the United States. The sample was comprised of 9,838 SGM adolescents (Mage=15.6 years).

Results

Across diverse sexual orientation and gender identity groups, 44%−70% of adolescents reported weight-based teasing from family members, and 42%−57% reported weight-based teasing from peers. Approximately one-third of adolescents reported these experiences from both family and peers. Weight-based victimization was prevalent across body weight categories, particularly at highest (obesity) and lowest (underweight) extremes. Moreover, weight-based victimization was prevalent across adolescents who endorsed established sexual identity labels (e.g., gay, lesbian, bisexual) and emerging labels (e.g., pansexual, asexual).

Conclusions

Weight-based victimization, from family members and peers, is prevalent in SGM adolescents, across diverse body sizes and sexual and gender identities. Pediatric providers should be aware that SGM youth may be vulnerable to weight-based victimization, across diverse body sizes.

Keywords: sexual minority, weight-based victimization, family, peer

Weight-based victimization has become a widespread form of teasing and mistreatment experienced by adolescents. With U.S. rates of adolescent obesity now reaching 20%1, those with high body weight are particularly vulnerable to peer victimization. Reports from students, parents, and educators corroborate that weight-based victimization is a common form of peer harassment in the school setting.2–4 These findings hold true in ethnically diverse populations of youth, national research, and international studies, which have identified weight-based victimization among the most prevalent reasons that youth are bullied.3,5,6 Emerging evidence further indicates that adolescents with high body weight commonly report weight-based victimization from family members; as many as 37–58% of adolescents with obesity (or at risk for obesity) report that their parents have teased or bullied them because of their weight.7,8

Adverse psychological and physical health consequences of weight-based victimization in youth are well documented. In addition to increased risk for depression, low-self-esteem, suicidal ideation, and poor body image, youth who face weight-based victimization have higher levels of disordered eating, harmful weight control behaviors, weight gain, and lower levels of physical activity.9–13 These health consequences can be long lasting; a recent longitudinal study demonstrated that parental weight-based teasing in adolescence predicted obesity, binge eating, unhealthy weight control, and eating to cope with distress 15 years later.14 Collectively, this evidence prompted a recent policy statement from the American Academy of Pediatrics recommending that pediatric health providers take steps to help youth who are vulnerable to weight stigma.15

Despite the mounting evidence of weight-based victimization in adolescence, there has been a lack of attention to this issue in sexual and gender minority (SGM) adolescents, including whether they are more or less vulnerable to weight-based victimization than heterosexual youth. The lack of research in this area is concerning for several reasons. First, evidence has documented high rates of overweight and obesity in sexual minority youth. Using data from the Youth Risk Behavioral Surveillance Survey (2005–2007), Austin and colleagues reported higher odds of obesity in bisexual identified girls and boys compared to same gender heterosexual youth.16 Prospective research in the Growing Up Today Study showed that females experienced elevated body mass index (BMI) in all sexual orientation minority groups compared to heterosexual peers.17 Similar findings were observed in the National Longitudinal Study of Adolescent Health, where white and Latina bisexual identified females had higher BMI’s than heterosexual peers of the same race and age.18 Thus, it may be sexual minority females who are particularly at risk for weight gain, as findings for males from these studies suggest a steeper increase in BMI among heterosexuals than sexual minorities. This pattern appears to continue into adulthood, with a higher prevalence of obesity in sexual minority women compared to heterosexual women and sexual minority men.19–22 While less attention has focused on links between weight-related disparities and gender identity among youth, emerging studies have found a higher likelihood of obesity among transgender college students compared to non-transgender peers,23 and that gender minority adults are more likely to be overweight compared to cisgender adults.24 Additionally, gender minority adolescents may experience weight gain if prescribed cross-gender hormone therapy.25 Collectively, this evidence underscores the importance of determining whether SGM adolescents are at risk for weight-based victimization, examining the nature and prevalence of these experiences, and whether their vulnerability to weight-based victimization varies across weight status or different sexual or gender identities.

Second, the amassing literatures on weight-based victimization and sexual identity have been largely isolated from one another, with little attention to the intersectionality of social identities related to body weight, sexual orientation, and gender identity in youth. The limited evidence in this area suggests that adolescents with obesity may be vulnerable to multiple forms of peer harassment;3 one study found that the odds of adolescents reporting sexual orientation discrimination were approximately three times higher for youth with overweight and obesity compared to healthy weight peers, and the combination of these experiences were associated with increased depressive symptoms, suicidal ideation, and self-harm.26 This initial evidence indicates the need to better understand links between body weight, weight-based victimization, and sexual and gender identity in youth. In particular, we know almost nothing about the nature or extent of weight-based victimization across diverse sexual identities of adolescents, including those who identify with more established categories of sexual identity (e.g., lesbian, gay, bisexual) versus emerging identity labels (such as pansexual or asexual). These emerging identity labels are being endorsed at higher rates by today’s youth;27 as such, the heterogeneity of sexual identities necessitates a comprehensive examination of body weight and weight-based victimization across these diverse groups, which is currently absent in the literature.

