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Epidemiological and clinical data indicate that modifiable lifestyle factors – including obesity, physical activity, and diet – significantly influence the risks of symptomatic benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS).Modifiable factors associated with significantly increased risks of symptomatic BPH and LUTS include obesity and consumption of meat and fat. Factors associated with decreased risks include increased physical activity, vegetable consumption, and moderate alcohol intake. Obesity potentially attenuates the clinical efficacy of 5α-reductase inhibitors (5-ARI). Randomized clinical trials of lifestyle alterations – such as weight loss, exercise, and diet – for the prevention or treatment of BPH and LUTS have yet to be performed.Obesity, physical activity, and diet substantially alter the risks of symptomatic BPH and LUTS. 5-ARIs exhibit diminished efficacy in obese patients. Although clinical trials of lifestyle modifications have yet to be undertaken, it is reasonable to promote weight loss, exercise, and healthy diet within the context of standard treatments for symptomatic BPH and LUTS.