Eric Reed always thought of himself as a “little heavy.” But he really started to gain weight around 2018, after a back injury in Army training and a messy divorce left him struggling emotionally. The pain made it difficult to exercise, and within two years of leaving the military, he put on another 50 pounds.
“I just drank all the time, at least a 12 to 24-pack a week. I was constantly ordering pizza, eating way too much food,” said Mr. Reed, now a 41-year-old medical imaging specialist living in Fairmont, W.Va. At his heaviest, he weighed 358 pounds.
Mr. Reed had been a wrestler in high school but could no longer finish a round of golf with his father. His new wife, Kathleen, loved exploring state parks and kayaking. “I would try to do those things with her,” Mr. Reed said, “and I couldn’t.”
Still, he never thought about seeing a doctor. He was just big, like a lot of his friends, and weight loss felt more like a woman’s concern; in his circles, bringing obesity up was like saying you’re a “vegan at a steakhouse,” he said.
But in 2023, his wife took him to the doctor’s office, where he was prescribed GLP-1 drugs for his Type 2 diabetes and obesity. “If it hadn’t been for her pushing me, I probably wouldn’t have done anything,” Mr. Reed said.
Recent data suggests that around 40 percent of adults in the United States have obesity, which sets the stage for high blood pressure, various forms of cancer and some 200 other complications. Men have similar rates of obesity as women, but they are less likely to seek medical care, making up only about 20 percent of bariatric surgery patients and around 22 percent of people on anti-obesity drugs. If men do take GLP-1 medications, a recent study suggests that they are also more likely to stop using them.
It’s hard to parse exactly why this treatment gap exists, but it’s probably tied to the greater societal focus on women’s bodies, and men’s general tendency to delay seeking health care, especially when it comes to weight. The consequences, however, can be severe, since obesity tends to be more deadly in men than women. And experts say that untreated obesity is one important contributor to the 5-year life expectancy gap between men and women.
Obesity can be more dangerous in men
Obesity is linked to accelerated aging and early death and is typically defined by body mass index, a measure of weight and height. While B.M.I. is widely used, it is an imperfect tool that can’t distinguish between muscle and different types of fat. Where someone stores excess fat also matters.
Women tend to store fat around their hips and thighs, while men tend to store visceral fat deep inside their bellies and around their organs, said Dr. Louis Aronne, director of the comprehensive weight control center at Weill Cornell Medicine.
Visceral fat is particularly dangerous. It produces inflammatory molecules and a steady stream of fatty acids, bathing the liver with these chemicals, said Dr. Aronne. Over time, this can lead to blood clots, insulin resistance and arterial plaques, which may help explain why men have an increased risk of heart disease, Type 2 diabetes and other obesity-related complications.
But subcutaneous fat — the type women tend to have — may actually protect against many of these complications, taking fatty acids out of circulation, Dr. Aronne said.
It’s a perfect storm since men are more prone to many obesity-related conditions but less likely to seek medical help, said Dr. Michal Luniewski, an endocrinologist and metabolic health researcher at the Medical University of Lublin in Poland. They often come to the clinic with late-stage complications that are harder to treat.
Why men don’t get treated for obesity
It’s hard to pinpoint one reason for the obesity treatment gap, but women generally face more rigid beauty standards, said Dr. Juliana Simonetti, director of the obesity medicine program at University of Utah Health. Because of this, women may feel more pressure to seek obesity treatments. But men are less likely even to recognize that they have obesity.
Many men feel like they can lose weight on their own, said Dr. Spencer Tilley, a California-based family medicine physician. There’s a machismo that makes men feel like they can cure obesity through sheer willpower, whether that means starting to drink less or going to the gym. “Some people don’t realize that it’s much more of a disease,” Dr. Tilley added.
Men already are less likely to see the doctor than women; for weight loss, it can feel emasculating, said Dr. Goutham Rao, chair of the family medicine and community health department at University Hospitals Cleveland Medical Center.
He’s never had a male patient come to a primary care visit to lose weight, but Dr. Rao said they might come because they’re constantly short of breath and want to better their fitness, or after they needed to go to the emergency room and want to improve their heart health. Stephen Brandon, a 46-year-old software engineering manager from Bremerton, Wash., only sought out medical help for obesity after a cardiac issue left him hospitalized for a week. For Mr. Brandon’s father, it took four heart attacks before he finally decided to start taking a GLP-1.
How doctors are trying to reach men with obesity
New obesity drugs like semaglutide and tirzepatide also treat cardiovascular disease, obstructive sleep apnea, kidney disease and severe fatty liver disease. That can be helpful for doctors counseling resistant patients because they can tie treatment to conditions that many men already take seriously, Dr. Tilley said.
Similarly, he will often emphasize how weight loss can help his patients get off their other medications. Obesity is also tied to low sperm counts, erectile dysfunction and poor fertility, said Dr. Neel Shah, chief medical officer of Maven Clinic, and men often take these conditions more seriously than weight alone.
Relationships can be another powerful motivator. Dr. Rao said that many men only come to his weight management clinic because a partner was worried about them, or they wanted to set a better example for their children.
When it comes to how best to reach men, Mr. Reed offers a simpler argument: the difference GLP-1 drugs make in his own life. Over the past two years, he’s lost 75 pounds, and as the weight has come off, his diabetes has come under control, his back pain has gotten quieter, and he and Ms. Reed are now trying to have children.
This month, they hope to go kayaking in Elk River, close to where Ms. Reed grew up. “And just a few weeks ago, I was able to complete 18 holes of golf with my father,” Mr. Reed said. It was the first time he’d been able to play in four years.
“I was tired and sore,” he said, “but I didn’t feel like I had to stop.”
Simar Bajaj covers health and wellness.
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