Electronic Journal of Human Sexuality, Volume 5, Jan. 15, 2002



Lilka Woodward Areton

Chapter 10


The objective of the research was to discover which factors were predictive of sexual satisfaction for obese women in long-term relationships. It was hypothesized that weight (BMI), body image, sexual attitudes, sexual confidence, sexual communication, sexual enjoyment, partner's sexual enjoyment, partner's attitude on weight, and the amount of negativity the participant has on weight would correlate significantly with the sexual satisfaction of the participant.

Linear regression was performed on the dependent variable, Sexual Satisfaction (SEXSAT). Three blocks of independent variables, known as predictors, were tested against it. By comparing the beta weights (in a multiple regression equation) we can determine what factors might predict sexual satisfaction.

The first block (Model 1) contained three variables related to demographics only: Length of the relationship, Education, and Age. The beta coefficient indicates that education (0.185) is the most important predictor of sexual satisfaction when compared to length of relationship (0.117) or age (-0.174). This means, that given the demographic information only, it can be surmised that the higher the education the better the possibility of sexual satisfaction in the participant.

The second block (Model 2), in addition to the block one demographics, contained added weight-related variables, such as Body Image, Number of Diet Months, Short-term Diet Success, and Index of Weight Negativity. While beta coefficient for education stayed practically unchanged (0.186), it became the second most important predictor, quite below the highest one, the body image. Body image then, with a beta of 0.557, is a major predictor of sexual satisfaction, when demographic and weight-related variables are considered. If a participant has a good body image the likelihood is substantial they will be sexually satisfied. Education was next, followed by the Index of Weight Negativity (0.157).

By far the most useful block of variables is contained in Model 3. In addition to the demographics and the weight-related items, the partner-related variables have been added, such as Partner Sexual Enjoyment, Partner on Weight and Sexual Communication. The analysis shows that education, as a predictor of sexual satisfaction falls to the 4th place, with 0.135 beta coefficient. Body image places second, with 0.322. The best predictor of sexual satisfaction is sexual communication (0.363). Then comes body image and the third predictor is partner sexual enjoyment (0.243).

Overall it can be summarized that sexual communication, body image, partner sexual enjoyment, and education are the four best predictors of sexual satisfaction. These could be considered the most useful areas a therapist would want to focus on when working with sexually dissatisfied obese couples. Conversely, focusing on weight, relationship length, and diet (all extremely small predictor betas) might mean a waste of expensive therapeutic time and effort.

Next, we will review the relationship among the 10 survey-based variables in Table 9. By ignoring the low (coefficient lesser than 0.2) and mid-level correlations (coefficients greater than 0.2 and lesser than 0.5), and analyzing only the high correlations, this discussion will bring into sharp focus the most significant findings of this study. (The high level of correlation is indicated by the coefficient greater than 0.5 or lesser than -0.5.)

The most dramatic correlation in Table 9 is the one between the weight negativity (WTNEG) and the body image (BODYIMAG), -0.780. The worse one feels about one's weight, the greater impact on one's body image. Not surprisingly, the next highest correlation is between the sexual confidence (SEXCONF) and body image, -0.771. Highly negative body image profoundly influences sexual confidence. Impact of weight negativity on sexual confidence has the third highest correlation among the participants of the survey, -.685. This revelation of the weight negativity-body image-sexual confidence triangle is most significant.

On the positive side and of tremendous importance is the finding of the fourth highest correlation. It is between the sexual communication (SEXCOM) and sexual satisfaction (SEXSAT), 0.642. Related to this finding is also the seventh highest correlation (0.516) - between the sexual communication and sexual attitudes (SEXATT). To the degree sexual communication takes place between the partners, the sexual satisfaction and positive sexual attitudes prevail in their relationship.

The survey participants indicated there was another important correlation, the fifth and the sixth highest, between the partner's sexual enjoyment (PRTSXJOY) and sexual communication (0.552) and their own sexual enjoyment (SEXJOY) (0.523).

These correlations tie together the couples' sexual attitudes, enjoyment and satisfaction with their ability to communicate. It is interesting to note that none of the 9 variables in Table 9 showed any significant, not even lower mid-level, correlation to the participants' weight (BMI). Moreover, the relationship between the body image and the weight showed itself to be of very low significance (0.171).

