The National Institutes of Health estimates that as many as 30 million men in the US may be affected by
(ED). ED, also known as impotence, is the repeated inability to get or keep an erection firm enough for sexual intercourse. ED is often associated with advanced age, but a study published in 2003 found that ED occurred in:
12% of men 59 and younger
22% of men aged 60-69
30% of men 70 and older
Chronic diseases—such as diabetes, kidney disease, chronic
, vascular disease, and neurologic disease—account for about 70% of ED cases. Many common medications list ED as a side effect, including blood pressure drugs, antihistamines, and antidepressants. Psychological factors, such as stress,
, and guilt, may lead to ED as well.
Several studies have found an association between weight, physical activity, and sexual function. In fact, a study published in 1999 found that in men reporting ED, the prevalence of being overweight or
was as high as 79%. Another study published in 2003 found that men with a body mass index (BMI) higher than 28.7 (
BMI is a measure of body mass based on weight and height; people with a BMI of 30 or greater are considered obese
) had a 30% higher risk of ED than did men of normal weight.
While clinical evidence points to a connection between weight, exercise, and ED, no previous studies have investigated whether losing weight and increasing physical activity may reduce the risk of ED. A new study published in the June 23/30 2004 issue of the
Journal of the American Medical Association
suggests that lifestyle changes designed to obtain a sustained and long-term weight loss and an increase in physical activity may positively affect erectile function in obese men.
About the Study
The study included 110 men with a body mass index (BMI) of 30 or greater. The men in the study suffered from ED and were aged 35–55 years. They were free of diabetes,
(abnormally high blood levels of lipids, such as LDL cholesterol or triglycerides). The men were randomly assigned into one of two groups: intervention and control. Follow-up lasted two years.
The intervention group received:
Individualized and detailed advice about how to achieve a reduction in total body weight of 10% or more (including reducing caloric intake, setting goals, and self-monitoring)
Individual guidance on increasing the level of physical activity
Monthly sessions with a nutritionist and exercise trainer in the first year and bimonthly sessions in the second year
The control group received:
General oral and written information about healthy food choices and exercise at the start of the study and every two months (no specific individualized program was developed)
At the end of two years, erectile function remained stable in the control group, but 31% of men in the intervention group had improved sexual function. These positive changes in erectile function were related to the reduction in BMI and body weight, and the increases in physical activity in the intervention group.
Other findings included the following: men in the intervention group had significant decreases in waist-to-hip ratio, blood pressure, levels of glucose, insulin, total cholesterol, and triglycerides, as well as an increase in HDL cholesterol (the “healthy” cholesterol). Men in the control group had no significant change in these parameters, as well as BMI, body weight, and physical activity.
This study is not without limitations. The authors point out that ED can be closely related to psychological factors or relationship issues. ED could have been improved due to possible alleviation of anxiety and depression and a subsequent improvement in mental health in the intervention group. Also, a possible improvement in self-image after weight loss may have affected outcomes.
Furthermore, a significant portion of obese men have diabetes, hypertension, and elevated lipid levels, but men with each of these conditions were excluded from the study. While limiting the study to the “normally obese” makes scientific sense, it does not allow us to say whether the benefits shown by the study would occur in men whose obesity is complicated by diabetes, hypertension, or elevated blood lipids.
How Does This Affect You?
Although millions of men experience ED, it is a deeply personal issue, which makes discussing ED difficult and oftentimes uncomfortable. With the advent of several medications that treat this condition, ED is moving more into the mainstream. Television commercials during prime time and celebrity spokesmen who admit they too have experienced ED have slightly eased the secrecy surrounding ED. This study offers a possible non-pharmaceutical alternative for obese men who suffer from ED. As treatment options increase, men may be more willing to see their doctor about ED.
Countless studies have found that lifestyle modifications, which include increasing physical activity and maintaining a healthful body weight, have a profound and positive impact on a wide range of diseases. With the results of this study, it appears that for obese men, ED may be added to the list.
Esposito K, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978-2984.Erectile Dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Available at:
. Accessed June 21, 2004.
Seftel AD, Mohammed MA, Althof SE. Erectile dysfunction: etiology, evaluation, and treatment options. Medical Clinics of North America. 2004;88(2):387–416.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a