Obesity and erectile
dysfunction: another sad story, same happy ending
In the pantheon of contemporary culture, neither
Adonis nor Aphrodite has love handles.
But two thirds of Americans do. Yet, contrary to
conventional stereotypes, their excess weight hasn’t hampered
their interest in having a healthy sex life. In fact, research
shows that overweight men are just as interested in sex as the next
guy; they just may not be as able to perform.
Now, when it comes to performance anxiety, low
self-esteem about body image can be a real impediment to
confidence, so that may account for some of the problem.
But experts say that 90 percent of erectile
dysfunction is physical in origin, not psychological. In
large-scale studies, nearly 80 percent of men who reported having
erectile dysfunction were also overweight or obese.
So perhaps it won’t be a surprise that a
recent study published in the Journal of the American Medical
Association has yielded some promising news about resolving this
sensitive problem, and it doesn’t have anything to do with
little blue pills you hear advertised during major sporting
events.
The research in question was a two-year study
conducted at the Second University of Naples, Italy. The subjects
were recruited from a campus weight-loss clinic. They were all
obese men between the ages of 35 and 55. All reported some degree
of erectile dysfunction, but they were otherwise healthy, without
the complications of diabetes, hypertension or heart disease that
are so common with obesity.
Half the subjects were supervised by medical
professionals in individualized weight-loss treatment programs.
They were educated about diet, fitness and personal behavioral
adjustments in visits with a nutritional counselor and a personal
trainer, every month for the first year, and then bi-monthly during
the second year of the study.
The other half—the control
group—just got general information about exercise and healthy
dietary choices during visits every other month during the two-year
study period.
By the end of the study, all the men in the
supervised group had lost weight and experienced various health and
sexual function improvements. In fact, by the time they’d
achieved a weight loss of just 10 percent, erectile dysfunction was
completely alleviated for one out of three men in that group.
But there was no change in weight for the
control group, and even by the end of the study, only three of the
55 men in the control group had recovered normal erectile
function.
Perhaps the most important finding of this study
is one the researchers weren’t even trying to prove:
regardless of the objective, the weight loss effort is more
effective with professional supervision. Remember that these men
were all what you would call “motivated” subjects; they
were recruited from among people who had already shown up at a
weight-loss clinic, so they wanted to lose some weight. But even at
that, the subjects who didn’t have any particular guidance
just couldn’t do it.
The men did not know that the study was
specifically examining the potential improvement in sexual
function. Had they known this was a possible outcome of their
effort, even the unsupervised group might have been more
“motivated.” When a healthy sex life is at
stake—and for most overweight men, it is—men
shouldn’t just try to handle the problem on their own,
because the right support seems to make all the difference.
- That said, consider some of the other
outcomes:In the supervised group, overall blood pressure was
lowered, but not in the control group.
- In the supervised group, overall cholesterol levels dropped,
but the subjects had an increase in their good HDL cholesterol
levels. The control group’s overall cholesterol went up, but
with no increase in their good HDL levels.
- Triglyceride levels and C-reactive protein counts also dropped
for the supervised group, but not the control.
You probably recognize these things as factors
in heart health and diabetes, and so you can understand how the
supervised subjects’ also reduced their disease risk.
The researchers also tested endothelial function —the
performance of cells lining the blood vessels— which has an
impact on both cardiovascular health and erectile function. The
chronic oxidative stress and inflammation caused by obesity impairs
endothelial function. Here again, the men in the intervention group
showed improvement, while the control group did not.
We already knew from previous research that
overweight men who initiate weight loss in mid-life have 70 percent
less risk of ever having erectile dysfunction than those who remain
sedentary. The current study was meant to determine if weight loss
could also reverse erectile dysfunction that had already set in,
and it seems clear that it can.
If sales of Viagra, Levitra and Cialis are any
indication, the pursuit of vigorous sexual function is a strong
motivator for men of any age. Hundreds of millions of dollars have
been invested in promoting the take-a-pill approach to that
pursuit, and millions of men have responded, in spite of potential
side effects and other health risks involved.
Imagine if even a few million dollars were
invested in a public education campaign letting men know that just
losing weight and improving their fitness could be the answer to
their personal distress.
It’s true that recently, there have been
more public health efforts to promote weight-loss and fitness in
general, especially given the epidemic of obesity and associated
increases in diabetes and heart disease. But imagine the impact of
a campaign that gave men the concrete goal of a healthy sex life.
Most would agree that seems more tangible to the average fellow
than say, lowering his triglycerides.
There’s likely to be some personal cost
involved in pursuing comprehensive weight loss treatment. But how
do those costs compare to the expense of prescription approaches?
And consider how much overall health care costs would go down if
men tried to recover their lost virility by losing weight and
getting healthy, instead of popping a pill.
No matter how medically appropriate and
cost-effective, this is one treatment that—as a JAMA
editorial put it—will never be “accompanied by free
pens, free notepads and its own Superbowl commercial.”
That means it’s up to public health
advocates and doctors to carry this message of hope without any
big-budget hype.
THROUGH THICK & THIN
Erectile dysfunction affects more than half of
American males between age 40 and 70, and nearly 80 percent of men
with the problem are overweight. Research shows that just walking a
couple miles a day can significantly help a man’s chances of
avoiding—or even reversing—erectile dysfunction, and
it’s a lot cheaper and less risky than certain pills we hear
a lot about.