Body Image Concerns, Correlates, and Community Connection Among Black and Latinx Sexual Minority Cisgender Men and Transgender/Gender Nonconforming Young Adults

Abstract

Purpose:

We extended the focus on body image research beyond cisgender, White sexual minority men (SMM) by describing body image concerns among Black and Latinx SMM and transgender/gender nonconforming (TGNC) adults and by examining protective effects of community connection.

Methods:

From 2016 to 2020, 447 Black and Latinx SMM (94%) and TGNC (6%) individuals in Los Angeles provided data semiannually. Participant endorsement of any body image concerns was determined by five body image codes (weight, fitness, appearance, body area dissatisfaction, and general body image) applied to participants' open-ended lists of health and body concerns. Fixed effects multivariable logistic regression was performed to examine the association between gay and racial/ethnic community connection and odds of any body image concerns, accounting for multiple records per person. An interaction term between gay and racial/ethnic community connection approximated the protective effect of connection to multiple, intersecting communities.

Results:

The majority of participants (51%) reported a body image concern, most commonly weight concerns, at least once across three years. Body image concerns were more common among Latinx participants (χ² = 17.79, p < 0.001) and participants experiencing food insecurity (χ² = 4.11, p = 0.04) and unmet basic financial needs (χ² = 10.56, p = 0.001). Gay community connection was protective against body image concerns, but only for participants who had high racial/ethnic community connection (adjusted odds ratio = 0.87, p = 0.05).

Conclusion:

Body image concerns were notable, especially among those with low community connection and higher socioeconomic burden. These findings suggest that building connections within SMM/TGNC and racial/ethnic communities may aid in building a support network that buffers against body image concerns.

Introduction

Over the past few decades, researchers have emphasized disparities in concerns regarding body image (i.e., a multidimensional construct comprising people's attitudes toward their bodies¹) between cisgender heterosexual and sexual minority men (SMM; i.e., individuals who identify as gay, bisexual, pansexual, or as a man who has sex with other men). Studies have consistently found that presumably cisgender SMM report greater body dissatisfaction, including concerns with physical appearance and pressure to conform to societal body ideals,^2,3 which in turn has been related to poorer mental health,^4,5 increased rates of disordered eating,^6,7 and poorer safer sex self-efficacy.⁸ The majority of body image research among cisgender SMM has predominantly focused on White SMM, thus overlooking the experience of SMM of color.

Historically, body image research has generally examined sociocultural identities from a single-axis or comparative approach^9,10; that is, studies have focused on one single identity or have highlighted comparisons between underrepresented groups (e.g., people of color) and White participants.^1,2,11 Regarding race/ethnicity, Black—presumably heterosexual—men may experience greater body satisfaction than White men.¹² For Hispanic/Latinx men, concerns with body fat and muscularity have been associated with loss-of-control eating.¹³

In the past decade, body image researchers have applied an intersectional framework to capture the body image experiences of individuals with multiple marginalized identities, including SMM of color. Through focus groups with Black, East/Southeast Asian, South Asian, and Latinx/Brazilian SMM, Brennan et al.¹⁴ found themes related to body image idealization (i.e., White, muscular bodies) for racially minoritized SMM both from the media and within the SMM community, as well as negotiating and resisting against how one's body is racialized as SMM of color (e.g., being ignored or exoticized for one's race).

Racial prejudice and discrimination toward SMM of color in sexual or romantic contexts (i.e., sexual racism) has also been associated with greater body image concerns, including dissatisfaction with one's physical appearance and muscularity.¹⁵ In one study comparing body image concerns among racially/ethnically diverse young adult SMM, White SMM reported higher levels of body dissatisfaction compared with SMM men of color.¹⁶

Recent findings also indicate a higher risk in developing body dysmorphic disorder among Hispanic SMM and Hispanic sexual minority women compared with sexual minority individuals of other races/ethnicities.¹⁷ Regarding body image and sexual health, greater investment in physical appearance and body dissatisfaction has been shown to place young Latino SMM at greater risk for HIV/AIDS due to increased sexual risk behavior (e.g., condomless anal sex).¹⁸

The relationship between community connection and body image among SMM of color is underexplored. Community connection comprises the cognitive and affective components of affiliation with members of one's community, and is distinguishable from community involvement, or one's participation or involvement in one's community.^19,20 In contrast to community involvement, which has predominantly been defined as overt behaviors (e.g., frequency of going to gay bars, attending Pride events), community connection has focused more on one's shared emotional connection in the community.

