Real Quick: Duke survey says fat ladies can’t get no satisfaction (…no no no!)

By | April 29, 2011

Vintage sepia-toned photograph, in which a nude woman kneels on a pillow-strewn bed, and holds a mirror over her head, while smiling. By Jean Agélou (1878-1921).

Hey hey hey!* There’s new research out about fatties and sex! A pack of scientists from Duke University wanted to find out how fat folks feel about their sex lives, using an established questionnaire that “assesses and scores sexual functioning broadly across nine domains — interest, desire, arousal, orgasm, satisfaction, behavior, relationship, masturbation, and problems.” They’ve published their findings in the May/June issue of the Journal of Sex and Marital Therapy, and the study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. I guess we’re counting sex parts as digestive organs here. Y’know, for the money.

Tina! Bring me the blockquote!

The researchers analyzed questionnaires completed by 91 men and 134 women before they enrolled in a weight-loss study. They found scores were significantly lower for women than men on all subscales.

“We found that there was lower sexual satisfaction and lower sexual quality of life among women than men, and overall sexual quality of life was low among both groups,” said Truls Ostbye, MD, PhD, professor in the Department of Community & Family Medicine at Duke.


“Our findings contribute to a growing body of research that indicates obesity is associated with reduced sexual functioning and sexual quality of life among both men and women,” Ostbye said.

Hmm. Here I shall stroke my imaginary beard and idly wonder why.

The study further compared the questionnaire scores of the fatties with those of the general population, and with those belonging to a group of cancer survivors. Give it up for the obese ladies, as their scores were the lowest, meaning fat chicks feel more crappy about their sex lives than people who have survived cancer. Fat dudes, for their part, were slightly more satisfied than the cancer group, but less than the general population.

The sample size in this study was pretty small, only two hundred and twenty-five people. That itself may be an issue that the more statistically-inclined may want to address. However, I want to focus on the fact that everyone included in the sample was on the verge of enrolling in a weight-loss study, which would seem to indicate that these are all people interested in losing weight. Usually, if one is interested in losing weight, it is because they are either a) suffering some illness or disability they believe weight loss will “fix” or b) they are dissatisfied with their body in an aesthetic way. Or both. It is extremely unlikely that anyone who did not want to lose weight would volunteer for such a study.

The problem is, there is no control here for fat people who are not actively having problems with their bodies. The study purports to represent the experiences of all fat people based on a small group of fat people with a demonstrated interest in changing their bodies, if not a demonstrated dislike of their bodies as they are.

Liking our bodies and being comfortable in our bodies are two critical requirements for healthy sexual function. Let’s look at how a general discomfort with one’s body, one that is supported by cultural fat hatred, might affect some of the domains in the questionnaire. Interest: sexual interest may understandably decline if you believe your body to be unattractive; I’d wager for most folks, the best sex is the sex where we feel most SEXAY. Desire: likewise, feelings of physical inadequacy or low self-esteem can make you feel you are unworthy of sexual pleasure, which is a major boner-killer. Arousal and orgasm: You know what’s poison to both of these? Anxiety. Discomfort. Self-loathing. I’m not suggesting everyone invested in weight loss feels this way, but if you dislike your body enough to want to change it, then these are likely to be factors. And so on.

Of course, there are individual exceptions to all of the above. But I argue that it’s only natural that a culture that consistently condemns fat people as disgusting, unclean, selfish monsters is going to extend its effects into the bedroom. Remember Maura Kelly’s well-publicized disgust at the sight of fat people making out? Or even just individual fat people doing anything in public at all? Kelly is hardly a lone ranger on this subject, and her faux pas was not feeling something lots and lots of people frequently feel when confronted with affectionate fat couples. She crossed the line by publicly broadcasting her disgust as though the fat people she was referencing weren’t actually people at all, like their feelings didn’t matter in the least.

Lots of fat people are accustomed to being treated as though we’re invisible, as though our lives contribute nothing to the world, but are instead merely a drag on resources. Of course this is going to have a chilling effect on how many fat people perceive their bodies, sexually and in every other respect. If fat people are less satisfied with their sex lives, it is likely because they are less satisfied with themselves, with their bodies and with the person they believe their body says they are.

