Monday, November 19, 2012

Sexual Function and Obesity

Excess weight can have a significant effect on sexual function.

A recent paper by Ronnie Kolotkin, Durham, NC, published in OBESITY, presents a systematic review of the literature on the relationship between obesity and sexual functioning.

Based on 11 population studies, 20 cross-sectional, and16 weight-loss studies the authors find a robust and consistent negative impact of obesity on sexual functioning.

Thus, in men, erectile dysfunction (ED) is most commonly associated with excess weight.

On the other hand, women with excess weight tend to generally report greater problems with various aspects of sexual desire, arousal and function.

Most weight loss studies have shown significant improvements in sexual function despite, as the authors note, varying study designs, weight loss methods, and follow-up periods.

Based on their review, the authors recommend that future studies

1) investigate differences and similarities between men and women with respect to obesity and sexual functioning,

2) use instruments that go beyond the assessment of sexual dysfunction to include additional concepts such as sexual satisfaction, interest, and arousal and,

3) assess how and the degree to which obese individuals are affected by sexual difficulties.

The authors also recommend that sexual functioning should be more fully addressed by clinicians, both in general practice and in weight loss programs.

AMS
Edmonton, Alberta

ResearchBlogging.orgKolotkin RL, Zunker C, & Ostbye T (2012). Sexual Functioning and Obesity: A Review. Obesity (Silver Spring, Md.) PMID: 22522887

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8 Responses to “Sexual Function and Obesity”

  1. NewMe says:

    To what extent have the researchers been able to factor in the psychological effects of weight bias and shaming? Sexual function has a huge psychological component.

  2. Alexander Schwartz says:

    Interesting info!

    Right now, my research has been tailored towards sex hormones and adiposity in pubertal males. There seems to be an effect of excess leptin on sexual function. Specifically, excess leptin inhibits leydig cell function in the testes peripherally thereby decreasing testosterone production (by preventing the conversion of 17-OH progesterone to testosterone). However, centrally, leptin seems to stimulate GnRH production in the hypothalamus, thereby increasing LH but with obesity this may be impaired because of a central resistance to leptin, so it could be a double whammy of a decrease in LH in addition to diminished testosterone production (not to mention the fact that excess adiposity leads to aromatization!).

    Thanks for this article!

  3. hopefulandfree (RNegade) says:

    Dear Dr. Sharma,

    I hate to point out the obvious, but the results of the research are next to worthless (seriously)—or even worse. I haven’t read the full research report, so please forgive my bluntness if the researchers took great care to discuss at length (in their “research limitations” section) the complex problems associated with “obesity” as a socially constructed condition and the potential harm of overlooking or minimizing (or ignoring) the severe and potentially traumatic results of social stigma accompanying “obesity.”

    From your report on their research, it appears that the researchers simply advance a common form of oppression and social domination while remaining ignorant of their own social bias and of the potential for harm from their ignorance (regarding the aforementioned matters of social stigma.)

    In other words, if the researchers cannot understand (or choose to ignore) that “obesity” is socially constructed as a vile and repugnant condition and undesirable condition, yet they continue to BELIEVE (nevertheless) that they are actually (somehow) measuring some REAL type of “objective” relationship between “obesity” and “sexual difficulties” then what possible value can result from their research “findings?”

    To conflate “obesity” with the source of “sexual difficulties” for people who fit that socially constructed category (“obese”)—without critically analyzing its social construction (as a particularly subjective kind of category, to begin with), and without making any distinction between a socially-constructed category and the social conditions of bias and stigma that accompany its construction (and the lived experiences of SHAME and suffering that result from that STIGMA, rather than from “obesity” as an “scientifically objective” condition)—is is just another way to blame “obesity” for CAUSING emotional and physical harm for people who fit a socially constructed category.

    How is that research any different from, say, research that claims to objectively measure the relationship between someone’s minority ethnic status (or their “race”) and their problems connected with finding rewarding employment in as society KNOWN for its widespread bias against that particular “race”—without ever considering the social construction of “race” and the consequences of social bias, discrimination, and prejudice that results in employment insecurity or “difficulties”?

