Sexual behavior of young women with obesity indicated for bariatric treatment: A cross-sectional study

Abstract

Objective

Obesity is linked to decreased quality of sexual life and the development of sexual behavior in adulthood. Because bariatric treatment is considered a promising method for young women with obesity, the purpose of this study was to assess the sexual behavior of women indicated for bariatric treatment and compare them with women indicated for conservative obesity treatment.

Methods

This cross-sectional study included 74 women with obesity who were indicated for bariatric treatment (mean age = 29.39 years, SD = 5.26 years; average body mass index =42.57 kg/m²) and 65 women with obesity (mean age = 31.23 years, SD = 5.22 years; average body mass index = 32.77 kg/m²) who preferred conservative treatment. Their data were compared with those of a control sample selected from the general population.

Results

Women treated with bariatric surgery reported a higher number of sexual partners over their lifetime (N = 13.10) and a higher number of casual sexual experiences for one night (N = 6.97) than women treated with conservative therapies.

Conclusions

Women seeking bariatric treatment show specific differences in their sexual partnerships compared with other women with obesity.

Introduction

Many studies report problems associated with obesity and its links to a higher prevalence of sexual dysfunctions.^1–12 These difficulties in partnerships and problems related to sexual behavior also significantly influence the quality of life of women with obesity.^4,9,13–16 Studies involving women with obesity who have undergone bariatric treatment have also been reported due to the high prevalence of sexual dysfunctions, dissatisfaction in partnerships, and problems related to sexual behavior.^{1–4,9,15,17,18}

However, specific factors of sexual behavior in young women with obesity—such as the age at the first long-term sexual relationship, number of casual sexual partners over a lifetime, and duration of the current partnership in relation to their sexual life with a partner—remain underexplored. In this context, the current study assessed the hypothesis that the opportunity for bariatric treatment attracts women who experience more problems in their partnerships and sexual behavior. The aim was to identify differences in sexual behavior between women preferring bariatric treatment for obesity and those treated with conservative approaches.

Methods

Participants

This cross-sectional study included 139 women aged 18–38 years who were treated as outpatients for obesity at a university hospital. All participants were selected consecutively and met the diagnostic criteria for obesity according to the International Classification of Diseases, Tenth Revision (ICD-10) (body mass index (BMI) ≥ 30 kg/m²). The sample was divided into two groups according to the type of treatment. The first group included 74 women with obesity who were indicated for and agreed to bariatric treatment (mean age = 29.39 years, SD = 5.26 years; average BMI =42.57 kg/m²). The second group included 65 women with obesity (mean age = 31.23 years, SD = 5.22 years; average BMI =32.77 kg/m²) who preferred conservative obesity treatment. The control group included 380 women (mean age = 28.76 years, SD = 5.94 years) recruited from the general population through advertising. Based on clinical data, women with intellectual disability, those with dependence on addictive substances or alcohol, or those treated for bulimia nervosa were excluded. This retrospective study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, ¹⁹ participants provided written informed consent, and all patient details were de-identified. The study was approved by the University Ethical Committee and was conducted in accordance with the Declaration of Helsinki (1975, as revised in 2024) (institutional review board (IRB) approval number MPP-JZ-0110).

Psychometric measures

Eating disorder examination questionnaire (EDE-Q)

Participants self-evaluated their eating behavior using the EDE-Q, which consists of 28 items. ²⁰ The questionnaire provides a comprehensive assessment of psychopathology related to disordered eating behavior, including the frequency of various forms of overconsumption, binge eating, and bulimic episodes. Most items are rated on a 7-point Likert scale, with the exception of six self-reported items assessing the subjectively experienced frequency of behavior. The overall score demonstrated high validity and internal consistency (Cronbach’s alpha = 0.91).

Assessment of sexual behavior

Participants also completed questions on sexuality and sexual behavior that were previously used in a national representative survey on the sexuality and sexual conduct of citizens of the Czech Republic. ²¹ The survey examined partnered sexual behavior within the European Union. Factors assessed included age at first sexual intercourse, number of casual sexual partners for one night over a lifetime, total number of lifetime sexual partners, and frequency of sexual intercourse with the current partner at the time of the study. Identical items assessing partnered sexual behavior were used to compare the sexual behavior of women with obesity with that of women from the general population. This allowed statistical comparison of sexual behavior between women with obesity and normative data from similarly aged women in the representative national sample.

Statistical methods

Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were used to summarize the basic characteristics of the sample. Analysis of variance (ANOVA) was applied to compare the means of three or more groups to determine whether significant differences existed in the number of lifetime sexual partners, the number of casual sexual partners for one night over a lifetime, and other characteristics.