This study seems to be careful not to draw medical or biological connections between body fat and sexual problems, and rightly so, as there’s little to demonstrate any such correlation. A recent study found that obese men actually last longer in bed—7.3 minutes to the average dude’s diminutive 1.8 minutes—and it guessed that different levels of hormones were the cause. A much larger study of sexual behavior amongst 7000 women found that body weight had little effect on whether a woman was having hetero sex, and that obese women were in fact more likely to be sexually active.

Of course, simply having lots of sex doesn’t ensure that sex is enjoyable and satisfying, but my point here is that these issues are a far more complicated suitcase of issues for a tiny study of 225 people to easily unpack. If a fat woman has lots of sex and yet feels an overall lack of satisfaction, that may be because she is not comfortable enough with herself as deserving of sexual pleasure to instruct her partner on what gets her motor running. Weight loss is unlikely to fix this, as a thinner body does not magically come pre-packed with a new, confident personality. Fact is, you deserve sexual pleasure no matter your size, whether you’re giving it to yourself or getting it from someone else. And no diet will ever convince you of that.

Because there is no study that controls for levels of body acceptance, we can’t really know what proportion of all fat people are unhappy with their sex lives. Anecdotally, the ones I know are all pretty stoked with theirs. It’s also worth noting that it is perfectly okay to be uninterested in sex overall, so long as you are comfortable with it. So often, our conversations on these subject carry a pressure to have a “normal” sex drive, when in reality sex drives are as diverse as everything else about humanity: some of them roar, some purr, and some are permanently parked in the back yard rusting their way back to nature. Feeling comfortable with a lack of sex is also an expression of satisfaction: nobody can tell you when or if you should or shouldn’t want sex.

Sexual functioning is an area not often discussed between health care providers and patients in general — and obese patients in particular — according to Ostbye. Providers should keep in mind the possibility of reduced sexual quality of life among their obese patients, and invite them to discuss this issue, he said.


“Because so many obese individuals experience discrimination and prejudice, they appreciate providers who create a warm, supportive environment in which to discuss these sensitive issues.”

Well, at least we agree on something.

* That’s what I saaaay.


Kristin on April 29, 2011 at 1:18 pm.

However, I want to focus on the fact that everyone included in the sample was on the verge of enrolling in a weight-loss study, which would seem to indicate that these are all people interested in losing weight. Usually, if one is interested in losing weight, it is because they are either a) suffering some illness or disability they believe weight loss will “fix” or b) they are dissatisfied with their body in an aesthetic way. Or both. It is extremely unlikely that anyone who did not want to lose weight would volunteer for such a study.

THIS. I was reading the article on the study and I got to that and the little record screech happened in my head.

They should do a study of ME and MY FAT FRIENDS, all of whom are comfortable in their skin and ALSO experience great sex.

Sing it with me: Correlation does not equal causation!


siouxZQ on April 29, 2011 at 1:40 pm.

BUNK, I say …
As a child of the 60’s, I had a very active sex life .. I was thin and never had an orgasm.
I was married (to the wrong man) for almost 6 years … I was thin and never had an orgasm.
I gained a lot of weight … and got older. Now, at 62 and 300lb, I am extremely happily married to the RIGHT guy and have a fantastic sex life – orgasm every time … always.
So all you idiots and your demoralizing studies about fat people – you really are not asking the right people or the right questions!!


Emerald on April 29, 2011 at 2:18 pm.

And the really sad thing? All the people in this study who are feeling kind of blah about sex are, presumably, about to make themselves feel even blah-er by embarking on weight loss, because there are sound studies out there that prove that calorie restriction has a negative effect on the whole gamut of human sexual interest and response – naturally, because a body that’s being starved is going to turn its interests and energies towards finding food and divert them away from other activities. Heck, they knew about this as far back as the Minnesota study, right?

This is, of course, assuming that the sexual blahs weren’t at least partially caused (apart from the stuff about confidence and self-esteem that you mention, Lesley) by being underfed, i.e. dieting, in the first place. One more instance in which nobody bothers to separate the effects of fat from the effects of the diets society pushes on fat people.


diane on April 29, 2011 at 2:43 pm.

As other posters mentioned, all participants about to enroll in a weight loss study skew the results. Although I actually dismissed this study as soon as I read that it was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Wild guess…many of those who are about to begin a new diet are already disatisfied with their body, giving “proof” to the already pre-determined outcome that the sponsors wanted. This way new grant money and headlines in the media can add to that ever growing list of things that are wrong or will be wrong if fat. Their advice, no matter what?…don’t be fat. (Alert the media.)