These research findings highlight the importance of examining unique vulnerabilities and experiences of adolescents as a result of their social identities pertaining to body weight, sexual orientation, and gender identity. However, these issues require study with large and diverse samples of SGM adolescents, with attention to the relationship between weight-based victimization and body weight status in different sexual minority groups, and whether the source of victimization (peers versus family) varies across these groups. To begin to address these notable research gaps, our study aimed to assess the nature and prevalence of weight-based victimization in a large, national sample of LGBTQ (lesbian, gay, bisexual, transgender, and queer) adolescents. To our knowledge, this study is the first large-scale examination of weight-based victimization and its primary sources (peers versus family), among SGM adolescents, and how these experiences vary across body weight status and sexual identity. We also examine differences in the frequency of weight-based victimization across body weight status and sexual identity, and how weight-based victimization compares to other forms of victimization experienced by adolescents in this sample.

Methods

Study Design and Population

Our study utilized data from a larger sample of 17,112 adolescents who participated in the 2017 LGBTQ National Teen Survey, a battery of online self-report questionnaires to assess victimization, school experiences, health behaviors, family relationships, and sexuality-specific experiences of LGBTQ adolescents across the United States (U.S.). Data were collected between April-December of 2017, in partnership with the Human Rights Campaign (HRC). English-speaking LGBTQ adolescents (ages 13–17) residing in the U.S. were invited to complete the anonymous, online survey, hosted by the survey website Qualtrics.com. Participants were recruited through social media (Twitter, Facebook, Instagram, Reddit, and Snapchat), HRC’s comprehensive network of community partners, and with the assistance of social influencers in the LGBTQ community who shared the survey weblink via their social media profiles. In exchange for participation, all participants were offered HRC wristbands and given the option to enter a raffle for a gift card to a popular online retailer. Procedures were approved by the authors’ Institutional Review Board. Additional details describing data collection, screening procedures, recruitment, and sample composition are reported elsewhere.28

As the present study focused on weight-based victimization among LGBTQ adolescents, we excluded respondents who were missing information on questions about height or weight needed to calculate their BMI (n = 1,722) or questions related to weight-based victimization or sexual identity (n = 5,552) resulting in a final sample of 9,838 SGM adolescents. Participants in the full sample (N = 17,112) were slightly younger than the study sample we analyzed (full sample M = 15.53, SD = 1.27; current sample M = 15.60, SD = 1.26, t (17,110) = −3.36, p = .001). In addition, adolescents in our study sample were slightly more likely to identify as White (χ2 (6) = 248.38, p < .001), cis-female or transmasculine non-binary (χ2 (5) = 170.23, p < .001), and lesbian or bisexual (χ2 (8) = 140.30, p < .001) relative to the full sample.

Measures

Demographic Information

Participants were asked to provide demographic information such as their age, race/ethnicity, and state of residence.

Sexual Orientation

Participants were asked ‘How do you describe your sexual identity? Participants could choose one of the following: ‘gay or lesbian,’ ‘bisexual,’ ‘straight, that is, not gay,’ or ‘something else.’ If a participant chose ‘something else,’ survey logic presented the additional response options: ‘queer,’ ‘pansexual,’ ‘asexual,’ ‘questioning,’ and ‘other’. Those who selected ‘other’ were asked to describe their identity using an open-ended response box, and their written responses were back-coded so that participants described identities that were already presented in forced-choice response options were appropriately categorized.

Gender identity

Participants were asked ‘What sex were you assigned at birth?’ (male/female) followed by ‘What is your current gender identity?’ Response options included male, female, trans male/trans boy, trans female/trans girl, non-binary, gender queer/gender non-conforming. Adolescents with concordant sex assigned at birth and gender identities were classified as cisgender, whereas those who reported a gender identity different from their sex assigned at birth (or a non-binary, genderqueer, gender non-confirming, or different gender) were classified as transgender.

Anthropometric Data and Subjective Weight Status

Participants self-reported their current height (in feet/inches) and weight (in pounds). BMI percentiles for age and sex were calculated using growth chart available from the Centers for Disease Control and Prevention29 and corresponding BMI categories were constructed: <5th percentile (underweight), ≥5<85th percentile (healthy weight), 85th<95th percentile (overweight), and ≥95th percentile (obese) (refer to Table 1). Subjective weight status (what participants perceive their weight status to be) was assessed by asking participants whether they considered their weight status to be ‘very underweight’, ‘underweight’, ‘just about right’, ‘overweight’, or ‘very overweight’.30,31

Table 1.

Sample Demographics (N = 9,838)

Range M SD
Age 13.00 17.00 15.60 1.26
BMI 12.55 67.14 24.26 6.30
BMI Percentile 0.00 99.90 64.86 30.52
N %
Race
White 6495 66
Biracial or Multiracial 1343 13.7
Hispanic/ Latino 981 10
Black 417 4.2
Asian 393 4
Other 159 1.6
Native American 41 0.4
Decline 9 .1
Region
South 3558 36.2
Midwest 2294 23.3
West 2191 22.3
Northeast 1795 18.2
Gender Identity
Cisgender Girl 4330 44.0
Transmasculine/ Non-binary 2262 23.0
Cisgender Boy 2062 21.0
Transgender Boy 855 8.7
Transfeminine/ Non-binary 215 2.2
Transgender Girl 114 1.2
Sexual Identity
Bisexual 3313 33.7
Lesbian 2023 20.6
Gay 1600 16.3
Pansexual 1358 13.8
Asexual 493 5.0
Queer 444 4.5
Questioning 228 2.3
Other 220 2.2
Straight 159 1.6
BMI Category
Underweight 422 4.3
Normal weight 5754 58.5
Overweight 1724 17.5
Obese 1938 19.7
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Weight-based Victimization

Perceived weight-based victimization was assessed using two yes/no questions from Project EAT;30–32 a large-scale longitudinal study examining eating and weight-related experiences of adolescents: ‘Have you ever been teased or made fun of by your peers because of your weight?’ and ‘Have you ever been teased or made fun of by members of your family because of your weight?’ To assess experiences of weight-based victimization in comparison to other forms of victimization, adolescents were asked how often (using a 5-point Likert scale from never = 0 to very often = 4) they are teased or treated badly by other students at school for each of the following reasons: body weight, gender, race/ethnicity, sexuality, religion, disability, how masculine or feminine they are, or something else.

