For today’s Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center, is joined by Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS).

Dr. Irgau begins the discussion by defining bariatric surgery as a surgery that is performed to help people lose a substantial amount of weight. A person’s weight must be at least one hundred pounds over their ideal weight to be eligible for bariatric surgery. A person can also meet the criteria for bariatric surgery if they have a body mass index (BMI) of at least forty or a BMI of thirty-five if the person also has certain illnesses such as type 2 diabetes, sleep apnea, or high blood pressure. 

The pair continue the discussion regarding their hypothetical surgical patients’, Katrina and Samantha, bariatric surgery journey. To recap, Katrina is thirty-seven years old with a BMI of forty-seven and no issues with diabetes; she ultimately chose to undergo a gastric sleeve per Dr. Irgau’s recommendation. Samantha is sixty-two years old with a BMI of forty-two and has diabetes and heartburn; she decided to undergo a gastric bypass. This week, the main discussion topic is sex and sexual health. “One of the benefits of bariatric surgery is removing certain barriers, and I am not just talking about physical barriers, this includes the psychological barriers, to live their lives like anyone else,” Erkan explains. He continues, “this is life… we are here to share this information and have a discussion”. Sexual health is necessary for people to live a happy and healthy life. That is why it is essential to explain how the bariatric surgery journey can impact one’s sex life. “Morbidly obese patients are more likely to have a negative sexual health compared to others. This is related to some extent to the psychological impact of obesity or self-image and confidence, which are important in determining a positive sexual life, but also there are hormonal changes that are imposed by obesity that interfere with the sexual health of a person,” Dr. Irgau states. Patients often have low confidence in their body image. It is likely that if a person does not feel confident while looking in the mirror, they do not feel confident undressing in front of a partner. This psychological barrier impacts sexual health. 

“Men tend to have a lower level of testosterone if they are obese,” Dr. Irgau claims. Testosterone is the hormone responsible for sperm production and sex drive. When this hormone is lower, the patient’s sexual drive will be lower. With this, it is common to also have erectile dysfunction; this affects the sexual performance. “All of these things accumulate and will deter a person from enjoying sex, so it does greatly impact the sexual health of a person,” Dr. Irgau explains. For females, menopause is impacted. “The problem is magnified… because menopause itself does have a negative impact on the sexual health of a woman… menopause also does encourage weight gain,” Dr. Irgau states. Women are hit with two major life changes at once with menopause, weight gain and a lowered sexual drive. This all adds difficulties to a woman’s sexual health. 

Sexual health has become a taboo topic that is rarely discussed. It is seldom discussed in depth in a doctor-patient setting. This is similar to obesity. Obesity is also seldom a topic that is mentioned in a doctor-patient setting. The stigma around obesity prevents productive conversations between a medical professional and their patient. Although doctors have come a long way with accepting obesity as a disease, society has yet to accept that fact. Society still has this strong stigma that the obese are at fault. This is apparent after the pair’s countless discussions with patients. “When we are talking about the sexual health of people who are suffering from obesity, we are not talking about the impact of obesity itself but also this is an issue that they will hardly bring up… they suffer in silence and that magnifies the impact of the problem as well,” Dr. Irgau mentions. 

Erkan references how sex can increase one’s immune system, lower blood pressure, increase self-esteem, and has many other benefits. Dr. Irgau states how some patients mention their sex lives during appointments. For example, when Dr. Irgau asks female patients if they are taking birth control pills, many women are quick to respond with ‘I do not have sex’. “They have accepted that situation as if it is okay for them,” Dr. Irgau explains, “(obesity) is not only affecting them physically… but it is also affecting them psychologically, their self-image, seeking partners… those things are lacking”. It is not a secret that poor sexual health can lead to depression; there is a correlation between both of those things and obesity. “When there is decreased self-confidence, it is no wonder that there is going to be poorer sexual health as well,” Dr. Irgau mentions. Sexual health should be discussed in the same way as any other health matter. All of these issues are related to the root of the problem, obesity. The weight creates so many problems not only physically but psychologically as well. Obesity is a disease. If standard weight loss methods are not working, it may be time to consider the most effective method, bariatric surgery. Bariatric surgery opens so many windows of opportunity to improve one’s health in multiple avenues. “Don’t delay your life, reclaim your life,” Erkan passionately proclaims, “there is a lot to enjoy… you want to be happy and healthy”.