Undressing the Body Image of “Bottoms”: Is BMI associated with high-risk sexual behavior?

Steven

There I was, taking my first stroll down Halsted Street in Chicago’s famous “gayborhood,” “Boystown,” recently out of the closet and with a renewed sense of self. I had just moved from socially conservative Bible Belt country to attend undergrad, and, needless to say, I had done my research on Chicago’s gay community. At eighteen years young, I wasn’t old enough to go anywhere in Boystown, so there I stood awkwardly in a Midwestern gay mecca, still wearing my “straight” clothes from high school, in a much more fashion-forward neighborhood. I was greeted by Mr. Billboard, sitting there shirtless on the 10×8 poster, with his perfect smile, sculpted chest, quasi-flexed biceps with one hand in his speedo, positioned so you couldn’t miss his eight pack abs and exposing a teeny tiny bit of kempt pubic hair that was playing peek-a-boo with my soul. Got the picture?… Two things happened that day: a) I had my Dorothy moment – “I’m not in [South Carolina] anymore” and b) I had entered gay culture, where I was convinced image was everything.

Ok sure. The reality of it all is that there’s more to gay culture than what’s hot and what’s not, but it’s no secret that the gay market is smart enough to know how to capitalize on the idea that “sex sells.” Whether through billboard ads, magazines, TV, pornography, pride events, and now even health campaigns geared toward gay men, we have been beaten over the head with the idea that “sexy” takes the form of “super muscle jock” or “pretty twink boy.” It almost seems like the new standard in gay marketing is to slap one or two as-naked-as-legally-possible hot men onto your ad and voilà, you’ve created a milkshake that brings the boys to the yard. Don’t get me wrong, this blog post is not meant to be read as a rant, just as my observations, as superficial as they might seem.

The point of my long introduction is that the ideas of “body” and “body image” continue to be reinforced in our minds even when we don’t know it. As a generation of emerging technologies, our dating and hook-up websites have been flooded with profile pictures leaving little to no imagination for the interested and horny viewer, emphasizing one’s best features (to say the least).

So imagine this scenario. Looking into the mirror as you’re getting ready to go out to a bar, a club, a party – you decide. You’ve done your getting-ready routine. Your hair looks great, you’ve brushed your teeth, and you’re a single guy ready for a night out on the town. As far as your looks are concerned, you’d “do” you. So you get to your destination, you dance, you drink, and you socialize. A hot guy with a nice body (according to your standards, of course) approaches you and you take him home. You take your clothes off, you guys have sex, and the rest is history.

A simple story, but hold on, let’s rewind because we all know, a lot can happen between taking a guy home and having sex… in our heads at least. Once you got home, it was just a matter of time before sex would happen, but a number of things can enter (or maybe not enter) your mind. Do the insecurities rush to your brain influencing your decision-making?

‘If he doesn’t think I’m sexy with my clothes off, is that good-bye to sex?’ ‘Should I turn the lights off?’ ‘If I ask him to use a condom, will it turn him off?’ ‘Does he have an STI? Do I ask?’ ‘He’s too hot to have an STI.’

To begin looking at this type of experience, my colleagues and I looked at the data from one of SexLab’s study called VLove, a web-survey examining health behaviors among young gay and bisexual men (ages 18-24) who use the Internet to find partners. We proposed two questions, “Does BMI* influence sexual risk-taking behaviors among young, receptive gay and bisexual men?” and “Does body image affect the relationship between the two?” Interestingly, much research has been done on the first question, but the results of the literature have been inconsistent and, therefore, inconclusive. Researchers have found:

a) A negative relationship – low BMI* gay men were at higher risk for unprotected sex (Kraft et al., 2006)
b) A positive relationship – high BMI* gay men were at higher risk for unprotected sex (Moskowitz & Seal, 2009)
c) A U-shaped relationship – gay men with low and high BMI* scores were at higher risk than those in the middle (Allensworth-Davies et al., 2008), and,
d) A non-existent relationship – All BMI categories were at equal risk (Guadamuz et al., 2012).

Additionally, in regard to body image, previous researchers have suggested that young men are more likely to engage in sexual risk behaviors if they are dissatisfied with their bodies, stemming from not valuing one’s self very much.

The point of our study wasn’t to find out who was right and who was wrong, but to see if our sample yielded similar results by taking a different approach. To contribute to the literature, my colleagues and I decided to look at individuals who engage in the receptive role (i.e., “bottoms”) because they are at greater risk of acquiring an STI. We looked to see if they reported differences in unprotected sexual encounters compared to the number of partners with whom they had unprotected sex. We also examined body image through three domains adapted from a Body Image Scale by Mendelson & colleagues (2001):

a) Body Attribution (how we perceive others opinions of our bodies)
b) Body Dissatisfaction (how much we are dissatisfied with our bodies) and
c) Body Pride (how happy we are with our bodies).