    How does one earn a Ph.D. in any field, I keep wondering, without grasping or recognizing (or being shown) these problematic and harmful gaps in knowledge (and basic epistemology)?

  4. hopefulandfree (RNegade) says:

    Re: my earlier comment (written in the throes of impatience with this kind of subjective research)

    Put another way, how do educated researchers study sexually-related issues experienced by people who fit a social category known (far and wide) for being stereotyped as sexually undesirable (in books, films, TV shows, etc)—a group whose stereotyped negative sexual image is repeatedly EXPLOITED for purposes of *entertainment* and making money (in those books, films, TV shows, etc)—yet apparently remain unaware (as a scientist) that the widespread social stereotype of that group as sexually undesirable has far more relevance to the “difficulties” they believe are being objectively measured than some range of numbers on a scale.

    I doubt very much that similar results would be found among “obese” Samoans circa, say, 1960—or even today (in spite of the stigma creeping to their culture). I would argue that the researchers are measuring results of a cultural, socially constructed (negative) sexual stereotype and results of damaging social stigma rather than any objective relationship between body size and sexual difficulties.

    It is aggravating, sad, and very disturbing (harmful to people) if highly educated researchers are unable to make that important distinction.

  5. Alexander Schwartz says:

    Hi Hopefulandfree,

    I understand your dilemna with the social constructs of obesity and perception of how attractive one may be. I do think you should actually read a report before coming to conclusions about it. Dr. Sharma made this statement which I’d like to springboard off of:

    “Based on 11 population studies, 20 cross-sectional, and 16 weight-loss studies the authors find a robust and consistent negative impact of obesity on sexual functioning. Thus, in men, erectile dysfunction (ED) is most commonly associated with excess weight.”

    I agree that perhaps, as you’ve stated, obese Samoans may have been desirable within their societal cultures (and many other cultures where higher bodyfat is associated with affluence and status), but as a physiologist I can say that their reproductive abilities are hampered due to aforementioned reasons (see my previous post). That being said, they can still reproduce which is why there is validity in what you’re saying. Perhaps the interaction of both our biology (diminished sexual functioning due to increased adiposity) and societal perceptions of obese individuals leads to a greater sexual impairment (in whatever way that may be defined)?

    Additionally, I’d like to address this comment:

    “Put another way, how do educated researchers study sexually-related issues experienced by people who fit a social category known (far and wide) for being stereotyped as sexually undesirable (in books, films, TV shows, etc)—a group whose stereotyped negative sexual image is repeatedly EXPLOITED for purposes of *entertainment* and making money”

    It depends on the research. I’m not a sociologist, so that’s beyond the scope of my work. I’m a physiologist and primarily concerned with the endocrinological factors surrounding sexual development and reproduction. Researchers are indeed able to make that distinction which is why we have specialized fields and a massive push towards collaborative research. I could find a psychology based sexual report and criticize it for it’s lack of depth on the physiological components of its research, but that would defeat the entire purpose of the report.

    I think the comparison you made with ethnicity and socioeconomic issues is like comparing apples and oranges. There are no biological reasons for someone to make less money or have better jobs as a result of their background, only societal ones from oppressive powers. On the other hand, increased fat tissue in males does lead to aromatization of testosterone in addition to diminished production of testosterone as a result of both central leptin resistance in the production of GnRH and diminished functioning of the sertoli cells in the testes responsible for testosterone production. Diminished levels of testosterone will lead to erectile dysfunction and prior to the ‘miracle’ ED drugs, it was not uncommon to treat ED with depo-testosterone injections from health care practitioners. In other words, yes, there are some factors associated with making an obese person feel less desirable, BUT it’s been well documented that body fat does impair biological sexual functioning.

    Finally, Dr. Sharma also pointed out (so you wouldn’t need to even read that article) that there are limitations to this work and that future studies need to investigate other psycho-social aspects of sexual functioning and obesity that go beyond merely biological explanations as sexuality is a multifaceted issue.

  6. Alexander Schwartz says:

    Correction, Sertoli cells should actually be Leydig cells.

