Obese men are at increased risk for erectile dysfunction (ED), likely caused by atherosclerosis-related hypertension and cardiovascular disease, as well as hormonal changes associated with obesity, as described in a timely article published in Obesity and Weight Management, a journalzine published by Mary Ann Liebert.

As many as 30-40% of men over the age of 50 may experience ED, and both obesity and physical inactivity may increase their risk. The build-up of atherosclerotic plaque in the arteries of obese men can damage the arterial lining and contribute to elevated blood pressure. In addition to atherosclerosis, the hormonal changes that accompany obesity, including lower testosterone, increase the risk of ED. The modifiable risk factors for heart disease, such as excess weight, diabetes, and hypertension, are generally the same as those for ED. Studies have shown that weight loss and increased physical activity can improve ED.

Adam Gilden Tsai, MD, MSCE, from the University of Colorado Denver, and David Sarwer, PhD, from the University of Pennsylvania School of Medicine, describe a 48-year-old man with mild obesity (weight = 197 lbs, body mass index = 32.6 kg/m2 ) and hypertension who suffers from ED in the article "Obesity and Erectile Dysfunction." Even with the use of ED medication (tadalafil, Cialis, Eli Lilly), he was not able to achieve an erection adequate for intercourse. After dietary counseling, a 4.6% weight reduction, and medication to lower his blood pressure to within the normal range (112/77 mm Hg), the patient has been able to achieve adequate erections with the use of ED medication as needed.

The authors emphasize that "the complicated interplay of weight and other health conditions relate to common medical symptoms, such as ED. We are reminded that atherosclerosis can cause not only macrovascular disease such as heart attack and stroke, but also microvascular disease, of which ED is one example."