We found a number of interesting results (Meanley, Hickok, Johns, Pingel & Bauermeister, in press). We found that among the guys in our study, BMI was independently associated with unprotected sex among bottoms; that is, guys with higher BMI scores were more likely to engage in sexual risk behaviors than middle to low BMI scores, both in number of unprotected occasions as well as number of partners.

Regarding body image, we found that the men in our study were no more or less dissatisfied with their bodies across BMI categories, suggesting body dissatisfaction had little to do with sexual risk-taking. However, body pride and body attribution were associated with increased odds of sexual risk – that is, guys who felt like others believed they had a hot body and guys who had higher body pride had riskier sex. Our findings supported previous research that noted pressures to conform to a body ideal (like the muscle jock or the pretty twink boy) might have an effect on gay men’s self-concept and, in turn, influence their sexual risk-taking behaviors. More specifically, men may believe that ideal-bodied men are healthier and less likely to have an STI, so when they hook up with a guy with a “perfect” body, they may think they have less risk of getting an STI from him than if he weren’t so hot. Lastly, higher scores of body pride may increase one’s confidence to look for multiple partners, increasing their opportunities to engage in unprotected sex.

So, where do we go from here? In public health, I believe the word we like to use is “empowerment.” Telling bottoms regardless of their BMI or body image to not care about what others think of their body or telling them not to be proud of their bodies in order to prevent them from engaging in sexual risk would be incredibly simplistic, impossible and, well, inappropriate on my part as an aspiring public health professional. As gay men, we are living in an “image-driven” culture, and though some of us are more prideful about our bodies than others, our data shows that most of us feel like there’s some part of our bodies that we wish we could improve.

Though it may be hard to believe that sexy muscle jock and pretty twink boy may be dissatisfied with some part(s) of their bodies, they have their own insecurities, too, maybe just moments before you’re about to get your freak on! Those few moments of awkwardness asking him to wrap it up probably beats the agony of waiting to hear the results of an HIV or STI test weeks after a few moments of unprotected sex.

Confidence and pride in one’s body is clearly a good thing to have. I would argue that a practical strategy might be finding ways to frame safer sex as a way of having pride for your body. It doesn’t matter if you have the body of an Adonis or a body with a few extra pounds – you only get one body per lifetime. You can still have an exciting and satisfying sex life, but also protect your bodily territory. We may one day look like the sexy muscle jock or pretty twink boy if we want to, but being healthy is more than just looking healthy. Casual sex is fine and dandy until someone’s “junk” gets hurt. I mean, am I right or am I right?

* BMI stands for body mass index. It is a standardized measure of a person’s body fat, calculated from their height and weight. Someone with a higher BMI is considered more overweight than someone with a lower BMI. However, there are criticisms of this measure; because BMI is calculated only with height and weight, someone with a lot of muscle mass and a low percentage of body fat may be considered overweight or obese.

References

Allensworth-Davies, D., Welles, S., Hellerstedt, W., & Ross, M. (2008). Body image, body satisfaction, and unsafe anal intercourse among men who have sex with men. Journal of Sex Research, 45(1), 49-56.

Centers for Disease Control and Prevention. (2011). Body Mass Index. Retrieved February 18, 2013 at http://www.cdc.gov/healthyweight/assessing/bmi/.

Guadamuz, T., Lim, S., Marshal, M., Friedman, M., Stall, R., & Silvestre, A. (2012). Sexual, behavioral, and quality of life characteristics of healthy weight, overweight, and obese gay and bisexual men: Findings from a prospective cohort study. Archives of Sexual Behavior, 41(2), 385-389.

Kraft, C., Robinson, B., Nordstrom, D., Bockting, W., & Rosser, B. (2006). Obesity, body image, and unsafe sex in men who have sex with men. Archives of Sexual Behavior, 35, 587-595.

Mendelson, B. K., White, D. R., & Mendelson M. J. (2001). Manual for the body-esteem scale for adolescents and adults.

Meanley, S., Hickok, A., Johns, M. M., Pingel, E., & Bauermeister, J. A. (in press). Body mass index, body esteem and unprotected receptive anal intercourse among young men who have sex with men who seek partners online. Archives of Sexual Behavior.

Moskowitz, D. & Seal, D. (2010). Revisiting obesity and condom use in men who have sex with men. Archives of Sexual Behavior, 39(3), 761-765.

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