Based on the minority strengths model, community connection has been posited as a source of strength that may foster improved mental health through greater identity pride, self-esteem, and resilience.²¹ Indeed, community connection has been associated with lower levels of internalizing symptoms, including anxiety and depression, with the strongest effect of this association observed among SMM of color.²² No associations have been examined between community connection and body image concerns²³; on the other hand, an association has been found between increased community involvement and greater body image concerns.^23,24

Although some studies have included racially diverse SMM samples,²⁴ associations between both gay and racial/ethnic community connection and body image concerns remain largely unexplored. Findings indicate that people of color tend to report more community connections compared with White individuals.²⁵ Furthermore, SMM of color report receiving support for coping with stigma in their racial/ethnic communities.²⁶ Therefore, different sources of community connection (i.e., from one's gay and racial/ethnic community) may converge to impact body image among SMM of color.

Body image research has predominantly focused on SMM who identify as cisgender. As a result, research on the experiences of sexual minority people, especially sexual minority people of color, who identify as transgender/gender nonconforming (TGNC) has been rather limited. Body image plays a significant role among individuals who experience incongruence between their gender identity and physical body.²⁷

Qualitative research has revealed unique body image experiences of TGNC youth, including body dissatisfaction (e.g., self-criticism and social distress as related to gender dissociation and body size) and satisfaction (e.g., self and social acceptance related to overcoming societal expectations regarding body size).²⁸ Furthermore, oppression and discrimination faced specifically by transgender women may contribute to elevated body image concerns and disordered eating.²⁹ To date, the majority of body image studies among TGNC participants have included predominantly White samples.

Given the burgeoning research on body image among SMM and TGNC people of color, the present study focused on Black and Latinx SMM and TGNC young adults and their experiences at the intersection of race/ethnicity and sexual/gender identity. The primary objective was to characterize body image concerns among Black and Latinx SMM and TGNC young adults. The researchers sought to investigate the prevalence of body image concerns based on differences across demographics (e.g., race/ethnicity, gender identity, sexual orientation, HIV status) and socioeconomic factors. The secondary objective was to examine the association between community connection (i.e., racial/ethnic and gay community) and body image concerns.

Methods

Data were from 447 SMM and TGNC young adults in the Healthy Young Men's Cohort Study, a semiannual, ongoing longitudinal study in Los Angeles beginning in 2016 focused on understanding HIV prevention and substance use among Black and Latinx men who have sex with men.³⁰ Recruited from LGBT venues, social media, and participant/clinic referrals, eligible participants (1) were 16 to 24 years of age at recruitment; (2) assigned male sex at birth; (3) self-identified as gay, bisexual, or uncertain about their sexual orientation; (4) reported sex with a man within the past year; (5) self-identified as Black or Latinx; and (6) lived in the Los Angeles area.

Ethics research approval was provided by the Children's Hospital Los Angeles' Institutional Review Board. Participants provided written consent during a face-to-face visit. A certificate of confidentiality was obtained from the National Institute on Drug Abuse and a waiver of parental consent/assent was obtained for participants 16 to 17 years of age. All items included in this study were administered face-to-face with researchers verbally asking the survey questions to participants.

Measures

At each of seven waves, participants reported whether there was “something about [their] health or body that [they] are worried about.” Participants who responded “yes” specified what they were worried about, generating brief, open-ended list responses from each participant at every wave.

Participant records (i.e., participant data within each wave) were coded to identify endorsement of body image concerns based on subcategories derived from the unpublished test manual of the Multidimensional Body-Self Relations Questionnaire [MBSRQ; T.F. Cash, 1990 (unpublished test manual)]. Codes based on the subcategories of the MBSRQ included weight concerns (e.g., “overweight,” “too thin”), fitness (e.g., “be more fit”), appearance (e.g., “don't like the way I look”), and body area dissatisfaction (e.g., “graying hair”). A fifth subcategory was added for general body image concerns that were reported broadly (e.g., “body image”) with no further specification. For each participant record at a given wave, an endorsement of one or more body image subcategory was recoded to indicate overall body image concern.