  7. DebraSY says:

    Truly, this study reveals such a gulf between the male and female experience. It seems to support a hormonal issue experienced by fat men and a social issue experienced by fat women.

    I would like to address Dr. Sharma’s observation:

    “Most weight loss studies have shown significant improvements in sexual function despite, as the authors note, varying study designs, weight loss methods, and follow-up periods.”

    From a female perspective, as a person who lost a lot of weight, I can tell you that the social rewards during weight loss and immediately after losing a radical amount of weight are enormous. Everyone tells you how great you look, with all kinds of sexual overtones in their comments. There’s a commercial running locally now for a weight loss program in which all the women (who have only recently lost weight, of course) gush about how their husbands feel like they’re married to new women, blah, blah, blah. These rewards, that do spike hormonal reactions and sexual activity, are relatively short lived. After a time, one is left to a lonely struggle with the maintenance of weight loss and all the positive comments that people like to make dribble off and fade into memory. At some point, you start to see your deflated skin differently, probably more realistically. In clothes, you are a more desirable object in our society’s sexual marketplace, but naked, a person over 40ish who has undergone radical weight loss looks like no one else their weight that they have seen in movies, photos, etc. I felt horribly deformed. With that realization, my sexual desire went on a gradual downward spiral. I had surgery to remove and tighten excess skin, which helped, but I never returned to that crazy hormonal rush of the later weight-loss and early maintenance period.

    Long-term follow up for these kinds of studies would be difficult because there are so few people who maintain losses long enough to be able to make these kinds of comparisons.

  8. hopefulandfree (RNegade) says:

    @Alexander Schwartz, who wrote, “Perhaps the interaction of both our biology (diminished sexual functioning due to increased adiposity) and societal perceptions of obese individuals leads to a greater sexual impairment (in whatever way that may be defined)?”

    Thank you for that. :)

    I have no way of knowing whether or not you have ever experienced, first hand, the social stigma and oppression which accompanies one’s entire lifeworld when you live (or have lived) as a fat person in our culture(s). I don’t understand how biological (physiological) processes taking place simultaneously under chronic conditions of social oppression can be conceptualized separately, in a very meaningful or ethical way, since human beings are not merely physical organisms but highly complex social creatures at our very core.

    Humans experience existence socially, as social organisms embedded in social systems in which social domination and control are always operating. We are completely dependent on social interaction for our human-being-ness (our humanity) and for our personal lived experiences as social creatures whose very perceptions of reality hinge, completely, on our shared language and social discourse (and on worldviews constructed through discourse)—for we are, all of us, universally dependent and reliant on language-making and language-sharing (and even nonverbal communication), hence our SOCIAL experiences tell us and show us who we are, as individuals and as a species.

    You don’t need to be a sociologist to become more profoundly aware of these realities.

    When most of one’s everyday lived experiences as a social participant (i.e. a human being) remind a fat person that she (or he) is defective, powerless, weak willed, ugly, emotionally damaged, physically and mentally diseased (both self inflicted), self-destructive, stupid, uneducated, sexually repugnant, disgusting, deserving of ridicule and contempt, and even worse…then there are not, simply, biological and “perhaps” psycho-social consequences, combined, from living with that worldview and that reality, day after day, year after year.

    Rather, I would argue that there are physiological consequences—chronic physiological forms of stress and trauma resulting from ongoing social oppression (oppression from which there is no apparent escape for the vast majority of fat people, even after weight loss, except death.)

    Why is it so difficult for many scientists and others to realize that severely oppressive social conditions can (and do) ALTER and change human physiological functioning (e.g. can change endocrine responses and neurobiochemical signalling processes)?

    I’m glad to hear about the “massive push towards collaborative research”, and I hope researchers who focus on obesity will actively collaborative with researchers and theorists who value and understand critical social perspectives (be they anthropologists, sociologists, social workers, philosophers, communication scholars or nurses…).

    An old (but useful) article from a nursing journal comes to mind as a helpful place to begin seeing the enormous burdens of weight stigma and oppression:

    http://journals.lww.com/advancesinnursingscience/Fulltext/2004/10000/Obesity,_Stigma,_and_Civilized_Oppression.6.aspx

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