There is considerable research on obesity and on sexuality as separate issues. The lack of research by sexologists or by obesity experts on the interrelation of the two subjects appear to indicate that researchers do not imagine that sexuality and obesity can co-exist. The prevailing attitude in the U.S. is that one must be thin to be sexual, that a fat individual does not have many sexual opportunities, is not capable of expressing sexuality nor able to perform sexually and therefore sexuality issues need not be considered. Researchers into the subject of obesity and sexuality have remarked on this phenomenon before (Jordan and Levitz, 1979; Shapiro, 1980; Spiegel, 1988; Blank, 2000). The lack of research leaves this attitude virtually unchallenged. However, in spite of this scarcity, there are some empirical studies that shed light on the subjects of obesity and sexuality.

Two well-researched and well-documented unpublished dissertations on obesity and sexuality are Sharen Shapiro's (1980) Sexual Attitudes and Activities of Obese Women and Joan Spiegel's (1988) Differences Between Obese Women in a Relationship and Obese Women not in a Relationship. Shapiro administered a 137-item questionnaire about sexual attitudes and behaviors to 100 Caucasian females, who were divided into two comparison groups on the basis of weight. The weight of one-half of the women was in the "normal range". The other half was obese. (For this Dissertation, obese was 25% above the Metropolitan Life Insurance Company's Table of Desirable Weight, 1959.) The survey results indicated that the obese women had a general, pervasively negative self-concept, felt more inhibited in discussing sex with their partners, rated their primary relationships more unhappy, and compared their physical attractiveness negatively to that of other women around them. They frequently wished they could change some part of themselves, and felt that their weight frequently interfered with their relationships - with sex in general and with sexual positions in particular. The obese women stated that they would like to have sex more frequently and that their sexual needs were often left unsatisfied. They wished they did not have to be initiators of the sexual relationships as often as they felt called upon to be. This study suggests that large women are interested in having more sex than they actually are having.

One factor that may have influenced Shapiro's results is that many of the subjects were found from people who were attending Overeaters Anonymous, a weight loss program. These subjects may have had a higher instance of dissatisfaction with weight and of negative body image (affecting self-esteem and self-concept) than a more randomly selected group of obese women.This may account for so many of the women having an extremely negative self-concept. It would be interesting to see the results of a similar study that selected subjects more at random. However, the results of a current study would also be affected by the development of the fat acceptance movement, which may have improved the self-esteem of many large women.

Joan Spiegel's (1988) study of the differences between obese women in relationships and obese women not in relationships surveyed 74 women between the ages of 23 and 52. Forty-five of the women were in a relationship and 29 were not in a relationship. The mean average weight of the women in a relationship was 236 pounds and the mean average weight of women not in a relationship was 247 pounds. The women filling out her questionnaire came from her article written for Radiance, a national size-acceptance magazine and from a plus-size fashion show. The women in relationships scored higher in self-satisfaction and self-esteem. The obese women not in relationships scored significantly higher in the emphasis they put on their weight as a cause of not having a relationship. They believed that their former partners cared a great deal about weight, and they felt that their sexual relationship was affected by their weight. Significantly, they also said they would more often have chosen a different partner if they had been thinner. They claimed that sex was not important to them, that their sexual adjustment was below average, that they would like to initiate sex more often, that their sexual needs were not satisfied, and that they did not feel comfortable discussing sex with their partners. This study supports the hypothesis that attitudes, not inherent psychological problems nor obesity, as such, are responsible for women's relationship health.