Age was measured continuously. Body mass index (BMI) was calculated from self-reported height and weight and converted to kg/m². Race/ethnicity included three mutually exclusive categories: Latinx, Black, and Afro-Latinx. Participants reported HIV status at each wave with lab tests to confirm self-report. Although the data were collected as part of a study of men who have sex with men, we assessed gender with multiple options at every wave to allow for diversity and fluidity of gender identity. Gender identity options of female, transgender male to female, gender nonconforming, and other write-ins were collapsed and categorized as TGNC, in contrast to participants identifying as cisgender men (referent).

Sexual identity response options of gay/homosexual, bisexual, pansexual, heterosexual/straight, not sure/questioning, and other same-sexual identity (referent; e.g., man who has sex with men, same-gender loving, Two spirit) were collapsed to three groups: (1) gay: homosexual, gay; (2) plurisexual: bisexual, pansexual; and (3) other sexual identities). Groups were dummy-coded to compare gay and plurisexual participants to participants with other sexual identities (referent). Heterosexual participant records were excluded (i = 26). Socioeconomic factors included dichotomous measures of unmet basic financial needs, food insecurity,³¹ and unstable housing. All demographic and socioeconomic variables were time varying, excluding race/ethnicity.

Participants rated how much they felt part of “a gay community” and part of “[their] racial/ethnic community” each on a four-point scale (not at all, not very, somewhat, a lot). Community connection was measured at baseline, 6-, 12-, 24-, and 36-month follow-ups.

Analytical plan

To characterize body image concerns, a content analysis of open-ended health and body worry lists was completed to determine the prevalence of each subcategory and overall body image concerns. A priori codes for body image concern subcategories were created using the approach to codebook development modeled by Bernard and Ryan³² and reflected the multidimensionality of body image concerns included in the MBSRQ. Code reliability was improved through a series of interrater reliability tests among the three first authors. The codebook was revised and retested with baseline and 6-month follow-up data until all codes reached high levels of interrater agreement (Cohen's κ > 0.7).³³

Each participant response was reviewed for each of the five body image concern subcategories. Individual person records may have been coded for multiple subcategories. The prevalences of body image concern subcategories were reported as the total number of person records across all waves endorsing each subcategory; the prevalence of overall body image concerns was reported as the number of person records across all waves endorsing at least one subcategory (i.e., weight, fitness, appearance, body area, general body image).

Chi-square tests of independence were performed to examine demographic and socioeconomic differences (race/ethnicity, HIV status, gender identity, sexual identity, unstable housing, food insecurity, unmet basic financial needs) in prevalence of overall body image concerns across all person records (n = 447; i = 2725). All tests were adjusted for the nonindependence of data due to multiple records per person and records within persons were assumed to be correlated. For each chi-square test, participant records with missingness on independent variables (e.g., demographics, socioeconomic factors) were excluded from the test.

Fixed effects multivariable logistic regression with Toeplitz covariance structure was performed to examine the association between community connection and odds of any overall body image concerns accounting for multiple records per person (n = 439; i = 1525); records within persons were assumed to be nonindependent and correlated. Main effects and an interaction effect of gay community connection and racial/ethnic community connection on odds of overall body image concerns were adjusted for BMI, race/ethnicity, HIV status, gender identity, sexual identity, unstable housing, food insecurity, and unmet basic financial needs. Age was added to the model to estimate and account for developmental change in odds of overall body image concerns.

To account for data sparseness on extreme ends of age in the sample, only ages with at least 50 person records were included in the regression model. Thus, the age range was limited to ages 20 to 28 and included an analytical subsample of 1525 person records. Because community connection was not assessed at 18- or 30-month follow-ups, person records from these waves were excluded from regression analysis.

Complete record analysis within a single person record was employed for all regression models, thus single person records missing community connection, age, or any covariates were excluded. Additional person records from the same participant at different waves may be retained in the model. Because weight-related concerns comprised most overall body image concerns, chi-square tests and regression models were contrasted between overall body image concerns and weight concerns as outcomes. All analyses were conducted in SAS version 9.4 (SAS Institute Inc., Cary, NC, USA).

