Obesity

Content written by Martin Miner, MD

Obesity is defined as a condition in which somebody’s weight is more than 20 percent higher than is recommended for that person’s height.

Which specific sexual health problems it relates to:

Erectile dysfunction, is thought to be a “portal” for Men’s Health, and a harbinger for early cardiovascular disease detection. An analysis of the 2001-2002 National Health and Nutrition Examination Survey (NHANES) published in 2006 revealed that the overall prevalence of ED in 3500 men aged 20 and older was 20%. This prevalence in men aged 75 years and older was more than 77%. This study was striking in establishing ED and its independent association with risk factors including diabetes mellitus, obesity, smoking and hypertension. Obesity conferred a 60% increased risk of ED (odds ratio [OR] 1.6).

Excess body weight adversely affects CVD risk factors (e.g. increasing low-density lipoprotein [LDL] cholesterol levels, triglyceride levels, blood pressure, blood glucose, and reducing high-density lipoprotein [HDL] cholesterol levels. It also increases the risk of developing CAD, heart failure, stroke and dysrhythmias.

What can be done to prevent the risk factor causing sexual dysfunction?

The relationship of erectile dysfunction as a harbinger of occult vascular disease may serve as a motivator to prompt men to make changes in diet and lifestyle, as improvements in BMI and physical activity are independently associated with improvements in sexual function, as documented by a recent randomized controlled trial.

* Weight loss represents a significant goal for improving physical and psychosocial health.
* The idea lifestyle management is that individuals make gradual changes in diet and physical activity with the use of behavioral changes, with an initial weight loss goal of 10%. Most vital to this is that any change in diet that is sustained is made slowly over a course of time. Most settings that result in failure establish unreasonable goals over too short of time.
* ‘Portion control’ is suggested , though it can be at conflict with the ‘cleaning your plate’ overtone with which many of us were raised.
* Understanding an individual’s food preferences is vital to determining adherence to any form of diet. If one does not like goat cheese and tofu, no prodding will alter that visceral desire.
* Incorporating physical activity into one’s day is vital, even if it begins with, “10 minutes of brisk walking till you are perspiring or short of breath” five days a week. Everyone can find ten minutes. And once achieved, the time can be lengthened, but the initial commitment is sought for ten minutes/five days/week for the first 3 months.
* Finally, the most commonly used and successful behavioral strategies are self-monitoring, goal setting, stimulus control, problem solving, and cognitive restructuring. This involves individuals recording their food, physical activity, and weight.

The 2006 published Diet and Lifestyle Recommendations Revision put forth by the American Heart Association Nutrition Committee amplify the above recommendations noting that diet is a vital part of overall healthy lifestyle, and for the first time (the prior set of recommendations were published in 2000) puts Lifestyle into the title. The goals of these recommendations are as follows:

+ Consume an overall healthy diet. Prior research has focused on individual nutrients and foods. Health dietary patterns are associated with a substantially reduced risk of CVD, CVD risk factors, and noncardiovascular diseases. Consistent with this principle, the AHA recommends that individuals consume a variety of fruits, vegetables, and grain products, especially whole grains; choose fat-free and low-fat dairy products, legumes, poultry, and lean meats; and eat fish, preferably oily fish, at least twice a week.
+ Establish a healthy weight to achieve a BMI of 18.5 to 24.9 kg/m2. Overweight is a BMI between 25 and 29.9, and obesity is a BMI>30. Currently, one third of adults are overweight and one third are obese, with the problem achieving epidemic proportions.

In a study of 110 obese men (with a lean body mass index [BMI] of at least 30, Esposito, et al., assessed the degree to which weight loss and increased physical activity affected erectile function. Subjects were aged 35 to 55 years and were free of diabetes, hypertension, and hyperlipidemia. All had erectile dysfunction. Half of the group (55 men) was randomized to active intervention. They were given plentiful, detailed advice about how to achieve a loss of 10% or more in their body weight. During monthly group sessions, they were taught how to reduce caloric intake, set goals, and monitor their food intake with food diaries. Each man received direction about the amount of carbohydrate, protein, fiber, and gat to eat, including types of fat. Men in the intervention group were also free to avail themselves of behavior and psychological counseling. Each participant also received individualized physical activity coaching, including advice on walking, swimming, or participating in group games. During the first year the men in the intervention group met with their nutritionists and exercise trainers once a month. During the second year, they met at 2-month intervals. The 55 men in the control group were given generic health information about food and physical activity.

Within 2 years, BMI decreased more among members in the intervention group (from 36.9 to 31.2) than in men in the control group (36.4 to 35.7). Men in the intervention group were more physically active than those in the control group, increasing the average time spent exercising from 48 to 195 minutes per week. Those in the control group increased their time spent in physical activity from 51 to 84 minutes per week. ED function improved significantly in the intervention group, with 17 of the 55 men normalizing their erectile function. 3 men in the control group normalized in regards to their ED, but there was no change in the IIEF (International Index of Erectile Function) scores among men in the control group. The results of the multivariate analyses showed that improvements in BMI and physical activity were independently associated with improvements in the IIEF score. The investigators concluded that about one third of obese men could expect improvements in erectile function if they lost weight and increased their physical activity levels.

In summation, weight loss and exercise represent significant goals for improving physical and psychosocial health. Studies conducted to date suggest that weight loss and increase in physical activity levels may improve erectile function and reduce cardiovascular risk.