Intro: This is BayCare HealthChat, another podcast from BayCare Health System.

Caitlin Whyte: Welcome to BayCare HealthChat. I'm Caitlin Whyte. Research shows that LGBTQ+ people are more likely to have problems with body image and to be overweight or obese compared to heterosexual people. Christopher Aguilar is an APRN with BayCare Medical Group and joins us today to discuss the importance of a healthy balance of diet and exercise and how to approach open conversations with your physician.

Chris, let's start with finding the right doctor. This is obviously crucial for everyone, but especially for minority populations and patients. How does finding the right doctor play into health care for LGBTQ+ people?

Christopher Aguilar APRN: Well, actually, it plays a critical part in everything in the LGBT world, including health, diet, everything, because throughout my years of practice, if you can't really connect with your doctor or trust your doctor, then you really won't have the best outcome. Sometimes you won't, express yourself or ask all the questions you wanted to, you might reserve yourself in a certain way. So the most important thing is you have to find that doctor that you can really trust, so that way you can get everything you need, especially when it comes to tough questions, for sure, because they do come up often in the LGBTQ community.

Caitlin Whyte: And what would you say is a good way to kind of search for a doctor if you're starting from scratch? Maybe you just moved or you're just looking for a new doctor. It could be a little overwhelming, I imagine.

Christopher Aguilar APRN: It's very overwhelming. As a matter of fact, I had a patient two to three days ago asking me. It's very difficult. He came from New York City to the Tampa Bay area. He was telling me he had difficulty finding an LGBTQ-friendly provider or LGBT provider because they're not well stated in our bios. Normally, a lot of our bios are incredibly general and it's just because for whatever protocols, for whatever reasons, it just has to be very general bios. And sometimes we try to search for those LGBT centers that are in communities, and then those can have challenges as well, because sometimes the wait to see a provider might be far out, just because they have limited providers or they might not accept your insurance. So it does get very, very challenging. I have heard that word of mouth sometimes is the best. So it goes to show, right? It goes to show that we still have ways we can strive to improve the LGBT health, for sure.

Caitlin Whyte: So today's episode is focusing on diet and exercise, healthy lifestyle. So let's focus on lesbians now. Research shows that lesbians are more likely to be overweight or obese compared to heterosexual women. Why do you think this is?

Christopher Aguilar APRN: So actually, I did some research in Canada-- not me, but I was like looking at these research articles in Canada and then compared it to the US. I looked up several meta-analyses, which is where we're grouping a lot of research articles into one to try to see if there's a common ground. When it came to lesbians and bisexual women, there was a lot of conflicting evidence. Some researchers were saying, "Oh yes, they might have higher chances of obesity or eating disorders." Others were saying actually the risk wasn't terribly high or somewhat very similar to their cisgender counterparts. It still said that there was a concern for eating disorders, which can lead to sometimes obesity. Many articles that I read were saying that in the lesbian community, they found more positivity in their bodies compared to other areas in the LGBTQ world, such as gay and trans. It was a big mix, okay? It was a really big mix. But obesity still in general is pretty big in the LGBT world because of food insecurities, poverty rates. Our access to food, depending where we are, that really can lead to those factors of increased weight, obesity. So that can be seen very easily in many communities for sure.

Caitlin Whyte: Now, in more statistics shifting to another population, problems with body image are more common among gay men and gay men are much more likely to experience eating disorders such as bulimia or anorexia. This is in other studies. So can you talk about those numbers and how we can manage them?

Christopher Aguilar APRN: Yeah. So actually, there's a huge body of evidence, like it's pretty big that can confirm this. And I was trying to figure out why. Multiple studies that I was reading up on were all saying that gay men and bisexual men as well did have the highest rates of eating disorders, food insecurities, body disapproval. And so I was trying to figure out exactly why. One of them was socioeconomics of it, high poverty rates. One study was saying we reflect back to what we dealt with in high school, middle school, these bullies or whatever we went through, these traumas do cause eating disorders in high school that do travel as the adult, which then lead to a lot of body insecurity issues. Within the gay world, there's also all of these group typings of bodies. For example, you have the jocks and then you have the twinks and then you have the bears, for example. They're used very common and so many gay men try to fit in one of these categories and that can cause further body disapproval.

So how to fix this, it's going to be multidisciplinary. It really has to see where this is coming from. Is it a mental health concern? Is it a mental issue that we're having some anxiety, depression? Why are we so unhappy for whatever reason it can be? And then if we have to solve like a food insecurity, is there a high poverty there that we can't get into really good food or good access to good vegetables? That's another thing there, because there is big, big poverty in a lot of LGBT communities. So it's very difficult. It's a very difficult question on how to answer it in only like what, 10 minutes?

Caitlin Whyte: Yeah. Yeah. I know it is a big question. But it's always good to hear some semblance of, you know, just that people are thinking about it, that it's on the minds of doctors and nurses and medical professionals. Shifting from specific population numbers, let's look at some broad issues. I'd love to focus on food insecurities in the LGBTQ+ communities. I imagine just as a lay person, this stems from some kind of job discrimination of some sort. Can you tell us more about the inequalities when it comes to food access in this population?

Christopher Aguilar APRN: So it can be pretty big. It can be. So I've been fortunate enough to work in Philly, because I went to school there and I did work in one of the most poor areas of Philly, definitely one of the top poor areas in the country. What I saw there is the access to food was just atrocious. My patients were relying on corner stores, a lot of corner stores. And these corner stores didn't have good vegetables. It was all canned food, highly processed food. So this leads to a lot of big issues.