Results

The sample was 59% (n = 264) non-Black Latinx, 21% (n = 93) non-Latinx Black, and 20% (n = 90) Afro-Latinx. Baseline ages ranged from 16.2 to 25.2 years (M = 22.3, SD = 2.0). A portion of the sample was living with HIV at baseline (11%, n = 51). Participants completed survey assessments at baseline and every 6 months for 3 years, yielding seven data waves for analysis. Across waves, retention rates were high (82%–92%) versus baseline. The majority of participants (93.7%, n = 419) consistently identified as cisgender men at all waves with the remainder (6.3%, n = 28) identifying as trans women or gender nonconforming in at least one wave.

Across all seven data waves, n = 447 participants provided i = 2725 person data records. Table 1 shows a summary of demographics and socioeconomic factors across all person records and results of the body image concerns content analysis.

Table 1.

Summary of Demographics, Socioeconomic Factors, and Body Image Concerns Across Person Records

	M	SD	Min	Max
Age	23.93	2.27	16.20	26.02
Body characteristics
BMI	25.09	5.30	12.30	52.35
Height	69.47	2.96	60.00	81.00
Weight	172.52	39.51	93.00	350.00
	n	% a
Race/ethnicity
Latinx (non-Black)	1613	0.59
Black (non-Latinx)	575	0.21
Afro-Latinx	537	0.20
Living with HIV	411	0.15
Gender identity
Cisgender man	2524	0.93
TGNC	67	0.02
Sexual identity
Gay	2099	0.77
Plurisexual	420	0.15
Other sexualities	139	0.05
Socioeconomic factors
Unstable housing	239	0.09
Food insecurity	891	0.33
Unmet basic needs	1424	0.52
	Participants		Person records
	n	% b	n	% a
Health/body concerns	371	0.83	1235	0.45
Any body image concerns	228	0.51	499	0.18
Weight	171	0.38	377	0.14
Fitness	42	0.09	55	0.02
Appearance	18	0.04	19	0.01
Body area	32	0.07	42	0.02
Other general body image	19	0.04	21	0.01

^a Percentages based on all person records (n = 2725), inclusive of records with missing data.

^b Percentage of individuals from the full sample (n = 447).

BMI, body mass index; HIV, human immunodeficiency virus; M, mean; Max, maximum; Min, minimum; SD, standard deviation; TGNC, transgender/gender nonconforming.

Characterizing body image concerns

As shown in Table 1, 371 (83%) participants (n) endorsed any health or body concern and 228 (51%) endorsed a body image concern in at least one wave. Across all person records (i), 1235 (45%) included endorsement of health or body concerns and 499 (18%) included body image concerns. Weight concerns were the most common with 171 (38%) participants reporting weight concerns at least once and 377 (14%) person records including an endorsement of weight-related concerns. Fewer than 10% of participants reported fitness, appearance, body area, or other general body image concerns.

Subgroup differences in body image concerns

As shown in Table 2, endorsement of overall body image concerns (p < 0.001) and weight concerns (p = 0.002) were higher across person records from Latinx participants (overall: 22%; weight: 17%) compared with Black (13%; 10%) and Afro-Latinx (12%; 9%) participants. Endorsements of overall body image concerns (p = 0.04), but not weight concerns, were higher in person records reporting food insecurity (21%) compared with person records reporting no food insecurity (17%).

Table 2.

Differences in Overall Body Image and Weight Concerns Across Demographics and Socioeconomic Factors

	Body image		Weight
	n	%	n	%
Race/ethnicitya (i = 2700)
Latinx	359	0.22	273	0.17
Black	75	0.13	55	0.10
Afro-Latinx	65	0.12	49	0.09
χ2 (p-value)	17.79	<0.001	12.50	0.002
HIV status (i = 2700)
Living with HIV	72	0.18	49	0.12
Living without HIV	427	0.19	328	0.14
χ2 (p-value)	0.09	0.758	0.68	0.410
Gender identity (i = 2566)
Cisgender man	463	0.18	350	0.14
TGNC	8	0.15	8	0.15
χ2 (p-value)	0.22	0.638	0.03	0.871
Sexual identity (i = 2689)
Gay	384	0.18	290	0.14
Plurisexual	75	0.18	59	0.14
Other sexualities	39	0.23	27	0.16
χ2 (p-value)	1.13	0.568	0.23	0.892
Socioeconomic factors
Housing (i = 2668)
Unstable	42	0.18	29	0.12
Stable	456	0.19	347	0.14
χ2 (p-value)	0.15	0.699	0.79	0.374
Food security (i = 2693)
Insecure	188	0.21	132	0.15
Secure	311	0.17	245	0.14
χ2 (p-value)	4.11	0.043	0.626	0.429
Basic financial needs (i = 2677)
Unmet	277	0.22	208	0.16
Met	219	0.16	167	0.12
χ2 (p-value)	10.56	0.001	6.56	0.011

