There are significant health disparities in eating and body image disturbances, as well as in eating disorders, in the LGBTQ+ community relative to their heterosexual and cisgender counterparts. As such, the EMBRACED Lab advances our understanding of how various forms of stress, including sexual minority, gender minority, and intraminority stress, explain disparities in the development and maintenance of eating and body image disturbances and eating disorders in the LGBTQ+ community (Barnhart et al., 2022a; Barnhart et al., 2023a; Barnhart et al., 2024a; Hong, Tang, Barnhart, et al., 2023). A primary avenue of this research strives to establish an empirical foundation for the inclusion of multicultural stressors in eating disorders evidence-based practice (e.g., CBT, ACT) with the LGBTQ+ community.

To this end, the EMBRACED Lab expands existing evidence on these stress models by speaking to the temporal nature of existing models in relation to eating and body image disturbances and eating disorders in the LGBTQ+ community. We are currently pursuing longitudinal data collection to test the temporal associations between sociocultural (e.g., appearance pressures from social contexts), sexual minority stress, and intraminority stress models and thinness- and muscularity-oriented eating and body image disturbances in a diverse, community sample of sexual minority men from the United States. This project builds on majority cross-sectional research to speak to the impact of stigma from outside and within the community on the development and/or maintenance of eating and body image disturbances in sexual minority men with other minoritized identities (e.g., Black gay men; Queer men living in larger bodies).

Sample Publications:

• Barnhart, W. R., Cui, S., Cui, T., Hong, D., & He, J. (2023a). Transgender congruence, body appreciation, body dissatisfaction, and disordered eating in Chinese transgender adults. International Journal of Eating   Disorders, 56(6), 1125-1134.

• Barnhart, W. R., Sun, H., Lin, Z., Lu, C., Han, X., & He, J. (2022a). Integrating the tripartite influence, minority stress, and social comparison theories to explain body image and disordered eating in Chinese sexual minority men and women. Body Image, 43, 95-106.

• Barnhart, W. R., Xiao, Y., Li, Y., Gaggiano, C., Jiang, Z., Wu, S., Cao, H., & He, J. (2024a). Beyond age, BMI, gender identity, and gender minority stress, weight bias internalization is uniquely associated with more eating and body image disturbances and poor physical and mental health in Chinese gender-diverse adults. International Journal of Eating Disorders, 1-14.

• ​​Hong, D., Tang, C., Barnhart, W. R., Cui, S., & He, J. (2023). Testing the associations between internalized cisgenderism, self-objectification, body shame, and mental health correlates in the framework of the pantheoretical model of dehumanization: A study in Chinese transgender adults. Body Image, 46, 62-72.

The EMBRACED Lab also identifies high-risk subgroups for eating and body image disturbances and eating disorders within the LGBTQ+ community, which is not a monolithic group. Combining sexual and gender minorities into a singular group assumes all members of the LGBTQ+ community have the same experience of eating and body image disturbances and eating disorders. Informed by an intersectionality framework, we have identified significant heterogeneity in the experience of eating and body image disturbances in the LGBTQ+ community (Barnhart et al., under review). We have also identified the role of self-labeling specific to LGBTQ+ individuals (e.g., sexual self-labeling) on disparities in eating and body image disturbances within the community (Barnhart et al., 2024).

This preliminary research underscores significant heterogeneity in eating and body image disturbances among sexual and gender minorities which has theoretical and practice implications. On the side of theory, explanations for eating and body image disturbances in the LGBTQ+ community should be responsive to such nuances to describe these symptoms more accurately. On the side of practice, treatments may need to target the specific needs and attributes of these subgroups compared to the current “one size fits all approach.” Both implications take steps in the direction of reducing health disparities in eating and body image disturbances and eating disorders in the LGBTQ+ community.

Sample Publications:

• Barnhart, W. R., Han, J., Zhang, Y., Luo, W., Li, Y., & He, J. (2024). Differences in thinness- and muscularity-oriented eating and body image disturbances and psychosocial well-being in Chinese sexual minority men reporting top, bottom, and versatile sexual self-labels. Archives of Sexual Behavior, 1-19.

• Barnhart, W. R., Jordan, A. K., Angoff, H. D., Kalantzis, M. A., Johnson, A. C., Dial, L. A., & McDevitt, A. N. (Under Review). Adopting an intersectional approach to eating and body image disturbances in sexual and gender minority adults from the United States: A latent class analysis. Psychology of Sexual Orientation and Gender Diversity.

Finally, the EMBRACED Lab helps establish a global understanding of eating disorders through cross-disciplinary and cross-cultural partnerships, a multidisciplinary view of eating disorders that incorporates different cultural, geographical, and geopolitical contexts as information relevant to the assessment, etiology, and intervention of eating disorders in all people.

