Obesity and Sexuality

• What is sexuality?
• Overview of obesity
• Relationship between obesity and sexuality
• Research findings
• Management of sexual dysfunction
• Effects of obesity treatments on sexuality

Research on the interaction between obesity and sexuality is limited, but some studies suggest that obesity can significantly impair sexual quality of life, particularly in women. Effective management of obesity using lifestyle changes, diet, drugs, behavioural therapies and, occasionally, weight loss surgery, may lead to improvements in self esteem, sexuality and quality of life.

What is sexuality?

Sexuality refers to an individual’s sexual attitudes, behaviours and practices. It is considered an integral part of our personality. The concept varies widely between individuals, and encompasses the physical (including sexual intercourse and sexual practices), the psychological and the cultural. For a long time, it has been recognised that medical conditions such as obesity can alter a peson’s sexuality. This may manifest as reduced sexual desire and lack of self-esteem in sexual relationships. Although it is a sensitive and difficult topic to discuss, with a high potential for embarrassment, proper consideration of any issues you have may lead to improvements in your overall quality of life. Most doctors will be receptive and non-judgmental when discussing these issues with you during your consultation.

Overview of obesity

Obesity is broadly defined as an excess in body fat or, more specifically, as a body mass index (BMI) greater than 30. Obesity is increasing at an alarming rate in Australia, and has now reached epidemic proportions. It remains a serious health issue due to the various medical complications, including type 2 diabetes, high blood pressure, high cholesterol, bone problems and obstructive sleep apnoea. In addition, it may have a negative impact on your quality of life, physical functioning, self esteem, emotional well-being and social functioning. Considerable research has gone into obesity in recent years and efforts have been made to control this growing health problem. A variety of different treatments to combat obesity are available, including lifestyle changes, weight loss drugs, meal replacement programs and surgical procedures.

Relationship between obesity and sexuality

There has been considerable research on obesity and on sexuality as separate issues, but not that much on the relationship between the two. This may reflect general societal misconceptions that obesity and sexuality cannot coexist – that only thin people are attractive, and that there are no sexual opportunities for obese people. However, with over 50% of the Australian population classified as overweight or obese, it is clear that sexuality is, in fact, an important issue.

Obese individuals commonly experience some sexual dissatisfaction or sexual difficulties related to their weight. In males, for example, it has been proven that obesity can lower sexual satisfaction and cause erectile dysfunction. The relationship between obesity and female sexual dysfunction is less clear, though obesity may lead to reduced sexual desires in women. Obese people may experience social stigmatization, discrimination and prejudice because of their weight. Poor self-esteem and body image affect overall sexuality. Overweight people may feel like sexual misfits, unattractive and undesirable, causing them to avoid potential or actual sexual relationships. Generally, those people who consider their weight to be a real problem and who seek treatment are those who have the highest rates of sexual problems.

Obesity can also be related to sexuality in the reverse fashion. If you have had problems with your sexuality or have been the victim of sexual abuse, you may turn to binge or comfort eating to help deal with your experiences. Psychological issues may cause you to use your weight as a means of avoiding relationships or intimacy. A doctor or psychologist can help you to explore the underlying basis for your problems.

Research findings

General results from recent studies show that:

• Obese individuals report higher incidences of sexual difficulties due to their weight (lack of sexual enjoyment, lack of sexual desire, difficulty with sexual performance, and avoidance of sexual encounters)
• A higher BMI is associated with a greater impairment in sexual quality of life
• Sexual quality of life is impaired in obese women more than in obese men, possibly because women place a greater importance on body image. Men, on the other hand, are more likely to have problems with sexual performance.

Management of sexual dysfunction

Management of sexual dysfunction in obese individuals can be challenging. First, ensure that the problem is adequately assessed. Doctors can help you by screening for sexual problems and discussing this sensitive topic with you. Remember that problems with sexual identity and function are common in both obese and non-obese people. Try not to let embarrassment stop you from receiving the proper care. Good communication, understanding and a strong doctor-patient relationship are important for your treatment.

 

Body image

Part of the management of sexuality issues may involve learning to accept your body, overcoming shame associated with your eating behaviour, and learning how to feel good about yourself. Your doctor can use cognitive and behavioural therapy to help you replace bad habits and ways of thinking with new, more productive habits. Improving your self-esteem and promoting your self-acceptance will help you overcome some of your sexuality problems.

 

Sexual therapies

There are numerous different sex therapies for non-overweight individuals that can be applied to obese couples. Programs may involve enhancing sexual communication and sexual assertiveness. Therapists may use group or couple therapy. It is also important to address how your partner feels about your weight, as this may cause strain in your relationship.

 

Weight loss strategies

Adequate weight loss using the various weight loss treatments may be an effective way to improve your sexual quality of life. Not only does it lead to health benefits, but it can improve your self-esteem, general well-being and quality of life.

Effects of obesity treatments on sexuality

Research into the effects of obesity treatments on sexuality is currently limited. It is thought that weight loss can improve sexual function and overall quality of life. Greater levels of weight loss can improve self-esteem, physical activity, social relationships, sexuality, and eating patterns. The effects of surgical weight loss methods on sexuality are unclear. Some studies have shown that the majority of women who underwent gastric banding enjoyed sex more after surgery than before, and that some found their relationships improved. However, sexual function can worsen after surgery, due to identity issues, new relationship demands, distorted body image, excess flabby skin and abdominal skin overhang. Research has confirmed that non-surgical weight loss techniques improve erectile dysfunction (in approximately one third of men) and improve arousal, orgasm, lubrication, and sexual satisfaction in women.

More information

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.

For more information on living with obesity, including discussing obesity with friends or loved ones, bullying and obesity in children, obesity and its cost on the workplace and links between obesity and pain, fertility and depression, see Living with Obesity.

 

References

1. 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
2. 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.
3. Esposito K, Ciotola M, Giugliano F, Bisogni C, Schisano B, Autorino R, et al. Association of body weight with sexual function in women. International Journal of Impotence Research 2007; 19(4): 353-7.
4. 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.
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7. Kolotkin R, Binks M, Crosby R, Ostbye T, Gress R, Adams T. Obesity and sexual quality of life. Obesity 2006; 14: 472-9.
8. Merhi Z. Bariatric surgery and subsequent sexual function. Fertility and Sterility 2007; 87(3): 710-1.