Brief Single-Session Body Neutrality Program for LGBTQ+ Adults in Central Alabama

Eating disorders (EDs) kill one person in the United States every 52 minutes, cost over $65 billion annually ($966 million annually in Alabama (AL) alone), have numerous barriers to treatment access, and are notoriously difficult to treat. Thus, scalable interventions that can target high-risk groups prior to ED onset are critical to reducing both the public health burden and number of people suffering from EDs. Researchers have found that LGBTQ+ adults are at a significantly increased risk for EDs. Further, LGBTQ+ adults who live in rural areas with high levels of anti-LGBTQ+ structural stigma and limited access to LGBTQ+-specific resources may have compounded risk for ED development and reduced access to care. Despite this glaring inequity, few scalable programs exist to prevent EDs in LGBTQ+ populations. Thus, the present study proposes a pilot digital single-session intervention to reduce ED risk for LGBTQ+ adults in a high-stigma, low-resource region of AL.

LGBTQ+ people represent a high-risk group for EDs due to minority stressors. LGBTQ+ individuals have a 2-3 fold increased risk for developing an ED compared to their cisgender heterosexual peers. LGBTQ+ young adults also exhibit higher rates of overall ED symptoms, binge eating, dieting, vomiting, laxative, or diet pill use, muscle-building supplement use, and fasting compared to their non-LGBTQ+ peers. Researchers, using minority stress theory, have identified that increased risk is due, in part, to chronic stressors (e.g., prejudice, victimization, discrimination, internalized homophobia and/or transphobia, sexual identity concealment) due to being part of a marginalized group. These stressors are exacerbated for LGBTQ+ people of Color and those living in poverty. Additionally, LGBTQ+ individuals living in rural areas have increased vulnerability for mental health concerns and EDs. LGBTQ+ adults living in rural areas that have high prevalence of anti-LGBTQ+ structural stigma (e.g., discriminatory laws, policies, and community attitudes that promote unequal treatment) and low access to LGBTQ+-specific coping resources (e.g., LGBTQ+ centers, specialized healthcare) have increased risk for mental health problems compared to their urban peers. Further, individuals living in rural areas of AL, especially rural people of Color, often experience high degrees of medical mistrust due to lack of culturally competent care and history of medical abuse, which further increases disparities in broader health care access and utilization. Given the commonality of EDs in rural areas, high LGBTQ-stigma, and limited resources, LGBTQ+ adults living in rural regions of AL may represent a particularly vulnerable and underserved group for EDs.

Despite consistent research supporting increased ED risk among LGBTQ+ individuals, no ED prevention efforts have targeted minority stressors in rural LGBTQ+ adults, who need these interventions the most. Brief digital single-session intervention that incorporates psychoeducation about minority stress and body neutrality may be efficacious in reducing ED risk and improve positive body image among LGBTQ+ adults in rural areas. A recent randomized controlled trial developed a similar single-session intervention among LGBTQ+ adolescents (13-17 years old) in the United States. This Project Body Neutrality study indicated immediate positive changes in participants' body satisfaction, functionality appreciation, hopelessness, and perceived agency. This study supports the potential of online single-session intervention in addressing LGBTQ+ populations' eating pathology and body image concerns. Importantly, research suggests that the use of community-engaged research methodologies, where members of the community are actively engaged in research study design, development, and implementation, are critical for addressing the needs of minoritized communities and mitigating medical mistrust. Indeed, community-engaged research is a common approach to help reduce health disparities in diverse LGBTQ+ populations and our team has successfully adapted multi-session body image interventions for LGBTQ+ populations (e.g., the PRIDE Body Project) using a community-engaged approach in both rural and urban settings.

The present project evaluates and adapts Project Body Neutrality for LGBTQ+ adults in a rural high-stigma, low-resource region. The proposed study will recruit N = 40 LGBTQ+ adults in central AL to complete our program and pre-intervention and post-intervention assessments. The investigators hypothesize that this intervention program will effectively address LGBTQ+ adults' eating pathology, as well as their experience of minority stress, and improve their positive body image, especially their functionality appreciation.

Inclusion criteria

• At least 18 years old,
• Identify as LGBTQ+,
• Currently living in one of the following AL counties: Lee, Dallas, Lowndes, Autauga, Coosa, Elmore, Tallapoosa, Macon, or Russell
• Have internet access (either via computer/tablet, mobile phone, or community center [e.g., library])

Exclusion criteria

• Being less than 18 years old,
• Identifying as cisgender and heterosexual,
• Not living in central AL,
• Not having internet access.