Body dissatisfaction and eating disorders in a sample of gay and bisexual men.

Men’s body image issues have a number of manifestations and

Male bodybuilder working out in a gym.

gay men are at particular risk for body dissatisfaction and eating

disorders. This study sought to examine body image and disordered eating

as they relate to demographics, conceptions of masculinity, external

motivations for fitness, and internalized homophobia in a sample of New

York City gay and bisexual men. Higher body dissatisfaction scores were

associated with external motivations for working out and older age.

Eating disorder scores were positively correlated with more frequent and

longer exercise sessions, and states of anxiety, depression,

ambivalence, and concerns about the perceptions of others, all in regard

to a gay or bisexual orientation. Findings are discussed with

implications for researchers and health care providers.

Keywords: men, gay/bisexual, body image, eating disorder,

internalized homophobia


Men’s body image issues range a wide gamut and have a number

of manifestations, including classic eating disorders, excessive

exercise, obsession with musculature or body parts, and use of steroids

and supplements. Popular media tend to portray the ideal male body in a

supermuscular form that is nearly unattainable without the use of

anabolic-androgenic steroids (Pope, Phillips, & Olivardia, 2002),

and this archetype of the male physique has created body image concerns

for some men that parallel those that many women have dealt with

historically. The effects of media images on how women perceive

themselves and their physical bodies have been well documented. Gay men,

however have recently been identified in research as being prone to even

greater levels of body image dissatisfaction when compared to their

heterosexual male and female counterparts (Drummond; Kaminski, Chapman,

Haynes, & Own, 2005; Martins, Tiggemann, & Kirkbride, 2007;

Yelland & Tiggemann, 2003). Male body dissatisfaction, which is

associated with having a stereotypical conception of masculine

attractiveness, has especially affected men who internalize the

media’s suggestion that men are more ideal and desirable if they

are muscular (Drummond, 2005; Frederick et al., 2007; Halkitis, Green,

& Wilton, 2004; Kaminski et al., 2005; Kimmel & Mahalik, 2005;

Pope et al.; Yelland & Tiggemann). As the media portray the average

desirable man as increasingly muscular, men of all sexualities are

likely to feel that their own bodies are inferior in comparison to

muscular ideals (Drummond; Leit, Pope, & Gray, 2001 ; Pope et al.).

Pope et al. describe such sources of media as men’s health

magazines, dating service advertisements, professional sports players,

pornography, and toy figurines.

Further, within the gay community exists a harsh competition to

embody the rigid standards of male beauty, a process that escalates the

tendency among gay men to believe that muscularity will grant social and

sexual desirability and power (Halkitis, 2001; Halkitis et al., 2004;

Martins, Tiggemann, & Kirkbride, 2007; Signorile, 1997; Wood, 2004).

Similarly, a number of researchers and historians have posited that the

dramatic onset of the “buff agenda” was, in part, an internal

reaction to the early AIDS epidemic and its physical manifestations,

namely, wasting and death, when muscles, tone, and youthfulness became

an ideal in strong contrast to the frailty associated with AIDS

(Drummond, 2005; Halkitis et al., 2004; Pope et al., 2002). Along these

lines, health care providers’ use of testosterone therapy

(prescribed steroids) to remedy the fatigue and physical deterioration

associated with HIV/AIDS and antiviral treatments has made it possible

for many gay men to achieve an exceedingly physically muscular

appearance (Halkitis et al., 2004).

Stereotypical conceptions of masculinity, such as the belief that

masculine men must have muscular bodies, may generate body

dissatisfaction in men who cannot achieve this muscular ideal (Halkitis,

2001 ; Pope et al., 2002). Since gay men are often pathologized as

effeminate and weak, men may strive for what is regarded as masculine

and powerful in an attempt to compensate for a degraded social status

(Kimmel & Mahalik, 2005; Wood, 2004). Strong, Singh, and Randall

(2000) found that gay men reported greater levels of childhood gender

non-conformity than heterosexual men, and further, that childhood gender

non-conformity was associated with adult body dissatisfaction,

regardless of sexual orientation. Many gay men were teased or criticized

during childhood for behaviors, thoughts, and physical characteristics

that were considered feminine, “weak,” or gender

non-conforming (Strong et al.; Wood). Along these lines, internalized

homophobia, which is also referred to as internalized homonegativity, is

the result of an internalization of anti-gay stigma experienced by gay

men living within a largely heterosexual society (Kimmel & Mahalik;

Meyer, 2003). Internalized homophobia may play a role in how gay men

perceive their bodies (Halkitis et al., 2004; Kimmel & Mahalik;

Williamson, 1999). Body image and masculinity are also inextricably tied

to gay men’s sexuality. “Sexual prowess” is perceived as

both an ideal and source of validation for gay men’s masculinity,

and has been associated with intentional sexual risk taking (Halkitis et

al., 2004).