Our hypothesis, that the attitude of the partner on the weight of the participant would show a significant correlation, did not relate in the expected direction. This was puzzling. Although this was not a survey of the partner but of the participant's perceived attitude of the partner, seventy-five percent of our participants believed that weight was rarely or never an issue in their relationship. Ninety-four percent of the participants had never or rarely been verbally abused about their size. Eighty-four percent did not believe their partner would find them less desirable if they gained weight. Seventy-three percent believed that their partners were quite attracted or very attracted to them. Obviously, sexually satisfied or not, most of the participants felt their partners had few issues with them about their weight. It would be an interesting subject for further research to ask the partners, themselves, about their attitudes and to see if their answers would correlate with the way their partners perceive them.

Comparisons with Past Research

Previous researchers have found that body image dysphoria is correlated highly with sexually avoidant behavior (Faith and Schare, 1993; Stuart and Jacobson, 1987; Shapiro, 1980; Spiegel, 1988). The current research agrees with this finding if we assume that sexual avoidance is the opposite of sexual satisfaction.

The current research indicates that sexual communication is the best predictor of sexual satisfaction. Assertive communication has previously been indicated as lacking in the sexual lives of obese women (Shapiro, 1980; Spiegel, 1988; and Stuart and Jacobson, 1987). Those researchers were not asking about sexual satisfaction factors but Stuart and Jacobson certainly received thousands of letters from women who were most likely trying to lose weight and who indicated that they were not satisfied sexually. These women were not communicating about their sexuality with their partners. The current research seems to corroborate these findings.

Weight has been predicted as a derogator to sexual satisfaction by many researchers (Marshall and Neill, 1978; Wise, 1978; Werlinger, King, Clark, Pera and Wincze, 1997). These researchers predicted that when their participants lost many pounds, their sexual lives would change either for the better or for the worse. Marshall and Neill found that there emerged conflict in the relationships of such couples. Marshall and Neill believed that the conflict arose because the weight of the obese person stabilized the marriage and the loss of it destabilized the marriage. The destabilization may have come from the fact that the partners of the obese women liked them the way they were. The women did feel more flirtatious and more willing to initiate sexual encounters due, they said, to a diminished fear of rejection. In the Wise study, the conclusions were that "There was no evidence that core sexual identity or mechanical activity was aberrant in the massively obese, however, they did display a sense of shame about themselves as attractive individuals" (p. 23). In the Werlinger et al. study, the participants suggested that their improved body image after losing weight was responsible for their improved sexual functioning. Our study also shows a correlation between sexual confidence and improved body image. If the weight loss leads to an improved body image, sexual confidence can rise. Ultimately, as our study indicates, body image does not depend on the weight of the woman but on her improved body image which in turn correlates with greater sexual confidence. This may explain why the conclusions of the medical approach were somewhat indecisive. If upon losing weight, the wife felt improved body image, she felt her sexual life improved. If the husband's approval of her new body was missing, there was conflict. The researchers did not test for improved sexual functioning. The current research showed that the partner's attitude on weight had almost no correlation to the sexual satisfaction of the participant.

The current research substantiated Masters and Johnson's claim that the therapist's "most important role" is as a catalyst to sexual communication (p. 14). In the current study sexual communication was most highly correlated to sexual satisfaction against all the other factors presented.


The population for this study was obtained primarily through announcements of the study on the Internet, size-acceptance magazines, and an article written by the author for major women's fashion magazine for large women. Of the approximately three hundred communications sent to inquiring persons, and of the 200 questionnaires sent out, 119 were returned. Of these 119 women, 100% had been or were presently in long-term relationships, defined as at least six months. The mean period of time that all the women were in long term relationships was 7.5 years. The mean age of the participants was 38 years. The mean weight was 298 pounds or a mean Body Mass Indicator of 49. Their weights ranged from 180 pounds to 524 pounds. The respondents were well educated with the mean number of years in school at 17 years. The mean income was $35,000. Eighty- four percent of the participants were of European ancestry with 6.7 percent of Afro-American ancestry. The rest were from various backgrounds. Seventy-eight percent of the women were professionals, 30% were in the trades and 11 had no profession.

Weight History

Overall, the respondents indicated that in comparison with their peers, throughout their lives, they had always been "somewhat bigger". This trend continued to the present time. There appears to be more weight variability during adolescence. The respondents also indicated that their peers' attitudes were more negative and critical than their fathers' or mothers' attitudes. During their childhood, 80% of the respondents said they were bigger than their peers, although 45% were only a small amount bigger than their peers. By adolescence, 89% were bigger but 38% were only a medium amount bigger. As adults, 92% said they were bigger than their peers with 26% a little bigger to somewhat bigger. Now, in the last 5 years, 100% said they were bigger than their peers with 13% saying they were a little bigger to somewhat bigger than their peers and 85% saying they were much bigger to super-size. Is the etiology of this obesity in their genes? Is it due to their pathology? Is it due to their diets? Eighty-two of the 119 respondents had dieted over their lifetimes. This is research that needs to be undertaken.

