Does obesity cause erectile dysfunction?

La Providencia Siglo XXI What is ED?

Erectile dysfunction is a common disorder that is characterized by the inability to achieve an erection or maintain it in the way that satisfies the man for his sexual performance.  

The normal function of the penis was always an important issue for men. It is considered by men as “the masculine symbol”.  It is also of great importance to doctors as any sexual dysfunction is often, not always, the first sign of a more serious condition and a wakeup call to men to begin healthier living.  

The statistics

According to data;  

• 150 million men worldwide face a type of erectile dysfunction and  
• There are estimations that this number will double by the year 2025. 

On the other hand, obesity is an epidemic that characterizes both developed and developing countries. In 2014–15, more than 60% of Australians aged 18 and over were overweight or obese. 

According to multiple studies, there is a connection between obesity and ED. Furthermore, the severity of ED is associated with several other metabolic diseases.  

Sohar How do you calculate your BMI?  

First lets calculate your Body Mass Index to assess your risk.

Being overweight or obese is used to express excessive fat accumulation that can potentially cause health risks. For decades, the body mass index (BMI) is considered as the “golden standard” for measuring overweight and obesity in population surveys. 

BMI is calculated by dividing a person’s weight (in kilograms) by their height (in meters) squared: BMI = kg/m² (Aihg.gov.au,2017). 

BMI classifications for adults defined by the World Health Organization
Underweight	<18.5
Normal Weight	18.5-24.99
Overweight	25-29.99
Class I obese	30-34.99
Class II obese	35-39.99
Class III obese	>40

What does a high BMI mean for your sex life?  

There is a negative correlation between the sexual quality of life and BMI. Obesity is also associated with;  

• lower levels of self-esteem,  
• depression, and  
• anxiety  

Such mood disorders are the causal factors of psychogenic erectile dysfunction and can significantly affect the sexual function of a person who has no physical reason for erectile dysfunction.   

In a study among obese patients before bariatric surgery, researchers found that  

• 12% of men reported no sexual desire  
• ¼ of the male participants were not sexually active 
• more than half of the male participants were moderately or very dissatisfied with their sexual life 

Factors like being single, older age, depression, and certain medication use is associated with poorer sexual function. 

What is the link between obesity and erectile dysfunction?  

There are studies indicating that when ED is accompanied by a person who follows a high caloric diet and has a high BMI, usually it is a result of damage to the interior surface of blood vessels and lymphatic vessels.

Obesity is considered an independent risk factor for ED and men with increased fat around the abdomen.

The major links between obesity and ED are derangements of hypothalamic regulation of the neuroendocrine system and endothelial dysfunction.  

The hypothalamus is responsible for the regulation of certain metabolic processes and other activities of the autonomic nervous system. It controls your hunger, your libido, your thirst, your energy levels and your sleep, amongst other things.

The neuroendocrine system responds to stimulation by secreting hormones into the circulatory system that travel to the target tissue.

The endothelium is a thin layer of cells that line the interior surface of blood vessels and lymphatic vessels. Endothelial dysfunction can be caused by several conditions, including diabetes or metabolic syndrome, hypertension, smoking, alcoholism, and an unhealthy lifestyle.

Vasculogenic ED is considered as the most common form of organic ED and can be caused by endothelial dysfunction. On top of that, research shows that vasculogenic ED usually characterizes obese patients at a higher level than the rest of organic ED cases. 

Body fat and LowT  

LowT is very common among obese men no matter their age. Obesity and hormones have a bidirectional relation. On the one side, LowT levels predict the development of abdominal obesity, on the other hand, obesity predicts low total and free T levels. 

In males, obesity is considered the most important factor associated with LowT levels. According to a study, obese men have 30 % lower total levels compared to lean men. There are human studies indicating that fat-derived adipokines and pro-inflammatory factors can potentially cause the suppression of production. In addition, LowT promotes fat tissue accumulation and reduces the formation of muscles, which are crucial for increased metabolism. 

