By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Obesity in men: why it deserves its own conversation
Obesity in men looks different from obesity in women, so the risks and the treatment differ somewhat too. Men tend to store fat in the belly, around the internal organs. Many men also come for treatment late, sometimes only after diabetes, a heart event or a problem with sexual function. In this article I explain what is distinctive about the male body, which warning signs to look for, and which treatments actually work.
Obesity in men by the numbers
Worldwide, obesity is slightly more common in women. The gap is small, though, and the picture varies from country to country. In the US national survey NHANES for 2017-2018, for example, the obesity rate was 43.0% in men and 41.9% in women. According to obesity statistics from the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), overweight without obesity is far more common in men: 34.1%, compared with 27.5% in women.
In other words, obesity in men is extremely widespread. Yet men take part in lifestyle-change studies far less often. A review of 244 studies found that men made up only 27% of participants. As a result, many well-known weight-loss programs were built mainly around women.
Belly fat: the danger you can’t see
Men store fat mainly around the abdomen and trunk, while women usually store it in the hips and buttocks. This is a consistent finding in research on body composition in men and women. The deep abdominal fat, known as visceral fat (the fat that wraps around the liver, pancreas and intestines), is highly active hormonally.
As Harvard explains in its overview of the dangers of abdominal obesity, this fat releases fatty acids directly into the liver. That increases insulin resistance and raises the risk of type 2 diabetes. It also secretes inflammatory substances linked to atherosclerosis. So a man with a “beer belly” and a seemingly normal weight may be at real metabolic risk.
How to measure your waist correctly
Breathe out, then wrap a tape measure around your bare abdomen, just above the hip bone. Don’t suck in your stomach and don’t pull the tape tight. In men, a waist of 102 cm (40 inches) or more signals high risk. A waist-to-hip ratio of 1.0 or more points to the same risk.
Obesity in men, testosterone and sexual function
The link between weight and sex hormones runs in both directions. Fat tissue converts some testosterone into estrogen, so testosterone levels fall. Low testosterone, in turn, makes it harder to build muscle and encourages belly fat to accumulate. The result is a cycle that is hard to break.
The good news is that the cycle is reversible. A meta-analysis of 24 studies showed that weight loss raises testosterone levels. The increase was especially large after bariatric surgery, and it grew the more weight a man lost.
In an Italian trial of lifestyle and erectile function, 110 men with obesity took part. After two years of weight loss and exercise, 17 men in the intervention group regained normal sexual function, compared with only 3 in the control group. If you are worried about how weight-loss medications might affect libido, read my article on weight-loss injections and sexual desire.
Should low testosterone be treated? The T4DM trial tested testosterone treatment alongside a lifestyle program in men aged 50 to 74 with a large waist. After two years, 12% of the treated men developed diabetes, compared with 21% in the placebo group. However, in 22% of the men receiving testosterone, the hematocrit (the concentration of red blood cells) rose above the safety threshold. This is therefore a treatment that requires a medical decision and close monitoring. I cover it in more detail in my article on testosterone and diabetes.
Obesity in men, snoring and sleep apnea
Fat around the neck and abdomen narrows the airway during sleep. That is why men with obesity snore a lot, and many of them have sleep apnea without knowing it. The result is daytime fatigue, high blood pressure and poor concentration. What’s more, bad sleep increases hunger the next day. I wrote about how sleep affects the brain in my article on sleep and brain health.
Other health risks
Obesity in men raises the risk of type 2 diabetes, high blood pressure and fatty liver. It is also linked to heart disease, joint wear and several types of cancer, such as colon cancer. I discuss this link at length in my article on obesity and cancer. Most important of all: losing 5% to 10% of body weight already improves many of these measures.
Treating obesity in men: what works
No single treatment suits everyone. So at the start we assess weight, waist circumference, blood tests, sleep and sexual function. Then we build a personal plan, sometimes combining several tools.
Lifestyle and nutrition
Men respond well to practical programs with measurable goals: counting steps, strength training two or three times a week, and cutting back on alcohol and sugary drinks. Planning the week’s meals in advance also helps a busy man a great deal. Combining a healthy lifestyle with medical treatment lowers the risk of heart disease as well.
Medication
Drugs in the GLP-1 family reduce hunger and improve metabolic balance. Today there are weekly injections as well as pill options. For example, orforglipron (Foundayo) received FDA approval for the treatment of obesity in April 2026. You’ll find an overview of the options on my page on medications for obesity and metabolic disease.
Bariatric surgery
When obesity is severe, bariatric surgery produces the largest and most lasting weight loss. It also raises testosterone levels significantly. The decision to operate is made after a thorough multidisciplinary assessment.
Obesity in men: why they seek treatment late
Many men see their weight as a matter of willpower rather than a disease, so they put off seeing a doctor. But obesity is a chronic disease with a biological basis, not a personal weakness. Often it is a partner or the children who encourage the first step. If you’d like to raise the subject at home, I’ve gathered tips in my article on how to talk with your family about treatment.
The bottom line
Obesity in men shows up mainly as belly fat, and it is linked to diabetes, heart disease, sleep apnea and low testosterone. Yet every one of these problems improves with weight loss. Ultimately, your waist measurement is a good place to start: if it is 102 cm or more, it’s worth seeing a doctor who specializes in obesity for an assessment.
The information in this article is general and does not replace personal medical advice.
Frequently asked questions
Is obesity more dangerous in men than in women?
Not necessarily, but it is different. Men mainly accumulate belly fat, which is strongly linked to diabetes and heart disease. That’s why it’s important to measure your waist, not just your weight.
What is a healthy waist size for a man?
According to Harvard, a waist of 102 cm or more signals high risk. A waist-to-hip ratio of 1.0 or more is also a concern.
Does losing weight raise testosterone?
Yes. A meta-analysis of 24 studies showed that testosterone levels rose after weight loss, and the rise was greater the more weight was lost.
Are weight-loss medications suitable for men?
Yes. GLP-1 drugs are effective in men and women alike. Whether they are right for you is decided after a personal medical assessment.
Sources
Overweight & Obesity Statistics
Why worry about your waistline?
Sex Differences in Body Composition
Male inclusion in randomized controlled trials of lifestyle weight loss interventions
Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial
