Weight-Loss Surgery Impacts Patients' Marriage and Divorce Rates

The patients featured in a new research article underwent Rous-en-Y gastric bypass or sleeve gastrectomy—two of the most common kinds of bariatric surgery.

Compared to the general U.S. population, adults who are not married and get weight-loss surgery are more than twice as likely to get married within five years, and adults who are married and get bariatric surgery are more than twice as likely to get divorced, a new research article found.

The primary motivations for bariatric surgery are weight loss and decreasing the risk of potentially deadly weight-related conditions such as heart disease, stroke, and high blood pressure, according to Mayo Clinic. However, preoperative patients have also reported having bariatric surgery for reasons related to romantic relationships such as improving intimacy and finding a life partner.

"Weight loss is generally the goal of bariatric surgery, but people have a variety of motivators for wanting to lose weight—for example, remission of Type 2 diabetes and improvement in joint pain," the lead author of the new research article, Wendy King, PhD, said in a prepared statement. "Patients have also described the desire for romantic partnership or improving relationships as important motivators. Before this study, we had no quantitative data in the U.S. on how marital status changes after bariatric surgery—are patients more likely to get married, divorced, find romantic stability?"

King is an associate professor in the Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health.

The new research article, which was published by Annals of Surgery Open, is based on data collected from more than 1,400 U.S. adults who were enrolled in the National Institutes Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study. The patients examined in the new research article underwent Rous-en-Y gastric bypass or sleeve gastrectomy—two of the most common kinds of bariatric surgery—from 2006 to 2009.

The new research article features several key data points.

• The relationship status of most of the LABS-2 participants did not change in the five years they were followed after surgery, with 81% of married participants staying married and 70% of always-single participants staying single.
   
• However, 18% of unmarried LABS-2 participants got married, compared to 7% of the general U.S. population during the same five-year time period; and 8% of the married participants got divorced, compared to 4% of the general U.S. population.
   
• Cohabitating or being separated versus always single, younger age, having a college degree versus a high school education, lower body mass index, and lower Beck Depression Inventory score before surgery were associated with an increased likelihood of marriage after surgery.
   
• Among LABS-2 participants who were not married before surgery, two of 16 pre- to postoperative changes evaluated in the new research article were associated with being married after surgery: improvement in physical health and an increase versus no change in household income.
   
• Female sex, younger age, household income under $25,000 versus greater than or equal to $100,000, smoking, alcohol problems, and having sexual desire greater than once a week versus never were associated with an increased likelihood of separation or divorce after surgery.
   
• Four pre- to postoperative changes were associated with being divorced or separated after surgery: greater weight loss, decrease versus no change in household income, starting psychiatric medication versus no preoperative or postoperative use, and increase versus no change in sexual desire.

"These estimates of change in marital status are higher than expected based on the percentage of U.S. adults who were married and the reported marriage and divorce rates from the same timeframe in the U.S. general adult population. Several preoperative predictors of marriage and of separation or divorce were identified, many of which have been identified in the general population. Greater weight loss was related to a higher chance of postoperative separation or divorce but not marriage," King and her co-authors wrote.

Interpreting the data

Lifestyle changes after surgery associated with weight loss likely contributed to higher rates of divorce and separation, King said. "This could indicate that a patient's changing lifestyle post-surgery put them out of sync with their spouse. It can be really hard when one spouse changes what they eat and how active they are, and desires more sexual activity, while the other doesn't. That can put significant strain on a marriage. It may be important for couples to consider this and have strategies to maintain their connection after surgery."

The new research article's findings about weight loss after bariatric surgery and its association with divorce were similar to the results of a Swedish study, King and her co-authors wrote. "The positive association between weight loss and divorce was also seen in the Swedish cohort and may reflect improved self-image and self-confidence that increase motivation or strength to leave an unhealthy marriage."

King and her co-authors offered other interpretations of the divorce data. "Additionally, partners of adults who undergo bariatric surgery may feel greater jealousy over their partner's weight loss and attractiveness or feel that they are no longer needed. Household income likely decreased as a function of the separation or divorce. Likewise, factors that prompted starting psychiatric medication may have stemmed from, rather than contributed to, separation or divorce."

King and her co-authors speculated on why an improvement in physical health and an increase in household income were associated with being married after weight-loss surgery. "Whereas improved physical functioning may have led to behaviors that increased the chance of marriage, household income likely increased as a function of marriage."