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Size alone is not the only factor. As well as sex hormones – fluctuations in oestrogen are known to make it harder for women to lose weight in middle age – Aveyard points out that men naturally have more muscle, while fat tissue makes up a larger proportion of women’s bodies. “Fat tissue uses less energy to keep the cells alive than does lean tissue, so men will tend to need to eat more food a day,” he says. “When men and women restrict by the same amount, men will tend to lose more weight than women.”
But the major issue remains finding a way to persuade men to commit to losing weight in the first place. Research has shown that structured exercise programmes, and particularly intensive low fat diets, tend to work better in men than women, though scientists suspect the reason for this is perhaps more psychological than biological.
“I think that possibly men have been harbouring fears about their weight and their health privately for some time before they come to a programme and so embrace harder, faster routes, feeling the issue to be more urgent and requiring more decisive measures,” says Phil Hilton, the editor who helped launch Men’s Health magazine, and hosts the Manatomy podcast.
Another problem is that general stereotypes about obesity and weight loss being female-only problems may have influenced perceptions within the scientific community. In recent years, it has been noted that the majority of academic research on obesity and methods of losing weight has been focused on women. While many other areas of health have recently been shown to be at risk of bias because of women being underrepresented, one review of 244 trials of weight loss programmes found that just 27 per cent of those involved were men.
Such perceptions have filtered over into clinical practice. Earlier this year a study from the National Institute for Health Research found that nine in 10 GP referrals for weight management regimes are for women. Aveyard believes that because GPs do not tend to refer men to such interventions, fewer men actually take the problem seriously.
“The main reason men are not going to NHS-provided weight loss interventions is because they are not being offered referral to such programmes,” he says. “GPs don’t get taught about how to help people with obesity in medical school or beyond, so they are doing the best they can on a scientifically informed lay understanding of obesity. But in the same way that we see weight loss programmes as typically for women, not men, so do GPs.”
The SMF suggests that one way of changing this could be to incentivise GPs to refer more men to weight loss services. While GPs are currently paid £11.50 for every patient referred to such a programme, regardless of gender, an additional premium could be given for male referrals.
New technologies could also provide a more practical way of getting men engaged with weight loss advice and support. Gillison suggests that digital apps could provide a means of helping with goal setting and behavioural management when it comes to men’s relationship with food.
“Men are big users of gadgets that allow them to set and monitor fitness goals, which can be extended to diet so can be a good way in,” she says.
The SMF is calling for more community weight management regimes to be held in local pubs and barbers to encourage more men to partake. This follows the success of a variety of schemes in recent years which have attempted to masculinise weight management. In 2019, Swedish researchers at Linköping University pioneered a programme which successfully recruited overweight male supporters of football and ice hockey clubs, aged between 35 and 65, and enrolled them in male-only weight loss programmes. A similar programme called Football Fans in Training, which started in Scottish football clubs, but has now spread around the globe, has also shown promise.
Of course not all men are interested in football, nor do they live near clubs to deliver this.
However, “these are weight programmes that men are happy to be seen going to, that feel relevant and designed for them,” says Gillison. “Men and women are not that different – we all need social support to help get through something as difficult to do as lose weight – but who we get it from and how we talk about it is.”
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