Statistical Analysis

Data were analyzed using SPSS version 25. Means, standard deviations, and frequency statistics are reported for sociodemographic characteristics (Table 1), weight-based victimization by sexual and gender identities (Table 2), and weight-based victimization by BMI category based on BMI percentiles for age and sex (Table 3). Using linear and logistic regressions, we examined odds of weight-based victimization (logistic) and mean frequency of weight-based victimization from peers at school (linear) as a function of sexual identity (reference group “Straight”), gender identity (reference group Cisgender boy), and BMI category (reference group: healthy weight), controlling for age, racial/ethnic identity (reference group: White), and U.S. region (reference group: Northeast) (Table 4). We calculated the mean frequency of school-based teasing due to sexual orientation, masculinity/femininity, weight, gender, race, religion or disability, and reported the frequency of youth who reported being teased ‘often’ or ‘very often’ for only one reason (i.e., these participants indicated ‘never’ to all but one source of teasing at school; see Table 5).

Table 2.

Rates of weight-based teasing by sexual and gender identity

Weight teasing by family Weight teasing by peers Weight teasing by both family and peers Frequency of peer weight teasing
Yes No Yes No Yes No (range 0–4)
N % N % N % N % N % N % M SD
Sexual Identity
Gay (n = 1600) 705 44.1 895 55.9 766 47.9 834 52.1 483 30.2 1117 69.8 1.02 1.15
Lesbian (n = 2023) 1111 54.9 912 45.1 983 48.6 1040 51.4 704 34.8 1319 65.2 1.07 1.17
Bisexual (n = 3313) 1858 56.1 1455 43.9 1703 51.4 1610 48.6 1221 36.9 2092 63.1 1.17 1.20
Straight (n = 159) 84 52.8 75 47.2 66 41.5 93 58.5 45 28.3 114 71.7 1.01 1.30
Queer (n = 444) 262 59.0 182 41.0 218 49.1 226 50.9 169 38.1 275 61.9 1.07 1.14
Pansexual (n = 1358) 842 62.0 516 38.0 780 57.4 578 42.6 569 41.9 789 58.1 1.37 1.26
Asexual (n = 493) 303 61.5 190 38.5 222 45.0 271 55.0 175 35.5 318 64.5 1.03 1.16
Questioning (n = 228) 127 55.7 101 44.3 104 45.6 124 54.4 76 33.3 152 66.7 1.11 1.29
Other (n = 220) 154 70 66 30 118 53.6 102 46.4 95 43.2 125 56.8 1.26 1.24
Gender Identity
Cisgender Boy (n = 2,062) 903 43.8 1159 56.2 996 48.3 1066 51.7 625 30.3 1437 69.7 1.04 1.16
Cisgender Girl (n = 4,330) 2436 56.3 1894 43.7 2109 48.7 2221 51.3 1515 35.0 2815 65.0 1.09 1.17
Transgender Boy (n = 855) 551 64.4 304 35.6 473 55.3 382 44.7 373 43.6 482 56.4 1.29 1.29
Transgender Girl (n = 114) 49 43 65 57 49 43.0 65 57.0 32 28.1 82 71.9 1.06 1.26
Transmasculine/Non-binary (n = 2,262) 1394 61.6 868 38.4 1220 53.9 1042 46.1 914 40.4 1348 59.6 1.26 1.24
Transfeminine/Non-binary (n = 206) 113 52.6 102 47.4 113 52.6 102 47.4 78 36.3 137 63.7 1.13 1.21
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Note. “Yes” refers to the number of adolescents indicating that they experienced weight-based teasing. Frequency of weight-based teasing from peers included the following response options: 0 (never), 1 (rarely), 2 (sometimes), 3 (often) and 4 (very often), with higher scores indicating greater frequency.

Table 3.

Rates of weight-based teasing by BMI category

Weight teasing by family Weight teasing by peers Weight teasing by both family and peers Frequency of peer weight teasing
Yes No Yes No Yes No (range 0–4)
N % N % N % N % N % N % M SD
Underweight (n = 418) 235 55.7 187 44.3 270 64.0 152 36.0 196 46.4 226 53.6 1.33 1.26
Healthy weight (n = 5,661) 2733 47.5 3021 52.5 2264 39.3 3490 60.7 1505 26.2 4249 73.8 0.79 1.02
Overweight (n = 1,695) 1083 62.8 641 37.2 931 54.0 793 46.0 688 39.9 1036 60.1 1.30 1.18
Obesity (n = 1,905) 1395 72.0 543 28.0 1495 77.1 443 22.9 1148 59.2 790 40.8 1.98 1.25
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Note. “Yes” refers to the number of adolescents reporting that they experienced weight-based teasing. Frequency of weight-based teasing from peers included the following response options: 0 (never), 1 (rarely), 2 (sometimes), 3 (often) and 4 (very often), with higher scores indicating greater frequency.

