- Nathalie Bajos, research director123, honorary professor4,
- Kaye Wellings, professor4,
- Caroline Laborde, research assistant123,
- Caroline Moreau, research fellow123
- for the CSF Group
- 1INSERM (Institut National de la Santé et de la Recherche Medicale), CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexual and Reproductive Health Team, F-94276, Kremlin Bicetre, France
- 2Université Paris Sud 11, UMRS 1018, F-94807, Villejuif, France
- 3Institut National des Etudes Demographiques, F-75020, Paris
- 4London School of Hygiene and Tropical Medicine, Department of Public Health and Policy, London WC1E 7HT
- Correspondence to: N Bajos
- Accepted 18 April 2010
Objectives To analyse the association between body mass index (BMI) and sexual activity, sexual satisfaction, unintended pregnancies, and abortions in obese people and to discuss the implications for public health practices, taking into account the respondents’ and their partners’ BMI.
Design Random probability survey of sexual behaviours.
Setting National population based survey of 12 364 men and women aged 18-69 living in France in 2006.
Participants Random selection of 5535 women and 4635 men, of whom 3651 women and 2725 men were normal weight (BMI 18.5-<25), 1010 women and 1488 men were overweight (BMI 25-<30), and 411 women and 350 men were obese (BMI >30).
Results Obese women were less likely than normal weight women to report having a sexual partner in the past 12 months (odds ratio 0.71, 95% confidence interval 0.51 to 0.97). Obese men were less likely than normal weight men to report more than one sexual partner in the same period (0.31, 0.17 to 0.57, P<0.001) and more likely to report erectile dysfunction (2.58, 1.09 to 6.11, P<0.05). Sexual dysfunction was not associated with BMI among women. Obese women aged under 30 were less likely to seek healthcare services for contraception (0.37, 0.18 to 0.76) or to use oral contraceptives (0.34, 0.15 to 0.78). They were also more likely to report an unintended pregnancy (4.26, 2.21 to 8.23).
Conclusion There is a link between BMI and sexual behaviour and adverse sexual health outcomes, with obese women less likely to access contraceptive healthcare services and having more unplanned pregnancies. Prevention of unintended pregnancies among these women is a major reproductive health challenge. Healthcare professionals need to be aware of sensitivities related to weight and gender in the provision of sexual health services.
We thank the participants in the study. The CSF group includes N Bajos, M Bozon, N Beltzer, A Andro, M Ferrand, V Goulet, A Laporte, C Le Van, H Leridon, S Levinson, N Razafindratsima, L Toulemon, and J Warszawski.
Contributors: NB, CM, and KW conceived and wrote the paper. CL carried out the statistical analysis and commented on the first draft of the paper and approved the final version, as did all the other members of the research team. NB is guarantor.
Funding: The survey was funded by the French National Agency of Aids Research (ANRS). The Fondation de France, the Institut National de la Prevention et d’Education pour la Sante, and the Direction de la Recherche des Etudes Economiques et Sociale (DREES) also contributed to funding. The researchers operated independently of the funders.
Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare (1) no financial support for the submitted work from anyone other than their employer; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.
Ethical approval: The survey was approved by the French Commission Nationale Informatiques et Libertes (www.cnil.fr/english/). This commission is in charge of examining both ethical and anonymity issues of research protocols. There was no possible linkage between the identity of the respondents, their answers to the questionnaire, and the results of the chlamydia test. Participants who underwent chlamydia testing signed an informed consent agreeing on the anonymous computerised treatment of the data.
Data sharing: No additional data available.
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