I used to play golf and cycle and fish 3 times all in the same weekend. Now I can’t even do one of those things without feeling exhausted.


The men I see in my medical weight loss practice most often come to me because of a combination of family obligations, change in work life with increased travel or increased desk time, and less time to spend being active.  They find themselves either having difficulty or unable to do the things they enjoy to the level they enjoy them.  In addition, these men are starting to have health complications that their doctors have attributed to their weight, their nutrition, or their activity level.

In this country, about 36% of our population is obese – have a body mass index, a standardizing measure of weight, above 30.  While BMI is not a perfect measure, it cannot differentiate between high muscle mass and high fat mass, it is the number used when studying the impact of weight on health, so it is a reasonable measure of risk in most people.  In Colorado, about 21% of men, slightly higher than the 19% of women, are obese, and even more are overweight.

Obesity impacts men’s health in a number of ways.  Most often, men carry their extra weight in their middle, a sign of not just extra weight, but of visceral adiposity – fat deposits in organs that affect their function.  Visceral adiposity is more commonly associated with heart disease, diabetes and fatty liver, and therefore, portends more negative health consequences than simple subcutaneous fat.  Obesity also increases the risk of a number of cancers, in both men and women.

Some effects of obesity are specific to men.  For example, obesity can lower testosterone levels.  We know that testosterone levels decrease as men age by about 1 percent per year.  However, studies have shown that it decreases much more significantly in men who are obese: one study showed that a 4 to 5 point increase in BMI had a similar impact on testosterone lowering as 10 years of aging!1  Waist circumference, which is correlated with visceral adiposity, has an even stronger association with low testosterone than BMI.2   For example, 4 inch change in waist circumference increased a man’s risk of having low testosterone by 75 percent!  Low testosterone, in turn, is associated with a multitude of health problems in men, including increased risk of diabetes, heart disease, erectile dysfunction, and stroke, among others.

Erectile dysfunction, which is associated with low testosterone, is also independently associated with obesity in men.  A 2009 study showed that either an obese BMI or a high waist circumference was associated with a 50 percent increased risk of erectile dysfunction in men, compared to men with a normal waist circumference or BMI.4

Benign prostatic hyperplasia (BPH), the non-cancer related enlargement of the prostate in men, can cause symptoms of having to urinate frequently during the day or night.  While most men develop prostatic enlargement while they age, men who carry extra weight are greater than 2 times more likely to have symptoms, and to have surgery as a result.5  Again, this correlation is more clear with waist circumference (greater than 43 inches, compared to less than 35 inches) in this particular study.

Fortunately, many of these problems are improved or reversed with weight loss, and specifically weight loss that improves visceral adiposity, or waist circumference.  At Healthful Life MD, we monitor markers of metabolic health that are indicators of visceral adiposity.  While there are many programs that help people lose weight, men in my program appreciate the medical approach backed by scientific evidence.  They like the one-to-one care they receive, particularly, they prefer not to go to meetings of predominantly women whose struggles may not be similar to their own.  They like the efficient and effective program which allows them to see changes right away, and that specifically addresses their personal goals.

There are many changes men can start right away to improve their health.  First is identifying whether they have a problem.

  • Check your BMI—A BMI over 25 is overweight, and a BMI over 30 is obese.  BMI calculators can be found online: http://bit.ly/1D0ZqDv
  • Measure your waist circumference – a waist circumference greater than 40 inches puts you at risk for health complications.
  • Decrease your intake of sugary and alcoholic beverages
  • Start an exercise routine, even walking regularly will have a positive impact on your health.  Exercising more than 150 minutes weekly decreases your risk of obesity and many health complications
  • Increase your vegetable intake—eating 3 or more servings of vegetables daily can improve your health
  • Consider if a comprehensive medical weight loss program would help support your healthy lifestyle changes and get you back to the things you enjoy!
1 Travison TG1, Araujo AB, Kupelian V, O’Donnell AB, McKinlay JB. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. 2007 Feb;92(2):549-55. Epub 2006 Dec 5.

2 Susan A. Hall, Gretchen R. Esche, Andre B. Araujo, Thomas G. Travison, Richard V. Clark, Rachel E. Williams, and John B. McKinlay. Correlates of Low Testosterone and Symptomatic Androgen Deficiency in a Population-Based Sample. J Clin Endocrinol Metab. 2008 Oct; 93(10): 3870–3877.

3 Svartberg J1, von Mühlen D, Sundsfjord J, Jorde R. Waist circumference and testosterone levels in community dwelling men. The Tromsø study. Eur J Epidemiol. 2004;19(7):657-63.

4 Peter M. Janiszewski MSc, Ian Janssen Ph, and Robert Ross PhD. Erectile Dysfunction: Abdominal Obesity and Physical Inactivity Are Associated with Erectile Dysfunction Independent of Body Mass Index. The Journal of Sexual Medicine. Volume 6, Issue 7, pages 1990–1998, July 2009

5 Edward Giovannucci  Eric B. Rimm  Christopher G. Chute  Ichiro Kawachi Graham A. Colditz  Meir J. Stampfer  Walter C. Willett. Obesity and Benign Prostatic Hyperplasia. American Journal of Epidemiology, Volume 140, Issue 11, 1 December 1994, Pages 989–1002

Thanks,
Dr. Abby