Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis

Area of Science:

• Public Health
• Epidemiology
• Sexual Health

Background:

• Obesity and overweight are significant public health concerns globally.
• Understanding variations in these conditions across different populations, including sexual minorities, is crucial for targeted health interventions.

Purpose of the Study:

• To analyze the prevalence and likelihood of overweight, obesity, and elevated Body Mass Index (BMI) among sexual minority men.
• To compare these metrics between men who have sex with men (MSM), men who have sex with men and women (MSMW), and all sexual minority men against a reference group of men who have sex with women (MSW).

Main Methods:

• A systematic review and meta-analysis of 43 studies reporting BMI or obesity/overweight prevalence by sexual orientation.
• Pooled analysis to calculate mean differences (MDs) in BMI and odds ratios (ORs) for overweight and obesity, with 95% confidence intervals (CIs).

Main Results:

• Sexual minority men (MSM and MSMW) exhibited lower mean BMI and reduced likelihood of overweight and obesity compared to heterosexual men (MSW).
• Specific prevalence rates for overweight, obesity, and elevated BMI were lower in MSM and MSMW groups than in the MSW group.
• A significantly lower mean BMI (MD -1.50 kg/m²; 95% CI [-1.93, -1.08]) and decreased odds of overweight (OR 0.75; 95% CI [0.64, 0.88]) and obesity (OR 0.84; 95% CI [0.78, 0.90]) were observed in sexual minority men.

Conclusions:

• Sexual minority men demonstrate a lower prevalence and likelihood of overweight and obesity when compared to their heterosexual counterparts.
• The "obesity paradox," characterized by a lower BMI despite potential underlying metabolic or cardiovascular issues, is proposed as a possible explanation.
• Further research is recommended to explore the implications of these findings, particularly concerning paradoxical cardiovascular outcomes in sexual minority men.