Trends in body image among Australian queer men during COVID-19 lockdowns

ABSTRACT

Existing literature demonstrates that COVID-19 lockdowns negatively impacted body image for most people. However, the exact nature of body image shifts during lockdowns and the impact sexuality had on these shifts remains understudied. We sought to investigate this phenomenon among queer men – an at-risk population for negative body image. Participants were 268 (M_age = 35.30 years) queer Australian men. They completed measures for lockdown-induced body dissatisfaction, disordered eating and exercising, dysmorphic symptomology, anxiety, depression, and suicidality. Increases in body dissatisfaction and disordered eating during lockdowns were associated with increases in anxiety, depression, and suicidality symptomology. Furthermore, the relationship between body dissatisfaction and depression was moderated by disordered eating and exercise, whereby body dissatisfaction predicted depression only for participants who engaged in heightened disordered eating and overexercise during lockdowns. In other words, body dissatisfaction was most harmful to queer men who specifically sought to remedy this dissatisfaction by engaging in problematic eating/exercise behaviours. These findings have clinical implications for supporting queer men with negative body image in the wake of COVID-19 lockdowns. Namely, queer men might benefit from therapies that build on body neutrality frameworks to help normalise experiences of body dissatisfaction and discourage subsequent disordered eating and exercise.

KEYWORDS:

• Body image
• queer men
• gay men
• COVID-19
• eating disorders

In March 2020 the World Health Organisation declared the novel coronavirus (COVID-19) a global pandemic (Buckley et al., 2021). In response, cities around the world went into ‘lockdowns’ (B.B.C. News, 2020) and restrictions on travel, socialising, exercising, and shopping became commonplace (Robertson et al., 2021). While essential to saving lives, existing literature suggests lockdowns typically had an adverse impact on mental health (Knowles et al., 2022; Poulain et al., 2022; Smith et al., 2022). For example, Knowles and colleagues (2022) examined how lockdowns influenced mental health over time for almost 13 000 participants from the UK and found a significant negative impact on wellbeing. In their sample, over 40% of participants were experiencing clinical levels of distress by the time the UK had entered its second lockdown.

Among other negative mental health outcomes, emerging evidence suggests that lockdowns had an adverse effect on body image and served to detriment individual’s relationships with food and exercise. One systematic review (Schneider et al., 2022) found across 75 mixed-methods studies that most individuals reported experiencing greater body dissatisfaction (e.g. Conceição et al., 2021; Keel et al., 2020; Nutley et al., 2021) and engaging in more disordered eating behaviours (e.g. Phelan et al., 2021; Philippe et al., 2021; Zhou & Wade, 2021) after lockdowns. These changes were also reflected in post-lockdown demand for clinical eating disorder services: inpatient admissions, readmissions (Hansen et al., 2021; Matthews et al., 2021), and outpatient referrals (Hansen et al., 2021; Solmi et al., 2021) all increased after the pandemic began.

Negative changes to body image brought on by lockdowns were thought to be the result of disruptions to everyday routine. For one, individuals consumed more social media content (including beauty- and health-focused content) during lockdowns, triggering an increase in appearance-based comparisons (Paludo et al., n.d.; Schneider et al., 2022). Dependence on videoconferencing software (e.g. Zoom) during lockdowns also meant that individuals spent more time looking at their own faces than ever before, prompting greater appearance scrutiny and heightened dysmorphic concern (Pikoos et al., 2021). As well as this, lockdowns left many people unable to engage in their usual physical activity routines (Paludo et al., n.d..) and limited their access to beauty treatments and aesthetic procedures (e.g. hairdressers, laser hair removal, Botox; Pikoos et al., 2020). Lockdowns also prompted changes to many people’s diets (Schneider et al., 2022) as a result of limited access to food vendors (e.g. grocery stores, restaurants), nation-wide food shortages (Godrich, 2022), and heightened engagement with ‘emotional eating’ (Cecchetto et al., 2021a).

