Kristal was only in her mid-30s when she decided to have surgery. Her doctor said it was too early. But the Oregon mom of three had found herself in the hospital twice for obesity-related lung complications before her 35th birthday. So she got the gastric sleeve.
And at first it seemed like the best decision for her and her family. She was losing weight – 100 pounds in 16 months – and so was her husband. The whole family was more active and seemed to have more energy. But then her husband's weight began to creep back up.
While she joined a running group and signed up for half-marathons, her husband's depression and drinking worsened. The healthier lifestyle they'd shared was now an unspoken wedge between them.
And the added attention Kristal was getting from men and women because of her thinner size only added to the tension. After 30 years together and 22 years of marriage, the high school sweethearts divorced in June 2021. Kristal's weight loss wasn't the only problem, but she and her ex-husband believe it was the beginning of the end.
An Unexpected Outcome?
New research from the University of Pittsburgh found that Kristal's experience is a common one. People who have bariatric surgery double their chances of marriage or divorce. The study looked at data from 1,441 bariatric surgery patients and found that never-married patients were over 50% more likely to get married, and married patients were more than twice as likely to get divorced, compared to the general U.S. population.
This U.S. data follows two Scandinavian studies from 2018 and 2020 that found similar relationship changes after bariatric surgery. But the post-surgery divorce rate in the U.S. was only about half that found in the Danish and Swedish studies, according to the new study published in the journal Annals of Surgery.
It's important to note that even with an increase in the divorce rate, most marriages in the study were unchanged, says epidemiologist and lead author Wendy King, PhD. In fact, 81% of couples were still married 5 years after surgery. But where the U.S. population has a divorce rate of 3.5%, bariatric patients in the study had an 8% divorce rate. Likewise, those who'd never been married before the surgery had a marriage rate of 18%, compared to 7% in the U.S. population.
Surgery certainly isn't a death sentence for a patient's love life. But the uptick in marriage and divorce suggests bariatric surgery significantly impacts how people engage in relationships.
"It makes sense," says clinical psychologist Rachel Goldman, PhD, who specializes in health and wellness issues in New York City. "People are changing their lifestyle." And those changes don't start or stop the day of surgery, they begin as soon as someone decides to have surgery and continue as a lifelong process, she says.
For some patients, these healthy habits may offer a "new lease on life," says King, the lead study author. According to the study, patients who had better physical health after surgery were more likely to get married.
But the continual lifestyle changes can also dramatically impact the rituals of existing relationships, says Goldman, who specializes in bariatric surgery cases. Maybe a couple loved to go out and enjoy an extravagant meal before surgery, or they had ice cream and watched a movie every Friday. The habit changes that come with bariatric surgery can require one partner to focus less on those rituals.
These sorts of changes may leave one or both people feeling like their partner is turning away from them, says Don Cole, DMin, a relationship therapist and clinical director at the Gottman Institute, a think tank focused on the science of relationships. The person who had surgery may feel unsupported in their new journey if their partner keeps advocating for unhealthy habits, he says. And the person who didn't have surgery may feel cast aside by their partner's new health priorities.
Changes, even those that are positive and healthy, create a kind of crisis for relationships, Cole says. It's not just bariatric surgery. Bringing a baby into the home, infertility treatments, and substance abuse recovery are all considered positive changes that are also predictors of relationship dissatisfaction and divorce, he says.
A couple could have a range of emotions after one partner gets bariatric surgery, Cole says. Unfortunately, "my experience as a therapist says they aren't that good [at talking about it]," he says.
But bariatric surgery isn't the only thing at play in these relationship changes, according to the study. Interestingly, married patients had a much lower chance of separation or divorce (13%) than patients who were unmarried but living together (44%) by 5 years after surgery. Similarly, most people who were already separated either got divorced or resumed being married. It's as if the surgery and lifestyle changes served as a catalyst for people who already had one foot out of (or in) the door, Goldman says.
A high sexual desire after surgery was also a predictor of divorce. In fact, there were more things before surgery that impacted divorce than surgery-related changes. It's possible that many of these patients are "on the path toward change already," King says. "Who knows how much the surgery had to do with it."
Goldman recalls a patient who, before surgery, had a very low self-worth. She wasn't satisfied with her relationship but admitted to staying because she didn't believe she could do any better than her current partner. After surgery, her perspective radically changed. She started to get healthier, invested in her education, and changed jobs. And when her partner refused to join her in making changes, she left. Maybe some of these patients "were already thinking about leaving but just didn't have the confidence," Goldman says.
Still, it's critical that patients receive more counseling on how choosing to have bariatric surgery can impact their relationship before and after their weight loss procedure, King says. It should be the standard of care.
Currently, relationship-specific counseling isn't required, Goldman says. Most programs do require a psycho-social evaluation before surgery, "but they are quite varied." And even in programs where relationships are mentioned, there often isn't a psychologist or licensed mental health professional on the team.
Since King's previous research on substance abuse after bariatric surgery changed common practice in the field, Goldman hopes this new data will have a similar influence and relationship counseling will become the norm.
Cole actually had bariatric surgery, himself. He recalls potential relationship issues were briefly mentioned. Someone at the clinic said if his marriage felt challenged, he should seek help from a professional, and that was it.
For Cole, there were unexpected negative feelings of shame and disappointment after surgery. He felt the extreme weight loss was all his colleagues could talk about and was very disappointed when there was no change in his chronic pain, a primary reason he had the procedure.
Fortunately, he could talk to his wife, who also happens to be a relationship therapist at Gottman, about the range of emotions. "One of the things that we know that creates a deep sense of trust is [when] I know my partner is there for me when I'm not well," Cole says.
But these negative emotions can be the very things that feel most difficult to talk about or hear from a partner. It's hard to share our own negative feelings and to hear someone else's, Cole says.
He advises creating a new "ritual of connection: moments in time when you plan to turn toward one another."
That could be a daily walk, where you intentionally talk about the surgery-related changes that both of you have had. Cole says to ask yourself, "Are we intentional about turning toward one another in those [challenging] moments?"
JAMA Surgery:"Associations of Bariatric Surgery With Changes in Interpersonal Relationship Status: Results From 2 Swedish Cohort Studies."
Bariatric Surgery: "Changes in relationship status following bariatric surgery."
Annals of Surgery: "Changes in Marital Status Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A US Multicenter Prospective Cohort Study."
Wendy King, PhD, epidemiologist, University of Pittsburgh School of Public Health.
Rachel Goldman, PhD, clinical psychologist, New York City.
Don Cole, DMin (Doctor of Ministry), relationship therapist; clinical director, Gottman Institute, Seattle.
Lead image: Jkha|Dreamstime.com
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Cite this: Weight Loss Surgery Has a Big Effect on Marriage - Medscape - Aug 10, 2022.