Obesity is a common medical problem in the Australian community. It is estimated that over 70% of Australian males and over 50% of Australian females are overweight or obese. Obesity not only contributes to a vast number of medical problems (including heart disease, type 2 diabetes mellitus, hypertension, dyslipidaemia and obstructive sleep apnoea) but research suggests obesity is also linked to impairments in quality of life, social functioning and sexuality. This article considers the latest research on the links between obesity and sexuality.
Whilst there has been considerable research on obesity and on sexuality as separate issues, research on the relationship between the two is currently limited. Obesity is defined as an excess in body fat or a body mass index (BMI) greater than 30. Obesity has been a focus of public health measures in recent years due to the alarming rise in prevalence and its various associated co-morbidities. Sexuality, on the other hand, refers to the aspect of our personalities defining our sexual behaviour and attitudes. Although medical experience suggests that obesity is associated with sexual dissatisfaction and/or sexual difficulties, few definitive studies have been conducted to date.
Results of the limited studies have shown that sexual difficulties are more common in overweight individuals. Impairments include lack of sexual enjoyment, lack of sexual desire, difficulty with sexual performance, and avoidance of sexual encounters.3,5 Low self-esteem and poor body image are thought to partly contribute to these problems with sexuality.4 Media and public perceptions that you have to be thin to be sexually attractive can also alter a patient’s sexuality. Patients may suffer social stigmatisation due to their weight and subsequently avoid entering sexual relationships.1,5 Studies also suggest that diminished sexual quality of life is more common in females compared to males. However, obese males have increased problems with sexual performances such as erectile dysfunction and penile vascular impairment.4
In the modern era, obese patients have access to a wide variety of weight loss strategies. Patients may consider diets, meal replacement programs, lifestyle changes, cognitive behavioural therapy (CBT), weight loss drugs and bariatric surgery (for the morbidly obese) in their battles to lose weight. In addition, specific treatments for sexuality problems may encompass communication, body image strategies and sexual therapies.
Unfortunately, data supporting many of the above therapies in the treatment of sexuality problems are sparse.7 Very few studies have been conducted that consider the effects of weight loss treatments on sexuality, and results are generally equivocal. Thus, there is a call for extra research into this field.
Non-surgical methods of weight loss (including diet, lifestyle changes and medications) have been associated with improvements in sexual functioning, while the effects of bariatric surgery on sexuality are far more controversial.2,8 Although it is expected that substantial levels of weight loss following surgery will lead to improved sexual function and greater sexual enjoyment, patients must be warned of the potential deleterious side effects of bariatric surgery.6 Bariatric surgery may be associated with new identity issues, relationship demands and distorted body image due to excess flabby skin and abdominal skin overhang.5 In addition, bypass operations can negatively affect fertility status and sexual function, particularly in males.8
The increased incidence of sexuality issues in obese individuals is non-disputable. To address the needs of your obese patients fully, it is essential that you consider the sensitive topic of sexuality during patient consultations.7 Moreover, the well documented benefits of weight loss on overall health and quality of life should be relayed to your patients. The ideal treatments for obesity-related sexuality problems are currently unknown but will hopefully become apparent with future research. As a medical practitioner, you are therefore encouraged to remain up to date with emerging research on the role of weight loss therapies on the treatment of sexuality issues.
For further detailed information on this topic, please refer to our lifestyle article on obesity and sexuality.
- Areton L, Factors in the sexual satisfaction of obese women in relationships. Electronic Journal of Human Sexuality, Volume 5, Jan. 15, 2002. Available [online] at URL: www.ejhs.org
- Esposito F, Giugliano C, Di Palo G, Giugliano R, Marfella, D’Andrea F. et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004; 291: 2978-84.
- Esposito K, Ciotola M, Giugliano F, Bisogni C, Schisano B, Autorino R, Cobellis L, De Sio M, Colacurci N, Giugliano D, Association of body weight with sexual function in women. International Journal of Impotence Research 2007; 19(4): 353-7.
- Kim K, Kang H, Kim S, Youn B. Influence of weight reduction by sibutramine on female sexual function. Int J Obes 2006; 30: 758-63.
- Kinzl J, Schrattenecker M, Traweger C, Aigner F, Fiala M, Biebl W, Quality of life in morbidly obese patients after surgical weight loss. Obesity Surgery 2007; 17: 229-35.
- Kinzl J, Trefalt E, Fiala M, Hotter A, Biebl W, Aigner F. Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding. Obesity Surgery 2001; 11(4): 455-8.
- Kolotkin R, Binks M, Crosby R, Ostbye T, Gress R, Adams T. Obesity and sexual quality of life. Obesity 2006; 14: 472-9.
- Merhi Z. Bariatric surgery and subsequent sexual function. Fertility and Sterility 2007; 87(3): 710-1.