While lifestyle changes during lockdowns have broadly been implicated in harming body image, lockdowns were thought to have been particularly damaging for individuals already at high-risk for negative body image (Robertson et al., 2021; Weissman et al., 2020). For example, those with lived experience of eating disorders reported significantly greater difficulties in regulating eating during lockdowns, and experienced greater increases in food and exercise preoccupation (Gobin et al., 2021; Robertson et al., 2021) and concerns about appearance (Robertson et al., 2021) compared to control groups. That said, other high-risk groups are still drastically underrepresented within existing lockdown literature (Schneider et al., 2022).

Underrepresentation of queer men in existing lockdown literature

Emerging literature suggests that queer men disproportionately experience negative body image and disordered eating and exercise (my narr rev). Queer men have lifetime eating disorder prevalence rates of between 14 and 42% (Ricciardelli & McCabe, 2015) and experience greater body dissatisfaction than both heterosexual men and queer women (Engeln-Maddox et al., 2011; Gigi et al., 2016; Kaminski et al., 2005; Peplau et al., 2009; Yean et al., 2013). They are also one of the fastest-growing client bases within the cosmetic surgery industry (Rashid et al., 2021). Among queer men, negative body image has been implicated in myriad negative psychosocial outcomes. For example, when queer men experience worsened body image, they are more likely to engage in disordered eating and subsequently develop eating disorders (Griffiths et al., 2018; Yean et al., 2013). Negative body image has also been implicated in queer men’s anabolic steroid use, sexual dysfunction, depression, reduced quality of life, and suicidal ideation (my narr rev).

Even though queer men disproportionately experience body image concerns, most literature to date has failed to examine the roles that gender and/or sexual orientation played in experiences of body image during lockdowns. For one, most literature has relied upon exclusively (e.g. Vall-Roqué et al., 2021) or predominantly (e.g. Baceviciene & Jankauskiene, 2021; Buckley et al., 2021; Sharpe et al., 2022; Trott et al., n.d.) female samples; men’s experiences of body image during lockdowns have been consistently underrepresented. As well as this, Schneider and colleagues’ (2022) note in their systematic review that only 12% of existing body image lockdown literature reported on participant sexual orientation. For studies that had collected sexual orientation data, participants were predominantly heterosexual and sexual orientation was typically not included as a variable in analyses. In sum, despite the fact that queer men are disproportionately affected by body image concerns, we still know relatively little about how this high-risk group experienced body image during lockdowns.

The present study

The present study sought to investigate the impact that COVID-19 lockdowns had on body image among queer men in Melbourne, Australia. Most lockdown body image literature to date has recruited samples from either Europe or North America (Schneider et al., 2022). Of all the cities in the world, Melbourne experienced the longest and most restrictive lockdown measures throughout 2020 and 2021 – we endured six lockdowns in total and spent more than 260 days under restrictions during the pandemic (B.B.C., 2021). Therefore, by examining body image experiences within the ‘world’s most locked down city’, the present study sought to garner more representative results than existing literature in terms of how lockdowns impact body image for queer men.

Given that, to our knowledge, no literature to date has explored this phenomenon, our research aims were exploratory. We examined queer men’s experiences of body image, disordered eating and exercise, and mental health during Melbourne’s COVID-19 lockdowns. Primarily, we investigated whether lockdown-driven changes to queer men’s body image and relationships with food and exercise had an impact on their mental health experiences. In addition, we explored factors that might have exacerbated or protected queer men from experiencing disordered eating and exercise during lockdowns. Overall, the present study is the first to shed light on how lockdowns impacted body image for queer men.

Method

Ethics approval for the study was obtained from the University of Melbourne prior to study commencement (Ethics ID: 24256). Data were collected from October 15 until 22 October 2022.