Table 4.

Regressions: Weight-based teasing as a function of sexual identity, gender identity, and demographic characteristics

Weight Teasing from Peers
R2= .10, χ2 (25)= 1,000.14, p < .001 		Weight Teasing from Family
R2= .08, χ2 (25)=841.63, p < .001
B β SE Wald p B β SE Wald p
U.S. Region (ref: Northeast)
Midwest −0.02 0.98 0.07 0.12 .734 0.13 1.14 0.07 4.03 .045
South 0.06 1.06 0.06 0.82 .366 0.08 1.08 0.06 1.61 .204
West 0.02 1.02 0.07 0.07 .787 0.00 1.00 0.07 0.00 .988
Racial Identity (ref: White)
Black −0.37 0.69 0.11 11.50 .001 0.16 1.17 0.11 2.18 .140
Asian −0.25 0.78 0.11 5.01 .025 0.87 2.39 0.11 58.64 < .001
Hispanic 0.05 1.05 0.07 0.51 .476 0.72 2.05 0.08 89.21 < .001
Multiracial 0.04 1.04 0.06 0.32 .571 0.42 1.52 0.06 43.36 < .001
Other1 0.54 1.72 0.17 9.74 .002 0.62 1.86 0.17 12.77 < .001
Age 0.01 1.01 0.02 0.35 .554 0.12 1.13 0.02 49.58 < .001
Gender Identity (ref: Cisgender Boy)
Cisgender Girl 0.13 1.14 0.09 1.98 .159 0.64 1.90 0.09 49.99 < .001
Transgender Boy 0.29 1.33 0.12 6.22 .013 0.94 2.56 0.12 66.79 < .001
Transgender Girl −0.31 0.74 0.22 2.04 .154 −0.05 0.95 0.21 0.05 .819
Transmasculine/ Non-binary 0.30 1.35 0.10 9.06 .003 0.83 2.29 0.10 70.83 < .001
Transfeminine/ Non-binary 0.27 1.31 0.15 3.04 .081 0.43 1.54 0.15 8.24 .004
Sexual Identity (reference: Straight)
Gay 0.47 1.59 0.20 5.31 .021 0.28 1.32 0.20 1.93 .164
Lesbian 0.43 1.53 0.18 5.30 .021 0.20 1.22 0.18 1.20 .274
Bisexual 0.54 1.72 0.18 8.94 .003 0.29 1.33 0.18 2.62 .105
Queer 0.28 1.32 0.20 1.91 .167 0.26 1.30 0.20 1.77 .184
Pansexual 0.67 1.96 0.19 13.15 < .001 0.41 1.50 0.18 5.03 .025
Asexual 0.20 1.22 0.20 0.97 .324 0.46 1.58 0.20 5.33 .021
Weight Teasing from Peers Weight Teasing from Family
B β SE Wald p B β SE Wald p
Questioning 0.20 1.22 0.23 0.76 .382 0.24 1.27 0.22 1.19 .276
Other 0.57 1.77 0.23 6.28 .012 0.87 2.37 0.23 14.08 < .001
BMI Category (ref: Healthy weight)
Underweight 1.06 2.88 0.11 97.15 < .001 0.52 1.68 0.11 24.07 < .001
Overweight 0.58 1.79 0.06 108.38 < .001 0.61 1.83 0.06 109.93 < .001
Obese 1.65 5.21 0.06 720.95 < .001 1.05 2.87 0.06 319.00 < .001
Both Peer & Family Teasing
R2= .09, χ2 (25)=891.21, p < .001 		Frequency of Peer Weight Teasing:
R2=.16, F (25, 9762) 76.95, p< .001
B β SE Wald p B SE β t p
Region (ref: Northeast)
Midwest 0.06 1.06 0.07 0.77 .379 0.06 0.04 0.02 1.78 .075
South 0.08 1.08 0.06 1.52 .217 0.06 0.03 0.03 1.98 .048
West 0.07 1.07 0.07 1.00 .318 0.05 0.04 0.02 1.46 .145
Racial Identity (ref: White)
Black −0.16 0.85 0.11 2.03 .154 −0.26 0.06 −0.04 −4.60 < .001
Asian 0.23 1.25 0.11 3.92 .048 −0.15 0.06 −0.03 −2.64 .008
Hispanic 0.39 1.48 0.07 27.60 < .001 0.03 0.04 0.01 0.83 .407
Multiracial 0.23 1.26 0.07 12.54 < .001 0.02 0.03 0.00 0.47 .640
Other1 0.66 1.94 0.17 15.40 < .001 0.26 0.09 0.03 2.99 .003
Age 0.09 1.09 0.02 24.77 < .001 −0.03 0.01 −0.03 −3.01 .003
Gender Identity (ref: Cisgender Boy)
Cisgender Girl 0.37 1.44 0.10 14.28 < .001 0.10 0.05 0.04 2.04 .041
Transgender Boy 0.66 1.94 0.12 31.01 < .001 0.18 0.06 0.04 2.94 .003
Transgender Girl −0.16 0.86 0.23 0.44 .508 −0.05 0.11 0.00 −0.43 .667
Transmasculine/ Non-binary 0.57 1.76 0.10 29.60 < .001 0.22 0.05 0.08 4.20 < .001
Transfeminine/ Non-binary 0.37 1.45 0.16 5.31 .021 0.14 0.08 0.02 1.69 .092
Both Peer & Family Teasing Frequency of Peer Weight Teasing:
B β SE Wald p B SE β t p
Sexual Identity (reference: Straight)
Gay 0.53 1.70 0.22 5.95 .015 0.15 0.10 0.05 1.42 .155
Lesbian 0.49 1.63 0.20 6.06 .014 0.12 0.09 0.04 1.23 .217
Bisexual 0.60 1.81 0.20 9.30 .002 0.21 0.09 0.08 2.22 .026
Queer 0.47 1.61 0.22 4.84 .028 0.01 0.10 0.00 0.12 .907
Pansexual 0.67 1.95 0.20 11.34 .001 0.30 0.10 0.09 3.20 .001
Asexual 0.45 1.57 0.21 4.46 .035 0.04 0.10 0.01 0.36 .716
Questioning 0.36 1.43 0.24 2.25 .134 0.09 0.12 0.01 0.75 .455
Other 0.79 2.20 0.24 10.98 .001 0.25 0.12 0.03 2.16 .031
BMI Category (ref: Healthy weight)
Underweight 1.01 2.75 0.11 91.61 < .001 0.59 0.06 0.10 10.52 < .001
Overweight 0.61 1.84 0.06 108.63 < .001 0.50 0.03 0.16 16.33 < .001
Obese 1.41 4.11 0.06 625.23 < .001 1.18 0.03 0.39 40.51 < .001
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Note. The logistic regressions (weight teasing from peers, weight teasing from family, both peer & family teasing) examined odds of indicating an experience of weight-based teasing. Frequency of peer weight teasing included the following response options: 0 (never), 1 (rarely), 2 (sometimes), 3 (often) and 4 (very often), with higher scores indicating greater frequency.