Researchers have coined the term “buff agenda” to

describe the cultural zeitgeist of muscle (Halkitis et al., 2004) that

some gay men may ascribe to in an attempt to compensate for their

experiences of disempowerment and minority stress (Kimmel & Mahalik,

2005). In other words, some gay men may choose to propagate the

“buff agenda” by attempting to gain social and interpersonal

power through acquiring hyper masculine traits and muscular bodies

(Halkitis et al., 2004; Halkitis & Wilton, 1999; Wood, 2004).

Similarly, Drummond (2005) found that gay men tended to overwhelmingly

describe muscles as portraying “control.”

Unfortunately, to attain the culturally prized, yet virtually

unattainable, muscular physique, many gay men decide to turn to

excessive exercise, restrictive diets, steroids, and other harmful

behaviors to create the physiques that they desire. Physicians and other

clinicians likely “miss” diagnoses of men’s eating

disorders and body image issues because of the synergy between clinical

training paradigms that present eating disorders primarily as a female

concern, and an overarching cultural paradigm where men’s body

image issues are invisible or non-existent (Andersen, 1999). This is

particularly problematic for countless men whose body image issues are

subclinical by current diagnostic guidelines (Pope et al., 2002). Thus,

the purpose of our study is to investigate body image in a sample of

gay, bisexual and other men who have sex with men (MSM), as it relates

to demographic states, conceptions of masculinity, and feelings of

internalized homophobia.


Participants were recruited in New York City at the annual Lesbian,

Gay, Bisexual, and Transgender Pride Week in June of 2007.

Questionnaires were given to men who indicated that they were at least

18 years of age, either gay or bisexual, and willing to take part in a

research study examining gym behaviors and body image. Respondents were

advised that the survey would take approximately 10-15 minutes to

complete and that they would be compensated with a $5 gift card to a

popular coffee chain. After providing consent on the first page of the

questionnaire, respondents were asked to provide their demographic

information, including gender, age, sexual orientation, HIV status,

ethnicity, educational background, gym behaviors, and length of

residence in New York City. Because the present study aimed to limit

findings to gay and bisexual men in the New York City metropolitan area,

respondents who identified as heterosexual, female, or transgender were

excluded from the analyses. Completed surveys were entered into a

database and checked for accuracy for later analyses.


The survey consisted of five domains (see Table 1). All variables

were tested to ensure normal distribution.

Demographics. Participants were asked their gender, age,

race/ethnicity, length of time living in the New York City metropolitan

area, educational attainment, sexual orientation, and HIV status.

Gym behaviors. Participants were asked whether they currently had

an active gym membership, at what age they first began working out at a

gym, the number of days they worked out in the past week, how many days

they worked out in an average week over the past 6 months, and the

duration (in hours) of their average workout.

External motivations for working out. This newly developed eight

item measure examined men’s external motivations for maintaining a

physically-fit body. Using a 5-point Likert-type scale, participants

indicated agreement with statements measuring motivations, including

social comparison (for example, “I keep my body in shape because I

want my body to be noticed”), sexual prowess (for example, “I

keep my body in shape because I want to increase my chances of having

sex”), and health reasons (for example, “I keep my body in

shape because I want to maintain a healthy body”). The final scale,

consisting of eight items, was tested for normal distribution and loaded

on one factor with an explained variance of 50.91% with [alpha] = .86.