Additional Demographics of Interest

The women self-reported that the factors they believed to have the most influence on feelings of satisfaction in their sexual relationship were their partner, their own positive sexual outlook, and their own positive body image. Similarly, they ranked their partner and their own negative body image as having the most influence on their feelings of dissatisfaction in their sexual relationship. The women did not feel counseling or diets had much influence on their reported satisfaction or dissatisfaction in the sexual relationship.

Forty-five percent of the women in the survey indicated that they were sexually attracted to "only men", whereas the remaining 55% of the women indicated that they were attracted to only women, mostly women, both men and women, and mostly men. Eight percent said they were attracted to mostly or only women. Eighty-two percent of the women reported that their partners were only sexually attracted to those of a different gender (see Table 6).

Self-Acceptance, Size-Acceptance, Self-Esteem

The respondents in the current research show an increased acceptance of their weight. Sixty-nine percent of the respondents said they feel comfortable sharing the truth about their weight always or sometimes. Eighty-one percent of the women said they did think their bodies were somewhat to extremely sexually appealing. Forty-nine percent of the women said that their current feelings about their bodies is somewhat better to much better. Thirty-two percent felt somewhat worse or much worse. Another indicator of a growing self-acceptance is that 87% of the respondents who do not believe that a person who prefers large women must have something wrong with him/her. Although not a majority, 38% of large women do not feel it is difficult to attract a partner. This may be due to the support large women are receiving from the fat-acceptance movement and from their admirers.

Answers about the weight of the participants' partners are of interest. Fifty-one percent of the partners are either about average (37%), somewhat thin (11.8%) or extremely thin (2.5%). Forty-one percent are somewhat large. About 6% are very large.

Sexual Dysfunctions


The women participating in this questionnaire (Table 6) answered these questions for their partners so these are perceived difficulties, not necessarily actual ones. It is also important to keep in mind that some women listed multiple answers for their partners. Sixteen percent of the partners climax too quickly. Twenty-four percent have difficulty achieving or maintaining an erection. Seventeen percent feel anxious about their ability to perform. Finally, 11% have a decreased interest in sex due to medication.


Our women respondents are most concerned with their difficulty in experiencing an orgasm with 32% responding to this question. There were 19% of the women who had a decrease in interest in sex due to medication. Thirty percent have difficulty lubricating which may be a problem after menopause and may be associated with lack of desire. None of these difficulties seem to be interfering with the sex lives of those that are sexually satisfied which is represented by 67% of the respondents.

Abuse History

The abuse history of the respondents indicated that approximately 50% were verbally abused, and 30% were sexually abused (see Table 4). They reported that the verbal abuse affected them emotionally "very much" (Mean 4.19) and affected them sexually "some" (Mean 2.4). The sexual abuse affected them emotionally "a medium amount" to "very much" (Mean 3.63) and affected them sexually "a medium amount" (Mean 3.24). The women reported that the abuse appears to have had a greater emotional rather than sexual aftereffect.

Clinical Usage of the Data

Most of the information we receive on the sexuality of obese women is obscure and inaccurate, based on assumptions, theories and unsubstantiated therapies that may have done irreparable harm to women. Few empirical studies have been done on the obese women, even though 52% of American women are now considered to be too heavy by the Insurance Industry's calculations. With ever more women joining the ranks of those with body-image dysphoria, it is important that we understand the truth about obese sexuality so that we can use it wisely.

Appropriate sexual therapy for the obese couple has not yet been designed. Specific recommendations could include those found in the literature reviewed, as they apply to individuals and to non-obese persons. As far as obese couples are concerned, the recommendations would need to be applied, where appropriate, to both persons.

Since it has been fairly well established, both in this study and in others, that a woman's actual weight has almost nothing to do with her sexual satisfaction, it behooves the therapist to desist from having any concern about this issue and address him/herself to healing the body-image dysphoria. Advice to the woman to lose weight, with the evidence that this may be a temporary adjustment of the woman's body image at best, would not be recommended.

