1. Greater gender conformity in childhood was associated with increased use of laxatives in females and muscle-building products in males, with the prevalence of such behaviors increasing with age.
2. Approximately 20% of sexual minority females (e.g., bisexual or lesbian) aged 23 to 25 years reported past-year laxative use for weight management.
Evidence Rating Level: 2 (Good)
Study Rundown: Using laxatives to lose weight or taking muscle-building products (e.g., creatine, steroids) to bulk up may lead to dependence and negative health outcomes. The use of such substances is known to vary along gender lines and sexual orientation, with females (in particular, minority orientation females) more likely to take laxatives and males more likely to use muscle-building products. To better understand these associations and investigate a potential link to gender conformity, authors surveyed the behaviors of adolescents and young adults from the Growing Up Today Study (GUTS). With regard to laxatives, sexual minority females were found to have approximately double the odds of use compared to their heterosexual counterparts. Further, regardless of sexual orientation, increased childhood femininity was associated with greater laxative abuse. The results for males and muscle-building products differed—while increased childhood masculinity was associated with use, the odds did not vary with sexual orientation. Limitations of this study included its reliance on retrospective data assessing childhood and not current gender conformity, lack of generalizability due to a homogenous sample (>90% Caucasian), and inability to account for potential confounding factors such as current occupation, hobbies (e.g., sports), and autoimmune disease status. Nevertheless, the results suggest that gender conforming children and sexual minority girls may be at greater risk of taking laxatives (females) or muscle-building products (males) in young adulthood, thus identifying at-risk populations that may benefit from earlier clinical surveillance.
Jerel P. Calzo, PhD, MPH and co-authors, talk to 2 Minute Medicine: Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts.
“Results from this study suggest that social pressure to conform to gender norms during adolescence, including those concerning appearance, are linked to harmful weight management and muscle-building behaviors among heterosexual and sexual minority youth alike. Clinicians should be aware that highly gender conforming girls may be at risk for abusing laxatives in adolescence, and highly gender conforming boys may be at risk for abusing muscle-building products (e.g., creatine, steroids) in adolescence.”
In-Depth [longitudinal study]: Survey respondents included a subset of adolescents and young adults from the GUTS, all of whom are children of women in the Nurses’ Health Study II. Data was analyzed from questionnaires completed from 1999 through 2007 (N = 14 134 sexual orientation, N = 10 904 childhood gender conformity, N = 12 965 laxative use, and N = 13 629 muscle-building products use). Sexual orientation, laxative use, and muscle-building product use, although surveyed in multi-answer format, were collapsed to dichotomous variables (e.g., “sexual minority” encompassed “mostly heterosexual,” “bisexual,” “mostly homosexual,” and “completely homosexual”). To assess gender conformity, gender expression during childhood was measured. Analysis was based on a repeated-measures design. Only laxative use in females and muscle-building product use in males were studied due to the low prevalence in cross-comparisons. In females, significantly greater odds of any past-year laxative use were found with advancing age (OR = 14.96 oldest (23 to 25 years) vs. youngest (13 to 15 years), p < 0.001), sexual minority status (OR = 2.10, p < 0.001), and childhood femininity (OR = 1.51 most vs. least, p < 0.01). As for males, advancing age (OR = 3.36 oldest vs. youngest, p < 0.001) and childhood masculinity (OR = 1.79 most vs. least, p < 0.001), but not minority sexual orientation, were associated with greater odds of muscle-building product use. Sexual orientation did not significantly modify the associations between childhood gender conformity and laxative use in females and muscle-building product use in males.
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