ORIGINAL ARTICLE Improvements in sexual quality of life after moderate weight loss RL Kolotkin 1,2 , M Binks 3,4 , RD Crosby 5,6 , T Østbye 2 , JE Mitchell 5,6 and G Hartley 7 1 Obesity and Quality of Life Consulting, Durham, NC, USA; 2 Department of Community and Family Medicine, Duke University Health System, Durham, NC, USA; 3 Duke Diet and Fitness Center, Duke University Health System, Durham, NC, USA; 4 Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Duke University Health System, Durham, NC, USA; 5 Neuropsychiatric Research Institute, Fargo, ND, USA; 6 Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA and 7 Hennepin Bariatric Center, Hennepin County Medical Center, Minneapolis, MN, USA We evaluated changes in sexual quality of life as they relate to weight loss over a 2-year period in individuals undergoing weight loss treatment. Six dimensions of sexual quality of life were measured using items from the Impact of Weight on Quality of Life questionnaire (feeling sexually unattractive, lacking sexual desire, reluctance to be seen undressed, difficulty with sexual performance, avoidance of sexual encounters and lack of enjoyment of sexual activity). At baseline women were more likely than men to report lack of sexual enjoyment and reluctance to be seen undressed in spite of lower body mass index (BMI). Weight loss averaged 13.1% and was significantly associated with improvements in all sexual quality of life dimensions. A 3–4% regain did not appear to negatively affect sexual quality of life. The greatest improvements for women had occurred by 3 months and were observed in all dimensions, whereas for men only ‘not feeling sexually attractive’ showed marked improvement in this short time frame. International Journal of Impotence Research advance online publication, 3 July 2008; doi:10.1038/ ijir.2008.32 Keywords: weight loss; quality of life; obesity; impact of weight on quality of life (IWQOL) Introduction Numerous studies have described the negative impact of obesity on health-related quality of life. 1–3 A particular aspect of health-related quality of life, sexual quality of life, has become a recent topic of interest in studies of obese populations, with reports of decreased sexual quality of life among obese persons. 4,5 There has also been a consistent association between erectile dysfunction and obesity in both prospective and cross-sectional studies. 6 Studies on obese patients undergoing weight loss surgery have described improved sexual quality of life, as assessed by interview and study-specific questionnaires. 7–11 Three recent randomized trials have also examined the effects of weight loss on sexual quality of life. In a randomized trial of weight loss/lifestyle change in Italian men with erectile dysfunction, about one third of men reported improved sexual function after the intervention. 12 In a randomized trial of a very low energy diet and behavior modification, obese Finnish men (not necessarily with erectile dysfunction) who lost weight showed increased serum testosterone, but no significant improvement in sexual function scores. 13 A randomized trial in Korea of sibutramine for weight reduction in overweight and obese women found significant improvements on the Female Sexual Function Index total score and the domain scores relating to arousal, orgasm and sexual satisfaction in the sibutramine participants relative to control subjects. 14 Regardless of treatment group, decreases in body mass index (BMI) were associated with improvements in arousal and orgasm. These trials are noteworthy in their use of validated instruments to assess sexual quality of life. How- ever, they are limited by their focus on the physical aspects of sexual quality of life (for example, erectile dysfunction, arousal, orgasm) and exclusion of salient subjective aspects of the human sexual experience such as sexual enjoyment and desire. Received 28 April 2008; revised 5 June 2008; accepted 8 June 2008 Correspondence: Dr RL Kolotkin, Obesity & Quality of Life Consulting, 1004 Norwood Avenue, Durham, NC 27707, USA. E-mail: rkolotkin@qualityoflifeconsulting.com International Journal of Impotence Research (2008), 1–6 & 2008 Nature Publishing Group All rights reserved 0955-9930/08 $30.00 www.nature.com/ijir