A mixed methods approach to understanding obesity risk among sexual minority women - Modified Project Summary/Abstract Section Over 70% of Americans have a body mass index (BMI) classified as overweight or obesity. Weight-related stressors, such as internalized negative attitudes, differential treatment in healthcare and social settings, and expectations of mistreatment in daily settings attributed to one’s weight, are more frequently encountered by certain groups and those with higher BMIs, and can influence behavioral health (e.g., dietary intake, physical activity, disordered eating behaviors), thereby increasing disease risk. Sexual minority women (SMW; i.e., non- heterosexual women) are up to twice as likely to live in larger bodies and experience these internalized, interpersonal, and contextual weight-related stressors compared to men and heterosexual women. Guided by the NIMHD research framework, which emphasizes influences across interpersonal, environmental, and contextual levels, this study examines how exposure to these experiences may increase risk for adverse health behaviors among some populations. Greater knowledge of these factors, particularly for at-risk groups like SMW, can clarify broader mechanisms influencing obesity risk and enhance public health strategies for population-based health. Research on obesity or on primary behavioral drivers (i.e., diet, unhealthy weight-control behaviors, physical inactivity) among women has given less attention to the aforementioned weight-related and contextual stressors, and little consideration of belonging to multiple disparity populations, often grouping individuals analytically that obscure important differences. Among the research on weight-related stress experiences (e.g., internalized negative attitudes, anticipated mistreatment, interpersonal mistreatment, and exposure to negative weight-related messaging) in relation to energy-balance behaviors or their health correlates (e.g., disordered eating), there is an overreliance on cross-sectional, retrospective self-report, or semi-annual longitudinal designs. These studies provide knowledge foundation, but are limited in the data they can provide. Experience sampling methods (ESM) can advance our understanding by identifying temporally proximal risk factors and disentangling risk factors from correlates. This exploratory sequential mixed methods study aims to delineate mechanisms that may be associated with behavioral risk among women with non-heterosexual orientation and from racial/ethnic minority groups to inform a more comprehensive understanding of population-level variability in weight-related health. Aim 1 utilizes a qualitative life history approach to identify preliminary barriers and facilitators to health cognitions and behaviors. Aim 2 uses ESM to test the model from Aim 1 and examine relationships between these weight-related stress experiences and real-time changes in behavior among SMW. These aims support my training plan with expert mentors and training in: multi-level contextual influences on behavioral health (Training Aim 1); mixed methods data collection and analysis (Training Aim 2); ESM and advanced statistics (Training Aim 3); and career development (Training Aim 4). Results will inform a multi-level model of body size-related experiences and day-to-day social and environmental conditions among SMW to clarify generalizable mechanisms influencing weight-related health across the population.
