Measuring a child's body fat, University of Iowa, 1930s

In the midst of public health panic over obesity, a parallel concern about “fat” girls and their sexuality exists. In particular, the question that appears to be on many researchers’ minds these days is: “Are “fat” girls at higher risk of sexual dysfunction or STI/pregnancy risk than girls of average BMI (body mass index)?” One way that researchers have attempted to answer this question is by searching for statistical correlations between BMI, sexual behavior and self-esteem.

Indeed, several recent studies have focused on the relationship between body image or body size and sexual health, with a special concern around girls and women. For example, the authors of a recent study (Bajos et al., 2010) found links between obesity and “adverse sexual health outcomes” for both men and women, noting that obese women were less likely to access family planning, more likely to have unplanned pregnancies and less likely to consider sexuality an important part of their “personal life balance.” In a June 2010 interview for HealthDay News,  Bajos went well beyond the reach of his data to make generalized comments about obese women:

“Being obese has a strong influence on people’s sexual life. Because of social pressure or social stigmatization, obese women are less likely to engage in sexual intercourse and more likely to find sexual partners via the Internet. Because of their obesity, they are not comfortable meeting men through friends, through work, through parties.”

In that same interview, Bajos made the assertion (despite any direct evidence from his data) that:

“a lot of these problems are driven by the stigmatization of obese women [because] these women are more likely to have low self-esteem.”

Beyond this particular study, researchers’ focus on female bodies and sexuality even occurs when larger cross-sectional studies survey both men and women about sexuality and sexual pleasure. Typically such studies describe associations between BMI and sexuality factors as measured by sexual attitude or behavior measure (Addofson et al 2004).

While the BMI measure is ubiquitous as an indicator of health, its measurement problems are numerous. For example, BMI does not account for the ratio of muscle and fat in bodies (e.g. why a bodybuilder or elite athlete could be labeled as overweight or obese) nor does it take into account a number of other important factors related to health beyond height and weight including cholesterol levels, blood pressure and family history of diabetes, all things commonly associated with obesity and poorer health (Burkhausera and Cawley, 2008).

Despite concerns over the adequacy of BMI as an indicator of health, BMI continues to be a popular measure in population-based studies of sexuality, sexual health and obesity. Another recent study that garnered press attention was led by Dr. Margaret Villers of Medical University of South Carolina. The study findings (based on data taken from the CDC’s Youth Risk Behavior Surveillance System, a large scale data set that gathers information of youth behaviors ranging from sexual behavior to substance  use to violence) were presented at the 2010 ACOG conference in San Francisco under the title “Sexual Behavior in Obese and Overweight Adolescent Females.” The researchers found that overweight and obese girls were more likely to have sex before the age of 13, have three or more sexual partners during their teen years and were less likely to use contraception. Although the findings have yet to be peer reviewed, or published, the results have been taken up by a number of news outlets and sexual health blogs including the Black AIDS Institute and Kinsey Confidential, a sexual health blog from the Kinsey Institute for Research in Sex, Gender and Reproduction. Eric Grollman, a sociology doctoral student at Indiana University, had this to say about about the Villers study:

Given the link between weight and attractiveness – a societal standard of beauty that favors skinny bodies over fat bodies – some might find the study’s findings surprising: why are heavy girls having more sex with more partners?  [In a press release from Dr. Villers' university – see Brazell reference below], Dr. Villers and her fellow researchers provide two possible explanations for the difference in sexual behavior among teen girls: development during puberty and self-esteem. The researchers suggest that overweight and obese girls may begin puberty sooner and thus develop faster, which may put them at risk from more pressure from boyfriends and friends to have sex.

Since Villers’ study has yet to be published, reviewing the findings is a bit of a challenge. But the popularity of the initial report of the study by MSNBC reinforces a number of ideas about sexuality and obesity, and especially about the sexuality of girls and women: early puberty means more sexual activity and/or body shame, which leads to sexual pressure from partners. In the press release from her department at the Medical University of South Carolina, Villers points to the need for conversations about sexuality and safer sex regardless of what “daughters” weigh; at the same time Villers’ work presents a clear message about the dangers of not just female teenage sexuality but in particular of obese female sexuality.

Portrayals of overweight girls and women, both in mainstream media and by many health and sexuality researchers, seem to be making several assumptions.  These include perceptions that obese women don’t deserve positive messages about their bodies or that these positive messages can only come from a (male) romantic partner (who is then demonized as pressuring the girl into sex). These messages speak to larger assumptions that obese girls/women are  (and perhaps should be?) disempowered in terms of their sexuality.

These simplistic and fat-phobic assumptions point to how research about sexuality is often more productive when it is not limited to simple associations. Instead, qualitative or mixed methods research (where both statistical/survey and open-ended questions are asked of participants) allow for greater understanding of how social context impacts the meanings that girls and women attach to their bodies and their sexual behavior. For example, what kinds of positive or negative messages do overweight or obese girls receive about their bodies from romantic partners, friends, or family? How did those messages make them think about their sexuality, and how do they resist or incorporate these messages into their lives? For that matter, what messages about sexuality or sexual behavior did they receive, and which had the most salience? How did those messages impact their view of their bodies?

While correlational studies will have a continued and important presence in almost all types of research, especially in public health, when the focus is on sexuality or sexual health, perhaps we need to think beyond numbers. In order to better understand how bodies and emotions relate to each other in the context of human sexuality, research about body size and sexuality warrants a more varied approach.

 

Natalie Ingraham is a doctoral student in sociology at the University of California, San Francisco. She is interested in fat studies, embodiment and human sexuality.

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References and Recommended Readings

  • Adolfsson, Birgitta , Stig Elofsson, Stephan Rössner and Anna-Lena Undén. 2004. Are Sexual Dissatisfaction and Sexual Abuse Associated with Obesity? A Population-Based Study. Obesity Research, 12, 1702–1709.
  • Bajos, Nathalie, Kaye Wellings, Caroline Laborde, Caroline Moreau. 2010. Sexuality and obesity, a gender perspective: results from French national random probability survey of sexual behaviours. British Medical Journal, 340:c2573. Accessed online at: http://www.bmj.com/cgi/content/abstract/340/jun15_1/c2573
  • Brazell, Dawn. 2010. “Obese teens more likely to have unsafe sex.” Press release. Accessed March 12, 2011.  http://www.musc.edu/catalyst/archive/2010/co6-18teens.html
  • Burkhausera, Richard V. and John Cawley. 2008. Beyond BMI: The value of more accurate measures of fatness and obesity in social science research. Journal of Health Economics. 27:2, 519-529.
  • Grollman, Eric. 2010. Plus-Size Girls Are More Likely To Have Sex Early And Unprotected. Kinsey Confidential blog. Accessed at: http://kinseyconfidential.org/plus-size-girls-unprotected-sex-early/
  • Reinberg, Steven . 2010. Obesity Can Take Toll on Sex Life. HealthDay News. ©2011 HealthDay Accessed at: http://www.healthfinder.gov/news/newsstory.aspx?docID=640149
  • Rothman, K.J. 2008. “BMI-related errors in the measurement of obesity.” International Journal of Obesity (2008) 32, S56-S59.
  • Simopoulos, Artemis P. 1986. “Obesity and Body Weight Standards.”American Review of Public Health, 7, 481-92
  • Villers, Margaret S. . 2010. Sexual Behavior in Obese and Overweight Adolescent Females. Presented at the annual meeting of the American Congress of Obstetricians and Gynecologists (ACOG), San Francisco, CA, May 2010.