1. Sexuality and Obesity: a Gender Perspective Nathalie Bajos1,2, Kaye Wellings2, Caroline Moreau1 1 CESP U1018, Kremlin Bicetre, France, 2 LSHTM, London, UK 12ème journéed’Endocrinologie, 27 mai 2011, Paris

2. Background Obesity and sexuality -nospecificsurvey Obesity and sexualhealth - erectiledysfunction in men - increase in STIs Clinical studies on morbidly obese men Few studies on women

3. Conceptualframework Issues surrounding sexuality are subordinated to issues in the reproduction of other social, economic and political relations. Social representations of sexuality form a coherent system which allows gender relations to (re)produce themselves, to shift or to weaken The effect of BMI on sexuality and sexual health outcomes would be different between men and women, social stigma being stronger on overweight and obese women Obese women may be at greater risk of negative sexual outcomes because of social stigma and lack of adequate medical follow-up

4. Method A surveycarried out in 2006 Randomsampling on fixed and mobile phones Population aged 18 to 69, over-representation of 18-24 yearolds, n=12 364 Length of questionnaire: 49 minutes Acceptance rate: 75% Chlamydia screening WHO classification of BMI

5. Objective and subjective BMI

6. BMI of respondents and their sexual partners

7. Sexual behaviours by BMI status (women)

8. Sexual behaviours by BMI status (men)

9. Sexual dysfunction and BMI

10. BMI and sexual and reproductive health (women)

11. BMI and sexual and reproductive health (men)

12. Discussion (1) Lowerprevalence of obesity / national nutrition survey (misclassificationunlikely to be associated with the reporting of sexualbehaviours) First survey on BMI and sexuality Increasedrisk of erectiledysfunctionamong OM noted in otherstudieshowever no increase in sexualdysfunctionamong OW Increasedrisk of unplannedpregnancyamong OW not found in a US study(national survey of familygrowth)

13. Discussion (2) A markedgendereffect in a context of stronger social pressure on womenregardingweight(women more likely to think that they were too fat; fewer OM than OW reported having an overweight or obese sexual partner; OW less likely than OM to have had a sexual partner in the last 12 months, OW more likely to seek partners on the Internet) Psychological factors (such as poor sexual self esteem leading to difficulty in allowing or initiating sex) may also be involved and derives from social stereotypes around obesity The lower prevalence of medical consultation for contraception among obese women may also be attributable to concerns over body image and weight.

14. Discussion (3) The marked increase in risk of unintended pregnancy, despite lower fecundity in OW, reflects, not patterns of sexual behaviour, but reliance on less effective methods of contraception. OW show more infrequent attendance at health care services for contraception may in part reflect “mal être” towards their fat body. It may also reflect reluctance on the part of health care professionals to prescribe oestro-progestative contraceptives for obese women because of concerns over increased risk of cardio-vascular accidents The lower prescription of oestro-progestative contraceptives for obese women does not seem to be compensated by greater use progestin-only methods