Right off the bat, let me say that almost everyone experiences body dissatisfaction. It is so universally present that normative discontent is now viewed by the social sciences as an integral feature of being human. That is, to be human is to be unhappy with one’s body. But various subgroups within our society experience bodily unhappiness more so than others with a distinct difference between the sexes along with sexual minorities. This blog-lecture looks at the latest research about sexual minority men showing they are the unhappiest.
The unofficial rule-of-thumb is that heterosexual women and men both experience body image disturbance (BID), but women slightly more so than men. Heterosexual men experience lower body surveillance, less identification with the thin-body ideal, less vulnerability to peer and media pressures. Black women adhere less to the thin-ideal internalization than White, Hispanic, and Asian women although this latter group are under greater family pressures. Being younger and having higher BMIs were associated with greater sociocultural appearance concerns across most measures (Frederick et al., 2022). A study of 11,620 adult men using Objectification Theory and the Tripartite Influence Model of Body Image examined how gender, sexual orientation, racial group, age, body mass relates to the sociocultural appearance concerns (McKinley & Hyde, 1996; Schaefer et al., 2015). Men were less likely than women to engage in body surveillance, internalize the thin-body ideal, succumb to appearance-related pressures from media images and family pressures although they had greater idealization of a muscular body. Both men and women had a stronger desire for their bodies to look leaner rather than thinner.
Gay men experience BID on a par with heterosexual women while lesbians and heterosexual men experience less. One systematic analysis of 136 research articles published between 2011 and 2022 showed that gay men had more negative body image concerns than heterosexual men. Their BID is often related to eating disorders, psychological issues, identification with cultural ideals of physical appearance, self-objectification, sexual and relationship problems, conflicted relationships with the gay community, and health problems (e.g., HIV, AIDS). There is a strong relationship between body image and various types of social sanctions including internalized homophobia and harassment for appearing gay (Nowicki et al., 2022).
To the point, gay men appear to be a stand-out in terms of weight discrimination–both from external sources and from internalized ideal standards–and BID.
Systemic Stigmatization
It will be helpful to frame the problem in terms of the Minority Stress Theory (MST). The MST asserts that sexual minority mental health problems–as compared to the heterosexual community–are caused by chronic stress from sexual stigmatization by the mainstream culture. The MST includes stigmatization stress experienced by gender minorities especially the transgender community (Meyer, 2003). A good supporting piece of evidence for the MST is found in Pereira (2022) in which he measured 210 self-identified, older gay and bisexual men between 50 and 80 years old and their mental health symptoms, suicidal ideation, and sexual stigma history. He found that older gay and bisexual men with higher levels of sexual stigma were more anxious, depressed, suffered from somatized aches and pains, and had more thoughts about suicide. Statistical analyses revealed that sexual stigma was related to 11 percent of anxiety symptoms, 10 percent of depressive symptoms, and 9 percent of somatized body sensations.
Dahlenburg et al. (2020) analyzed 48 studies confirming that gay men have higher body dissatisfaction while other studies show they have less body appreciation (Alleva et al., 2018), more body surveillance and body shame (Dakanalis et al., 2012), and were more likely to engage in disordered eating than heterosexual men (Calzo et al., 2017). Gay transexual men are 149 to 349 percent more likely than heterosexual transexual men to experience eating disorders (Bonell, 2023). The problem may be even greater for non-white, gay men as they are 2.5 times more likely to engage in anabolic steroid use (Blashill et al., 2017).
Therefore, sexual minority members–especially men–experience more issues from social discrimination for their sexuality, but there is also stress experienced from within the gay community and also intrapsychically within individuals.
Two sociologists have proposed that gay men, as they include the feminine in their somatic identity, are under similar stressors as women are by heterosexual cultural ideals (Jones & Pugh, 2005). They draw extensively from the ideas of Tseelon (1995) that there are five paradoxical pressures based on attitudes toward the female form and that the gay community exerts them upon gay men just as the heterosexual culture forces them upon straight women.
