August 9, 2022 – Crystal was only in her mid-30s when she decided to have surgery. The doctor said it was too early. But the Oregon mother of three was twice hospitalized for obesity-related lung complications before her 35th birthday. So he got a stomach arm.
And at first it seemed like the best decision for him and his family. She lost weight – 100 pounds in 16 months – and so did her husband. The whole family is more active and seems to have more energy. But then her husband’s weight began to creep up again.
While she joined a running group and signed up for a half marathon, her husband’s depression and drinking habits worsened. The healthy lifestyle they share is now an unspoken wedge between them.
And the added attention the Crystal gets from both men and women due to its thinner size only adds to the tension. After 30 years together and 22 years of marriage, the high school sweethearts divorced in June 2021. Crystal’s weight loss wasn’t the only problem, but she and her ex-husband believed it was the beginning of the end.
New research from the University of Pittsburgh finds that Crystal experiences are common. People who have bariatric surgery double their chances of getting married or divorced. The study looked at data from 1,441 bariatric surgery patients and found that unmarried patients were more than 50% more likely to marry, and married patients were twice as likely to divorce, compared to the general US population.
These US data follow two Scandinavian studies from 2018 and 2020 that found similar association changes after bariatric surgery. But the postoperative divorce rate in the US is 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 increasing divorce rates, the majority of marriages in this study did not change, says epidemiologist and lead author Wendy King, PhD. In fact, 81% of couples are still married 5 years after surgery. But where the US population has a 3.5% divorce rate, the bariatric patients in the study had an 8% divorce rate. Likewise, those who had never been married before surgery had an 18% marriage rate, compared to 7% in the US population.
Surgery is certainly not a death sentence for the patient’s love life. But the increase in marriage and divorce suggests bariatric surgery is significantly impacting 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 start as soon as a person decides to have surgery and continue as a lifelong process, he said.
For some patients, these healthy habits may offer “new life,” said King, lead author of the study. According to research, patients who have better physical health after surgery are more likely to marry.
But persistent lifestyle changes can also dramatically impact existing relationship rituals, says Goldman, who specializes in bariatric surgery. Maybe the couple likes to go out and enjoy a fancy meal before surgery, or they eat ice cream and watch a movie every Friday. The habit changes that come with bariatric surgery can require one partner to focus less on the ritual.
This kind of change may make one or both people feel 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 relationship science. People who have surgery may feel unsupported on their new journey if their partner continues to advocate unhealthy habits, he says. And people who don’t have surgery may feel sidelined by their partner’s new health priorities.
Changes, even positive and healthy ones, create a kind of crisis in relationships, says Cole. It’s not just bariatric surgery. Bringing a baby home, infertility treatment, and substance abuse recovery are all considered positive changes that are also predictors of relationship dissatisfaction and divorce, he said.
Couples can have a variety of emotions after one partner has bariatric surgery, says Cole. Unfortunately, “my experience as a therapist says they are not that good [at talking about it],” he says.
But bariatric surgery isn’t the only thing playing a role in this changing relationship, according to the study. Interestingly, married patients had a significantly lower likelihood of separation or divorce (13%) than patients who were not married but living together (44%) at 5 years after surgery. Similarly, most people who are separated either get divorced or remarry. It’s as if surgery and lifestyle changes serve as a catalyst for people who already have one foot out of (or in) the door, Goldman said.
High sexual desire after surgery is also a predictor of divorce. In fact, there are more things before surgery that impact a divorce than surgery-related changes. It is possible that many of these patients “are already on the path to change,” King said. “Who knows how much to do with the operation.”
Goldman recalls a patient who, prior to surgery, had very low self-esteem. She is dissatisfied with her relationship but admits to sticking with it because she doesn’t believe she can do better than her current partner. After the surgery, his perspective changed radically. He started getting healthier, invested in his education, and changed jobs. And when his partner refuses to join him in making a change, he leaves. Perhaps some of these patients “had thought about leaving but lacked the confidence,” Goldman said.
However, it is critical that patients receive more counseling about how choosing to have bariatric surgery may affect their relationship before and after their weight loss procedure, King said. It should be the standard of care.
Currently, relationship-specific counseling is not required, Goldman said. Most programs do require a preoperative psycho-social evaluation, “but they are quite variable.” And even in programs where relationships are mentioned, there are often no licensed psychologists or mental health professionals on the team.
As King’s previous research on substance abuse after bariatric surgery changes common practice in the field, Goldman hopes the new data will have the same effect and relationship counseling will become the norm.
Cole actually had bariatric surgery, himself. He recalls potential relationship problems briefly mentioned. Someone at the clinic said if her marriage felt challenged she should seek help from a professional, and that was it.
For Cole, there were unexpected negative feelings of shame and disappointment after the surgery. She felt extreme weight loss was all her colleagues could talk about and was very disappointed when there was no change in her chronic pain, the main reason she underwent the procedure.
Luckily, he was able to talk to his wife, who also happens to be a relationship therapist at Gottman, about emotions. “One of the things we know that creates a deep sense of trust is [when] I know my partner is there for me when I’m not feeling well,” Cole said.
But these negative emotions can be the most difficult things to talk about or hear from a partner. It’s hard to share our own negative feelings and hear the feelings of others, says Cole.
He suggests creating “new connection rituals: those times when you planned to turn your back on each other.”
It could be a daily outing, where you purposely talk about the surgery-related changes you both had. Cole said to ask himself, “Do we intend to turn on each other on that? [challenging] a moment ago?”