Weight_reduction1
Obesity
and Erectile Dysfunction - Another Sad Story, Same Happy Ending
Caroline Cederquist
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
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.
###
Caroline J. Cederquist, M.D. is a board certified Family
Physician and a board certified Bariatric Physicians (the
medical specialty of weight management). Dr. Cederquist is the
founder of [http://www.bistromd.com]Bistro MD formerly Diet To
Your Door, a home diet delivery program that specializes in low
calorie gourmet food that is delivered to your home or office.
Bistro MD serves as culmination of Dr. Cederquist's expertise in
the world of medical weight loss.
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