The first is the modesty paradox which forces women to disguise their forms because female sexual signs are too arousing or threatening for straight men. Likewise, gay men must dress appropriately to downplay their sexuality yet be attractive to other gay men. This results oftentimes in a duality of appearance depending on the social situation.
Second, women are accused of duplicity because they are pressured to make themselves attractive but are criticized for being manipulative by doing so. Gay men who meet the community standards of a lean muscular form may be seen as desirable but often condemned for assumed narcissism and insincerity.
Next is the paradox of visibility. Women are constantly on visual display even when in situations they are socially invisible. The female body is prized as a sexual trigger, but this can also be threatening and so women are eternally dissatisfied with their appearance depending on different social situations. Gay men have the same problem in balancing being visible to other gay men and yet invisible to heterosexual ones.
Another paradox is that of beauty. When are expected to be attractive, but as female sexuality is often too stimulating or threatening or confusing to men, and so women must strike a balancing act between their appearance and their own sexuality. The main problem connected with this paradox is that most women cannot attain the highest standards of beauty—this being physically impossible—because of age and the limitations of their own individual forms. Again, gay men share a similar problem in that only a minority are able to meet the ultimate standards of beauty and this only for a short time. Those who do not achieve the standard or, worse, fail to maintain it, are subjected to social condemnation for being lazy.
Finally, there is the paradox of death. As the female body represents new life, it also signals death, thus stimulating fear and a reactive desire to control the female body. This is played out in the lifespan of many women who having enjoyed great beauty slowly lose it with age. Ageing and death cannot be stopped and the physical deterioration of the feminine form attests to this reality. Gay men are also subject to this paradox as those who lose their youth with middle-age face increasing social and sexual rejection. This means that gay men are subject to a kind of premature aging process in which they “age out” of the sexually-attractive category.
Internal Stigmatization
One study of 326 American sexual minority men measured relationships among internalized standards of beauty and desirability, level of body self-surveillance, degree of body dissatisfaction, drive for muscularity and internalized heterosexism and their strength in motivating compulsive exercise and/or AAS use. Internalized heterosexism—a form of self-hatred—related positively to the internalization of attractiveness; the stronger the identification with heterosexist attitudes then the greater the body dissatisfaction. The desire to achieve a body type approximating the culturally ideal fueled the drive for muscularity which in turn drove body surveillance and AAS use (Brewster et al., 2017).
Links between weight stigma and negative health outcomes regardless of sexual orientation are well documented, but risk and protective factors remain unclear. A study of 458 higher-weight Australian adults measured their perceived weight stigma, weight-based identity, internalization of weight bias, and level of emotional suffering. Perceived stigma was positively associated with social identification and psychological distress. A key factor influencing the severity of psychological distress is the degree to which a person internalizes weight prejudice. That is, their own level of self-stigmatization (Curll & Brown, 2020).
Age & Weight Prejudice
Sexual minority men are very much victimized by weightism especially those with higher body-mass indices. A study of gay Australian and New Zealander men (N=2,733) found that both underweight and overweight subjects experienced prejudicial treatment. The BMIs of the subject pool ranged from 14.15 to 68.12. Three percent were underweight, 50 percent were of “normal” weight, 28 percent were overweight, and 17 percent were as obese. Weightism was experienced by 38.9 percent of participants (Griffiths et al., 2018).
Differences in experienced weight discrimination, weight bias, and internalized weight bias were measured in two other studies. The first study was of gay (n=351), bisexual (n=357), and heterosexual (n=408) men and the second of gay (n=614) and bisexual (n=123) men only. Bisexual men in the first study experienced more weight discrimination than their gay and heterosexual counterparts. Bisexual and gay men have a strongly internalized weight bias and far more so than heterosexual men. In the second study, gay men had internalized weight bias far more than bisexuals. Those gay and bisexual men who experienced discrimination against them because of their weight had a lower psychological quality of life (Austen, Greenaway, & Griffiths, 2020).