Results

The main results of this study showed that women with obesity undergoing bariatric treatment began their sexual life at a similar age (N = 16.60 years) as women in the general population (N = 17.06 years) but reported a much higher number of lifetime sexual partners (N = 13.10 ) and a higher number of casual sexual partners for one night (N = 6.97) than women in the general population (number of sexual lifetime partners = 6.20; number of casual sexual partners = 3.25) and women undergoing conservative obesity treatment (number of sexual lifetime partners = 6.68; number of casual sexual partners = 1.52) (Table 1).

Table 1.

Statistical differences among groups in sexual behavior (ANOVA, p < 0.05).

Group	Age at sexual debut (N)	Number of sexual partners per life (N)	Number of casual sexual partners per life (N)	Duration of current relationship (months)	Frequency of sexual relations per month with current partner (N)
Bariatric women with obesity	16.60	13.10	6.97	88.65	7.43
Conservative women with obesity	18.47	6.68	1.52	73.82	6.35
Normal women	17.06	6.20	3.25	51.08	10.58

ANOVA: analysis of variance.

In contrast, women with obesity undergoing conservative treatment started their partnered sexual life significantly later (N = 18.47 years) than women in the general population (N = 17.06). However, their number of lifetime sexual partners (N = 6.68) did not differ from that of the general population (N = 6.20).

Compared with women in the general population, both groups of women with obesity reported a longer duration of their current relationship at the time of the study (general population = 51.08 months; conservative obesity = 73.82 months; bariatric obesity = 88.65 months), although the frequency of sexual intercourse with their current partner per month was significantly lower (conservative obesity  = 6.35; bariatric obesity = 7.43) than in the general population (N = 10.58).

Comparison of all three groups showed no statistically significant differences in the choice of first sexual partner (long-term partner vs. casual partner) for first sexual intercourse. All groups preferred a long-term partner for their first sexual experience.

Discussion

The results of this study confirm previous findings that women with obesity exhibit several significant differences in partnered sexual behavior. Women with normal BMI are typically considered more attractive in industrialized countries.^22,23 Women with obesity often report higher levels of body dissatisfaction, negative body image, and lower self-worth,^4,16,24–29 which may influence their strategies for partnered sexual engagement. For example, some studies indicate that adolescent girls with obesity date less frequently ³⁰ and are generally less successful in forming romantic and sexual relationships^30–32 because they are perceived as less attractive than their peers. ³³

Other studies have reported that women with obesity tend to exhibit riskier sexual behavior, including a higher number of sexual partners in their lifetime,^34,35 less interpersonal experience with potential partners, ³⁴ inconsistent condom use, ³⁵ and a higher likelihood of engaging in sexual activity following alcohol or drug use. ³⁶ Additionally, research has identified increased vulnerability to unintended pregnancy and sexually transmitted infections (STIs) in this population.^32,37

The results of this study indicate that women with obesity undergoing conservative treatment tend to postpone the onset of sexual and partnered life, but their sexual activity—including the numbers of lifetime sexual partners and casual sexual partners—is similar to that of women in the general population. In contrast, women with obesity who opted for bariatric treatment typically begin sexual activity at an age similar to that of women in the general population; however, they report a significantly higher numbers of lifetime sexual partners and casual sexual partners for one night.

These findings suggest that differences in sexual behavior may influence preferences for the type of obesity treatment. Consistent with this, previous research indicates that treatment preferences—conservative versus invasive surgical methods—may reflect specific personality traits,^38,39 lifestyle tendencies related to risk and benefit, ⁴⁰ higher impulsiveness and weaker emotional self-control,^28,41,42 and lower self-esteem,^28,38,39 often associated with prior traumatic experiences.^41,43–46

This study has several limitations. The available sample was restricted to women aged 18–38 years, which may have influenced the number of sexual partners, duration of stable relationships, and frequency of sexual intercourse with the same partner. Future research will aim to address this issue with a broader age range. Other limitations include potential confounding variables such as mean age, weight, and BMI, which may affect sexual behavior independently of treatment preferences. Additionally, the study relied on self-reported sexual behavior data, which may be subject to recall or social desirability bias.

Conclusion

The results of this study suggest that the quality of women’s sexual life plays a key role in their preference for specific obesity treatment method, which may have important implications for therapy and treatment outcomes. Because preoperative psychological assessments include psychosocial parameters—such as quality of life, sexual life, stress levels, coping mechanisms—and motivational aspects related to bariatric surgery, these findings indicate that the sexual behavior of women with obesity may be valuable for selecting the appropriate treatment method and predicting therapeutic outcomes. Furthermore, these behavioral assessments could serve as useful clinical tools and be incorporated into preoperative psychological evaluations.