April 6, 2007

Obesity and Erectile Dysfunction: Another Sad Story, Same Happy Ending

Written by Caroline Cederquist, M.D.

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.

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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.

About The Author:

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 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 and experience in the world of medical weight loss.

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