1

Given the limited numbers in these categories, the other racial category in this model includes individuals who indicated “other” for a racial/ ethnic identity as well as individuals who reported a Native American racial/ ethnic identity.

Table 5.

Sexual minority adolescents’ reported frequency of different reasons for peer victimization at school

Frequency of teasing (range 0–4) Often or Very Often Teased for this Reason Only
M SD N %
Perceived reason for victimization
Sexual Orientation 1.51 1.28 414 4.2
Masculine/Feminine 1.44 1.32 502 5.1
Weight 1.14 1.20 377 3.8
Gender 1.01 1.20 170 1.7
Race 0.89 1.43 188 1.9
Religion 0.54 0.95 119 1.2
Disability 0.52 0.98 102 1.0
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Frequency of teasing for each reason was assessed on a scale ranging from 0 (never) to 4 (very often). The percentages in the last column reflect adolescents who indicated they were ‘often’ or ‘very often’ teased for a single reason only (i.e., they indicated ‘never’ being teased for every other reason listed in the table).

Results

Sample Characteristics

Table 1 summarizes sample characteristics. Participants were on average 15.60 (SD = 1.26) years old, with a mean BMI percentile in the healthy weight range (M = 64.81, SD = 30.55); 17.5% had a BMI consistent with overweight, and 19.7% with obesity. The most common gender identities reported by adolescents included cisgender girl (44.0%), transmasculine/non-binary (23%), and cisgender boy (21%), and the most common sexual identities included bisexual (33.7%), lesbian (20.6%), gay (16.3%), and pansexual (13.8%). All participants who reported a straight sexual identity identified as a gender minority (i.e., they were a sexual and/or gender minority). In the ‘other’ category, adolescents identified as demisexual (n = 49), fluid (n = 30), having multiple sexual identities (n = 113), or selected another identity that fewer than five other participants endorsed (n = 28).

Frequency of Weight-based Victimization Across Sexual Identities and BMI

Across sexual identities, between 44% and 70% of adolescents reported weight-based teasing from family members (see Table 2). Forty-four percent of adolescents identifying as gay reported weight-based teasing from family, while over half of participants identifying as lesbian (54.9%), straight (52.8%), bisexual (56.1%), or questioning (55.7%) reported weight-based teasing from family. Larger proportions of adolescents identifying as queer (59%), pansexual (62%), asexual (61.5%), and ‘other’ (70%) reported weight-based teasing from family. Similarly, across sexual identities, between 41.5% and 57% of adolescents reported weight-based teasing from peers. Over half of participants identifying as pansexual (57.4%) or ‘other’ (53.6%) reported weight-based teasing form peers. The frequency of these incidents from peers was relatively low across sexual identities (M = 1.02 to 1.37, SD = 1.15 to 1.26) on the on the scale ranging from 0–4. Across all sexual identity groups, 28–44% reported experiencing weight-based teasing from both family and peers.

Across gender identities, 43% to 65% of adolescents reported weight-based teasing from family members. Both cisgender boys (43.8%) and transgender girls (43.0%) were least likely to experience weight-based teasing from family, while over half of cisgender girls (56.3%) and transfeminine/non-binary girls (52.6%) experienced weight-based teasing from family. Transgender boys (64.4%) and transmasculine/non-binary adolescents (61.6%) experienced the most weight-based teasing from family members. Between 43% and 55% of gender minorities experienced weight-based teasing from peers, with the highest percentages reported by transgender boys (55.3%), transmasculine/non-binary adolescents (53.9%), and transfeminine/non-binary (52.6%) adolescents. In total, 28–43% of gender minority adolescents experienced weight-based teasing from both friends and family members; the highest percentages reporting teasing from both friends and family were transgender boys (43.6%) and transmasculine/non-binary identified youth. Similar to sexual identity, frequency of peer-based teasing at school was relatively low (M = 1.0–1.4, SD = 1.2–1.3) on the 4-point scale.

