Obesity, Sexual Abuse and Sexual Orientation: Women Enrolled in the ESTHER Study

Prior studies indicate that women who have experienced childhood sexual abuse (CSA) are at greater risk for obesity. Published research shows that lesbians have higher rates of both self-reported sexual abuse and overweight/obesity when compared to heterosexual women; however, this association has not been fully explored. Our aim was to investigate the association between obesity and sexual abuse history among women who participated in the ESTHER Project (Epidemiologic STudy of HEalth Risk in Women). The ESTHER Project (2003-2006) included 1084 women 34 years and over, half self-identified as lesbian (n= 504). Three self-reported sexual abuse measures were used. CSA was assessed by asking respondents whether they were sexually abused by a family member or non-family member prior to age 18. Adult sexual abuse asked about forced activity after age 18. Chi square tests compared prevalence rates of five World Health Organization (WHO)-defined BMI Categories (underweight, normal, overweight, obese and severely obese), reported sexual abuse, and sexual orientation. Lesbians were significantly more likely to report all three types of sexual abuse and were more likely to be obese (BMI >30) and severely obese (BMI>40) than heterosexual women. Logistic regression analysis adjusting for potential confounders indicated that having less education than a bachelor's degree, lower income, African American race, lesbian sexual orientation, reported sexual abuse by a family member at ages < 18, and history of depression were associated with current obesity in adulthood. Future weight loss interventions should examine the impact of sexual abuse and sexual orientation.