In a 1976 unpublished study conducted at Michael Reise Hospital in Chicago, Shipman and Schwartz found that fat women were more sexually appetitive than thinner women. This study, described by Beller (1977), was particularly interesting because, as Freudians, the researchers had hypothesized before the study that "fat was…a kind of somatic metaphor for the psychic armor fat people are supposed to have elaborated as a defense against sex and love" (p. 74). Furthermore, the factors that were supposed to have led the larger women to become fat should also, according to the researchers' theories, have made the women uninterested in sex. This hypothesis was not supported by the results of the study. Shipman and Schwartz discovered that the fat women's desire for food and sex existed simultaneously. "In terms of erotic readiness and general sexual excitability, fat women outscored their thin sisters by a factor of almost two to one" (pp.74,75). Beller hypothesizes that "the fat woman's sexual readiness may be part …of a generalized nervous-system syndrome in which appetite, once triggered-- whether for food, sex, 'love,' housework, poetry or anything else…may be much more difficult to turn off" (Beller, 1977, pp. 74,75).

Ileal and intestinal by-pass surgeons have contributed to our understanding of the meaning of obesity and sexuality in marriages. Marshall and Neill (1978), studied the effect of weight loss after surgery on the sexuality of married couples. The study involved 12 persons, 10 females and 2 males and their spouses before and a year after surgery. The preoperative weight of the obese members averaged 338 pounds, with a range of 214 pounds to 485 pounds. After the operation had been performed and the subjects had lost an average of 135 pounds, there were marked changes in the areas of sexuality and dependence/ independence parameters. The authors concluded that there was a function to the symptom of obesity within these marital systems. "Many of the men had dated only obese females, and several had noted, 'I have always preferred heavy women (p. 278). Ten of the 12 patients were obese when they married. This would indicate that these men were sexually attracted to the obese women. An operation to eliminate the obesity would be predictive of conflict. The interpretation of the data indicated that the obesity served as a stabilizing force in the marriage as there were some sexual conflicts within the marriage after the operation. Some female patients described themselves as "feeling sexually attractive, playful, occasionally flirtatious, and more willing to initiate sexual encounters…. Several attributed the change to a diminished fear of rejection….Anxiety and jealousy were prominent in the spouses (p. 276)." After surgery, the women shifted to greater assertiveness, with more anger and hostility displayed. There were 2 divorces after the surgery.

Wise (1978) studied twenty-three massively obese individuals, 13 men and 10 women, who were screened for ileal bypass surgery. In addition to a test to determine the presence of any psychiatric illness, the obese persons were given "...a detailed sexual history to ascertain the frequency of sexual activity, their level of arousal…their global sexual attitudes…physical ability to tolerate sexual activity, their libidinal drive, and self-concepts of body image were also determined" (p.10,11). The conclusions of this study were that "There was no evidence that core sexual identity or mechanical activity was aberrant in the massively obese….It is apparent that hyper-obese individuals feel and display a sense of shame about themselves as attractive individuals. This aspect of learned social behavior can modify sexual activity (p.23)."

According to a retrospective study of 32 obese women, conducted by Werlinger, King, Clark, Pera and Wincze (1997), participants were studied who lost weight by dieting under a medically supervised weight management program using either OPTIFAST liquid diet or a 1200 kcal per day diet. The participants were asked to complete two sets of questionnaires. The first was to be filled out according to how they had felt before they dieted and the second to how they were feeling in the present. Participants self reported experiencing improvements in sexual function that they suggested was due to improved body image occurring along with the weight loss (p. 77).

Wise (1978), Shapiro (1980), and Spiegel (1988) have established that obesity, in itself, does not affect sexual functioning. These researchers found that the attitude of the obese person toward her body and her sexuality was the determining factor in the prediction of sexual functioning.

