How can obese men revive their sex lives? Exercise more and eat less.
A new study reports that one third of obese men with erectile dysfunction, or ED, regained sexual function after two years of treatment at a weight loss clinic.
Some experts say the finding is yet another reason to encourage their patients to lose weight and take on healthy habits. A healthy lifestyle will not only improve sexual function, but also provide myriad other benefits to the patient.
And the results are tangible, not only during the patient's physical exam, but also in the bedroom.
"If a patient is obese and has erectile dysfunction, losing weight has a positive effect of regaining sexual function in one in three patients," says Christopher S. Saigal, a urologist at the David Geffen School of Medicine at the University of California at Los Angeles.
The study, published in this week's Journal of the American Medical Association, reports that out of a group of 55 obese men between the ages of 35 and 55 who had erectile dysfunction, 17 men regained sexual function after two years of intensive help at a weight loss clinic.
"That almost one third of obese men reversed their ED after exercising more and losing weight is striking," wrote Saigal in an accompanying editorial to the study.
The successful men upped their level of physical activity from an average of 48 minutes of exercise a week to three hours of exercise a week — mainly walking, but also swimming or aerobic games like football or baseball. By adopting a low-calorie diet, they also reduced their body mass index from an average of 37 to 31, a marked improvement over the control group.
Thirty million American men suffer from ED, which the American Urological Association defines as "the consistent inability to achieve an erection that is adequate for satisfactory sexual function."
According to Ira Sharlip, assistant clinical professor of urology at the University of California at San Francisco, and spokesman for the American Urological Association, "There is increasing evidence that erectile dysfunction is not just a separate condition in itself, but is a marker of endothelial function (how well the cells that line blood vessels work) and cardiovascular disease in general."
Other experts also agree the risk factors associated with erectile dysfunction, including obesity, are similar to the risk factors for heart disease.
"From a clinical point of view it makes sense to say that erectile function can either be prevented or delayed or reduced by avoiding risk factors that include diabetes, smoking, high blood pressure, and obesity. It makes sense to say to patients, 'your choice for developing erectile function is reduced if you avoid these risk factors,' " says Sharlip.
Adds another expert: "This study provides more corroborative evidence that a healthy lifestyle is conducive to longevity and in this case it's sexual longevity." According to Michael O'Leary, associate professor of surgery, Harvard Medical School, and senior urologic surgeon, Brigham and Women's Hospital, "There are many men who want to be sexually active into their 70s and into their 80s. If you don't smoke and stay healthy and watch your weight, there's a better chance of doing that."
Little Blue Pill or Lose Weight?
For some experts, this study suggests diagnosing Viagra is not the only — or the best — way to treat obese men with erectile dysfunction.
"So many men are reaching for instant solutions to their medical problems rather than making the harder and long term changes which lead to health promotion," says Eli Coleman, director, Program in Human Sexuality at the University of Minnesota Medical School. "Why lose weight when you can just take a pill to lower your cholesterol, blood pressure, increase your erectile capacity?"
Coleman has this recommendation for obese men with erectile dysfunction: "Lose weight and exercise. Not only will it possibly help their erections (unless there are other contributing factors), but will increase their chances of living healthier longer — thus retaining their sexual capacity till older age."
But patients do not necessarily respond to their physicians' encouragement to lose weight.
Saigal notes in his editorial, "Counseling overweight patients to begin and sustain effective weight-reducing behaviors can be a daunting challenge for clinicians."
But O'Leary is optimistic the results of this study will help get the message across to obese men that losing weight is beneficial to their all-round health.
"This is like the smoking story several years ago, and I've found that I can get some people to stop smoking by telling them they'll lose their erections, when telling then they'll die of heart disease or cancer doesn't get their attention," says O'Leary. "Maybe now they'll be motivated to lose some weight too."
But with the obesity epidemic on the rise, instances of erectile dysfunction might increase.
"Obesity is one of the most serious problems that our nation faces. It results in a myriad of health-related problems. There needs to be a major health promotion campaign as vigorous as smoking cessation to address this public health problem," argues Coleman.
For obese men with ED, experts suggest that there is a wide range of effective options, starting with a visit to an urologist.
"There are great therapeutic options for [men with erectile dysfunction] and urologists are specially trained to select treatments or provide different options for them. … Visiting your urologist is the beginning of the story," says Saigal.
Exercise benefits can start when men are still young. Earlier research found that men who adopted exercise regimes in mid-life had a 70 percent lesser risk for ED than men who remained sedentary.
"My advice would be that it is in their general best interest for long-term health care to reduce their BMI and get back to a more appropriate weight. Not only will they avoid the subsequent problems associated with obesity, but they may also have a decrease in the incidence of ED, or if ED occurs, it will be more responsive to oral therapies," says Larry Lipshultz, chief of the Division of Male Reproductive Medicine and Surgery at Baylor College of Medicine in Houston.
Saigal agrees adopting healthy lifestyles may be the first line treatment for obese men with erectile dysfunction. "It's worth trying. It's not going to hurt the person to try and lose weight."