Central to gaining a global understanding of eating disorders, including representation of identities and lived experiences outside of “SWAG” and “WEIRD” populations, is scale adaptation of self-report measures in non-Western cultural contexts. In several demonstrations of this, we have adapted self-report scales for the assessment of drive for muscularity in women (Tang, Barnhart, et al., 2022), body talk in women and men (He, Lu, Barnhart, et al., 2023), and appearance schemas (e.g., investment in one’s body image) in women and men (Chen, Wang, Barnhart, et al., 2024) from China. Furthermore, we have examined the psychometric properties of these adapted measures, as well as existing measures that have already been adapted to Chinese (Mandarin) such as muscularity-oriented disordered eating in women (He, Cui, Barnhart, et al., 2023a), functionality appreciation (i.e., a facet of positive body image) in women and men (He, Cui, Barnhart, et al., 2023b), and intuitive eating (i.e., an adaptive eating behavior) in women and men (Ji, Sun, Barnhart, et al., 2024). Furthering this line of research, we have created a new construct, muscularity bias internalization, a counterpart of weight bias internalization reflecting the degree of endorsement of muscularity-based stereotypes and negative, self-directed evaluations of one’s muscularity in Chinese men and women (He et al., 2022; He, Cui, Barnhart, et al., 2023c).

In addition to quantitative assessment, the EMBRACED Lab is also interested in better understanding the etiology and correlates of eating disorders outside of the Western cultural context. In support of these interests, we have extended well-supported explanations of eating disorders— of which the evidence base is largely confined to Western cultural contexts— to Chinese heterosexuals (Barnhart, et al., 2022b), sexual and gender minorities (Barnhart, et al., 2022a; Barnhart et al., 2023a), and adolescent (Barnhart et al., 2023; Barnhart, et al., 2023b), emerging adult (Liang, Barnhart, et al., 2023), general adult (He, Barnhart, et al., 2023), and older-aged (Barnhart, et al., 2023c) populations to provide theoretical and empirical backdrops for future research into treatments that are sensitive to diverse, non-Western populations across the lifespan.

Sample Publications:

• Barnhart, W. R., Cui, T., Cui, S., Ren, Y., Ji, F., & He, J. (2023). Exploring the prospective relationships between food addiction symptoms, weight bias internalization, and psychological distress in Chinese adolescents. International Journal of Eating Disorders, 1-11.

• Barnhart, W. R., Cui, S., Cui, T., & He, J. (2023b). Relationships between weight bias internalization and biopsychosocial health outcomes: A prospective study in Chinese adolescents. International Journal of   Eating Disorders, 56(5), 1021-2033.

• Barnhart, W. R., Cui, T., Zhang, H., Cui, S., Zhao, Y., Lu, Y., & He, J. (2023c). Examining an integrated sociocultural and objectification model of thinness- and muscularity-oriented disordered eating in older Chinese men and women. International Journal of Eating Disorders, 56(10), 1875-1886.

• Barnhart, W. R., Cui, T., Cui, S., Han, X., Lu, C., & He, J. (2022b). Examining appearance pressures, thinness and muscularity internalizations, and social comparisons as correlates of drive for muscularity and thinness- oriented disordered eating in Chinese heterosexual men and women: Testing an integrated model. Body Image, 43, 429-439.

• Chen, Y., Wang, S., Barnhart, W. R., Song, J., Cui, S., Ji, F., & He, J. (2024). Translation and validation of a Chinese version of the Appearance Schemas Inventory-Revised in Chinese adults. Body Image, 48, 101671.

• He, J., Cui, T., Barnhart, W. R., Cui, S., Xu, Y, Compte, E. J., Murray, S. B., & Nagata, J. M. (2023a). Validation of the Muscularity-Oriented Eating Test in adult women in China. International Journal of Eating Disorders, 56(6), 1207-1218.

• He, J., Cui, T., Barnhart, W. R., & Chen, G. (2023b). The Chinese version of the Functionality Appreciation   Scale: Psychometric properties and measurement invariance across gender and age. Journal of Eating Disorders, 11, 99.

• He, J., Cui, S., Barnhart, W. R., Xu, Y., Shen, S., Lin, J., & Nagata, J. M. (2023c). Validation of the Muscularity Bias Internalization Scale in Chinese women. Body Image, 47, 101627.

• He, J., Lu, Y., Barnhart, W. R., Tang, C., Zhang, H., Zhao, Y., & Lin, L. (2023). Translation and validation of a Chinese version of the Body Talk Scale for women and men. Journal of Eating Disorders, 11, 153.

• ​​He, J., Tang, C., Song, J., Cui, T., Barnhart, W. R., Cui, S., Ren, Y., & Nagata, J. M. (2022). The  Muscularity Bias Internalization Scale: Development and initial validation in Chinese adult men. Body Image, 43, 326-336.

• Ji, F., Sun, H., Barnhart, W.R., Cui, T., Cui, S., Zhang, J., & He, J. (2024). Psychometric network analysis of the Intuitive Eating Scale-2 in Chinese general adults. Journal of Clinical Psychology, 80, 1098-1114.

• Tang, C., Barnhart, W. R., Zhang, B., & He, J. (2022). Psychometric properties of the Chinese version of the Female Muscularity Scale among Chinese young women. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 27(8), 3187–3196.