The demographics of the patients are listed in Table 1. We compared females who identify as lesbian or bisexual to females who identify as straight and found no significant differences in demographic characteristics except the following: 1)Patients who identify as lesbian were more likely to be single (p=0.0083) than patients who identify as straight; 2)Patients who identify as bisexual were younger (p<0.0001) and less likely to be diagnosed with hypertension (p=0.008) and dyslipidemia (p=0.0005) than patients who identify as straight; and 3) Patients who identify as bisexual were more likely to be single and were less likely to be married (p<0.0001) than patients who identify as straight.
The median (interquartile range) BMIs for the patients who identify as lesbian and straight were 35.53 (32.32-40.79) and 34.82 (32.26-39.38), respectively. The median (interquartile) BMIs for the patients who identify as bisexual and straight were 35.49 (31.37-43.74) and 34.79 (31.6-39.82), respectively. The unadjusted bivariate analysis showed no statistically significant difference in BMI between the patients who identify as lesbian and straight (p=0.44) or between patients who identify as bisexual and straight (p=0.42). As shown in Supplementary Table 2, there was no statistically significant difference in BMI between patients who identify as lesbian, bisexual, and straight when controlling for age at visit, total number of visits, race, ethnicity, marital status, provider type, and diagnosis pre or type 2 diabetes, hypertension, or dyslipidemia (p=0.36 for patients who identify as lesbian and straight and p=0.22 for patients who identify as bisexual and straight).
Next, we compared the proportion of lesbian, bisexual and straight female patients with BMIs>30 who received a diagnostic code for obesity. The unadjusted bivariate model showed there was no statistically significant difference in the proportion of patients with BMIs>30 who received a diagnostic code for obesity between patients who identify as lesbian and straight (p=0.45) and patients who identify as bisexual and straight (p=0.74). As shown in Supplementary Table 3, there was no significant difference in number of patients who received the diagnosis of obesity between patients who identify as lesbian, bisexual, and straight even when controlling for age at visit, total number of visits, BMI, race, ethnicity, marital status, provider type, and diagnosis of relevant medical conditions pre or type 2 diabetes, hypertension, or dyslipidemia (OR 1.11 95% CI [0.62-1.97], p=0.72 for patients who identify as lesbian and straight) and (OR 0.96, 95% CI [0.39-2.35], p=0.92 for patients who identify as bisexual and straight). Of note as shown in Table 2, 44.71% of patients who identify as lesbian and 50.20% of patients who identify as straight to which they were compared did not receive a diagnosis code of obesity. Similarly, 43.75% of patients who identify as bisexual and 46.58% of patients in the control group did not receive a diagnosis code of obesity.
We then compared the proportion of lesbian, bisexual, and straight cisgender female patients who received a provider recommendation for weight management. As shown in Table 2, there was no significant difference between the proportion of definite weight management recommendations received between the patients who identify as lesbian and straight (p=0.62) or patients who identify as bisexual and straight (p=0.51). As shown in Supplementary Table 4, there was no significant difference in proportion of definite weight management recommendations between the patients who identify as lesbian, bisexual, and straight even when controlling for age at visit, total number of visits, BMI, race, ethnicity, marital status, provider type, and diagnosis of pre or type 2 diabetes, hypertension, dyslipidemia, or obesity (OR 0.70 95% CI [0.40-1.21], p=0.20 for patients who identify as lesbian and straight) and (OR 1.34, 95% CI [0.55-3.53], p=0.48 for patients who identify as bisexual and straight).
As shown in Table 2, there was no significant difference between the proportion of definite and possible provider recommendations received between the patients who identify as lesbian and straight (p=1.00) and patients who identify as bisexual and straight (p=0.30). As shown in Supplementary Table 5, there was no significant difference in proportion of definite or possible weight management recommendations between the patients who identify as lesbian, bisexual, and straight even when controlling for age at visit, total number of visits, BMI, race, ethnicity, marital status, provider type, and diagnosis of medical conditions including pre or type 2 diabetes, hypertension, dyslipidemia, or obesity (OR 0.87, 95% CI [0.50-1.52], p=0.63 for patients who identify as lesbian and straight) and (OR 1.55, 95% CI [0.61-3.97], p=0.36 for patients who identify as bisexual and straight).
As shown in Table 2, 55.29% of patients who identify as lesbian and 51.37% of patients who identify as straight to which they were compared did not receive a definite recommendation for weight management. Similarly, 43.75% of patients who identify as bisexual and 50.00% of patients who identify as straight to which they were compared did not receive a definite yes recommendation for weight management.