Erectile dysfunction (ED) is an important cause of decreased quality of life in men, and may affect an estimated 30 million men in the United States, according to background information in the article. In a previous study, moderate-to-severe erectile dysfunction was reported by 12 percent of men younger than 59 years; 22 percent of men aged 60 to 69 years; and 30 percent of men older than 69 years.
Katherine Esposito, M.D., of the Center for Obesity Management, Second University of Naples, Italy, and colleagues conducted a study to determine if lifestyle changes designed to obtain a sustained and long-term reduction in body weight and an increase in physical activity would improve erectile function and endothelial (cells lining the inside of blood vessels) function in obese men.
The randomized trial included 110 obese men (body mass index 30 or greater) aged 35 to 55 years, without diabetes, hypertension, or hyperlipidemia, who had erectile dysfunction that was determined by having a score of 21 or less on the International Index of Erectile Function (IIEF). The study was conducted from October 2000 to October 2003 at a university hospital in Italy.
The 55 men randomly assigned to the intervention group received detailed advice about how to achieve a loss of 10 percent or more in their total body weight by reducing caloric intake and increasing their level of physical activity. Men in the control group (n = 55) were given general information about healthy food choices and exercise.
The researchers found that after 2 years, weight and body mass index decreased significantly more in the intervention group than in the control group. The average level of physical activity increased more in the intervention group (from 48 to 195 min/wk) than in the control group (from 51 to 84 min/wk). The average IIEF score improved in the intervention group (from 13.9 to 17), but remained stable in the control group (from 13.5 to 13.6). Seventeen men in the intervention group and 3 in the control group reported an IIEF score of 22 or higher. In multivariate analyses, reductions in body mass index and increases in physical activity were independently associated with changes in IIEF score.
"Our data demonstrate that lifestyle changes, including a reduced calorie diet and increased exercise, improve erectile function in obese men and resulted in about one-third of men with erectile dysfunction regaining sexual function after treatment. This improvement was associated with amelioration of both endothelial function and markers of systemic vascular inflammation. Interventions focused on modifiable health behaviors may represent a safe strategy to improve erectile function and reduce cardiovascular risk in obese patients," the authors conclude.
Editor's Note: Financial support for the research presented in this article was provided by the Second University of Naples, Italy.
EDITORIAL: OBESITY AND ERECTILE DYSFUNCTION - COMMON PROBLEMS, COMMON SOLUTION?
In an accompanying editorial, Christopher S. Saigal, M.D., M.P.H., of the University of California, Los Angeles, writes that the findings from the study by Esposito et al are provocative but come with some caveats.
"The population studied may differ from obese patients typically seen in primary care clinics in that these patients did not have known coronary heart disease, diabetes, or hypertension, all commonly seen in obese patients in practice. The presence of these comorbid diseases may lessen the impact of the effect of exercise and weight loss on ED. Another limitation to the generalizability of the findings is these obese patients were seeking treatment for weight loss at a specialized clinic. Counseling overweight patients to begin and sustain effective weight-reducing behaviors can be a daunting challenge for clinicians. Some obese patients may lack the motivation demonstrated by the patients in this study. Even among these motivated patients, benefit was evident only in those who were entered into an intensive program, which may be difficult to replicate in many practices."
"At a time in which obesity has become a public health crisis, this study provides evidence of efficacy for what perhaps should be the first-line treatment for obese patients with ED. This treatment strategy produces many benefits for the patient if it is successful and incurs no untoward risk if it is not. Unfortunately, however, this is one treatment for ED that will not be accompanied by free pens, free notepads, and its own Super Bowl commercial," writes Dr. Saigal. (JAMA. 2004; 291:3011-3012. Available post-embargo at JAMA.com)