Belkasa on April 29, 2011 at 2:50 pm.

My question is – where’s the follow up? They interviewed before they started weightloss right? Well, after weightloss did their sex life improve? I’m a firm believer that self-confidence has everything to do with sex and pleasure. I’m 300lbs and have great sex with my boyfriend. I have friends who are significantly thinner and have terrible sex! Weight has little to do with it. If you lack self-confidence, you’re probably not having great sex because you won’t ASK for what you want. You can lack self-confidence if you’re thin or not-so thin. I’m pretty sure the women’s interest magazine industry depends on it!


Rosa on May 2, 2011 at 11:34 am.

what a really fabulous question.


Heather on April 29, 2011 at 3:56 pm.

As other people have pointed out, you hit the statistical nail on the head by noting the huge bias in the sample. Compared with that, the sample size itself is not important at all. But the degree of bias does invalidate the study scientifically.

-Your Friendly Neighborhood Fat Mathematician

P.S. Personally, my sex life got better as I got fatter, even though I wasn’t always pleased with my body. I don’t know what that says, but good things about my beloved late husband, for sure!


Catherine Leary on April 29, 2011 at 3:58 pm.

How exactly are they measuring “sexual activity”? Is is about orgasms? Is this only about partner sex? Because if you’ve got someone who is masturbating regularly to orgasm (with or without a partner), I’d call that an active and satisfying sex life.


Emma on April 29, 2011 at 4:36 pm.

hey! I dont comment here often, and i l-o-v-e your shit, lesley.

but! I had a bit of a problem with this premise:

Liking our bodies and being comfortable in our bodies are two critical requirements for healthy sexual function.

thinking about this through a disability lens, some body are not comfortable. some have pain almost all the time.

i belive your utilizing “comfort” in a slightly different way than the one I have brought up, but when thinking about use comfort in out bodies as a precursor to sexual satisfaction, i believ that its important to understand that folks who live in uncomfortable bodies also have sexy sex time.


silentbeep on April 29, 2011 at 6:54 pm.

“i believe your utilizing “comfort” in a slightly different way than the one I have brought up, ”

Actually, I really believe that above sentence is correct. Of course, I don’t want to put words into Lesley’s mouth but I’m a big fan of her work, and considering the context of her work in addition to this post, from what I can glean, “comfort” is used maybe as another word for “mental and emotional acceptance for one’s own body, no matter what state its in” meaning a lack of shame about it.

Of course, just because a person is physically uncomfortable a lot of the time, doesn’t mean they are not able to achieve some level of comfort (which suits their own needs) to enjoy sex (at least, not so much discomfort as to prevent orgasm, or not so much discomfort as to prevent some level of enjoyment).


Emma on April 29, 2011 at 4:37 pm.

*believe you’re

*also i fucked up the italics!


Arwen on April 29, 2011 at 5:32 pm.

If they need a list of quotes from the health media, pop culture, crass comedians, and pseudo-evo-psychologists to explain why a number of fat people feel a little inhibited about their sexualities, I’m sure we could provide a New York phonebook sized compilation for ’em. Irritating.


Arwen on April 29, 2011 at 5:33 pm.

Oh, let me see if I can get the italics. There?


Arwen on April 29, 2011 at 5:34 pm.

Nope. There?


Arwen on April 29, 2011 at 5:34 pm.

Nope. Sigh. Sorry!


keltron on April 29, 2011 at 6:06 pm.

1.8 minutes? This is the average length of time men can last during sex? Is this real? Have I just been really lucky? Please tell me this isn’t real?


LadyWhoKnows on April 30, 2011 at 10:04 am.

Well, that study, as well as this one was flawed in its sample. It was a survey of men who had enrolled in a program for those who were experiencing sexual difficulty or dissastisfaction. I’d say 1.8 minutes counts as dissastisfaction. I doubt that the numbers would have come out the same in a general populace survey.


Lesley on May 3, 2011 at 11:46 am.

Yeah, I thought that survey was especially ridiculous. Apparently optimum sex takes between 3 and 13 minutes!


