Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Effects of a low-energy diet on sexual function and lower urinary tract symptoms in obese men



Abdominal obesity and type 2 diabetes mellitus are associated with erectile and urinary dysfunction in men. The extent to which sexual function and lower urinary tract symptoms (LUTSs) are improved by weight loss remains unclear.


We compared the effects of 8 weeks of a low-calorie diet using meal replacements (Kicstart) on insulin sensitivity, plasma testosterone levels, erectile function (measured by the five-item version of the International Index of Erectile Function, IIEF-5), sexual desire (measured by the Sexual Desire Inventory, SDI) and LUTS (measured by the International Prostate Symptom Score, IPSS), in abdominally obese (body mass index 30 kg m−2, waist circumference (WC) 102 cm) men (mean age 49.7 years) with uncomplicated diet or oral hypoglycemic-treated type 2 diabetes mellitus (n=19) or without type 2 diabetes mellitus (n=25), with a control group of nondiabetic men (n=26) with similar body mass index and WC.


Weight loss of 10% was significantly associated with increased insulin sensitivity, plasma testosterone levels, IIEF-5 and SDI scores, as well as reduced WC and IPSS scores, in diabetic as well as nondiabetic men. The degree of weight loss was significantly associated with improvements in plasma testosterone levels (r=−0.34), erectile function (r=−0.26) and LUTS (r=0.65). Reduction in LUTS was significantly associated with increased plasma testosterone (r=−0.35), erectile function (r=−0.42) and sexual desire (r=−0.40).


Diet-induced weight loss significantly and rapidly improves sexual function, and reduces LUTS, in obese middle-aged men with or without diabetes.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2


  1. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts Male Aging Study. Prev Med 2000; 30: 328–338.

    CAS  Article  Google Scholar 

  2. Fung MM, Bettencourt R, Barrett-Connor E . Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study. J Am Coll Cardiol 2004; 43: 1405–1411.

    Article  Google Scholar 

  3. Esposito K, Giugliano F, Martedi E, Feola G, Marfella R, D’Armiento M . High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care 2005; 28: 1201–1203.

    Article  Google Scholar 

  4. Kolotkin RL, Binks M, Crosby RD, Ostbye T, Fress RE, Adams TD . Obesity and sexual quality of life. Obesity 2006; 14: 472–479.

    Article  Google Scholar 

  5. Derby CA, Zilber S, Brambilla D, Morales KH, McKinlay JB . Body mass index, waist circumference and waist to hip ratio and change in sex steroid hormones: the Massachusetts Male Ageing Study. Clin Endocrinol (Oxf) 2006; 65: 125–131.

    CAS  Article  Google Scholar 

  6. Giugliano F, Esposito K, Di Palo C, Ciotola M, Giugliano G, Marfella R et al. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest 2004; 27: 665–669.

    CAS  Article  Google Scholar 

  7. Trussell JC, Legro RS . Erectile dysfunction: does insulin resistance play a part? Fert Steril 2008; 88: 771–778.

    Article  Google Scholar 

  8. Ma RC-W, So WY, Yang X . Erectile dysfunction predicts coronary heart disease in type 2 diabetes. J Am Coll Cardiol 2008; 51: 2045–2050.

    Article  Google Scholar 

  9. Rohrmann S, Smit E, Giovannuci E, Platz EA . Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III). Int J Obes 2005; 29: 310–316.

    CAS  Article  Google Scholar 

  10. Rohrmann S, Smit E, Giovannuci E, Platz EA . Associations of obesity with lower urinary tract symptoms and noncancer prostate surgery in the Third National Health and Nutrition Examination Survey (NHANES III). Am J Epidemiol 2004; 159: 390–397.

    Article  Google Scholar 

  11. Boyle P, Robertson C, Mazetta C, Keech M, Hobbs FD, Fourcade R et al. The association between lower urinary tract symptoms and erectile dysfunction in four centres: the UrEpik study. BJU Int 2003; 92: 719–725.

    CAS  Article  Google Scholar 

  12. Rosen R, Altwein J, Boyle P, Kirby RS, Lukacs B, Meuleman E et al. Lower urinary tract symptoms and male sexual dysfunction: the Multinational Survey of the Aging Male (MSAM-7). Eur Urol 2003; 44: 637–649.

    Article  Google Scholar 

  13. Carson CC . Combination of phosphodiesterase-5 inhibitors and alpha-blockers in patients with benign prostatic hyperplasia: treatments of lower urinary tract symptoms, erectile dysfunction, or both? BJU Int 2006; 97 (Suppl 2): 39–43.

    CAS  Article  Google Scholar 

  14. Dallal RM, Chernoff A, O’Leary MP, Smith JA, Braverman JD, Quebbemann BB . Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg 2008; 207: 859–865.

    Article  Google Scholar 

  15. Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D’Andrea F et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004; 291: 2978–2984.

    CAS  Article  Google Scholar 

  16. Kaukua J, Pekkarinen T, Sane T, Mustajoki P . Sex hormones and sexual function in obese men losing weight. Obes Res 2003; 11: 689–694.

    CAS  Article  Google Scholar 

  17. Rhoden EL, Teloken C, Sogari PR, Vargas Souto CA . The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction. Int J Impot Res 2002; 14: 245–250.