Appropriate therapy would need to acknowledge that, indeed, large women are just as psychologically healthy as their thinner sisters, except they may be harboring a great deal of dissatisfaction with their bodies. Large women are not asexual. They are sensual and can enjoy their sexuality. Therapy should focus on the improvement of self-esteem, and it should encourage women's assertiveness and willingness to talk about their sexual needs, feelings, and concerns. It should help them to love and appreciate their bodies. Very importantly, it needs to identify and lower their shame, not only for their bodies, but for all those other areas related to shame: movement, appearance, eating, self-esteem, touching and being touched, and their sexuality. Furthermore, and most important, it needs to bring in the partner with whom the woman wants to be sexual. What good would body-image-improvement make to a relationship if the partner can not accept the body of his/her lover. Lovers are hurt by the fat-phobia of the society also. Expanding the lover's erotic taste to include large women may be difficult but it needs to be addressed by the therapist, if effective change is to occur.

Treatment in the prevention of sexual dissatisfaction would include information from this study and from the literature review. Education would suggests that weight gain is normal, excessive caloric restriction is not effective in the long-term, and caloric restriction may actually potentiate weight gain. The more girls are concerned about gaining weight, the higher the risk for eating disorders later on. Young people would be forewarned about the way our society attaches status to thinner bodies and ridicules the larger bodies, making it almost impossible for young people, boys in particular, to show an appreciation for bigger girls. The consequences of rejecting our bodies should be taught. When we look for symptoms of sexual avoidance we see that there is little sexual communication, agonizing self-consciousness, a tendency to avoid interpersonal erotic encounters, neglect of one's appearance, a possible failure to be seen athletically or in sexy clothing. These are the surface symptoms that we can pinpoint early. Finally, we should make available to young people Body Acceptance classes. Our society has wounded our young people and there are so many forces that pressure them to reject themselves.

Therapists who work with obese couples must learn the specific problems that accompany people with large bodies other than body image concerns, such as difficulty in finding comfortable positions for sexual intercourse, difficulties accepting the lower status that being with a large woman implies, the problems of handling ridicule and ostracism from peers, difficulties for the obese woman who feels she is not desirable.

Therapists, educators, sexologists, sex educators, doctors, and professionals working with young people and adults need to use the information learned here, the better to teach, advise, support and counsel.

Limitations of Study

The limitations of the study are two-fold.. The vast majority of the respondents were from the Internet. This limited the population to the highly educated (a mean of 17 years of education) and may have skewed the results. The other problem stems from the fact that most of the respondents were connected in some way with the size-acceptance movement through Radiance magazine, size acceptance newsgroups referred from Radiance participants, and from other size-acceptance magazines. Only 20 of the respondents participated anonymously or came from other resources and it could not be ascertained where they heard about the survey. It would be helpful to reach large women at all levels of the social strata for a more representative group. Nevertheless, it became apparent that many of the women who volunteered did report being sexually satisfied and did volunteer information that led to new knowledge. Any other group of large women might not have been as satisfied as this group. We were also limited to using large women only. This prevented from including all the thinner females  that may have had the same experience.

Suggestions for Future Research

Many women, who are not obese, feel unattractive due to even a small amount of weight gain. It would be appropriate to survey all sizes of women for body image dysphoria, their sexual communication with their partner, discovering how much negativity they have about their weight, and their BMI. This might lead to firm predictors of sexual satisfaction of all women, not just the obese ones. In 1997, Abraham and Llewellyn-Jones found that 65%-87% of women between the ages of 20 and 60 were dissatisfied with their bodies due to a perception of too much fat, compared to 48% in 1972. This statistic implies that there are great many women who are or will be struggling with issues of sexual satisfaction.

It would also be of interest to question large men about their sexual lives to discover what brings them sexual satisfaction. We would then have a composite, which could be compared to women. Is the lack of sexual communication, body image dysphoria and a partner who does not enjoy sex, interfering with obese male sexual satisfaction? Should these questions be answered, therapists would then know more about appropriate treatment for both members of the obese couple rather than just one half of it.

In addition, there needs to be more research done on how the therapy that heals body image dissatisfaction affects that person's sexual life. There are a number of healing therapies for the body (Hutchinson, 1985; Bergner, 1985; Tenzer, 1989; Freedman,1988), but an integration of these therapies with the sexual lives of the participants has not been surveyed. More research in this area would be very helpful.

Finally, there needs to be developed an integrative therapy that addresses obese couples and their particular concerns. It should addresses itself to any issues they have that may affect their sexual life together. Obviously, our predictors would most likely be involved; not enough sexual communication, dissatisfaction with the body of one or both persons, and a lack of shared sexual joy. Those therapeutic and educational therapies deemed appropriate from the literature review might be included.

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