Rachel on April 29, 2011 at 7:12 pm.

A brilliant deconstruction, as always.


thirtiesgirl on April 29, 2011 at 8:13 pm.

Agreed on every point. Over the past 3-4 years, I’ve started to become more aware of when guys notice me and when they don’t. Noticing could be as simple as a smile and a nod from a male co-worker when we pass in the hall; offering to open the door for me as we both approach it; offering to help carry something that I’m carrying and am about to drop (such as a large stack of paper or books); greeting me and asking if I need assistance when I walk into the store where they work. I’ve spent most of my life being oblivious to this kind of typical attention, but now I’m starting to notice it much more frequently.

Well, actually, I’m starting to notice it happening to other women much more frequently. I rarely noticed it at all before, whether it was happening to me or someone else. But now that I’m beginning to notice it, I notice it’s happening to others. If I’m walking down the hall with a thinner female co-worker, the guy smiles at her; offers to open the door for her; helps her with the large load she’s carrying; approaches her in the store and asks if she wants help. I’m left to myself, without any acknowledgment or assistance.

I’m guessing that’s part of the reason why I never noticed whether I was being noticed by guys or not. They’ve never noticed me. I’m invisible to them: a fat, white woman (now middle-aged). I sometimes joke that I could commit murder in this country and get away with it because no one would ever suspect me. I’m not noticeable, unless I’m wearing something that someone finds unattractive and they feel they need to let me know.

…Point being, now that I’m beginning to recognize the fact that most guys won’t even give me a smile and a nod when I pass them in the hall, I notice that I feel less attractive in my own skin. I do my best to remind myself that just because I’m not sexually desirable to the guys who act this way, it doesn’t mean I’m sexually undesirable to others or myself, and that I have no self worth or integrity. But there are days when this is damn difficult to do, and I start feeling like the women in this study. I start feeling bad about my body and myself and stop seeing myself as a sexual being. My sexual desire wanes and I don’t even enjoy spending time with myself.

I know finding a loving sexual partner who sees me and loves me as I am is not the total answer to this dilemma, but some days, it really feels like it is.


Tetra on May 3, 2011 at 11:48 am.

A lot of being sexy and having good relationships has to do with being confident and not overloaded with self hatred. I can’t claim a similar experience to your own, I’m in my early 20s and thus have all kinds of age privilege. But I am quite fat (just below being a Death Fat), and I’ve run the gamut of bad romantic experience — from an abusive relationship to being raped to being married and subsequently divorced. A great deal of this has come from poor self esteem. The first batch of it was teenaged body hatred spiced with mental disorder which lead me by the nose into the abusive relationship I got into, and helped keep me in it for months after I knew I should leave. It was this nasty self feeding thing: The worse I felt about myself, the more likely I was not to leave the relationship, the longer I stayed in the relationship the worse I felt about myself. Near the end it had literally dissolved into a situation where I was nightly being instructed as to what a horrible bitch I was. Not healthy, not good.

The second batch of it was everything-about-myself hatred borne of mental disorder, body insecurity (my body was the one thing I no longer absolutely loathed about myself), and emotional trauma left over from the aforementioned relationship. My improved confidence in terms of my body, however slight the improvement, introduced a variety of romantic experiences I had previously thought unattainable. Unfortunately, I still regarded myself as an undesirable human being and that lead to some spectacularly bad decisions which culminated in a divorce.

I can speak — in twisting, painful, way — of how I discovered the entire You ‘Must Have a Partner To Be Fulfilled’ societal dictum was a load of crock. While shitty self confidence lead me to make shitty decisions within my relationships, and lead me to make a shitty choice in partners, that particular dictum is what got me into those relationships in the first place. It’s been at the core of a lot of poor choices. Eventually I went out on a date and it took a horrible, horrible turn. Evidently at 250 I’m thin enough to be raped. One of the good things to come out of that experience though, was the realization that I 100% don’t NEED a partner. I’d eventually like one, but, not at the cost of any more misery, pain, and suffering. I’ve already paid way more than the cost ought to be.

I can’t really give much advice — I’ve done all the wrong things. But through them I’ve gotten an idea of what the right things might look like. I’ve certainly gotten romantic attention all my life — I realized a while back that my teenage years were spent single largely because I hung out with older people and I was considered jailbait — but was blind to a great deal of it due to my poor self conception. As I’ve gotten older, actually, and improved my self image in regards to my body little by little the romantic attention has also gone up with it. I can fairly confidently say that if you want that romantic attention a good portion of it is smiling and casting off an aura of confidence and good humor.

