Obesity may be more associated with disordered eating behaviors, somatization, insecure attachment styles, and sexual dysfunction: an exploratory study.

Background: Obesity is a challenging disease due to its multifactorial pathogenesis. However, sexual health is a poorly explored aspect in these patients, and the interaction between eating behavior, psychological factors, and sexual function remains insufficiently characterized, although it may represent a key aspect in clinical management.

Aims: To provide a characterization of psychological, eating, and sexual function characteristics of patients with obesity through an exploratory analysis.

Methods: A cross-sectional, single-center study was carried out at Umberto I Hospital of Sapienza University of Rome (Italy), where patients with obesity (body mass index ≥30 kg/m2) were recruited. Additionally, a control group of age-matched, normal-weight (body mass index = 18-25 kg/m2) subjects was enrolled online. All subjects compiled a series of validated psychometric questionnaires that evaluated psychological distress, disordered eating behaviors, attachment styles, and sexual dysfunction.

Outcomes: To evaluate the psychological distress, attachment style, disordered eating behavior, and sexual dysfunction in patients with obesity and to explore the correlations between these aspects.

Results: Seventy-two patients (45 women, mean age 51.4 ± 4.3 years and 27 men, mean age 39.6 ± 16.6 years) and 76 controls (51 women, mean age 36.8 ± 14.3 years and 25 men, mean age 39.2 ± 16.6 years) were recruited. Subjects with obesity reported significantly higher scores in somatization and paranoid ideation symptoms, higher scores in food addiction and binge eating domains, and a more fearful attachment style. Women also reported lower sexual desire, arousal, and lubrication, while men showed significantly lower erectile function, orgasmic intensity, and sexual satisfaction.

Clinical implications: Subjects with obesity are characterized by higher somatization, maladaptive eating behaviors, insecure attachment style, and worse sexual function compared to controls, which highlights the necessity of a multidimensional treatment approach.

Strengths and limitations: A large and comprehensive battery of questionnaires was employed to examine both the clinical and the control population. However, the absence of stratification by age and the small sample size prevent the generalizability of the results.

Conclusion: Our results highlight the intricate interplay between psychological, behavioral, and sexual factors in individuals affected by obesity. Further studies should focus on larger and more diverse samples and examine longitudinal trajectories of psychological and sexual health changes in response to weight-loss interventions, to assess how such interconnection may help to improve the personalization of care programs.