Furthermore, even when obese men have normal levels there is an increased risk of erectile dysfunction. 

Body fat and blood glucose  

There are numerous studies confirming the association between obesity and blood glucose. Earlier studies suggested that the hormonally active visceral adipose tissue is the main among the fat tissues that causes resistance. In addition, the mechanisms by which visceral obesity results in resistance appear to be related to excess lipid accumulation in the liver which can potentially lead to impaired function.

A recently published study highlights the association between body fat percentage and hormonal resistance in adults with a normal BMI. Specifically, researchers concluded that the prevalence of this resistance was increased in the participants who have elevated body fat percentage compared to the ones who had normal body fat levels. 

Can weight loss treat erectile dysfunction?  

Weight loss is one of the suggested lifestyle modifications to improve or even treat the erectile dysfunction. 

The first step is to make small daily changes to your dietry habits.

• Reduce the amount of carbs on your plate
• Increase the amount of vegetables
• Drink more water
• Cut out sugar
• Reduce the amount of take-away you consume
• Increase daily activity
• Decrease alcohol consumption

There is a study concluding that bariatric surgery significantly improves ED in obese men.  Moreover, weight loss through bariatric surgery improves blood glucose levels and increases pressure and endothelial functions that are involved in penis erection. 

It is worth mentioning that not only long-term but also short-term weight-loss studies have demonstrated improvement in ED. In addition, a 4- week study showed that weight loss seemed to have been beneficial on sexual life among men. 

In an intervention study among obese participants who lost an average of 15% of their body weight, the endothelial, and inflammatory markers all reduced. Moreover, almost one out of three men had erectile function restored after the weight loss intervention. 

I have lost weight but I still have ED. Now what?  

An experienced sexual health doctor at a reputable clinic will understand that ED can be caused by a combination or variety of factors and will explore all the options.   

Obesity is not the only causal factor of ED. Therefore, we might need to find the causal factor of ED to act accordingly. Weight loss can be beneficial not only for erectile dysfunction but to prevent or treat several other diseases as well. Therefore, keeping a low body weight should be a lifelong goal no matter of the noticed improvement in erectile dysfunction. 

The good news.  

The good news is that there are a variety of ways to treat a weak erection quickly and easily in addition to lowering your BMI. For a permanent improvement in your sexual function we highly advise you first uncover the underlying reason of your ED and then combine lifestyle changes with any potential pharmaceutical intervention that is deemed medically necessary.  In addition to lowering your BMI consider the following options;

• TREATMENTS: Nowadays, doctors have many treatment options that can help you improve your erectile function. However, there is a significant percentage of 30%–35% of patients who do not respond to the most common over the counter treatments, i.e. diabetics.
• EXERCISE: Exercise has a protective role against erectile dysfunction and it improves erectile function of males who face vascular erectile dysfunction. Physical activity can be a useful tool to decrease ED and according to the current recommendations, this can be achieved by 40 minutes of aerobic training (moderate to vigorous intensity) for at least 4 times per week.  
• QUIT SMOKING: Even a short smoking abstinence period of 1-5 days in heavy smokers can lead to significant improvements in vascular erectile parameters. When smoking cessation was studied with the use of an 8-week nicotine replacement therapy, researchers reported a significant improvement in erectile function at a 1-year follow-up. However, this improvement was only noticed in younger males with a more minor smoking history who did not have other comorbidities. The sooner you quit the better.
• PSYCHOLOGY: As a supplementary but equally important therapy for ED, doctors also suggest psychotherapy. Psychotherapy for ED aims to understand the context in which men make love, to identify the resistances to medical intervention that lead to premature discontinuation, to reduce anxiety and stress related to performance and to implement psychological education involving sexual scripts. Psychotherapy is a useful tool for clinicians as it significantly increases the effectiveness of their treatment interventions for ED.