Duke study says sex life sags with obesity
Herald-Sun
November 15, 2004

By Jim Shamp, The Herald-Sun

Durham -- Size matters -- but Duke University Medical Center researchers can't pinpoint yet why obese people in their preliminary study reported sexual problems as much as 25 times more than people who aren't obese.

The findings showed "striking difference in sexual quality of life between obese and normal-weight people," said study co-investigator martin Binks, a clinical psychologist and director of behavioral health at the Duke Diet & Fitness Center.

Binks and a co-investigator, consulting psychologist Ronette Kolotkin, presented their data Monday during the annual meeting of the North American Association for the Study of Obesity in Las Vegas.

Binks said the clinicians, who specialize in helping people with obesity, had noticed many reports of unsatisfactory sex lives among clients. "Body image issues seemed to contribute at a clinical level," he said. "But when we went looking for research in this area, we found it's very sparse."

So, the researchers mined the data Kolotkin collected during the late 1990s from a 31-item questionnaire, "Impact of Weight on Quality of Life-Lite," which asks about aspects of weight-related quality of life, including sex. Kolotkin formerly held Binks' job at the Duke diet and fitness facility before entering private practice, although she still consults there.

The 1,210 volunteers were surveyed about the general quality of their sexual life and their enjoyment of sexual activity, sexual desire, difficulty with sexual performance and avoidance of sexual encounters.

Almost two-thirds seeking obesity treatment reported impairments in at least one of those four specific areas, compared to only 5 percent of normal weight people, the study found.

Kolotkin and Binks also found that obese people had reported far less sexual desire and enjoyment than normal weight people. Obese people tended to avoid sex and reported far more performance problems, the analysis found, and although women had more problems than men in both weight groups, the gender differences were minor.

"We know that things like diabetes and hypertension are considered co-morbidities to obesity," Binks said. "But some obese people are also suffering from quality-of-life issues and may think they're alone in that. But the important information here is, according to our data, it is a common occurrence among people who are obese."

Additionally, the Duke researchers questioned obese people who were not seeking weight loss treatment. Of those, 41 percent reported experiencing sexual impairment.

Slightly more than 500 study participants were drawn from the Duke Diet & Fitness Center, while the remainder were recruited from the community. The average body mass index (BMI) of the obese groups was 41 for the obesity treatment seekers and 40 for the non-obesity treatment seekers. The normal weight group had an average BMI of 22.

BMI is a measurement of body fat based on height and weight, and obesity is defined as a BMI of 30 or greater.

The average age was 48 for treatment seekers, 45 for non-treatment seekers and 35 for normal weight people. The balance between men and women varied, but about 53 percent of the obese treatment seekers were women, rising to 67 percent in the obese non-treatment group and 71 percent in the normal weight group.

Meanwhile, the biggest difference was that only 2 percent of the normal weight group reported sometimes, usually or always feeling no desire for sex, compared to 50 percent of the obese treatment seekers.

Forty-two percent of the treatment seekers said they sometimes, usually or always had sexual function problems, while 41 percent said they avoided sex. Among those with normal weight, the responses were 1.8 percent and 2.5 percent, respectively.

The obese people who weren't seeking to lose weight didn't report as many sexual problems, but they still had rates far higher than the normal weight volunteers. About 29 percent said they sometimes, usually or always felt no desire for sex or had problems with sexual function, and 24 percent said they avoided sex.

But nearly the same tally -- 28 percent of treatment seekers and 30 percent of non-treatment seekers -- said they did not enjoy sex some of the time, usually or always. That compared to only 3.9 percent of normal weight people.

"We expected differences, but I don't think we expected them to be that large," Binks said. "But I really need to stress that this is a very preliminary snapshot. It's just that there's such a paucity of data in this area that it called for some attention."

He said more research is needed to understand what's causing the problems for obese people.

"Body issues and self esteem problems affect willingness of obese individuals to approach those situations," he said.

But he said it's also possible that physical variables could be involved, such as body fat reducing genital blood flow. Exercise, although possibly more difficult for obese people, also can increase blood circulation and has been linked with the ability to overcome depression.

"This is a very important area," Binks concluded, "especially because we're normalizing this very important area of the human condition. Sexual quality of life is a very important part of everybody's well being and their general quality of life. To treat it as a co-morbidity to obesity may be as important as treating the other co-morbidities."

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