Percentages based on valid data and represent % of a given subgroup who endorsed overall body image concerns (e.g., % of Latinx participants who reported overall body image concerns was 22%).

^a Race/ethnicity groups are mutually exclusive. Latinx indicates non-Black Latinx participants and Black indicates non-Latinx Black participants. i = person data records. Bold indicates significant differences at p < 0.05.

Endorsements of overall body image concerns (p = 0.001) and weight concerns (p = 0.01) were higher across records with reported unmet basic financial needs (overall: 22%; weight: 16%) compared with records with met basic financial needs (16%; 12%). There were no differences in overall body image concerns or weight concerns across person records by HIV status, gender identity, sexual identity, or unstable housing (ps > 0.05).

Community connection and body image concerns

As shown in Table 3, age was associated with lower odds of body image concerns and weight concerns. BMI was associated with higher odds of body image concerns and weight concerns. Participants who identified as gay and participants who identified as plurisexual had lower odds of body image and weight concerns compared with participants with other sexual identities. Unmet basic financial needs were associated with higher odds of body image concerns and weight concerns. Compared with Latinx participants, Black and Afro-Latinx participants had lower odds of overall body image concerns but did not differ in odds of weight concerns.

Table 3.

Association of Demographics, Socioeconomic Factors, and Community Connection with Body Image and Weight Concerns

	Overall body image concerns				Weight concerns
	β	p	aOR	CI	β	p	aOR	CI
Intercept	−1.23	0.01	0.29	0.12–0.73	−1.22	0.01	0.30	0.12–0.76
Age	−0.13	0.00	0.88	0.81–0.95	−0.11	0.02	0.90	0.82–0.99
BMI	0.11	<0.0001	1.12	1.08–1.15	0.14	<0.0001	1.15	1.11–1.19
Race/ethnicity
Latinx (referent)
Black	−0.44	0.05	0.65	0.41–1.01	−0.42	0.11	0.66	0.39–1.11
Afro-Latinx	−0.48	0.04	0.62	0.39–0.97	−0.42	0.13	0.66	0.38–1.13
Gender identity
TGNC (referent)
Cisgender man	0.72	0.10	2.05	0.88–4.78	0.39	0.33	1.48	0.67–3.26
Sexual identity
Other sexualities (referent)
Gay	−0.93	0.00	0.39	0.22–0.70	−0.97	0.00	0.38	0.20–0.73
Plurisexual	−1.17	0.00	0.31	0.16–0.61	−0.99	0.01	0.37	0.18–0.78
HIV	0.15	0.50	1.16	0.75–1.80	0.01	0.95	1.01	0.62–1.67
Socioeconomic factors
Unmet basic financial needs	0.34	0.03	1.40	1.03–1.92	0.33	0.04	1.39	1.01–1.92
Food insecurity	0.00	0.99	1.00	0.74–1.34	−0.18	0.25	0.83	0.61–1.14
Unstable housing	−0.05	0.80	0.95	0.62–1.45	−0.07	0.76	0.93	0.60–1.46
Community connection
Gay community	−0.12	0.17	0.89	0.75–1.05	−0.16	0.08	0.85	0.71–1.02
Racial/ethnic community	0.01	0.90	1.01	0.86–1.19	0.01	0.89	1.01	0.84–1.22
Gay*racial/ethnic community	−0.14	0.05	0.87	0.76–1.00	−0.21	0.01	0.81	0.70–0.95

n = 439; i = 1525.

Bold indicates statistically significant (p < 0.05).

aOR, adjusted odds ratio; CI, confidence interval.