I gotta warn that I’m pretty sure that a good self image in regards to just one’s body isn’t enough. At least for me, I got to find out the hard way that even if you’re OK with your body, if you’re not OK with the rest of you then that can lead to some spectacularly bad decisions. I also gotta warn that the mindset that a relationship is needed to fulfill you — even if it’s only a ‘sometimes’ thing — is probably something that needs to go. For me, at least, it was an actively dangerous mindset that cost me a lot of pain.

Er, apologies if I seem like an uppity kid who has no fucking clue what she’s talking about. I may very well be! Just. I have feelings on these things.


GreatBigGirl on April 30, 2011 at 11:31 am.

This is all the more reason not to shy away from visibility when it comes being sexual creatures. Propriety be damned! IF you’re happy with your sex life, clap your hands!


Violet on April 30, 2011 at 12:41 pm.

I’d be curious to see the result if they gave the same survey to average-sized or thin women who were embarking on weight loss programs. That would be harder to do since those women usually don’t do doctor-supervised weight loss programs so you’d have to go find them. Another population that would be interesting to compare are women who get cosmetic surgery. What about women being treated for eating disorders? That would help to get a better comparison to explore the connection between self-perception and sexual functioning.

I will also say that I’m even suspect of the result in the first place. Lesley already pointed out the small sample size and the sponsor of the survey, anecdotally, I had a friend who worked on survey research like this and her boss would have her throw out surveys and rerun the data if they didn’t get the result they were going for. That’s just one guy of course, and she quit and went to med school after that experience so I have no idea if it was just one unethical guy or if this is a more widespread practice, but it’s another possibility.


Loquaciouslaura on April 30, 2011 at 9:40 pm.

Totally random question, but where did you find that lovely photo??? I’m so digging it!


Lesley on May 3, 2011 at 11:42 am.

It’s a public domain French postcard. The photo is by Jean Agélou (1878-1921).


MsHart on May 3, 2011 at 4:58 am.

Then there’s this…


marjorie on May 4, 2011 at 5:32 pm.

Just had a convo with someone who made a great point about this study — if that control group was indeed representative of “the general population,” that means that 2/3 of the people they asked were overweight or obese. And happier with their sex lives than people enrolled in a weight-loss program! ENROLLING IN DUKE MEDICAL CENTER’S WEIGHT LOSS PROGRAM LOWERS LIBIDO, FILM AT 11!

(Also loving the Mommie Dearest reference, thank you)


Judy on May 5, 2011 at 10:47 am.

I don’t usually comment on your blog though I often enjoy reading it (and get mad about the obesity obsession). But this discussion makes me wonder if parts of society have not kind of regressed from being obsessed with sex to being obsessed with food (and its effect on the body). This study implies that there is an agreed-upon normalizable degree of sexual satisfaction proper to a healthy life, and tries to blame sexual repression, so to speak, on food.
Of course the traditional kind of women’s magazine aimed at housewives features diets and delicious food side-by-side on the front pages, where “ladymags” show sexy bodies and clothes (with, often, paeans to celebrity monogamy and fecundity). A cycle of cook-and-eat and dieting would keep a housewife stimulated. But now the social forces that used to damn sexual activity seem to be directed at not having the right body shape.
Don’t know if this makes sense. But sometimes I feel as if this is a “post sexual” age, where everyone has sexual emotions all tidy but is anxious about food.


me on May 5, 2011 at 7:53 pm.

You’re right when you say that most women have the best sex when they feel sexy, but would men answer that question in the same way? I think the problem here has two parts. The fact that the skinny ideal is the normative sexy body for women, and that women who fail to meet this ideal feel inadequate is only half of the issue. The real problem is that women’s bodies are the focus of sexual attention for men AND women. Fat men who feel badly about themselves can have great sex and focus almost entirely on the body of the woman he desires, rather than their own bodily anxieties. When women have great sex, their desire is often mediated through the man desiring her body. And thus when she perceives her body to be undesirable (despite all the messages from the man in her bed to the contrary), she can’t have good sex.


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