Open science commitment

Our study was pre-registered as part of a larger investigation (https://osf.io/zvcxg). All materials and data are available for public access on the Open Science Framework (https://tinyurl.com/ysxxcnd5). We did not substantively deviate from our pre-registered study aims or design, though minor amendments were made to subscale scoring (EDE-Q-13). Prior to data collection but after pre-registration, we also decided to conduct moderation analyses in place of our intended mediation analyses. This change to our analysis plan was informed by new literature uncovered during the literature review and introduction writing phases of this project.

Participants

Participants were 268 (M_age = 35.30 years, SD = 10.90) queer Australian men recruited via Grindr (an online dating app). All participants needed to be at least 18 years old, as per Grindr’s user policies. Participants had lived in Melbourne, Australia through all the 2020 and 2021 COVID-19 lockdowns, though did not necessarily live in Melbourne at the time of their participation. Participants did not need to be cisgender to participate. They were entered into a prize draw for the chance to win a 200AUD gift card as compensation for completing our 10-minute survey.

Of our 268 participants, 13 identified as of Aboriginal or Torres Strait Islander descent. When asked about their sexual orientation (of which they were allowed to select more than one), 74% of participants (N = 198) identified as gay, 18% (N = 47) as bisexual, 7% as queer (N = 18), 4% as pansexual (N = 11), 3% as questioning or unsure (N = 8) and 2% as something else (e.g. asexual or aromantic; N = 5). Participants were also asked to describe what their employment status, relationship status, and living situation was during the Melbourne COVID-19 lockdowns. If participants’ statuses/situations had fluctuated during the lockdowns, they were asked to select the option that applied to them most of the time throughout that period. These demographic variables are summarised below (see Table 1).

Table 1. Participants’ employment statuses, relationship statuses, and living situations during Melbourne’s 2020 and 2021 COVID-19 lockdowns.

		N(%)
Employment status	Full-time	136(51%)
	Part-time or casual	69(26%)
	Unemployed	33(12%)
	Other	16(6%)
	Missing data	14(5%)
Relationship status	Single	157(59%)
	In a monogamous relationship	34(13%)
	In a non-monogamous or polyamorous relationship	24(9%)
	Married	17(6%)
	Separated, divorced, or widowed	14(5%)
	Other	8(3%)
	Missing data	14(5%)
Living situation	Alone	79(30%)
	With only housemate(s)	62(23%)
	With only romantic partner(s)	49(18%)
	With parent(s), grandparent(s), or other older relative(s)	33(12%)
	With romantic partner(s) and housemate(s)	10(4%)
	With romantic partner(s) and child(ren)	5(2%)
	With only child(ren)	1(1%)
	Other	15(6%)
	Missing data	14(5%)

As per G*Power (where alpha = .05, power = 0.8, effect size = 0.02, small), the total sample size needed to detect small effects for a moderation analysis is 395 participants. Therefore, to power our intended mediation analysis we intended to recruit at least 395 participants. Ultimately, however, the number of participants recruited for this study was influenced by funding constraints at the time of data collection. Thus, moderation analyses conducted within the present study were underpowered for small effects but adequately powered for medium effects.

Measures

Across our measures, participants received a mean score on each (sub)scale for which they completed at least 50% of items. As per Eisinga and colleagues (2013), we used Cronbach’s alpha to calculate scale score reliability for (sub)scales with 3+ items and Spearman-Brown for (sub)scales with ≤ 2 items.

Affective and behavioural changes promoted by Melbourne’s COVID-19 lockdowns

In the present study, we assessed how Melbourne’s COVID-19 lockdowns prompted affective and behavioural changes in our participants. We used modified versions of three established scales to retrospectively assess participants’ lockdown experiences. For these measures, we prompted participants to recount how often they experienced certain things during the lockdowns relative to before the pandemic started. Participants then responded to all items on a 5-point Likert scale (where 1 = much less often during lockdowns, 3 = the same amount during lockdowns, and 5 = much more often during lockdowns). Participants were also given the option of responding ‘I have never done this or felt this way’; these were analysed as non-responses. Our full survey containing these modified scales is available on the Open Science Framework (https://tinyurl.com/ysxxcnd5).

