The Association Between Sexual Orientation, BMI, Diagnosis of Obesity, and Provider Recommendation for Weight Management | BMC Women’s Health

There were 3872 people who met all inclusion and exclusion criteria, including sexual orientation. 3334 people met all other inclusion and exclusion criteria except that they did not state their sexual orientation and therefore should be excluded from the study. Thus, 46.27% of patients were excluded for not having indicated their sexual orientation.

Patient demographics are listed in Table 1. We compared women who identify as lesbian or bisexual with women who identify as heterosexual and found no significant differences in demographic characteristics except of the following: (1) Patients who identify as lesbian were more likely to be single and less likely to be married (p = 0.01) than patients who identify as straight; (2) Patients who identify as lesbian were more likely to be white than patients who identify as straight (p = 0.03); (3) Patients who identify as bisexual were younger (p

Table 1 Patient demographics

As shown in Table 1, the median BMIs (interquartile range) of patients who identify as lesbian and straight were 35.53 (32.32–40.79) and 34.82 (32.26–39.38 ), respectively. The median BMI (interquartile range) of patients who identify as bisexual and heterosexual was 35.49 (31.37–43.74) and 34.79 (31.60–39.82), respectively. Unadjusted bivariate analysis showed no statistically significant difference in BMI between patients who identify as lesbian and straight (p=0.44) or between patients who identify as bisexual and straight (p= 0.42). As shown in Table 2, there was no statistically significant difference in BMI between patients who identify as lesbian, bisexual, and straight when controlling for age at visit, total number of visits , race, ethnicity, marital status, type of provider, and diagnosis of pre- or type 2 diabetes, hypertension, or dyslipidemia (p=0.74 for patients who self-identify as lesbian and straight and p = 0.67 for patients who identify as bisexual and straight).

Table 2 BMI1 comparison between patients

Next, we compared the proportion of lesbian, bisexual, and heterosexual patients with a BMI ≥ 30 who received a diagnosis code for obesity. As shown in Table 3, the unadjusted bivariate model showed that there was no statistically significant difference in the proportion of patients with a BMI ≥ 30 who received a diagnosis code for obesity between patients who identify as lesbian and straight (p = 0.45) and patients who identify as bisexual and straight (p = 0.74). As shown in Table 4, there was no significant difference in the number of patients diagnosed with obesity between patients who identify as lesbian, bisexual, and straight, even controlling for age at birth. visit (bisexuals only), race (lesbians only), marital status, provider type (bisexual only), and diagnosis of relevant medical conditions hypertension (bisexual only) or dyslipidemia (bisexual only) (aOR 1.31 95% CI [0.78–2.19], p = 0.30 for patients who identify as lesbian and straight) and (aOR 0.89, 95% CI [0.40–1.98], p = 0.78 for patients who identify as bisexual and straight). Of note, as shown in Table 3, 44.71% of patients who identify as lesbian and 50.20% of patients who identify as straight to whom they were compared did not receive a code. diagnosis of obesity. Similarly, 43.75% of patients who identify as bisexual and 46.58% of patients who identify as straight to whom they were compared did not receive an obesity diagnosis code.

Table 3 Bivariate analysis for patients who received a recommendation for weight management and diagnosis of obesity
Table 4 Multivariate analysis of the proportion of patients who received an obesity diagnostic code

We then compared the proportion of lesbian, bisexual, and heterosexual cisgender patients who received a provider referral for weight management. As shown in Table 3, there was no significant difference between the proportion of final weight management recommendations received between patients who identify as lesbian and straight (p = 0.62) or patients who s identify as bisexual and straight (p = 0.51). As shown in Table 5, there was no significant difference in the proportion of definitive weight management recommendations received between patients who identified as lesbian, bisexual, and heterosexual, even controlling for age at visit. (bisexuals only), race (lesbians only), marital status, provider type (bisexual only), and diagnosis of hypertension (bisexual only) or dyslipidemia (bisexual only) (aOR 0.81 95% CI [0.49–1.34], p = 0.41 for patients who identify as lesbian and straight) and (aOR 1.44, 95% CI [0.65–3.18], p = 0.36 for patients who identify as bisexual and straight).

Table 5 Multivariate analysis of patients who received a definite positive recommendation for weight management

As shown in Table 3, there was no significant difference between the proportion of final and possible provider recommendations received between patients who identify as lesbian and straight (p = 1.00) and patients who s identify as bisexual and straight (p = 0.30). As shown in Table 6, there was no significant difference in the proportion of definite or possible recommendations for weight management between patients who identified as lesbian, bisexual, and heterosexual, even controlling for age at birth. visit (bisexuals only), race (lesbians only), marital status, provider type (bisexual only), and diagnosis of health conditions including hypertension (bisexual only) or dyslipidemia (bisexual only) (aOR 0.97, CI 95% [0.57–1.65], p = 0.91 for patients who identify as lesbian and straight) and (aOR 1.52, 95% CI [0.66–3.49], p = 0.32 for patients who identify as bisexual and straight).

Table 6 Multivariate analysis of patients who received a definitive yes or possible yes recommendation for weight management

As shown in Table 3, 55.29% of patients who identify as lesbian and 51.37% of patients who identify as straight to whom they were compared did not receive a definitive recommendation for weight management. . Similarly, 43.75% of patients who identify as bisexual and 50.00% of patients who identify as heterosexual to whom they were compared did not receive a definitive positive recommendation for weight management.

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