In other bigger cities, so in Tampa and in other big Florida cities, there's a lot of good supermarkets around, definitely, that are very easily reachable by 15, 20-minute car rides. The roads are very easily accessible, so that can cause some differences there between where you are geographically, how you can reach food. The next thing is also your job and financial security. It's been very well documented, very, very well-documented, how LGBTQ individuals suffer some of the highest poverty rates, some of the highest homeless rates out there as well. So then we had to figure out, "Okay, where are they getting their food from? Are they going to these food pantries? Do they know where these food pantries are?" And sometimes they don't want to go to food pantry, which is totally fine. I do understand that from there. So it is very difficult. So it depends where you are geographically, but also financially as well. That can really change how one becomes more available with these food insecurities.

Caitlin Whyte: Absolutely. I know a lot of big topics and big questions here today, but we're just trying to scratch the surface.

Christopher Aguilar APRN: Yeah.

Caitlin Whyte: So when we talk about healthy diets, I mean, we hear this term all the time and it's pretty vague and could mean a lot of different things, but what does that mean to you, a healthy diet?

Christopher Aguilar APRN: Oh, yeah, healthy diets, I get asked that a lot. A healthy diet can mean so much. We have the keto diets. We have the Atkins diet. We have the Mediterranean diet. We have the DASH diet. So there's just so many good diets out there. When it comes to a diet in general, it just has to be very well-balanced. Are you getting enough good vegetables? Are you getting enough good fruits? Are you getting good sources of protein that are not saturated in cholesterol? So there's a lot of good, good diets out there.

Now, not all diets are good. You can go overboard on keto. You can go overboard on Atkins and many other ones. So you do have to just monitor what you're doing and what you're consuming. Looking at those labels, for sure. What the cholesterol looks like, what those sugar levels look like, what those sodium levels look like. When I educate my patients on healthy diets, I'm like, "Listen, you can choose your food. But just make sure you're looking at those labels, you're looking at is it high sodium? Is it high sugar? What nutrients are in it? If there's no nutrients at all and it is just calories, is this a good food option for you?" So that's how you can better tolerate or, I guess, create a healthy diet for yourself, because you do make it based on what's around you and you can make a healthy diet.

Caitlin Whyte: Absolutely. And then kind of on that same note, a lot of health issues, we're told a way to fix it is lifestyle changes. So when it comes to something as broad and vague as lifestyle changes, what exactly does that mean to you?

Christopher Aguilar APRN: So lifestyle changes means what is it that you're doing for your life? So we have tried getting away from the diet notion. We try to do diets for whatever reason. We want to lose weight for a wedding. We want to lose weight for a ceremony. We just want to go on a diet just to lose a couple pounds, but that's great. So we lose those couple of pounds, but then what next? Did we learn anything from that experience? Did we get anything, like find new recipes, for example?

So what our lifestyle is, it just encompasses your whole life and it encompasses who you're hanging around with, what are you doing with your food, what are you buying more often, what is your exercise routine? So it encompasses way more than just food, okay? Are you exercising plenty? Which they're saying now, 100 to 120 minutes per week? Yeah. Cool. Check. But what else are you doing for your life? Are you going with the right friends? Are you going to the right restaurants? Are you all supporting each other to have a healthy lifestyle, healthy diet? So it can mean a lot for sure. Healthy lifestyles, it's just a big term just to try to better encompass more of your life into what a diet is, because a diet can be just calorie restricting, a lifestyle can mean so much more.

Caitlin Whyte: And wrapping up here, Chris, what are some commonly asked weight loss questions that you hear in your office and maybe some ways that we can, not fix them, but deal with them?

Christopher Aguilar APRN: So a lot of weight loss questions I do get is what can I do? Who should I talk to? Should I start supplements? Do talk to a provider before you start any of these, for sure. Many supplements are very harmful. We do want to make sure that you're consuming good medications, good supplements. A lot of supplements are unregulated. So we do have to look at that ingredient component list to see if there's any interactions with food or other medications that you have. I'm also asked often, "What should I be doing? Should I just only count my calories?" I'm like, "No, well, you want to count a couple of things you want to keep a log, you want to keep how many carbs is it that you're consuming, how many sugars is that you're consuming." Yes, calories are definitely important for sure. More often than not, I do refer my patients to dietitians, nutritionists, so that way they can just better understand and get like a really good comprehensive education on a goal they want to achieve, a better nutrition designed just for them, so that way they can get the best education. And from that education they choose what food options to select.

Caitlin Whyte: Beautiful. Well, Chris, like we've mentioned a few times today, health in the LGBTQ+ communities is such a broad and nuanced topic at the same time. But as we wrap up here, is there anything else you want to let patients know, especially when it comes to kind of our basic diet, exercise, things like that?

Christopher Aguilar APRN: Yes. Number one, I can't stress enough the importance of finding a provider that you do trust. It makes a really big difference. It really, really does. Someone that understands you as a person, what you're going through and someone that's very easy to talk to, so that way you can have open communication regardless of what is happening within those doors. Nutrition is super important, yes. You can't shame anyone, absolutely not, for what they go through. Many people face so many challenges, especially in the LGBT communities. We have a ton of issues with our bodies. We have a ton of issues acquiring food, healthy food, and that plays a big role. It really, really does.

How to change this and how to change all of this as a whole for all of us is going to be a little difficult. It might take some time. The good thing is there is so much out there. There's so many big movements, so a lot of these things are changing. There's more access now than there have ever been, which is really, really exciting.

Caitlin Whyte: Wonderful. Well, Chris, in all the podcasts I do, we don't spend enough time on these topics. So thank you for bringing them to light and advocating for the LGBTQ+ communities and their care. And thank you for listening. You can find more about us online at BayCare.org. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. This has been another episode of BayCare HealthChat. I'm Caitlin Whyte. Stay well.