The interaction between gay community connection and racial/ethnic community connection approached significance (p = 0.05) in the overall body image concerns model and was significant (p = 0.01) in the weight concerns model (see Table 3). As shown in Figure 1, lower gay community connection (dotted line) was associated with greater odds of overall body image and weight concerns at higher levels of racial/ethnic community connection. In contrast, high gay community connection (dashed line) was associated with lower odds of body image and weight concerns at higher levels of racial/ethnic community connection.

FIG. 1.

Odds of overall body image concerns and weight concerns by interaction of gay and racial/ethnic community connection. “Low” indicates 1 SD below the mean and “high” indicates 1 SD above the mean. Associations in overall body image concerns approached significance at p = 0.05 and were significant for weight concerns at p = 0.01. SD, standard deviation.

Discussion

The present mixed-methods study examined body image concerns endorsed by Black and Latinx SMM and TGNC individuals to characterize these concerns among these historically underrepresented populations. More than half of respondents reported a body image concern and over one-third specifically reported weight concerns. In contrast to studies with face-valid body image measures, participants in the present study notably endorsed their responses with minimal prompting (i.e., providing examples only after endorsing “something about [their] health or body that [they] are worried about”). Overall, the present study contributes to the growing body of research highlighting the experiences of SMM diverse in terms of racial/ethnic identity,^17,18 as well as provides preliminary findings on the body image concerns of TGNC people of color.

One explanation is grounded in minority stress theory.^34,35 Previous research has supported the role of distal (e.g., discrimination) and proximal (e.g., internalized heterosexism) stressors as related to body dissatisfaction.^36,37 Although not examined in the present study, such minority stressors may play a role in body image concerns among SMM and TGNC people of color: meta-analytic evidence supports a small-to-moderate relationship between internalized heterosexism and body image concerns.³⁶ Specifically among SMM of color, an association between minority stressors and body image has been supported.²⁴

Relatedly, a more recent theory of multiple minority stress (i.e., the integration of minority stress and intersectionality theory) applied to SMM of color may be a more accurate framework.³⁸ That is, the racial/ethnic stigma experienced by SMM of color in queer spaces, as well as the sexual minority stigma in their neighborhood may yield differences in body image concerns compared with White SMM.

Another explanation pertains to stress that SMM of color may experience from within the gay community. Intraminority stress theory has posited that within-group stressors may emanate from perceptions of the gay community's focus on social status, sex, competitiveness, and exclusion of diversity.³⁹ Such foci may also encompass body image pressures within the gay community that contribute to increased body image and weight-related concerns. Aligned with intraminority stress, a highly perceived status in terms of a body hierarchy within the community of SMM has been described as including a muscular but lean, hairless, and White body,⁴⁰ with studies conducted among SMM of color endorsing such experiences of having these body image ideals placed upon them.^14,41–44

The present study found that low gay community connection was associated with higher odds of overall body image and weight concerns among respondents who reported higher levels of racial/ethnic community connection. This lack of gay community connection may relate to perceptions pertaining to the gay community's focus on exclusion of diversity as described by intraminority stress theory,³⁹ specifically related to diverse body types, which in turn may relate to body image concerns among SMM of color.

High gay community connection was also associated with lower odds of body image and weight concerns among respondents who reported higher levels of racial/ethnic community connection. Given the celebration of lean but muscular, White body types within “mainstream” gay communities,⁴⁰ SMM with racial/ethnic minority identities—particularly those whose bodies do not conform to Westernized beauty and fitness rooted in hegemonic cisgender, White masculinity—may feel less connected to the mainstream gay community.

In terms of the study's survey items, participants were asked about their gay and racial/ethnic community connection as separate domains. However, this distinction may not denote wholly separate communities. Indeed, based on an intersectionality framework⁹ and as evidenced in previous research,¹⁴ for many SMM of color, their gay community may comprise members of their racial/ethnic community and vice versa; thus, such questions may presuppose a distinction that may not be experienced by SMM of color.

