Prevalence and Incidence of Erectile Dysfunction in Men With Overweight and Obesity: A Systematic Literature Review

23 studies, 52,981 men — and researchers still can't agree on how common ED is in obese men

Journal: Obesity Reviews | Published: 2025-12-03 | Type: Systematic Review | PMID: 41337750 Authors: Biernikiewicz M, Szuster E, Pawlikowska-Gorzelańczyk A, Kałka D (Men's Health Centre in Wrocław, Poland; University Centre of Obstetrics and Gynecology) Funding/COI: Not reported

Summary

A PRISMA-compliant systematic review screened 554 records and included 23 studies covering 52,981 participants (18,104 with overweight or obesity) to quantify ED prevalence in this population. The headline finding is essentially an admission of failure: wildly inconsistent BMI cutoffs and ED measurement tools across studies make it impossible to produce a reliable pooled estimate. Older men and those with additional comorbidities showed higher ED rates, which surprises no one.

Claims

• 23 studies met eligibility criteria out of 554 screened records
• Total sample: 52,981 participants; 18,104 classified as overweight or obese (BMI ≥ 25 kg/m²)
• ED prevalence in men with overweight/obesity "varied globally" — no specific range or pooled estimate is reported in the abstract
• Higher ED prevalence observed in older age groups and men with additional risk factors
• Authors conclude current evidence is insufficient to draw clear conclusions due to methodological heterogeneity

Study Quality

This is a qualitative synthesis, not a meta-analysis — meaning no pooled statistics were calculated. The inability to meta-analyze is itself a finding: the included studies used incompatible ED assessment tools and inconsistent BMI classifications, precluding quantitative combination. Following PRISMA guidelines is a baseline, not a quality signal. With 23 studies and nearly 53,000 participants, the raw material was substantial; the failure to synthesize it reflects the field's measurement chaos, not necessarily this review's execution.

The review's scope (BMI ≥ 25 kg/m²) lumps "overweight" and "obese" together in ways that may obscure dose-response relationships between adiposity and ED severity. No distinction between incidence and prevalence is apparent in the abstract despite the title claiming both.

Red Flags

• No pooled prevalence estimate produced — the main number readers want is absent
• Funding and conflict of interest not reported for a review from a men's health clinic with commercial implications
• Title promises incidence data; abstract mentions only prevalence findings
• "Varied globally" without a reported range is uninformative
• All four authors share the same institutional affiliation (Men's Health Centre in Wrocław), raising questions about independent perspective
• No sensitivity analysis or quality scoring of included studies mentioned

Strengths

• Large aggregate sample (52,981 participants) across 23 studies
• PRISMA methodology at least ensures transparent reporting of what was and wasn't included
• Honestly acknowledges the heterogeneity problem rather than forcing a spurious meta-analysis
• Identifies a genuine gap: the field lacks standardized ED assessment protocols for obesity research

Verdict

This review documents a problem without solving it. The authors correctly identify that BMI classification chaos and inconsistent ED measurement tools make the existing literature nearly uninterpretable — but a 2025 systematic review that can't produce a number is hard to call a contribution. The real value here is as a methodological indictment: a decade of obesity-ED research apparently can't agree on what to measure or how. If you're researching this area, the paper's reference list of 23 studies is its most useful feature. The review itself is a map of a problem, not an answer.