Eating Disorder Examination Questionnaire 13 (EDE-Q-13) – modified

The EDE-Q-13 is a validated 13-item questionnaire that assesses multiple body image and disordered eating experiences (Lev-Ari et al., 2021). The EDE-Q-13 is usually assessed as five subscales: restricted eating, shape and weight over-evaluation, body dissatisfaction, bingeing, and purging. For the present study, we assessed scale score reliability for these established subscales. Scale score reliability was typically good (α_{restricted eating} = .83, 95%CI[.7887]; r_{over-evaluation} = .84, 95%CI[.7888]; r_{dissatisfaction} = .76, 95%CI[.6882]; α_binge = .83, 95%CI[.7788]). However, the purging subscale had poor scale score reliability, α = .49, 95%CI[.0674]. Results indicated that dividing the purging subscale into two separate subscales was advised: a two-item measure for using vomiting or laxatives as a means of purging (r = .72) and a single item for over-exercising as a means of purging.

For each of these subscales, participants rated how often each of the EDE-Q-13’s items occurred for them during Melbourne’s COVID-19 lockdowns, relative to before the pandemic. Responses on each subscale were averaged to obtain a final score out of 5, with higher scores indicating increased restricted eating, shape and weight over-evaluation, body dissatisfaction, bingeing, purging, and/or overexercise during Melbourne’s lockdown periods.

Dysmorphic Concerns Questionnaire (DCQ) – modified

The DCQ is a validated 7-item questionnaire that assesses dysmorphic symptomology (Mancuso et al., 2010). Participants rated how often each of the DCQ’s items occurred for them during Melbourne’s COVID-19 lockdowns, relative to before the pandemic. Responses were averaged to obtain a final score out of 5, with a higher score indicating that the participant experienced increased dysmorphic symptomology during Melbourne’s lockdown periods. Scale score reliability was good (α = .84; 95%CI[.7889]).

Patient Health Questionnaire-4 (PHQ-4) - modified

The PHQ-4 is a validated 4-item questionnaire that screens participants for depressive symptomology (2 items) and anxiety symptomology (2 items; Kroenke et al., 2009). We chose to use the PHQ-4 to minimise survey completion time for our participants (i.e. similar scales like the DASS contain far more items). For each subscale, participants rated how often they experienced the symptoms outlined in the PHQ-4 during Melbourne’s COVID-19 lockdowns, relative to before the pandemic. Responses were averaged to obtain a final score out of 5 for each subscale, with higher scores indicating that the participant experienced increased depressive symptomology and/or anxiety symptomology during Melbourne’s lockdown periods. Scale score reliability for the anxiety subscale was good (r = .83; 95%CI[.7887]). Reliability for the depression subscale was acceptable (r = .67; 95%CI[.5675]).

Suicide ideation and attempt(s)

To predict pandemic-era suicidal ideation or attempt participants answered two questions: (1) ‘since the beginning of the pandemic (i.e. March 2020), have you seriously thought about killing yourself?’ and (2) ‘since the beginning of the pandemic (i.e. March 2020), have you tried to kill yourself?’ on yes/no response scales.

Procedure

Participants were recruited via advertisements sent to their inboxes on Grindr on Saturday NaN Invalid Date \. From this advertisement, interested participants were directed to our Qualtrics-hosted survey where they were provided with our plain language statement and consent form. Once participants had consented, they completed a screening questionnaire to ensure they identified as male and were queer, at least 18 years old, and had lived in Melbourne during all the 2020 and 2021 lockdowns. Eligible participants then proceeded to provide demographic information. In a randomised order, participants completed the EDE-Q-13, DCQ, PHQ-4, and suicide ideation and attempt(s) measures. Items within each of these measures were also presented in a randomised order.

