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.
Kolotkin RL, Zunker C, & Ostbye T (2012). Sexual Functioning and Obesity: A Review. Obesity (Silver Spring, Md.) PMID: 22522887
Yesterday, I ended my posting on the Megasexual MEGARS on the rather sobering note of erectile dysfunction.
Yes, obesity is an important risk factor for this rather embarassing and annoying, but seldom talked-about complication of obesity. (I continue to be amazed by just how many grateful male patients have thanked me for the great improvements that they experienced in their sex lives as a result of obesity treatment.)
Some, if not most of this may be related to the hypogonadotrophic hypogonadism that I have blogged about before.
Indeed, healthy lifestyle factors are strongly associated with maintenance of erectile function in men – and in obese men with erectile dysfunction – weight loss sure helps.
Perhaps the best study on this issue was done by Katherine Esposito and colleagues from the Second University of Naples, Naples, Italy (published in JAMA). They conducted a randomized, single-blind trial of exercise and weight loss in 110 obese men (BMI > or =30) aged 35 to 55 years, WITHOUT diabetes, hypertension, or hyperlipidemia, who had erectile dysfunction as determined by a score of 21 or less on the International Index of Erectile Function (IIEF).
The 55 men randomly assigned to the intervention group received detailed advice about how to achieve a loss of 10% or more in their total body weight by reducing caloric intake and increasing their level of physical activity. Men in the control group (n = 55) were given general information about healthy food choices and exercise.
After 2 years, BMI decreased more in the intervention group (from 36.9 to 31.2) than in the control group (36.4 to 35.7) while the IIEF score improved significantly in the intervention group (from 13.9 to 17.0), but remained unchanged in the control group. Remarkably, 17 men in the intervention group but only 3 in the control group reported an IIEF score of 22 or higher at the end of the study.
The authors thus concluded that in about one third of obese men with erectile dysfunction, increased physical activity and weight loss can markedly improve sexual function.
So to all obese men: if sexual function is fine – GREAT! If erectile dysfunction is an issue – obesity treatments may just be worth a shot.