Self-hatred from internalized weight bias is common among gays men and is related to depression, anxiety, and body dissatisfaction. Evidence for this comes from one study of a multi-national cohort of 2,953 sexual minority men. Results showed that the degree of weight bias and BMI level are inversely related to psychological well-being. Weight bias and psychological well-being appear inversely related; as one increases, the other decreases (Austen & Griffiths, 2022). The psychological internalization of external standards such as homophobia and weight prejudice lead to negative emotional experience, high body dissatisfaction, and low self-esteem. Weight prejudice/shame is a very strong predictor of poor mental and physical health (Pearl & Puhl, 2016).
Body Dissatisfaction vs. Body Dysmorphic Disorder
Gay men are at increased risk for experiencing body
If dissatisfaction with a specific body part becomes obsessively overwhelming then common body anxiety may grow into Body dysmorphic disorder (BDD). This is an anxiety disorder in which a person believes that some part of their body is severely flawed in some way. The flaw may be quite minor and sometimes is imaginary, but either way, the person obsesses over it constantly and tries to either fix it or disguise it. BDD has a prevalence rate of 2.4 percent among US adults, but not much is known about how it affects the sexual minority communities. It is assumed that sociopsychological stressors such as fear of rejection, concealing one’s sexual orientation, and internalizing the self-hatred of homophobia may be BDD risk factors. One study estimated the occurrence of BDD in a sample of sexual minority men in relation to minority social stressors and BDD symptoms. Data came from 268 gay boys and adult men with the media age within the sample pool being 24.59 years. The occurrence rate of BDD was 49 percent. Sensitivity to being rejected because being gay and concealing one’s sexual orientation were also strongly associated with BDD (Oshana, Klimek, & Blashill, 2020).
Closing Thoughts
I have a few take-aways from all of this research. The first is that gay men are far more vulnerable to body image disturbance and psychological suffering for inadequacies in their somatic beauty. They are under sociocultural and psychological pressures both from the dominant heterosexual society and their own gay communities. And, many who internalize the cultural body beauty standards–and eventually fail to meet them–as well as those who internalize negative beliefs about their sexuality, are under intrapsychic stress.
Assuming that the MST holds for body image disturbance in gay men, the question is what level of system is responsible? Bonell et al. (2023) blames most of the body image problems of gay men on white hegemonic masculine culture, but I believe this is a smaller factor than the pressures exerted by the gay community itself and the degree to which gay men internalize and identify with the gay cultural standards of male beauty. My reasoning is that the cultural ideals—be they of traditional masculinity and approved by the culture-at-large or idealized by a sub-culture community—are social expressions of underlying biological desires which are quite powerful. There is evidence indicating that the relationship between body image and self-esteem may be moderated by one’s acceptance into and involvement with gay culture (Levesque & Vichesky, 2006). Further evidence comes from the gender oppression experienced by gay males by their own community (Wood, 2004). This level of sub-system seems more accessible and powerful, at least to me, than some pie-in-the-sky “hegemonic masculine culture.” Biology in most cases always trumps sociology; a position not popular in the current sociopolitical zeitgeist.
Secondly, I believe in personal responsibility and if an individual willingly identifies with unrealistic goals of somatic beauty, then don’t blame the dominant culture.
Next, it seems to becoming increasingly clear that rates of BDD are alarmingly high—or at least potentially high at any given time—and so assessing weight stigma among sexual minorities is very important. Bisexual men appear particularly vulnerable to this stigma. In any event, the LGBT communities seem to experience higher levels of body unhappiness and somehow this needs to be addressed. Identifying the factors that lead to BID and especially BDD provide potential strategies for therapy and somatic intervention. Targeting somatopsychic treatment interventions around a client’s Internalized weight bias may prove to be valuable strategy.
Paul Shane, Ph.D., LMT
Director, Academic Content
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Updated 02-14-24