Beyond the Numbers: Diabetes Risk in the LGBTQ Population

We’ve heard it before. Members of the LGBTQ population are at higher risk of poor health outcomes. But why? Why does my gender identity or sexual orientation affect my risk of developing chronic diseases—AKA, a condition that lasts a year or longer—at some point in my life? 

The answers are, of course, underreported in research. Data collection from LGBTQ community members is not yet systematic, is prone to measurement error, and has historically been omitted from mainstream science. This means that researchers weren’t always including us in research, may not be asking the right questions, or don’t yet have a consistent way to track our health data. 

That said, let’s take a look at what we do know about one chronic disease, type 2 diabetes. According to a 2021 study, transfeminine individuals are at a 40 percent greater risk of developing diabetes than their cisgender counterparts. A 2018 study showed lesbian and bisexual women have a higher prevalence and risk of diabetes compared with straight, cisgender women. Also, gay and bisexual men and transgender women are disproportionately living with HIV, which increases risk of developing type 2 diabetes, and more lesbians than heterosexual woman are living with Polycystic Ovarian Syndrome (PCOS), a risk factor for type 2 diabetes.

What contributes to these inequities?

• Healthcare and overall discrimination – In routine healthcare visits, up to 39 percent of transgender people face harassment and up to 60% of queer folks report a “less than ideal” experience.
• Healthcare and insurance access – Difficulty obtaining medical care and health insurance may be influenced by family estrangement, houselessness, lower employment rates, etc.
• Food and nutrition insecurity (or lack of access to nutritious food)—According to a 2016 report from The Williams Institute, in 2016, 27 percent of queer folks experienced food insecurity versus 17 percent of straight, cis folks. These social factors increase chronic disease risk. 
• Mental illness and trauma – LGBTQ people suffer mental illnesses such as depression at a rate two to four times higher than cis, straight counterparts, and are at higher risk of experiencing adverse childhood events. Depression increases the risk of diabetes (and vice versa), and according to a 2018 study, experiencing childhood trauma increases the risk of developing diabetes.

We can’t talk about discrimination without discussing the compounding ‘isms’ that increase the cumulative burden from chronic stress. Queer Black, Indigenous, and other people of color face the aggregate traumas of systemic racism and are at even higher risk of type 2 diabetes than white individuals. Queer folks in larger bodies face weight discrimination—which, according to one 2017 study—increases risk of disease and death by up to 60 percent regardless of body mass index (think: that weight-centric tool that doesn’t capture the whole picture). More research is needed to fully understand the impacts of all kinds of discrimination on health.

In addition to experiencing increased risk of type 2 diabetes, LGBTQ people may find that some diabetes prevention and intervention programs are not inclusive. Programs follow strict standards that may include white-centered, weight-centric, and heteronormative curriculum. 

Here’s where the good news comes in—cue “OFM Journey to Wellness,” the LGBTQ health diabetes prevention class series led by yours truly! In partnership with OFM, Tri-County Health Department’s Diabetes Education Program brings this program at no cost to you. We welcome all folks to join, no matter your individual health goals. We incorporate:

• Warm and welcoming peer support 
• Health At Every Size approach and weight-neutral language
• Inclusive and joyful movement (physical activity is not a punishment, nor does it have to look like conventional “exercise”)
• Adding nutrient-dense foods into our day (we say no to diet culture)
• Attention to mental health and trauma-informed care (mental health is physical health)

In addition to meeting your health goals, we discuss topics covered in this article more in depth. Twenty-six interactive sessions are spread out throughout the year, with one class per month held at OFM Headquarters and the rest via Zoom.* There’s still time to enroll at www.tchd.org/JourneytoWellness – the deadline is February 16th!

My own increased risk of developing type 2 diabetes – because of my family history of diabetes, sexual orientation, and growing up nutrition insecure – is what led me to become a registered dietitian nutritionist. My passion for deconstructing the social barriers to a just healthcare system is what brought me to this space, and I can’t wait to share it with all of you. 

The bottom line: It is not the fault of the oppressed that systems and phobias increase poor health outcomes – AND, we can take matters into our own hands. With access to an inclusive wellness space, we can become health champions for ourselves and our communities. 

Zoom training and/or support for accessing discounted iPads, laptops, or desktop computers available upon request.