Stuart and Jacobson (1987) received 9,000 responses to a questionnaire about weight and sex. The book, Weight, Sex and Marriage, published as a result of this survey discusses the relationship of food and fat to many aspects of marriage and relationship, including sexuality. The results of the survey were usually not statistically evaluated so that it is difficult to establish the scientific evidence from the subjective evaluation of the data. Women who said they did not enjoy or want sex were the exception in this study, and many women reported a desire for more sex or for more satisfying sex. Most of the women surveyed were having sex approximately 8 times per month. Women in unhappy marriages had sex less than half as often and they would become particularly frustrated when the number of times fell to less than once a week. If there were any problems with their sexual lives, these women usually blamed the difficulty on their weight, even when the husband was abusive, unfaithful, impotent or asexual. Stuart and Jacobson believe that women overeat as a response to stress in their lives. Some of the stresses they list relate to sexuality: not enough sex; bad sex; not enough foreplay; not enough time; not enough intimacy, and a lack of comfort, support, and love. The authors write that those who said they did not enjoy or want sex were extremely rare.

"A majority of women, however, believe that changes in their attitudes were as important as the changes in their weight. Women reported greater sexual desire and less sexual inhibition when they felt better about their bodies. This accounts for the fact that almost 60 percent of the women in our study have sex more often, and enjoy it more, after they lose weight... Some (letters) were from the 40 percent of our sample who said their weight had no effect on their husbands' sexual interest, but it made all the difference in their own willingness to be sexual..." (p. 106).

Most of the book concentrates on how marriage is linked with sex and weight, and it attempts to explain why losing weight is so difficult in marriages. Near the end of the book, there is an interesting chapter that hints at the emerging attitude that maybe dieting is not always the best path. Stuart and Jacobson address themselves to those who "don't naturally [italics added] conform to current standards of thinness." (p. 116) The authors suggest that for these people "the self-torture directed toward an impossible ideal is sheer foolishness…. The key here is a sense of self worth based on factors other than weight." (p.117)

"Once these women appreciate themselves, their bodies become a valuable part of a worthy person. And once they accept their bodies, they are no longer self-conscious. In contrast to the many women who let their inhibitions about their weight ruin their sex lives, these women usually have very satisfying sexual experiences." (p. 118)

While Stuart and Jacobson's work is important because they established a clear link between obesity and sexuality, some of their interpretations are subject to controversy since most behaviors are multiply determined. The causes of weight gain have not been irrefutably established. Blaming others and self-reported motivations and feelings provide some information but will probably more than likely reflect the society's general ideas on the subject. Furthermore, the questionnaire was sent to subscribers of a "national magazine directed toward weight-conscious women" (p.19), a group which one can reasonably assume to be significantly concerned about their weight. These individuals are not necessarily representative of the obese population in general.

In 1997, Cash, Winstead, and Janda renewed the massive three decade long investigation into the subject of body image. Approximately 2000 men and women that answered a query from Psychology Today were surveyed in detail regarding their opinions and feelings about their bodies. Thirty-eight percent said they were dissatisfied or very dissatisfied with their body image (p. 32). Sixty-three percent of the women said they were afraid of becoming fat (p. 34). One hypothesis is that body image dysphoria is highly correlated with sexual dysfunction in women.

Faith and Schare (1993) explored this hypothesis by investigating whether negative body image plays a role in sexually avoidant behavior. Using 108 males and 140 females and using Masters and Johnson's concept of spectatoring ("cognitive self-absorption on one's body parts and/or the adequacy of personal sexual functioning") (p. 345) the investigators found that "body image scores significantly predicted frequency of sexual behaviors for both genders" (p. 345). "Having a negative body conceptualization significantly predicts sexual avoidance…" (p. 355). "Sexual avoidance is postulated to perpetuate a negative view of the body, and so the cycle continues as the individual refrains from healthy sexual relations" (p. 353). It is suggested in this study that "males and females who are more likely to conceptualize their bodies and performance in negative terms are also more likely to report less sexual experience (p. 352)." This study showed predictability of sexually avoidant behavior in women with body image dysphoria. Sexually avoidant behavior included self-consciousness, failure to flirt, avoidance of erotic encounters, anticipation of rejection, feelings of shame, failure to initiate sexual encounters, and trying to hide one's body.

