Lesbians' weight debate: research shows that lesbians may face a greater risk of heart disease. But are the findings skewed against larger women?

For Shira Stone, like many lesbians, sexuality and size oppression are tightly linked. "My parents thought I became a lesbian because I wouldn't be able to find a man," says the longtime "fat acceptance" activist and board member of the National Organization for Lesbians of Size.

Stone constantly fights the oppressive attitudes she sees society directing at overweight people. Although she has noticed a positive shift in people's perceptions of larger women--including those within the lesbian population--she says, "it's nowhere near what I'd like to see."

Fighting weight gain has always been a complex issue for lesbians, who are less likely to be preoccupied with weight and body image than straight women, according to researchers. "Lesbians don't subscribe to the Playboy theory of how women need to look," says Kate O'Hanlan, a gynecologic oncologist and lesbian-health advocate.

Yet some doctors are worried that the push for size acceptance has eclipsed very real dangers that are facing overweight lesbians. Last September the journal Women's Health Issues published findings by a team of researchers at the University of California, San Francisco, that suggest lesbians may face a greater chance of heart disease compared to women overall. The 324 lesbians they studied, all living in California, had significantly higher body mass index, waist circumference, and waist-to-hip ratios, malting them prime targets for heart disease, high blood pressure, and severe chest pain, the researchers assert. Statistics show that heart disease kills half of all women, but some experts say the rate may be as high as 60% for lesbians. The University of California researchers also found that lesbians report more weight fluctuation.

Most controversial, however, was the researchers' suggestion that lesbians' attitudes about weight may contribute to the risk. The coming-out process is partly responsible, says clinical psychologist Debby Burgard. "Our bodies have already been perceived as outlawed," says Burgard, coauthor of Great Shape: The First Fitness Guide for Large Women. "We have some pride in defining for ourselves what we find attractive."

Kate Kendell, executive director of the National Center for Lesbian Rights, agrees that there is a complex overlap of the issues of size acceptance and health among lesbians: "The last thing I want is to erase the enormous progress around self-esteem and body image that fat-activists have made. I hope that acknowledgment can coexist with a dialogue around health and obesity that permits a still wide range of body types to live happily and healthfully."

Research shows that though lesbians tend to have a higher body mass index than straight women, they often don't consider themselves overweight, says San Francisco-based cardiologist Jane Mallet. Because women (and men) who "carry a lot of weight in the midsection have higher incidences of heart disease, lesbians may be at a higher risk," she says.

Some say that additional lesbian-specific research is needed. "Correlation is simply not causation," says Marilyn Wann, author of Fat? So! "Just because a study finds data correlating higher weights with some health problem, that doesn't mean that being fat caused that health problem."

Burgard agrees: "Since body mass index is linked to socioeconomic status, access to health care, ethnicity, level of physical activity, weight cycling, and stress--including stigma--there are an awful lot of confounding factors here which are rarely teased apart."

For his book Big Fat Lies, University of Virginia exercise physiologist Glenn Gaesser examined a wide spectrum of mainstream research. He concluded that "body weight--and even body fat, for that matter--do not tell us nearly as much about our health as lifestyle factors, such as exercise and the foods we eat." Contrary to commonly accepted medical beliefs, Gaesser argues that "the obesity-heart disease link is just not well-supported by the scientific and medical literature."

As the debate continues, most agree that regular exercise and a healthy diet are essential for women at any weight. "The goal is not to fit into a bikini--it's to reduce the elevated risk of cancers, heart attack, stroke, and blood clots," says O'Hanlan. "Even if weight or body mass index stays the same, cancer risk and heart attack risk diminish with healthy eating and exercise habits."

In order to promote health among lesbians, Burgard stresses the need for a message that's positive rather than punitive. She urges a "public-health message about getting outside to play, eating your fruits and vegetables, and treating your body as an essential partner in health, without vilifying fat."

RELATED ARTICLE: Mautner's mettle.

A grassroots health organization has taken up the challenge of advocating for lesbian health amid declining government support.

Government recognition of lesbian-specific health issues has declined since the 2000 elections, says Kathleen DeBold (pictured above), executive director for the Washington, D.C.-based Mautner Project for Lesbian Health. And her organization, an advocacy group launched in 1990, has had to take up the slack--changing its name from the Mautner Project for Lesbians with Cancer and expanding its focus.

"[In the 1990s] we had moved to a point where we had started developing some partnerships with the government, and now we're back in the place where we have to take care of our own again," DeBold says, noting that references to gays and lesbians have been omitted from several recent federal health reports. "The [National Institutes of Health] is under attack for doing valid research that includes LGBT people. There are people with a definite right-wing agenda who are having an effect."

The result is little government help for Mautner, but that hasn't stopped them from doing their work. Despite the absence of a federal grant, in February the group began "The Heart Truth for Lesbians," a national heart health awareness campaign targeted at lesbians. "Heart disease is the number 1 killer of women in the United States, and lesbians may be at even greater risk than heterosexual women," DeBold says. Common causes of heart disease among all women--such as obesity and smoking--are even more prevalent in the lesbian community, she says.

Mautner then took rite initiative in registering as a resource in U.S. Health and Human Services' national campaign for women, the Heart Truth. "The Heart Truth campaign was not including us, so we needed to do it on our own," DeBold says.

Mautner also recently launched the first-ever national health education program for African-American lesbians. Funded in pale by the Centers for Disease Control and Prevention, the Spirit Health Education Circle (SHE-Circle) is a comprehensive, holistic educational program to promote wellness of mind, body, and spirit, says Mautner deputy director Cheryl Pearson-Fields.

"For black lesbians, the confluence of race, gender, and sexual orientation can create powerful barriers to accessing quality health care and attaining a healthy lifestyle," says Pearson-Fields. "By coming together in a community, SHE-Circle participants will share information, resources, and the mutual support necessary to break down these barriers and make healthier lifestyle choices."

With the help of other national and community-based health organizations, Mautner is developing a wide curriculum for all lesbians, including sessions on breast, cervical, and colorectal cancer screening; smoking cessation; nutrition and exercise; and coming out to your physician.

--Jessica DuLong and John Caldwell