    CAS  Article  Google Scholar 

  18. Spector IP, Carey MP, Steinberg L . The Sexual Desire Inventory: development, factor structure, and evidence of reliability. J Sex Marital Ther 1996; 22: 175–190.

    CAS  Article  Google Scholar 

  19. el Din KE, de Wildt MJ, Kiemeney LA, Debruyne FM, de la Rosette JJ . Reliability of the International Prostate Symptom Score in the assessment of patients with lower urinary tract symptoms and/or benign prostatic hyperplasia. J Urol 1996; 155: 1959–1964.

    CAS  Article  Google Scholar 

  20. Luscombe ND, Tsopelas C, Bellon M, Clifton PM, Kirkwood I, Wittert GA . Use of [14C]-sodium bicarbonate/urea to measure total energy expenditure in overweight men and women before and after low calorie diet induced weight loss. Asia Pac J Clin Nutr 2006; 15: 307–316.

    CAS  PubMed  Google Scholar 

  21. Hrbicek J, Janout V, Malincikova J, Horakova D, Cizek L . Detection of insulin resistance by Simple Quantitative Insulin Sensitivity Check Index (QUICKI) for Epidemiological Assessment and Prevention. J Clin Endocrinol Metab 2002; 87: 144–147.

    Article  Google Scholar 

  22. Capstick F, Brooks BA, Burns CM . Very low calorie diet (LCD): a useful alternative in the treatment of the obese NIDDM patient. Diab Res Clin Pract 1997; 36: 105–111.

    CAS  Article  Google Scholar 

  23. Moreno O, Meoro A, Martinez A, Rodriguez C, Pardo C, Aznar S et al. Comparison of two low-calorie diets: a prospective study of effectiveness and safety. J Endocrinol Invest 2006; 29: 633–640.

    CAS  Article  Google Scholar 

  24. Holden CA, Mclachlan RI, Pitts M, Cumming R, Wittert G, Agius PA et al. Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle- aged and older Australian men. Lancet 2005; 366: 218–224.

    Article  Google Scholar 

  25. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB . Sexual function in men older than 50 years of age: results from the Health Professionals follow-up study. Ann Intern Med 2003; 139: 161–168.

    Article  Google Scholar 

  26. Esposito K, Ciotola M, Giugliano F, Maiorino MI, Autorino R, De Sio M et al. Effects of intensive lifestyle changes on erectile dysfunction in men. J Sex Med 2009; 6: 243–250.

    CAS  Article  Google Scholar 

  27. Kolotkin RL, Binks M, Crosby RD, Ostbye T, Mitchell JE, Hartley G . Improvements in sexual quality of life after moderate weight loss. Int J Impot Res 2008; 20: 487–492.

    CAS  Article  Google Scholar 

  28. Fairbrun C, McCulloch D, Wu F . The effects of diabetes on male sexual function. Clin Endocrinol Metab 1982; 11: 749–762.

    Article  Google Scholar 

  29. Niskanen L, Laaksonen DE, Punnonen K, Mustajoki P, Kaukua J, Rissanen A . Changes in sex hormone-binding globulin and testosterone during weight loss and weight maintenance in abdominally obese men with the metabolic syndrome. Diab Obes Metab 2004; 6: 208–215.

    CAS  Article  Google Scholar 

  30. Abate N, Haffner SM, Garg A, Peshock RM, Grundy SM . Sex steroid hormones, upper body obesity, and insulin resistance. J Clin Endocrinol Metab 2002; 87: 4522–4527.

    CAS  Article  Google Scholar 

  31. Vermeulen A, Kaufman JM, Giagulli VA . Influence of some biological indexes on sex hormone-binding gobulin and androgen levels in aging or obese males. J Clin Endocrinol Metab 1996; 81: 1821–1826.

    CAS  PubMed  Google Scholar 

  32. Subak LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009; 360: 481–490.

    CAS  Article  Google Scholar 

  33. McVary KT . Erectile dysfunction and lower urinary tract symptoms secondary to BPH. Eur Urol 2005; 47: 838–845.

    Article  Google Scholar 

  34. Wyld B, Wilson C, Noakes M . Barriers and facilitators to success of weight loss in overweight men. Obes Rev 2006; 7 (suppl 2): 93.

    Google Scholar 

  35. Litwin MS, Nied RJ, Dhanani N . Health-related quality of life in men with erectile dysfunction. J Gen Intern Med 1998; 13: 159–166.

    CAS  Article  Google Scholar 

  36. Wong SY, Chan D, Hong A, Leung PC, Woo J . Depression and lower urinary tract symptoms: two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China. Int J Urol 2006; 13: 1304–1310.

    Article  Google Scholar 

Download references


Funding for this study was provided by the National Heart Foundation and the Medical Benefits Foundation of Australia. Kicstart was supplied by Pharmacy Health Solutions Pty Ltd, who had no role in the design, implementation or analysis of the study. None of the authors have financial interests in Pharmacy Health Solutions.

Author information

Authors and Affiliations


Corresponding author

Correspondence to G A Wittert.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Khoo, J., Piantadosi, C., Worthley, S. et al. Effects of a low-energy diet on sexual function and lower urinary tract symptoms in obese men. Int J Obes 34, 1396–1403 (2010).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • weight loss
  • sexual function
  • urinary tract symptoms
  • male
  • diabetes

Further reading


Quick links