Analysis

All analyses were exploratory and conducted using pairwise deletion to maximise power (except in the case of logistic regressions, where listwise deletion had to be used). We first calculated means and standard deviations for all outcome variables. Next, we generated a correlation matrix and ran multiple logistic regressions to investigate whether participants who experienced increased body image concerns, disordered eating and exercise behaviours (EDE-Q-13), or dysmorphic symptomology (DCQ) during lockdowns also experienced increased mental ill health symptomology (PHQ-4 and suicidality questions). Correlations were used in place of multiple regression because independent variables were highly correlated with one another (violating the multicollinearity assumption). Thirdly, we used moderation analyses to determine whether the relationship between body dissatisfaction and mental ill health would be stronger for those experiencing disordered eating and exercise symptomology (restrictive eating, bingeing, purging, overexercising). We also used moderation analyses to explore whether the relationship between body dissatisfaction and disordered eating and exercise behaviours would be attenuated for those who were ‘socially integrated’ during lockdowns (i.e. those in relationships or living with other people). For this analysis, participants were dichotomised as ‘in a relationship’ or ‘not in a relationship’ and ‘living with other people’ or ‘not living with other people’. All moderations were performed a series of Hayes’ PROCESS macro model 1. All analyses were conducted both including and excluding outliers (of which there were 10 total). Because results were substantively unchanged after outlier exclusion, we report our analyses below including outliers.

Results

We computed descriptive statistics for all variables (see Table 2). On average, participants tended to experience more shape and weight over-evaluation, body dissatisfaction, bingeing, dysmorphic symptomology, and depression and anxiety symptomology during lockdowns compared to before COVID-19. Conversely, they experienced less overexercising and roughly the same amount of restrictive eating and purging. Suicidal ideation was experienced by almost a third of participants during lockdowns, with small subset attempting suicide during lockdowns.

Table 2. Descriptive statistics.

Scale	Subscale	N	Mean(SD)	Skew	Kurtosis
EDE-Q-13	Restrictive eating	189	2.99(1.13)	−0.11	−0.68
	Shape and weight over-evaluation	198	3.73(0.99)	−0.63	0.27
	Body dissatisfaction	209	3.66(1.04)	−0.39	−0.36
	Bingeing	165	3.54(1.02)	−0.54	−0.12
	Purging	59	2.99(1.27)	−0.22	−0.78
	Overexercising	170	2.91(1.44)	0.02	−1.32
DCQ		171	3.37(0.80)	−0.42	0.25
PHQ-4	Anxiety	204	3.78(1.01)	−0.78	0.27
	Depression	208	3.75(0.98)	−0.72	0.16
Suicidal ideation		214 Nyes = 66(31%) Nno = 148(69%)
Suicide attempt		214 Nyes = 11(5%) Nno = 203(95%)

As demonstrated in Table 3, we found statistically significant correlations between most EDE-Q-13 subscales and measures for mental ill health (i.e. anxiety and depression symptomology). Dysmorphic symptomology (DCQ) also predicted mental ill-health. Further, logistic regressions demonstrated that suicidal ideation was positively predicted by shape and weight over-evaluation, β = 1.86, p = .001, body dissatisfaction, β = 1.60, p = .003, bingeing, β = 1.65, p = .007, purging, β = 2.07, p = .007, and dysmorphic symptomology, β = 2.15, p = .001. It was not predicted by restrictive eating, p = .732, or overexercising, p = .866. No factors predicted suicide attempts, ps > .05.

Table 3. Correlation matrix.

Variable	1	2	3	4	5	6	7	8	9
Restrictive eating^1	_-
Shape and weight over-evaluation^2	.01	-
Body dissatisfaction^3	−.14	.66**	-
Bingeing^4	−.49**	.41**	.53**	-
Purging^5	.12	.45**	.38**	.21	-
Overexercise^6	.61**	−.01	−.09	−.37**	.17	-
DCQ^7	.20*	.65**	.61**	.21*	.52**	.25**	-
Anxiety symptomology^8	−.15	.35**	.36**	.33**	.30*	−.03	.29**	-
Depression symptomology^9	−.12	.23**	.33**	.24**	.36**	−.03	.27**	.70**	-

*p <.05, **p < .001.