Across all body weight categories, high percentages of sexual minority adolescents reported weight-based teasing from family members and peers (see Table 3). Adolescents with a BMI percentile in the healthy weight range were least likely to report weight-based teasing from family (47.5%) or peers (39.3%). More than half of participants with an underweight BMI percentile reported weight-based teasing from family (55.7%) or peers (64%). Among those with an overweight BMI percentile, 62.8% reported weight-based teasing from family and 54% from peers. Approximately three-quarters of participants with obesity reported weight-based teasing from family (72%) or peers (77.1%). For adolescents who reported weight-based teasing from both sources (family and peers), a similar pattern of results emerged with the highest rates of teasing reported by adolescents with obesity (59.2%), followed by those with an underweight BMI (46.6%), overweight BMI (39.9%), and healthy weight BMI (26.2%).

Differences in Weight-based Victimization by Sexual Identity and BMI

Logistic Regression Results

A logistic regression assessing odds of weight-based peer teasing by gender identity, sexual identity, BMI category, racial/ethnic identity, age, and U.S. region accounted for 10% of the variance in odds of weight-based teasing from peers (see Table 4). Transgender boys (B=0.29, p = .013) had 1.33 increased odds of experiencing weight-based teasing relative to cisgender boys, and transmasculine/non-binary adolescents (B=0.30, p = .003) had 1.35 increased odds of experiencing weight-based teasing from peers relative to cisgender boys. No other gender minorities differed in odds of weight-based teasing from peers relative to cisgender boys. Relative to adolescents identifying as straight, those identifying as gay (B=0.47, p= .021, odds increase: 1.59), lesbian (B=0.43, p= .021, odds increase: 1.53), bisexual (B=0.54, p= .003, odds increase: 1.72), pansexual (B=0.67, p < .001, odds increase: 1.96), or other (B=0.57, p= .012, odds increase: 1.77) had higher odds of experiencing weight-based teasing from peers. Adolescents with an underweight BMI (B=1.06, p< .001) were 2.88 times more likely to experience weight-based teasing from peers than adolescents at a healthy weight, while overweight adolescents (B=0.58, p< .001) had 1.79 increased odds, and adolescents with obesity (B=1.65, p< .001) had 5.21 increased odds of experiencing weight based teasing from peers relative to adolescents at a healthy weight.

A logistic regression assessing odds of weight-based teasing from family members by adolescents’ gender identity, sexual identity, BMI category, racial/ethnic identity, age, and U.S. region accounted for 8% of the variance in odds of weight-based teasing by family members. Cisgender girls (B=0.64, p<.001) had 1.90 increased odds of experiencing weight-based teasing from family compared to cisgender boys. Transgender boys (B=0.94, p<.001) had 2.56 increased odds relative to cisgender boys of experiencing weight-based teasing from family. Compared to cisgender boys, transmasculine/non-binary adolescents (B=0.83, p<.001) had 2.29 increased odds, and transfeminine/non-binary adolescents (B=0.43, p=.004) had 1.54 increased odds of experiencing weight-based teasing from family. Relative to adolescents identifying as straight, pansexual (B=0.41, p= .025, odds increase: 1.50), asexual (B=0.46, p= .021, odds increase: 1.58), and adolescents with other sexual identities (B=0.87, p< .001, odds increase: 2.37) experienced increased odds of teasing from family members. Adolescents with an underweight BMI (B=0.52, p< .001) were 1.68 times more likely than adolescents at a healthy weight to experience weight-based teasing from family, while overweight adolescents (B=0.61, p< .001) had 1.83 increased odds and adolescents with obesity (B=1.05, p< .001) had 2.87 increased odds of experiencing weight-based teasing from family compared to adolescents at a healthy weight.

A logistic regression assessing odds of both peer and family weight-based teasing by region, racial/ethnic identity, age, gender identity, sexual identity, and BMI category accounted for 9% of the variance in teasing from peers and family. Relative to cisgender boys, cisgender girls (B=0.37, p< .001) had 1.44 increased odds, transgender boys (B=0.66, p< .001) had 1.94 increased odds, transmasculine/non-binary adolescents (B=0.57, p< .001) had 1.76 increased odds, and transfeminine/non-binary adolescents (B=0.37, p= .021) had 1.45 increased odds of experiencing weight-based teasing from both family and peers. Compared to adolescents identifying as straight, adolescents who identified as gay (B=0.53, p= .015, odds increase: 1.70), lesbian (B=0.49, p= .014, odds increase: 1.63), bisexual (B=0.60, p= .002, odds increase: 1.81), queer (B=0.47, p= .028, odds increase: 1.61), pansexual (B=0.67, p= .001, odds increase: 1.95), asexual (B=0.45, p= .035, odds increase: 1.57), adolescents with other sexual identities (B=0.79, p= .001, odds increase: 2.20) had increased odds of experiencing weight teasing from both peers and family members. Adolescents with an underweight BMI (B=1.01, p< .001) were 2.75 times more likely, adolescents with an overweight BMI (B=0.61, p< .001) were 1.84 times more likely, and adolescents with obesity (B=1.41, p< .001) were 4.11 times more likely to experience weight-based teasing from peers and family compared to adolescents at a healthy weight.

