Abstract & Commentary
Synopsis: A randomized, controlled trial of obese men, ages 35 to 55, with erectile dysfunction showed that weight loss and increased physical activity allowed 31% to regain sexual function and most reduced their cardiac risk factors.
Source: Esposito K, et al. JAMA. 2004;291:2978-2984.
In the Health Professionals Follow-up Study, moderate-to-severe erectile dysfunction was reported by 12% of men younger than 59 years, 22% of men aged 60-69 years, and 30% of men older than 69 years.1 This study from Italy followed 110 obese men with erectile dysfunction (ED) over 2 years. They were relatively young (ages, 35-55) and did not have the comorbidities of diabetes and hypertension. Fifty five of the men were randomly assigned to an intervention group to achieve a weight loss of 10% or more through calorie control, behavioral counseling, and increased physical activity (walking, swimming, or aerobic games). They were seen monthly. Men in the control group were given general oral and written information about healthy food choices and exercise and were seen bimonthly. All men were obese with BMIs ranging from 30 to 49. About 30% of men in both groups smoked.
After 2 years, men in the intervention group had significant decreases in body weight, BMI, waist-to-hip ratio, blood pressure, levels of glucose, cholesterol and triglycerides, and a significant increase in HDL cholesterol. There was no significant change in any of these parameters in the control group. Erectile function improved in the intervention group but remained stable in the control group. 31% of the men (17) in the intervention group regained normal sexual function, while only 3 men regained normal function in the control group.
Saigal from UCLA provides an editorial in the same issue putting these findings into perspective.2 These study patients were young and did not have the common comorbidities seen in common primary care practice. However, the findings suggest that significant ED may be prevented by early intervention in obesity and a sedentary lifestyle in younger men.
Comment by Joseph E. Scherger, MD, MpH
Ever since sildenafil (ViagraTM) was released in 1998, men have come in reporting some degree of erectile dysfunction in large numbers. Now, 3 related medications are dominating the commercial airwaves. If we neglect to get a history of erectile dysfunction during an office visit, patients often ask for samples as part of an "Oh by the way. . . ." We can only wonder how much of this is recreational use, based on insecurity, or a desire for better sex. While these medications may improve sexual function, they do not improve the patient’s overall health. Weight loss and increased physical activity definitely will improve health, and it is rewarding to see that it also improves sexual function.
With the epidemic of obesity and metabolic syndrome going on in our communities, this study gives an added incentive for men to achieve better health. While it is easier, albeit more expensive, to take a pill, improved sexual function without medication can be added to counseling for weight loss and increased physical activity. Whether or not the patient ends up trying medication for ED, we should be aggressive in helping obese men reduce their cardiac risk factors and improve their quality of life.
Dr. Scherger, Clinical Professor, University of California, San Diego, is Associate Editor of Internal Medicine Alert.
1. Bacon CG, et al. Ann Intern Med. 2003;139:161-168.
2. Saigal CS. JAMA. 2004;291:3011-3012.