Future research should consider the use of intersectionality-rooted measures that explore the joint and combined nature of people's experiences within different communities based on their race and sexuality, as well as acknowledge that for many people, these are not mutually exclusive communities. Measures based on an intersectional framework are of particular relevance for TGNC people of color to capture their experiences at the intersection of their marginalized racial, sexual, and gender identities. At the same time, the current lack of intersectional measures should not prevent current examination of body image concerns among SMM and TGNC people of color.⁴⁵

Alternatively, for participants who reported both high levels of racial/ethnic community connection and high gay community connection, these SMM and TGNC people of color may be less likely to report body image concerns potentially due to views that their gay community and racial/ethnic community have significant overlap/integration, and thus, may be enmeshed in social networks that include other SMM or TGNC racial/ethnic minority individuals. As previously described, this may foster more inclusivity in terms of body image within SMM and TGNC racial/ethnic communities. Furthermore, racial/ethnic pride may serve as a buffer against body image and weight concerns for racial/ethnic minority SMM men and TGNC young adults.

Limitations

These findings provide an important step forward in documenting body image concerns among SMM and TGNC people of color using intersectional strengths; however, this study is not without limitations. The results may not be generalizable beyond SMM and TGNC people of color outside of Los Angeles. Although this study provided data across many waves, secondary data analysis provided only a limited measure of body image concerns through open-ended response and no use of a validated measure of body image.

Furthermore, Black, Latinx, and Afro-Latinx SMM and TGNC individuals may share many experiences related to their identities, marginalization, and community; however, these groups are not monolithic,⁴⁶ as evidenced by higher rates of body image concerns among Latinx compared with Black and Afro-Latinx participants, and different social histories that impact the ways participants may be racialized, objectified, or subjected to White body ideals.

It is uncertain to what extent the cisgender SMM and TGNC participants of color interpreted the “gay community connection” differently. For example, it is possible that participants who identified as plurisexual or TGNC may have interpreted the items related to gay community connection as applicable only to cisgender men who identify as gay. As such, their responses might have differed if the items specifically identified their connection to the broader community of sexual minority and/or TGNC individuals.

Although it is notable that a majority of participants reported a body image-related concern in their open-ended responses, it cannot be inferred that those participants who did not make any such endorsements experience an absence of body image concerns. Relatedly, the higher frequency of weight-related concerns may have been due to the phrasing of the item (i.e., “health or body”), which may have cued participants to focus on weight, a variable associated more with health compared with other body image codes in the study.

Still, although not the same as other appearance or shape-related concerns, weight dissatisfaction among cisgender SMM and TGNC people of color may be indicative of both weight- and shape-related health behaviors, such as food restricting and purging. Among predominantly White, young adult SMM, it has been found that a greater focus on both weight- and shape-related concerns is present among SMM compared with their heterosexual peers.⁴⁷ Although no such conclusion can be made from the present study, the findings may lead to further investigation of weight-specific concerns among SMM and TGNC people of color.

Finally, based on the design of the parent study with a focus on SMM and HIV prevention, the sample included only a small number of participants who were TGNC. Inclusion of these participants is critical to representing their experiences in research and identifying needs for intervention, however, more proactive recruitment and inclusion is needed.

Conclusion

Despite decades of body image science that has predominantly focused on the experience of White, heterosexual individuals, more recent research has begun to highlight the specific body image concerns of diverse groups, including persons with historically underrepresented sexual and racial/ethnic identities. With an emphasis on recognizing intersectionality, the present study contributes further understanding of body image concerns among Black, Latinx, and Afro-Latinx SMM, and TGNC individuals. In summary, concerns related to body image and weight are of notable concern among this population. Furthermore, among SMM and TGNC people of color, community connection may play a protective role from pressure to conform to societal body norms.

Authors' Contributions

Z.A.S. contributed to the conceptualization of the study, assisted in conducting the qualitative analyses, led the writing of the original draft, and reviewed and edited the article. E.K.L. contributed to the conceptualization of the study, conducted formal analyses, assisted in the writing of the original draft, and reviewed and edited the article. J.C.S. contributed to the conceptualization of the study, assisted in conducting the qualitative analyses, assisted in the writing of the original draft, and reviewed and edited the article. M.D.K. and B.C.B. conducted the investigation, curated the data associated with the study, and reviewed and edited the article. All coauthors reviewed and approved of the article before submission.

Disclaimer

The views expressed are solely those of the authors and do not necessarily reflect the views of the National Institutes of Health.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research was supported by the National Institute on Drug Abuse (U01DA036926; P50 DA039838) and the National Institute of Mental Health (T32MH020031) of the National Institutes of Health.