Disordered eating and exercise as moderators between body dissatisfaction and mental ill health

The interaction between body dissatisfaction and restrictive eating in predicting depression symptomology was significant, N = 175, β = 0.13, 95% C.I. (0.03, 0.24), p = .013. Body dissatisfaction did not predict depression symptomology at −1SD restive eating but did predict depression symptomology at mean and + 1SD restrictive eating (see Table 4). Conversely, the interaction between body dissatisfaction and restrictive eating in predicting anxiety symptomology was non-significant, p = .618.

Table 4. Body dissatisfaction as predictive of depression symptomology at different levels of restrictive eating.

Level of restrictive eating	Effect	p	LLCI	ULCI
−1SD	.11	.225	−0.07	0.28
Mean	.26	<.001	0.13	0.39
+1SD	.41	<.001	0.24	0.59

The interaction between body dissatisfaction and bingeing in predicting anxiety symptomology, p = .468, and depression symptomology, p = .095, were both non-significant. The interaction between body dissatisfaction and purging in predicting anxiety symptomology, p = .262, and depression symptomology, p = .053, were both non-significant.

The interaction between body dissatisfaction and overexercising in predicting depression symptomology was significant, N = 158, β = 0.10, 95% C.I. (0.01, 0.18), p = .026. Body dissatisfaction did not predict depression symptomology at −1SD overexercising but did predict depression symptomology at mean and + 1SD overexercising (see Table 5). Conversely, the interaction between body dissatisfaction and overexercising in predicting anxiety symptomology was non-significant, p = .361.

Table 5. Body dissatisfaction as predictive of depression symptomology at different levels of overexercising.

Level of restrictive eating	Effect	p	LLCI	ULCI
−1SD	.10	.223	−0.06	0.27
Mean	.24	<.001	0.12	0.37
+1SD	.38	<.001	0.20	0.56

Social integration variables as moderators between body dissatisfaction and disordered eating and exercise

The interaction between body dissatisfaction and living with other people significantly predicted bingeing, N = 157, β = 0.39, 95% C.I. (0.11, 0.67), p = .006, whereby the relationship between body dissatisfaction and bingeing was stronger for participants who lived with other people during lockdowns (see Table 6). However, the interaction between body dissatisfaction and living with other people did not significantly predict restrictive eating, p = .766, purging, p = .09, or overexercising, p = .417.

Table 6. Body dissatisfaction as predictive of bingeing depending on living situation during lockdowns.

Living Situation	Effect	p	LLCI	ULCI
Lived alone	.23	.049	0.01	0.46
Lived with others	.62	<.001	0.47	0.77

The interaction between body dissatisfaction and being in a relationship did not significantly predict restrictive eating, p = .995, bingeing, p = .217, purging, p = .090, or overexercising, p = .316.

Discussion

Broadly, the present study sought to examine associations among queer men’s body image, disordered eating and exercise, and mental health during the Melbourne COVID-19 lockdowns. Firstly, we examined whether changes to queer men’s body image and relationships with food and exercise during lockdowns impacted their mental health experiences. We found that increased lockdown-induced body dissatisfaction was more predictive of depression symptomology for participants who engaged in relatively average or high (i.e. mean or + 1SD) levels of restrictive eating and overexercising behaviours during lockdowns. Secondly, we investigated factors that might have exacerbated or protected queer men from experiencing disordered eating and exercise and mental ill health during lockdowns. We found that living with other people exacerbated the relationship between lockdown-induced body dissatisfaction and binge eating for our participants. Taken together, our findings illuminate how lockdowns impacted body image for queer men.