Linear Regression Results

A linear regression assessing frequency of weight-based peer teasing at school as a function of U.S. region, racial/ethnic identity, age, gender identity, sexual identity and BMI category accounted for 16% of the variance in frequency of weight-based peer teasing at school. Cisgender girls (B = 0.10, p =.041), transgender boys (B = 0.18, p =.003), and transmasculine/ non-binary adolescents (B = 0.22, p< .001) experienced more frequent weight-based teasing from peers in school relative to cisgender boys. Pansexual adolescents (B = 0.21, p= .026), bisexual adolescents (B =0.30, p = .001), and adolescents with other sexual identities (B=0.25, p= .031) experienced more frequent weight-based teasing from peers in school compared to straight adolescents. Adolescents with an underweight BMI (B = 0.59, p< .001), overweight BMI (B = 0.50, p< .001), or obesity (B = 1.18, p< .001) experienced more frequent weight-based teasing from peers at school compared to adolescents at a healthy weight.

Comparison of Reasons for Peer Victimization

Table 5 shows the mean frequency of teasing from peers at school for different reasons. The three most frequent reasons for which adolescents reported being teased at school were 1) sexual orientation, 2) masculine/feminine presentation, and 3) body weight. Among adolescents who reported being victimized for a singular reason, sexual identity, masculinity/femininity, and body weight were the most common reasons that they were teased or treated badly by peers.

Discussion

Our study assessed the nature and extent of weight-based victimization in a large, national sample of SGM adolescents. This is the first large-scale examination of experiences and sources of weight-based victimization in this population. We found that weight-based victimization is a common experience for adolescents across diverse sexual and gender identities and body weight categories, with important implications for advancing research in this understudied area and improving anti-bullying initiatives.

A high percentage of adolescents (45–57%, depending on identity category) across sexual identity and gender identity groups reported experiencing weight-based victimization from their peers. These rates appear to be comparable, and in some cases higher, than weight-based harassment and teasing reported in previous samples of primarily heterosexual adolescents,3,33 including studies using highly similar questions about weight-based teasing.12 Furthermore, approximately one-quarter of sexual minority adolescents in our study reported being teased about their body weight at school at least sometimes, often, or very often, and body weight was the third most common reason they reported being teased or treated badly compared to other motives for peer victimization. A priority for future research in this area will be to determine the nature, frequency, and temporal aspects (e.g., onset and duration) of different types of weight-based victimization experienced among SGM youth, including verbal, cyber, relational, and physical forms of victimization. Body weight is often a neglected topic in school-based anti-bullying policies,34 and our findings suggest that heightened awareness of this is issue may be warranted in school settings and in anti-bullying policies to ensure that weight-based victimization is adequately addressed and that sexual and gender minority youth are recognized as potentially vulnerable targets for this form of victimization.

Concerning levels (44–70%) of adolescents across sexual identity and gender identity groups reported weight-based victimization from family members. Higher odds of experiencing weight-based teasing from family occurred for cisgender girls, transgender boys, transmasculine/non-binary adolescents, and transfeminine/non-binary adolescents compared to cisgender boys. Compared to adolescents who identified as straight, youth who identified as pansexual, asexual, and ‘other’ had higher odds of experiencing weight-based teasing from family. It is also notable that the highest rates of family teasing (70%) were reported by adolescents who classified their sexual identity as “other”. These youth warrant further examination to determine reasons for their potentially heightened vulnerability to family teasing, and whether factors such as gender non-conformity or disclosure of their sexuality play a role. While parents have been previously documented as a common source of weight-victimization toward youth with overweight or obesity,8,14 our study offers novel insights about these family experiences for sexual and gender minority youth. As parents may be sources of sexual orientation victimization toward their children,35–37 our findings suggest that SGM youth may be additionally vulnerable to weight-based victimization, placing them at risk for compounding stressors in the home setting. Furthermore, the considerable range in reports of family teasing (e.g., 44% in gay identified adolescents versus over 60% of adolescents who identified as pansexual or asexual) reiterate the need for research to examine diverse sexual and gender identities of youth and identify unique vulnerabilities of those with emerging sexual identity labels, as well as more established identities.

Taken together, the high frequency of SGM youth reporting familial weight victimization in our study indicates the need for research to examine potential differences in the nature and extent of weight-based victimization from mothers, fathers, and siblings, as well patterns of parental communication about body weight across youth with different sexual and gender identities. Given that approximately one-third of adolescents across sexual identity groups reported experiencing weight-based victimization from both family members and peers, our findings also suggest that some SGM youth are vulnerable to mistreatment in both the home and school settings. Compared to adolescents who identified as straight, odds of weight-based teasing from both family and peers were higher for those who identified as gay, lesbian, bisexual, queer, pansexual, asexual and other. Compared to cisgender boys, higher odds of weight-based teasing from both family and peers were observed for cisgender girls, transgender boys, transmasculine/nonbinary adolescents, and transfeminine/nonbinary adolescents. Collectively, these findings indicate the need for additional research to examine vulnerabilities to weight-based victimization across different sexual and gender identities, and suggest that these youth may be benefit from support from other caring adults in their lives, such as teachers, coaches, or health care providers. Further, given the high levels of weight-based teasing reported in our sample, it will be informative for future work to examine whether, and to what extent, SGM youth internalize weight bias, which has been linked with adverse health outcomes in emerging studies of heterosexual youth.38