Sexologist Marty Klein (1996) conducted an investigation in conjunction with McCalls Magazine. An article titled "Is weight wrecking your sex life?" included the results of a telephone survey of 350 McCalls readers who answered the question "Does your weight affect how sexy you feel or how attractive your husband finds you?"

Fifty-four percent said they thought their husbands would find them less desirable if they gained weight. Forty percent reported they were less interested in sex when they'd gained weight. Thirty percent felt their husbands would find them more sexually desirable if they were thinner. Nearly 20 % said their husbands were less interested in sex when they'd gained weight. (p. 96)

Researchers Anderson and Legrand (1991) believe that: "Despite empirical efforts and theoretical discussions…body image remains ill defined. We view women's body images as attitudes--general and enduring positive or negative feelings about the body…. Current assessment reviews note two general and independent contents--perceptions of the physical self (or specifically body size estimations) and attitudes toward body parts. It is the latter category, body part attitude measures, which the present research examines." (p. 458)

Anderson and Legrand studied the content and valence of women's body image attitudes, general and enduring positive or negative feelings about the body. According to their findings, weight, and its distribution, has the most significant effect on women's evaluation of their bodies. "…measures of body image could be constructed which are little more than measures of satisfaction with weight. Such findings could be interpreted as ''body image dissatisfaction when the dissatisfaction is, more accurately, weight dissatisfaction (p.474)." They also found that body attitudes remained stable following the diagnosis and treatment of a physical disease. These results concur with the research of Kriss and Kraemer (1986), and Ghizzani, Pirtoli, Bellezza, and Velicogna (1995).

Keeton, Cash, and Brown (1990) criticized the research on body image and the "dubious" assumptions of the "unidimensionality of the construct and the equivalence of body image measures (p. 214)." They found that there was a "distinction between attitudinal and perceptual modalities of body image…only attitudinal body image and perceptual self-ideal discrepancy measures were significantly linked to eating disturbance" (p. 214).

Haimovitz, Lansky and O'Reilly (1993) hypothesized that body satisfaction can be influenced by situational factors. The subjects had significantly different body approval scores for different situations, such as when they were on the beach, at home, or in a dressing room. The subjects were especially self-critical when they were in more sexually charged situations than in "everyday" places (p. 78). Keeton, et al. also suggested that "the gender and attractiveness of the experimenter or of other subjects present during the administration of a particular measure may significantly affect the results" (p. 83).

A study by Roth and Armstrong (1993) corroborated the last study when they found that a participant's experience of bodily thinness-fatness was "influenced by the affective state, performance evaluation, public scrutiny, self consciousness, and the nature of one's interpersonal field" (p. 355).

In 1991, Burgard, co-author of Great Shape (p. 36), asked over 100 women, readers of Radiance, "Is it possible to 'accept' your body size regardless of weight? " Of all the respondents, whose average weight was 287 pounds, 50% were found to basically accept their bodies no matter how much they weighed. Another interesting finding was that the women who did not believe that they were responsible for their weight regain, that it might be due to "normal physiological and psychological reactions to caloric deprivation (p. 38)," these women registered higher self-esteem than those who constantly dieted and regained the weight. The latter felt out of control and registered lower self-esteem.

Before we decide that all obese women are pathological, addicted, victims of dependent marriages, under the power of Capitalism, or on the wrong diet, it might behoove us to remember that other cultures do not experience any of this to be true and, instead, consider large women to be the most beautiful (Ford and Beach, 1951; Brown, 1993). Beller, a researcher on the history of obesity, also summarizes worldwide reports on men's preferences regarding women's body size.

A strong presumptive case for the general desirability of fat women can be made from the ethnographic evidence: Of a total of twenty-six tribes from all over the inhabited globe who have ever been put on record as expressing any preference in the matter, only five preferred their women slender. To this meager roster should now be added, presumably, the vote of twentieth-century Americans and western Europeans; but even so, the naysayers are resoundingly outnumbered by those who like their women fat.

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