Obesity and sex are subjects that doctors find especially difficult to discuss with patients, despite evidence that such discussions help. Although short conversations (three to five minutes) during routine Visits can contribute to changes in behaviour, such as increasing physical activ¬ity, eating less fat, and losing weight, most primary care professionals do not talk to their patients about weight.
Bajos and colleagues’ study of 12 364 French men and women aged 18-69 found that obese men and women are at greater risk of negative sexual outcomes than their non¬obese counterparts. This was particularly true for obese women, who were 30% less likely to report a sexual part¬ner in the past 12 months, whereas obese men were 700/0 less likely to report more than one partner in the same period and 2.6 times as likely to report erectile dysfunc¬tion. Although no other differences were found in indices of sexual function in existing relationships, obese women were five times as likely to have met their partner on the internet, more likely to have an obese partner, and less likely to view sex as important for personal life balance.
The factors that underlie these observations of self reported sexual experience and the directions of causal¬ity cannot be determined from a cross sectional study,
Obese women in the 18- 29 year old age group were less likely to report that they used oral contraception or sought contraceptive advice in the past year, and, most startling of all, they were 4.3 times more likely to report unintended preg¬nancy. Obesity in pregnancy is a major public health concern. Obesity in pregnancy is associated with markedly increased mater¬nal and neonatal morbidity and mortality, and increased healthcare costs. It is the principal maternal health project of the Centre for Maternal and Child Enquiries (CMACE) for 2008- 2011, and it is the subject of a new joint guide¬line from CMACE and the Royal College of Obstetricians and Gynaecologists.’ So if the message of this paper-that obese women have nearly five times the risk of unwanted pregnancy-is reproducible in other populations, this shoul.d be a matter of concern for public health and prac¬titioners in reproductive health.
The data on contraception need cautious interpreta¬tion, however, because they focus purely on oral contra¬ception and condoms, ignoring long acting reversible contraceptives, which the UK’s National Institute for Health and Clinical Excellence (NICE) recommends as particularly suitable for obese women.
Goldbeck-Wood (2010) Obesity and poor sexual health outcomes BMJ vol 341 pp 56-7
Bajos (2010) Sexuality and obesity, a gender perspective: result from French national randomn probability survey of sexual behaviours . BMJ vol 340, p 84

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