Regardless of the source of weight-based victimization (peers or family), SGM adolescents reported these experiences at diverse body weight categories. Compared to previous research in primarily heterosexual samples of adolescents documenting disproportionally higher rates of weight-based victimization among adolescents with overweight and obesity compared to lower body weight categories,3,26 we observed a different pattern in our study; weight-based victimization was reported at both low and high body weight categories in our sample. Compared to healthy weight peers, adolescents with an underweight, overweight, or obese BMI had increased odds of weight-based victimization from both peers and family members. Although odds of weight-based victimization remained highest (as much as 5 times higher) among adolescents with obesity, these findings highlight the importance of recognizing that SGM youth may be vulnerable to weight-based victimization at overweight and especially underweight BMI categories; this experience is not limited to adolescents with obesity. These findings are timely in light of the recent policy statement from the American Academy of Pediatrics recommending that pediatricians assess youth with obesity for emotional comorbidities associated with body weight, including weight-based victimization.15 Our results suggest that pediatric providers should be aware that SGM youth may be vulnerable to weight-based victimization, regardless of their body size, and should screen these youth for victimization experiences not only in the context of sexual identity, but also body weight. This can include assessment of psychosocial comorbidities associated with weight-based victimization, such as low self-esteem, depression, anxiety, poor school performance, and maladaptive eating behaviors.15

Finally, it is important to highlight the high percentages of adolescents with emerging sexual identity labels (e.g., pansexual, asexual) who reported weight-based victimization in our study. While sexual minority youth have typically been represented as a homogenous community in the scientific literature,39,40 our study highlights the importance of including measurement of diverse sexual identities in research, and the need for increased recognition of the heterogeneity of sexual identity in youth. Only with more comprehensive measurement of these diverse sexual identities can we accurately understand the differences in their lived experiences and health-related disparities. Future research might additionally explore if there are patterns of youth who endorse emerging identity labels, such as pansexual, and also resist the victimization of diverse body sizes. We are not able to conclude from our data whether or not youth who are identifying as emerging sexual orientation labels are resisting oppression in unique ways, but there may be something unique about the disposition of this group of young people.

Our study has several limitations. This research represents cross-sectional data and non-probability sampling methods, thus it will be important for longitudinal research to study SGM youth throughout adolescence and into emerging adulthood, as their sexual and gender identities, body weight, and experiences of weight-based victimization may change over time. Our study focused on 13- to-17-year-olds and cannot be generalized to younger or older LGBTQ individuals. As a point of comparison, HRC’s 2012 ‘Growing up LGBT in America’ report of over 10,000 LGBT adolescents had a higher representation of Hispanics and Blacks compared to our sample41; yet our sample had a substantial portion of youth who identified as biracial or multiracial (13%). These racial-ethnic differences reiterate that our study results pertain to those who responded to our survey and may not be generalizable to other populations of LGBTQ youth. The lack of a heterosexual cisgender comparison group also prevents direct comparisons of weight-based victimization between SGM and heterosexual adolescents. Finally, our study relied on self-reported responses of adolescents; some evidence has found that sexual minority youth underreport BMI42; so it is possible that misreporting of body weight in this manner could have resulted in fewer participants being accurately classified in overweight or obese BMI categories. Thus, objective measures for height and weight are ideal. Similarly, it is possible that SGM youth in our sample may have underreported weight-based victimization given that our survey questions did not inquire about different forms of victimization (e.g., cyber-bullying versus verbal teasing) and/or if they perceived victimization related to their sexual orientation or gender identity as being more salient. It will be important for future research to explore different forms of weight-based victimization using more comprehensive measures, and how SGM youth perceive the severity of weight-based victimization relative to victimization they experience because of their sexual orientation or gender identity. Nevertheless, our study has important strengths, including a large, diverse sample of sexual minority adolescents, and novel insights about the extent and sources of weight-based victimization in adolescents with diverse sexual identities.

In conclusion, this large-scale examination of SGM minority adolescents indicates that weight-based victimization is a common experience across diverse sexual and gender identities and body weight categories. Our results emphasize the high percentage of adolescents across both established and emerging sexual identity groups reporting weight-based victimization from peers and family. While research on weight-based victimization and sexual identity have been primarily studied in isolation of each other, our findings highlight the importance of increased attention to the intersection of social identities related to body weight, sexual orientation, and gender identity in youth. These issues warrant attention not only in research, but also among parents, educators, and health providers who interact with adolescents, who should exercise heightened awareness of the vulnerability of weight-related mistreatment among SGM youth.

Acknowledgments

This research uses data from the 2017 LGBTQ Teen Study, designed by Ryan J. Watson and Rebecca M. Puhl in collaboration with the Human Rights Campaign, and supported by the Office for Vice President of Research at the University of Connecticut. The authors acknowledge the intensive efforts of Ellen Kahn, Gabe Murchison, and Liam Miranda in their support, conceptualization, and management related to the 2017 LGBTQ Teen Study.

RW conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. RP contributed to the conceptualization, design, and survey instruments of the study, drafted the initial manuscript, and revised the manuscript. MH carried out the statistical analyses and contributed to writing and revising the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Footnotes

Conflicts of Interest Statement

The authors have no conflicts of interest to disclose.

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