Bariatric surgery could have an impact on relationship status

Two new Swedish studies have reported that bariatric surgery could have an impact on relationships, with one finding that major weight loss after bariatric surgery was associated with more divorces, and a second study noting that singles were more likely to form new relationships or marry after a weight-loss operation.

"Those of us who take care of bariatric surgery patients notice that many patients experience a pretty profound change in their lives," said Dr Luke Funk, an assistant professor of surgery at the University of Wisconsin in Madison, and co-author of an editorial published with the study. "Their significant weight loss and improvements in other health problems, like high blood pressure and diabetes, cause changes in both their physical and mental well-being. They often take up new hobbies, become much more physically active, and feel much more confident about themselves. They also tend to have an improved self-image. I think this leads many to re-examine their relationships with others.”

One of the new studies, tracked the relationship histories of nearly 2,000 obese Swedish patients who underwent bariatric surgery over ten years. The investigators compared patients from the Swedish Obese Subjects (SOS) study with about 1,900 obese adults who did not have surgery. The other study using data from the Scandinavian Obesity Surgery Registry (SOReg) - looked at post-surgical data on about 29,000 patients who underwent gastric bypass surgery and compared with over 280,000 individuals in the general public, three years post-surgery.

The study authors found that bariatric surgery was tied to increased odds for divorce or separation for those in a prior relationship, especially for those who lost the most weight. Among those who had been unattached, significant weight loss was associated with higher odds for a new relationship or marriage. The report, ‘Associations of Bariatric Surgery With Changes in Interpersonal Relationship Status: Results From 2 Swedish Cohort Studies’, published in JAMA Surgery.

The SOS study included 1,958 patients who had bariatric surgery (of whom 1,389 [70.9%] were female) and 1,912 matched obese controls (of whom 1,354 [70.8%] were female. The SOReg cohort included 29,234 patients who had gastric bypass surgery (of whom 22,131 [75.6%] were female) and 283,748 comparators from the general population (of whom 214,342 [75.5%] were female).

"Unfortunately, our study can only give limited insights to why some couples separate after bariatric surgery."

In the SOS study, the surgical patients received gastric banding (n=368; 18.8%), vertical banded gastroplasty (n=1,331; 68.0%) or gastric bypass (n=259; 13.2%); controls received usual obesity care. In SOReg, all 29,234 surgical participants received gastric bypass surgery. In the SOS study, bariatric surgery was associated with increased incidence of divorce/separation compared with controls for those in a relationship (adjusted hazard ratio [aHR] = 1.28; 95% CI, 1.03-1.60; p=0.03) and increased incidence of marriage or new relationship (aHR = 2.03; 95% CI, 1.52-2.71; p<.001) in those who were unmarried or single at baseline.

In the SOReg and general population cohort, gastric bypass was associated with increased incidence of divorce compared with married control participants (aHR = 1.41; 95% CI, 1.33-1.49; p<0.001) and increased incidence of marriage in those who were unmarried at baseline (aHR = 1.35; 95% CI, 1.28-1.42; p<0.001). Within the surgery groups, changes in relationship status were more common in those with larger weight loss.

"In solid partner relationships, weight loss after bariatric surgery is probably not an issue, and in many cases the relationships can even be strengthened,” said Svensson. "However, in partner relationships that are somewhat unstable or non-functional, weight loss may increase the risk of partner separation. Unfortunately, our study can only give limited insights to why some couples separate after bariatric surgery."

Funk explained that it may be presumed that existing relationships would strengthen as bariatric patients experienced an improvement in their mental well-being and self-image. However, perhaps bariatric patients want to experience new relationships and/or maybe the partners of those patients felt less connected to the 'new person' that they were married to.

Another possibility, he said, is that previously healthy relationships suffered when things that couples may have had in common before surgery perhaps were no longer shared interests after surgery. He cautioned that this research did not establish a direct cause-and-effect relationship and the cautioned that the findings might not apply outside of Sweden.

"Many patients have told me that bariatric surgery was the best decision they've ever made, and they really do have a new outlook on life. A fresh beginning," he said. Nevertheless, he cautioned that healthcare professionals need to discuss the potential impact of bariatric surgery on their patients' relationships with others.