Risper* cherishes her traditional African values. Her mother taught her that the way to a man’s heart is through his stomach. As such, she does her best to cook delicious meals frequently for her husband.
"My problem is that this man remains thin," she lamented when she brought her husband, Isaac, to the Sexology Clinic. "His mother is likely to accuse me of not taking care of her son."
In most African families, a woman is accused of neglecting her duties if her husband remains thin. There are plenty of jokes about fat men in the street, suggesting that they have good spouses and enjoy peace and good food at home.
The same is true for women in Africa. Unlike in the West, where being skinny is considered beautiful, we admire the curvy bodies of our African women. In fact, to celebrate African beauty, many curvy women are now forming groups whose membership is determined by their body weight.
However, when it comes to sexual health, we have to choose between a pot belly/curvy body and pleasurable, satisfactory sex. The two do not coexist in the long term, scientifically speaking.
"I'd rather have good sex," Isaac interjected, paying closer attention to the direction the discussion was taking.
"Well, your mother will not give me peace if you stay as bony as you are. You decide whether you want me to have peace of mind in this marriage or whether you want your mother to ostracise me," Risper retorted.
There is scientific evidence that being lean is good for everyone. A pot belly or a curvy body indicates the accumulation of fat around internal organs. Scientifically, we say that one has excess visceral fat. This is fat that pads the liver, kidneys, heart and intestines, among other internal organs.
Visceral fat is characterised by an increase in inflammation of the blood vessels, the formation of fatty deposits inside the blood vessels that interfere with blood flow, and the disturbance of body hormone profiles. This has a detrimental effect on blood vessels, which is the main cause of erectile dysfunction as well as chronic heart and kidney disease. Inflammatory conditions such as arthritis and back pain also become commonplace. Studies of cancer frequency also show a higher prevalence of cancer among people with increased visceral fat.
"I feel you are overthinking it, doctor," Risper said, becoming uncomfortable with the discussion. "All I am saying is that we need good physical and social health. Looking emaciated is not a good social image and shows that I am not fulfilling my role as a wife!"
While body image has social implications, it is also important to understand the health implications. The hormonal changes that accompany visceral fat accumulation are also problematic. Testosterone levels decrease, and oestrogen levels tend to increase. As a result, men and women with excess visceral fat are likely to have a low sex drive. They may experience challenges with sexual stimulation, with men suffering from erectile dysfunction and women having difficulty lubricating. Furthermore, men may start ejaculating prematurely, while women may fail to reach orgasm.
However, the bigger picture is that sexual problems may be the first sign of serious underlying health issues. If a lifestyle change is not implemented immediately, diabetes will follow, then hypertension, then heart problems and kidney failure.
“For me, the important thing in this discussion is knowing how to detect visceral fat accumulation,” said Isaac. “I would rather stay healthy than please people by getting fat.”
It is possible to diagnose visceral fat accumulation yourself at home. Overall, your body weight increases. However, that alone is not enough to make the diagnosis. Your body shape starts to resemble a pear, with the girth of your tummy grossly exceeding that of your pelvis. Most people realise that their trousers or skirts are getting tight around the waist, even though their pelvis and thighs have not changed. If you measure your waist size and divide it by your height, the result is likely to be less than 0.5.
At the hospital, the doctor will tell you that your body mass index (BMI) is high. If they check your cholesterol, it is likely to be high, too. Your blood pressure will also most likely be rising, and you may be told that you are pre-diabetic, if not already diabetic. Sex will probably already be problematic at this point.
"So, what you're saying is that Isaac can stay the way he is?" Risper asked, visibly upset at the end of the counselling session.
"No, the doctor is saying we have to decide what we want: good health or a good social image," Isaac answered.
"Whatever decision you make, it's important to make it with all the facts. In this session, my objective was to provide information," I said as the couple stood to leave. It was clear that we hadn't reached a consensus on this matter.
