The National Institutes of Health estimates that as many as 30 million men in the US may be affected by erectile dysfunction (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:
Chronic diseases—such as diabetes, kidney disease, chronic alcoholism , multiple sclerosis , atherosclerosis , 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, anxiety , depression , 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 obese 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.
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, hypertension , and hyperlipidemia (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:
The control group received:
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.
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.
RESOURCES:
American Foundation for Urologic Disease
http://www.afud.org/
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov/
Sources:
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: http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/ . 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.
Last reviewed June 24, 2004 by Lawrence Frisch, MD
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