How obesity affects urological health

The downsides of being overweight and especially obese are well known when it comes to health. For example, we know that carrying excess body weight can increase the risk of heart attacks, stroke, congestive heart failure, hypertension, type 2 diabetes, gallstones, arthritis, and sleep apnea. But how many know that obesity, in particular, can also increase the odds of multiple urological conditions?

The U.S. obesity problem has been growing for decades. In 1960, the obesity rate of adults in the U.S., ages 20 to 74, was only 13.4 percent. Today, that percentage has risen to about one-third or 35.7 percent of adults in the U.S.  The list of why obesity rates have increased as a nation include less physical activity and more sedentary time using electronic devices; large portion sizes of ultra-processed, refined foods; and skyrocketing stress levels from the pandemic and now out-of-control inflation. 

And now, a recent comparative cohort study of participants stratified by body mass index (BMI) and whether they had metabolic syndrome helped determine the prevalence of common urologic conditions. What the study found was individuals with a BMI of 40, or greater (morbid obesity) have a significantly higher association of approximately 1.3 greater odds of developing kidney stones and kidney cancer, and a 1.8, 1.4, and 3.0 fold increased odds of overactive bladder (OAB), erectile dysfunction (ED) and hypogonadism, respectively. 

This current study brings attention to the importance of addressing obesity and its impact on urological and overall health. 

Urologically, obesity directly impacts the ability of the body to have good urinary functioning. Individuals who are obese are at a more significant disadvantage for the following urological problems:

• Urinary incontinence – This problem is associated with unintended urine leakage, typically occurring when coughing, sneezing, laughing, or when lifting something heavy
• Kidney stones – The rate of obese Americans with kidney stones is higher than that of normal weight Americans and has risen in the U.S., which correlates with the rising levels of obesity nationwide. One factor why obesity may increase kidney stones is dehydration. Obese individuals’ larger body requires more water than thinner people and may be mildly dehydrated over time. 

• Kidney cancer – The risk of kidney cancer when obese can be twice that of individuals with a healthy body weight. Too much body fat increases insulin levels and insulin growth factor-1, hormones known to increase the risk of certain cancers. Excess body weight also increases chronic inflammation increasing kidney cancer risk. In addition, fat cells may interfere with certain processes that regulate cancer cell growth in the kidneys. 

• Hypogonadism – Also known as low testosterone levels, is found in about 50 percent of obese men. A symptom of hypogonadism is increased body fat. Other symptoms include lack of energy and fatigue, reduced muscle mass, and depression. Erectile dysfunction, low libido, weaker and fewer erections, and reduced sexual activity are other symptoms associated why hypogonadism. Besides hypogonadism being a cause of ED in obese men, obesity can lead to weaker blood vessels with poorer blood circulation necessary for men to achieve an erection.

• Benign Prostatic Hyperplasia or BPH – BPH is an enlargement of the prostate gland and is a common condition as men get older. It is a noncancerous condition with common but annoying symptoms includimg nocturia, difficulty starting urination, frequency or urgent need to urinate, and a weak urine stream. Men with central or abdominal obesity have a higher incidence of BPH due to increased intra-abdominal pressure that worsens BPH symptoms leading to inflammation and oxidative stress associated with obesity. 

• Prostate cancer – Men who are obese have a higher prevalence of prostate cancer. Diagnosing and treating prostate cancer in obese men is more difficult. The prostate-specific antigen (PSA) test may be lower due to a hormonal imbalance in obese men and, as a result, may not be diagnosed until a more advanced, less treatable stage. Also, obese men are at a greater risk for infections after a prostate biopsy and for complications after prostate cancer treatment such as urinary incontinence, erectile dysfunction, and deep vein thrombosis. 

• Overactive bladder – This urinary condition is sometimes considered the same as urinary incontinence. The two conditions are not the same. Overactive bladder is associated with urinary frequency or urgency, while urinary incontinence is associated more with leakage. People with a healthy bladder have plenty of warning before emptying their bladder. In contrast, someone with overactive bladder is fine one minute but needs to urgently and painfully urinate right away. The reason why obese adults are more likely to have an overactive bladder is due to increased abdominal pressure from the excess body weight that puts pressure on the bladder and urethral mobility. 

Addressing obesity and urinary health

As you can see, obese adults’ health and well-being go beyond conditions such as heart disease, type 2 diabetes, and arthritis. Urinary health is significantly impacted by weight gain and should be addressed by doctors every time they see these patients. 

There is a clear benefit from losing weight when obese and urinary health. Weight loss can help by:

• Reversing some urologic conditions, including incontinence, benign prostatic hyperplasia (BPH), hypogonadism, and ED. 
• Possible slow progression of kidney or prostate cancer 
• If in remission, it can reduce the odds of urinary cancer recurring
• May prevent recurrence of kidney stones 

Reaching a healthier body weight or even just a 10 percent body weight loss can have a meaningful impact on urinary health. The path to losing weight is not always easy but is well worth it regarding health. The best ways to reach a healthy body weight include the following suggestions:

• See a registered dietitian specializing in adult weight loss for their advice on safely losing weight.
• Establish a regular exercise routine.
• Choose, 90% of the time, healthy foods, eating three meals a day.
• Drink water as the main beverage choice. A good guide is to divide weight in half and aim for that number of fluid ounces. For someone who weighs 200 pounds, that would be 100 ounces of water a day or about 12.5 glasses a day. This would include water coming from food and other beverage choices.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.