WOMEN’S OBESITY AND SEXUAL QUALITY: A DYADIC STUDY ON WOMEN AND THEIR MALE PARTNERS

Research supports a relationship between people with obesity and decreases in psychosocial functioning as it relates to their sexual health. While sexual health problems are more commonly found in women with obesity than men, contributing factors outside of biological ones have been relatively unexplored. In addition, few have investigated obesity as a dyadic experience, seeing its impact on sexual health with individuals only. This manuscript style dissertation was designed to extend the literature on the effects of women’s obesity on both partners’ sexual health within heterosexual relationships. The first article, a systematic review, reviewed 172 studies to better understand the biological, psychosocial, and contextual factors impacting obesity and sexual functioning. Overall, less research is available regarding the association between excessive weight and female sexual functioning; whereas, the same association for the men was supported by the majority of the studies included in this review. The findings from the systematic review indicated the need for more robust research on the effects of women’s obesity and multiple biopsychosocial health dynamics associated with quality of sex, as well as demonstrating the need for moving from individual-level research to dyadic studies accounting for the interdependence of both partners’ sexual quality within a romantic relationship context. The second article was a dyadic cross-sectional quantitative survey designed to study the association between biological, psychological, and interpersonal domains of health and quality of sex life in women with obesity and their male romantic partners. Results from the dissertation highlighted the critical importance of dyadically studying the biopsychosocial dynamics of health to better explain quality of sex in the context of obesity and romantic relationships. The results of actor-partner interdependence model (APIM) suggested that female obesity parameters (i.e., body mass index and waist circumference) did not have an actor or partner effect on quality of sex while controlling other biopsychosocial health factors (i.e., sexual functioning, body image self-consciousness during sexual intimacy with a partner, and couple’s attachment behaviors) in the model. Expectedly, sexual functioning and couple’s attachment behaviors had positive actor effects on quality of sex in women with obesity and their male partners. This finding indicated that both women with obesity and their male partners reported having higher quality of sex within their romantic relationship with their current partner when their own sexual functioning and secure attachment behaviors were higher. Aside from the actor effect, female sexual functioning had a positive partner effect on male’s quality of sex suggesting that male partners had higher quality of sex when their female partners had lower sexual dysfunction. Lastly, the actor–partner interdependence moderation model (APIMoM) unveiled a dyadic synergistic interaction effect of sexual functioning between waist circumference and quality of sex. When female partners’ sexual functioning was higher, higher waist circumference of male partners was associated with lower quality of sex among female partners. Based on findings from the dissertation, recommendations for clinical work, research, policy, and the field of medical family therapy included: (a) conceptualizing women’s obesity and its impact on their sexual quality from a systemic biopsychosocial perspective and utilizing dyadic research methods to account for interdependent relationships among reflect this standpoint, (b) addressing systemic and ongoing interactions between both partners’ biopsychosocial health dynamics and sexual quality integrating the romantic partner into the treatment model, (c) implementing changes in current policies to strengthen interprofessional collaboration and training healthcare providers in regard to detrimental effects of obesity and other biopsychosocial health factors on individuals’ and their partners’ sexual quality within romantic dyads, and (d) advocating for patient- and family-centered systemic biopsychosocial-spiritual care to better serve sexual health needs of women with obesity and their male partners