Existing literature suggests that lockdowns provided a unique context in which changes to everyday routine prompted negative body image, exercise, and diet a societal level (Cecchetto et al., 2021b; Godrich, 2022; Paludo et al., n.d.; Pikoos et al., 2020, 2021; Schneider et al., 2022). Further, these changes may have been especially pronounced for queer men given that they were already a high-risk group for negative body image and its related disorders (i.e. eating disorders and dysmorphic disorders; my review; Engeln-Maddox et al., 2011; Gigi et al., 2016; Kaminski et al., 2005; Peplau et al., 2009; Yean et al., 2013). In the present study, body dissatisfaction and shape and weight over-evaluation changes prompted by lockdowns were associated with anxiety, depression, and suicidality symptomology for queer men. Queer men’s increased propensity to binge and/or purge during lockdowns was also associated with these negative mental health outcomes. Overall, our results suggest that queer men who underwent negative body image shifts during lockdowns may also have experienced a decline in mental health. While we are unable to determine directionality using correlational data, we posit that this relationship may have been bi-directional. For example, in line with existing literature, worsening body image may have prompted participants to feel worse about themselves in general, thereby exacerbating anxiety, depressive, and suicidality symptomology (Blashill & Wilhelm, 2014). Conversely, worsening mental health brought on by lockdowns (i.e. depression, anxiety, suicidality (Knowles et al., 2022; Poulain et al., 2022; Smith et al., 2022); may also have prompted participants to experience worsening body image. For example, some existing literature posits that depression leads to body dissatisfaction because depression involves negative self-appraisal and body dissatisfaction is a external/physical manifestation of this appraisal (Chen et al., 2015).

While increased bingeing and purging behaviours predicted worsening mental health in the present study, restrictive eating and overexercising did not. Perhaps this is because these arguably problematic behaviours are relatively normalised in Australian culture. Government health campaigns (e.g. the 2008 ‘Measure Up’ campaign; King et al., 2013) and media discourse (Bonfiglioli et al., 2007) have long persuaded Australians to (erroneously) equate health with size, often encouraging Australians to ‘take control of their health’ by using diet restriction and/or exercise to lose weight (i.e. ‘diet culture’; Jeffery, 2021). Conversely, bingeing and purging are seldom conventionally framed as means to achieve health; rather, these facets of disordered eating are systemically framed as moral failings (e.g. an inability to correctly ‘control’ one’s food intake; Fielding-Singh, 2019) and/or as signs of an eating disorder (e.g. bulimia, binge eating disorder). Where individuals are made to feel righteous for dieting and/or exercising (Williams, 1996), bingeing and purging induce feelings of shame (Blythin et al., 2020). It therefore follows that only these two facets of disordered eating would directly harm mental health. To our knowledge, our study was the first of its kind to demonstrate this phenomenon among queer men.

Interestingly, the relationship between body dissatisfaction and depression symptomology was moderated by restrictive eating and overexercise, whereby body dissatisfaction predicted depression only for participants who engaged in relatively average to high (i.e. mean or + 1SD) levels of disordered eating and/or overexercise. Taken together, these findings could suggest that neither an increase in body dissatisfaction nor restrictive eating and overexercising during lockdowns alone were enough to trigger mental ill health for queer men. Rather, the queer men most at risk of lockdown depression were perhaps those who experienced worsened body image and then tried to remedy this worsened body image by engaging in restrictive eating and overexercising. These findings are in line with body neutrality frameworks which suggest that appearance evaluations (whether they be good or bad) can ultimately be separated from mental wellbeing so long as these evaluations are framed as fundamentally inconsequential (Bissonette Mink & Szymanski, 2022; Cohen et al., 2020). That is, body dissatisfaction might only impact mental health for those individuals who care that they are dissatisfied and wish to remedy this dissatisfaction; being dissatisfied with one’s appearance in and of itself is not inherently harmful to wellbeing. Therefore, we recommend that mental health clinicians trying to help queer men recover from the impacts of lockdowns focus not on remedying body dissatisfaction among these men but rather on normalising experiences of dissatisfaction and encouraging these men to explore alternate pathways through which they might seek validation and self-worth (my narr rev).

