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. …