Wednesday, June 8, 2011

Why Little is Known About Obesity Management in Men

One of the interesting epidemiological findings in virtually every population study, is that the prevalence of overweight and obesity in men and women, with a few minor differences in age distribution, is virtually identical.

Yet, both commercial and non-commercial weight loss programs as well as bariatric centres are overwhelmingly frequented by women.

Interestingly, research studies on weight loss and obesity management are also almost exclusively done in women.

This, not surprising, but important fact, is elegantly demonstrated in a paper by Sherry Pagoto and colleagues from the University of Massachusetts, published in the latest issue of OBESITY, which examined the inclusion of men in randomised controlled trials of lifestyle weight loss interventions.

Their analysis of 244 studies with a total of 95,207 participants published in the last 10 years (1999-2009), revealed on average 27% male vs. 73% female participants.

Interestingly, trials recruiting a diseased sample included a larger proportion of males than those not targeting a disease (35% vs. 21%).

About 32% of trials used exclusively female samples, whereas only 5% used exclusively male samples .

No studies in the past 10 years specifically targeted minority males as a result of which ethnic males composed 1.8% of total participants in US studies.

Only 24% of studies that underrepresented males provided a reason for doing so.

This of course has major clinical implications, as it means that very little is known about the efficacy or effectiveness of lifestyle interventions in men and virtually nothing is known about weight management in non-white men.

Based on these data, evidence-based lifestyle management of obesity in men is virtually impossible and appears to be a major knowledge gap.

While I appreciate the many reasons why women are so much more likely to participate in weight loss studies and seek out obesity treatments, the fact remains that for men seeking (and perhaps requiring) such treatments, there is virtually no knowledge base on which to make any kind of recommendations.

This gender discrepancy that is perhaps unique for a non-gender related health problem (remember obesity is as common in men as in women), is something that may have to be addressed in future funding-policy decisions.

Currently, there are ‘affirmative action’ type rules in place to ensure fair representation of women in clinical trials – in fact the Canadian Institutes of Health Research has a whole institute dedicated to addressing the issue of gender and health and it appears that much of its activities appear dedicated to studying issues of particular significance for womens’ health.

This discrepancy in gender distribution in obesity research may be a reason to prompt specific initiatives by this and other institutes to ensure that future studies on obesity management (be it lifestyle or other interventions) include a proportion of men that equitably represents the prevalence of excess weight and the burden of obesity in the male population.

AMS
Edmonton, Alberta

Pagoto SL, Schneider KL, Oleski JL, Luciani JM, Bodenlos JS, & Whited MC (2011). Male Inclusion in Randomized Controlled Trials of Lifestyle Weight Loss Interventions. Obesity (Silver Spring, Md.) PMID: 21633403

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8 Responses to “Why Little is Known About Obesity Management in Men”

  1. Rachel says:

    Hopefully, the more life threatening obesity is examined as a medical condition and less as a moral/social issue (where the negative judgements fall more heavily on women) obese men will get the attention they are entitled too. Its frustrating how unscientific medicine is sometimes.

  2. Lisa S says:

    Dr Sharma

    I think you have made an error here.

    First you say
    “research studies on weight loss and obesity management are also almost exclusively done in men,” but then you say male participation is only 27 per cent.

    Did you mean studies are also almost exclusively done BY men?

    Just wondering….

  3. Arya M. Sharma, MD says:

    @Lisa: It was actually meant to read “…almost exclusively in women”. Thanks for spotting, have made the correction :)

  4. vesta44 says:

    Maybe the reason fewer men participate in these studies is because men are not held to the same standard of health/beauty that women are – at least, they haven’t been up until the last few years, that is changing. A man can be 5′ 8″ and weigh 195 lbs and no one says anything to him – not doctors, not other men, not women, no one. But let a 5′ 8″ woman weigh 195 lbs and her doctor is right in her face about losing weight, other women are telling her she’s fat, the media is telling her she’s fat, men are telling her she’s fat – she’s bombarded day in and day out with the fact that she doesn’t measure up to society’s expectations and is therefore not worth anything unless and until she loses weight. Men just haven’t had to face that kind of pressure from their doctors, friends, or the media, so why would they worry about their weight/health and rush to enroll in studies about how to reduce their weight and keep it off in order to improve their health? They haven’t been conditioned to see it as a problem the way women have.

  5. Mitzi says:

    I agree with the previous comment. I saw a man at church this past week smile, pat his huge abdomen, and call it his “pet”. Large men in our local culture are not stigmatized at all, and even when diagnosed with heart problems or diabetes, seem to make no connection between their diet (barbecue and chicken with lots of chips, no veg please,) their activity level (office work and TV reclining), their size, and their health. How can we lessen the stigma for overweight women (which gets downright pathological) while still maintaining the clear connection between losing weight and gaining health?

  6. tess says:

    i think that this is a molehill-converted-to-mountain issue. in every diet book i’ve ever read, the author makes the point that women will lose weight more slowly on the technique-du-jour than men will. when studies began to be planned, very few decades ago, concentrating more on women than men, it seemed to be a reflection of the “more complicated biology” in female fat loss, rather than a neglect of the large number of men needing to lose weight.

    as Mitzi pointed out, overweight men seem to be more comfortable with their body images than overweight women are. my husband is clinically obese to my slight overweight, but i’m the one who is careful about what i eat. he can lose (and has lost) fat easily, through very moderate restrictions, but doesn’t care enough to do it.

  7. cass_m says:

    I have to disagree with tess about this being a false issue. Do women loose weight more slowly or is this just a meme because women start trying to loose weight to be like a model when they are a healthy weight then get stuck in a diet trap while men don’t do anything until they have a “pet”?

    My spouse was told to lose weight or go on meds because of an elevated cholesterol. Until that point he hadn’t considered that he was significantly overweight (BMI* Obese). It was just as easy for him to loose that initial 10 to 15 kilos as it was for me to loose my first 5 (BMI overweight). He has struggled way more to get into a normal BMI, and still has not hit it, while I kept cruising and find it easy to maintain in the range. Yes this is anecdata but it does show that weight loss/maintenance issues is not inherently gendered.

    *I know BMI is based on population averages but is handy for this example.

  8. DeeLeigh says:

    How can we lessen the stigma for overweight women (which gets downright pathological) while still maintaining the clear connection between losing weight and gaining health?

    That’s easy. By connecting health to habits rather than emphasizing weight.

    If someone really is fat because of bad habits, then they’ll lose weight when they improve their habits. If we focus on the connection between health and habits, thin and unhealthy people with bad habits will also be encouraged to improve their health and fat, healthy people won’t be pressured to lose weight. That makes so much more sense than using weight as a proxy, since weight is a complex issue that is not hard wired to either health or habits.

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