Broadly, we did not find any evidence that relationship status or living situation served to exacerbate or protect queer men from experiencing disordered eating and exercise during lockdowns. However, we did find that body dissatisfaction was only predictive of binge eating in individuals who lived with other people. This is in direct contrast with existing literature (from both before COVID-19 and from during lockdowns) that demonstrated that living alone was a risk factor for bingeing (e.g. Bianchi et al., 2022; Engstrm & Norring, 2001). Perhaps then for queer men – but not other demographics – binge eating served as a social activity during lockdowns. Future research should explore whether risk factors associated with binge eating for queer men specifically do indeed differ from previously identified risk factors.

Findings from the present study have concerning implications for queer men’s risk of suicide. In late 2019, a national survey examining suicidal ideation and attempts among queer Australians demonstrated that 32% of queer men had experienced suicidal ideation and 2.5% had attempted suicide (Lyons et al., 2022). Our sample reflected comparable suicidal ideation rates; however, the number of men in our sample who had attempted suicide was doubled (5%). This might reflect the role of lockdowns in triggering increased suicide attempts among queer Australian men. Conversely, our findings might suggest that queer men who use Grindr might be especially susceptible to suicide attempts. Our study paves the way for future research to investigate these phenomena.

As well as this, our findings that suicidal ideation during lockdowns was positively predicted by shape and weight over-evaluation, body dissatisfaction, bingeing, purging, and dysmorphic symptomology have substantial clinical implications. Whilst prior research has identified queer men in general as at elevated risk of suicide relative to heterosexual men (Nystedt et al., 2019), the findings presented here add value in highlighting further diversity within populations of queer men in terms of risk of suicide. Namely, our results link queer men’s suicidal ideation with body image concerns. This suggests that targeted prevention and early intervention for negative body image among queer men might contribute to reduced suicidal ideation among this at-risk population.

Limitations

The present study had several limitations. Namely, we were underpowered to detect small effects in our moderation models due to the sample size attained. We were also limited by power in that we were unable to examine multi-categorical moderation effects. That is, we were unable to explore diverse living situations and relationship styles as moderators – instead, we had to group these categories together under larger umbrellas to amplify power (living alone vs living with people; single vs in a relationship). Further, our study was limited by the use of retrospectively worded questions pertaining to changes induced by lockdowns. Ideally, a longitudinal design would have been implemented to examine effects of lockdowns, thereby reducing the demand on participants to correctly recount their feelings during a period of change several years ago. However, at the time of lockdowns, no research examined shifts in queer men’s experiences of body image and mental health. Thus, while our methodology was not ideal, our findings still provide valuable insights that otherwise would not be explored. Finally, our study was limited by its exploratory, cross-sectional design. We are unable to draw causal inferences from our results. However, should society ever return into another lockdown, the present study’s exploratory findings pave the way for future longitudinal studies to examine how prolonged periods of isolation might impact body image and mental health outcomes for queer men over time.

Conclusion

The present study investigated queer men’s body image, disordered eating and exercise, and mental health during Melbourne’s COVID-19 lockdowns. We found that changes to body image, eating, and exercise for queer men during lockdowns were associated with an increase in mental health concerns. Importantly, we also found evidence that body dissatisfaction was only predictive of mental ill health among queer men who were engaging in disordered eating and exercise in an attempt to remedy their body concerns. These findings have implications for clinicians who wish to support queer men who experienced negative body image as a result of the COVID-19 lockdowns. Namely, they suggest that queer men might benefit from therapies that build on body neutrality frameworks to help normalise experiences of body dissatisfaction and discourage disordered eating and exercise. Binge eating and suicidality findings from the present study also suggest that future literature needs to continue to investigate these phenomena in queer male samples.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Simon Rice was supported by the National Health and Medical Research Council (APP1158881).