The Dual Burden of Weight in YMSM: Structural Inequities and Body Image Pressures

Young men who have sex with men (YMSM) navigate a unique intersection of health risks characterized by structural drivers of obesity and intense sociocultural pressures for thinness. While Body Mass Index (BMI) differences are documented in the general population, less is known about how these patterns manifest within the specific appearance-potent subcultures of YMSM. This study describes BMI profiles across racial/ethnic groups in a large YMSM cohort to examine the interplay between weight status and the dual pressures of structural inequity and body image disturbance.

We conducted a cross-sectional analysis using data from 2,704 YMSM (age 17-29 years) in a US digital cohort study. Participants self-reported height, weight, race, and ethnicity. We used Analysis of Variance (ANOVA) and Chi-squared tests to assess BMI differences across five racial/ethnic groups (Asian Non-Hispanic, Black Non-Hispanic, Hispanic, White Non-Hispanic, Other Non-Hispanic).

Significant variations in mean BMI (F(4, 2699) = 13.59, p < 0.001) and weight category distribution (χ²(12) = 73.05, p < 0.001) were observed. Asian Non-Hispanic and White Non-Hispanic men exhibited significantly lower mean BMIs and higher prevalence of healthy weight classification compared to Black and Hispanic peers. However, in the context of YMSM culture, this lower weight profile warrants clinical attention, as prior literature suggests it may co-occur with restrictive behaviors and body image disturbance. Conversely, Black Non-Hispanic and Hispanic men exhibited higher mean BMIs, reflecting persistent structural disparities.

Significant racial and ethnic differences in BMI exist among US YMSM, reflecting a polarized risk environment. The BMI profiles of Black and Hispanic YMSM are consistent with structural risk patterns documented in the broader population, while the lower BMI profiles of White and Asian YMSM align with prior literature on body image pressures in gay subcultures. Both structural and sociocultural risks are relevant across all groups. These findings suggest that weight status in YMSM serves as a marker for divergent sociocultural and structural pressures. Public health strategies must address this dual burden by targeting both obesogenic environments and toxic body ideals.