Meanings of masculinity. This 18 item scale measures men’s

conceptions of masculinity on a 5-point Likert scale using 3 subscales

(Halkitis et al., 2004). The first subscale measures Masculinity as

Physical Appearance ([alpha] = .82 with this sample; for example,

“Physical appearance does define masculinity”), the second

subscale measures Masculinity as Social Behavior ([alpha] = .74 with

this sample; for example, “I watch my behavior to make sure that I

act masculine around other gay men”), and the third subscale

measures Masculinity as Sexual Behavior ([alpha] = .84 with this sample;

for example, “Sexual performance is an important part of


Lesbian, Gay, and Bisexual Identity Scale. This 27 item scale

measures lesbian, gay, and bisexual identity, constructed as six

subscales (Mohr & Fassenger, 2000). Using a 7-point Likert scale,

the 6 subscales measure Internalized Homonegativity/ Binegativity (for

example, “Homosexual lifestyles are not as fulfilling as

heterosexual lifestyles”), Need for Privacy (for example, “I

prefer to keep my same-sex romantic relationships rather private”),

Need for Acceptance (for example, “I often wonder whether others

judge me for my sexual orientation”), Identity Confusion (for

example, “I’m not totally sure what my sexual orientation

is”), Difficult Process (e.g., “Admitting to myself that

I’m an LGB person has been a very painful process”), and

Superiority (for example, “Straight people have boring lives

compared with LGB people”). The scale also provides a second-order

factor of Negative Identity, measured by Homonegativity, Need for

Privacy, Need for Acceptance, and Difficult Process. The alphas ranged

from 0.87 to 0.53 with this sample.

Eating Attitudes Test–Eating Disorder. Based on the work of Garner

& Garfinkel (1979), this modified 17 item scale ([alpha] = .92)

measures attitudes toward food and eating, using symptoms that are

characteristic of eating disorders. Sample items include: “I find

myself preoccupied with food,” “I feel uncomfortable after

eating sweets,” and, “I am preoccupied with the thought of

having fat on my body.” Participants respond using a 5-point Likert

scale, ranging from “Always” to “Never.”

Body dissatisfaction. Based on the work of Garner, Olmstead and

Polivy (1983), this nine item scale, originally a subscale of the Eating

Disorder Inventory, measures body dissatisfaction according to specific

body parts. This scale was modified to be more specific to men; sample

items include: “I think my pecs are just the fight size” and

“I like the size of my cock.” Principal component factor

analyses yielded one factor explaining 50.3% of the variance after

removing 1 item (“I think my abs are not developed enough”),

and with a final a = .80.

Sample Characteristics

In total, 219 eligible respondents completed surveys, and the mean

age of respondents was 33 years (SD = 10.67, Median = 31). In regard to

sexual orientation, 90.9% (n = 199) identified as gay, homosexual, or

queer, 6.8% (n = 15) identified as bisexual, and 2.3% (n = 5) were

unsure of their sexual orientation. The majority of the sample (88.6%, n

= 194) self-reported an HIV negative status, 7.8% (n = 17) reported an

HIV-positive status, and 3.2% (n = 7) were unsure of their HIV status.

Age was unrelated to sexual orientation. However, age was related to HIV

status as HIV-positive men tended to be older (M = 41.94) than both

HIV-negative men (M = 31.89) and HIV-status unsure men (M = 31.86) (F =

7.34, p < .001). In terms of race/ethnicity, 64% (n = 140) of the

sample identified as White, 8.2% (n = 18) identified as Black/African

American, 9.1% (n = 20) identified as Asian/Pacific Islander, 18.3% (n =

40) identified as Latino, and less than 1 percent (n = 1) identified as

other. Age, HIV status, and sexual orientation were unrelated to


Our sample was highly educated, with 30.1% (n = 66) of the men

having a master’s, doctorate, or other professional degree. Also,

37% (n = 81) of the men had a bachelor’s degree, 22.8% (n = 50)

attended some college or had an associate’s degree, and 7.3% (n =

16) held a high school diploma or GED. Only 2.3% (n = 5) did not

complete high school.

Gym behaviors. Within the sample, 58.9% (n = 129) of the men

reported having an active gym membership. These men reported working out

approximately 3 days per week (SD = 1.74, Median = 3) in the previous

week, and an average of 3 workouts per week in the past 6 months (SD =

1.53, Median = 3). On the days that men worked out, their regimens

averaged 1.44 hours (SD = 0.68, Median = 1.25) in duration. Men reported

beginning to work out at a gym at 25 years-old (SD = 9.0, Median = 24).

Men with an active gym membership tended to be older (M = 34.36) versus

those without an active membership (M = 30.33) (F = 7.65, p

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