Erectile dysfunction (ED) has been reported by 12% of men under 59, 22% of men aged 60 to 69, and 30% of men 70 and over. Being overweight makes it even more likely. Men with a body mass index (BMI) over 28.7 have a 30% higher risk of having ED than those with a normal BMI (i.e. 25 or below).

Physicians in Naples, Italy, have studied whether weight loss and increased physical activity can improve ED in overweight men. Their findings are reported in the Journal of the American Medical Association , and are summarized here.

Obese men with erectile dysfunction, aged 35 to 45 years, were recruited. They had to have a body mass index of 30 or above, and a score of 21 or less on the International Index of Erectile Function (IIEF). (This score was the result of answers to 5 questions; each allocated up to 5 points, so the maximum score possible was 25.) Men with diabetes, high blood pressure, or raised cholesterol levels were excluded from the study.

Of 140 men assessed initially, 30 were eliminated - for health reasons or because they were unwilling to undertake the suggested lifestyle changes. The remaining men were allocated at random to join either the so-called 'intervention' group, or the 'control' group.

Men in the intervention group received detailed advice on how to reduce their body weight by 10% or more - individually tailored dietary recommendations, and guidance on increasing physical activity. The trial lasted 2 years, during which the men had regular sessions with the nutritionist and the exercise trainer - monthly in the first year and bi-monthly in the second.

Men in the control group were given general information about healthy eating and exercise at baseline, and then again every two months, but they received no further counseling.

Tests conducted at baseline and after 2 years included height, weight, waist size, and blood pressure measurements; total cholesterol, HDL, and triglyceride levels; blood inflammatory markers (C-reactive protein or CRP, interleukins 6 and 8); and the function of the cells lining the blood vessels (endothelium) after L-arginine stimulus. And, of course, the IIEF was repeated after 2 years, as the measure of success or failure in improving erectile dysfunction.

At baseline the results of the IIEF and the tests outlined above were similar in both groups of men. Their average BMI was 36.5, and the average IIEF score was 13.7.

The lifestyle intervention was effective in reducing the BMI levels and improving the IIEF scores in the men who received it. After 2 years, 17 out of 55 men in the intervention group, compared with 3 out of 55 controls, reported IIEF scores above 22 i.e. their symptoms of erectile dysfunction had nearly disappeared.

Along with the improved symptoms, there were reductions in some of the inflammation markers in the blood, and improvements in the blood lipid profiles, indicating a reduced risk for cardiovascular disease. No such changes were seen in the control group men.

In an earlier US study, men who began to exercise in midlife had a 70% lower likelihood of developing erectile dysfunction, compared with those who remained sedentary. In the study we've summarized here, weight loss achieved by changes in lifestyle (diet, exercise) clearly improved existing erectile dysfunction in obese men. The take-home message is clear-cut. Start exercising in midlife to avoid erectile dysfunction, and if you are overweight and have developed this problem, diet and exercise will help you get back to normal functioning. You should certainly try this approach before turning to Viagra® and its near relations.