When a person is morbidly obese, their sex life often suffers. Desire for sex, performance, and enjoyment can nosedive. Many simply avoid sex altogether, new research shows.

In fact, morbidly obese people are 25 times more likely to report problems in their sex lives, compared with normal-weight people. “What struck us was this magnitude of difference… far greater than any of us expected,” researcher Martin Binks, PhD, a psychologist and director of behavioral health at the Duke Diet & Fitness Center at Duke University Medical Center, tells WebMD.

Binks presented his report at the annual meeting of The North American Association for the Study of Obesity held in Las Vegas.

“It’s a difficult topic for people to talk about, men and women alike,” says Binks. “Yet the fact that the majority of the American population is overweight, we’re going to see more people affected by this. This is not just a physical issue; it’s a psychosocial issue involving body image and performance anxiety.”

Morbid Obesity and Quality of Sex Life

His study involved 928 obese men and women — with an average BMI (body mass index) over 40. BMI is an indicator of body fat. You can easily determine your BMI with WebMD’s BMI calculator.

About half were seeking treatment for their obesity. All the obese people — plus 282 normal-weight people — completed questionnaires asking about four aspects of their sexuality: enjoyment of sexual activity, sexual desire, difficulty with sexual performance, and avoiding sexual encounters.

Almost two-thirds — 65 percent — of obese people in the treatment group reported significant sexual problems; 41 percent of the nontreatment group cited sexual problems; only 5 percent of normal-weight people did.

In the treatment group, 50 percent had difficulties desiring sex, 42 percent had performance problems, and 41 percent avoided sex. In the nontreatment group, 29 percent had desire difficulties or performance problems; 24 percent avoided sex. In the normal-weight group, 2 percent had function problems and 3 percent avoided sex.

Enjoyment was seriously impaired. Twenty-eight percent of the treatment group and 30 percent of the nontreatment group reported less enjoyment of sex, compared with 4 percent of the normal-weight group. That’s 10 times less enjoyment among the obese people, Binks points out.

Women reported more sexual problems than men did. However, those getting treatment had fewer problems compared with obese people not seeking treatment.

“This is not just about overweight people coming for weight loss treatment,” Binks tells WebMD. “They’re out in the world, feeling alienated, not even realizing that this is a common problem.”

“People who are struggling with their weight must not make [their weight problem] define who they are,” Binks says. “They are entitled to have the same quality of life as anyone else. You don’t have to hate your body or your weight to work to improve it. If someone is really struggling with this issue, they need to seek out some help. The answer to their sexual problems may not be just losing weight. The issues may be at a deeper level than we realized, involved with body image and self-esteem. People’s self-esteem can improve when they take control of their lives.”

Sexual Problems of Morbidly Obese Need More Attention

“I am very happy to see that this issue of obesity and sexual quality of life has been addressed,” says Birgitta Adolfsson, MD, an obesity researcher with the Karolinska Institute in Stockholm, Sweden. Just last month, Adolfsson published a similar study in the journal Obesity Research — but her study had a different conclusion.

In her study of 2,810 men and women, there were no significant differences in terms of satisfaction with sex life between the overweight and obese people and normal-weight people.

“It is conceivable that the expectations of what is needed for satisfaction is lower among overweight and obese persons compared with subjects of normal weight,” writes Adolfsson in her study. “Critical attitudes toward obese people are prevalent. Some obese people internalize the negative social messages. This may be the cause of self-imposed restrictions on important aspects of life, such as enjoying a sexual relationship… [for] obese people — or even people of normal weight who feel obese.”

The results of Binks’ study “confirm my experience from clinical practice that many obese patients need to discuss sexual matters,” Adolfsson tells WebMD. Obesity “has been recognized as a lifestyle issue. Sexual satisfaction is a basic human need.”

If doctors show an open attitude about sexual issues and obesity, their patients will find it easier to discuss their difficulties, she notes.

By Jeanie Lerche Davis, reviewed by Michael W. Smith, MD

SOURCES: Annual meeting of The North American Association for the Study of Obesity, Las Vegas, Nov. 14-18. Martin Binks, PhD, psychologist; and director, behavioral health, Duke Diet & Fitness Center at Duke University Medical Center. Birgitta Adolfsson, MD, obesity researcher, Karolinska Institute in Stockholm, Sweden.