August. September 9, 2022 – Krystal was in her 30s when she decided to undergo surgery. Her doctor said it was too early. But the Oregon mother of three was hospitalized twice with obesity-related lung complications before her 35th birthday. So she got the stomach sleeve.
At first, this seemed like the best decision for her and her family. She’s losing weight — 100 pounds in 16 months — and so is her husband. The whole family is more active and seems to have more energy. But then her husband started gaining weight again.
Her husband’s depression and alcoholism worsened when she joined a running group and signed up for a half marathon. The healthier lifestyle they shared is now an unspoken wedge between them.
Krystal getting more attention from both men and women due to her thinner body only adds to the tension. After 30 years together and 22 years of marriage, the high school couple divorced in June 2021. Krystal’s weight loss isn’t the only problem, but she and her ex-husband think it’s the beginning of the end.
New research from the University of Pittsburgh finds that Krystal’s experience is common. People who undergo bariatric surgery are twice as likely to be married or divorced. The study looked at data from 1,441 bariatric surgery patients and found that unmarried patients were more than 50 percent more likely to be married, and married patients were more than twice as likely to be divorced, compared with the general U.S. population.
This US data follows two Scandinavian studies in 2018 and 2020 that found similar changes in the relationship after bariatric surgery. But according to new research published in the journal Annals of Surgery, the post-operative divorce rate in the United States is only about half that of the Danish and Swedish studies.
It’s important to note that even as divorce rates rose, most marriages in the study were unchanged, said epidemiologist and lead author Dr. Wendy King. In fact, 81% of couples are still married 5 years after surgery. But while the U.S. population has a divorce rate of 3.5 percent, the weight-loss patients in the study had a divorce rate of 8 percent. Likewise, the marriage rate for people who had never married before surgery was 18 percent, compared with 7 percent for the U.S. population.
Surgery is certainly not a death sentence for a patient’s love life. But the rise in marriages and divorces suggests that bariatric surgery significantly affects people’s relationships.
“It makes sense,” said Dr. Rachel Goldman, a clinical psychologist who specializes in health and wellness in New York City. “People are changing the way they live.” Those changes don’t start or stop the day of surgery, she says, they start as soon as someone decides to have surgery and continue as a lifelong process.
For some patients, these healthy habits may offer “a new life,” said lead study author Kim. According to the study, patients with better physical health after surgery were more likely to marry.
But ongoing lifestyle changes can also dramatically affect the rituals of existing relationships, says Goldman, who specializes in bariatric surgery cases. Maybe a couple likes to go out for an extravagant meal before surgery, or maybe they eat ice cream and watch a movie every Friday. The habit changes that come with bariatric surgery may require a partner to pay less attention to these rituals.
Gottman Institute These changes can make a person or two feel like their partner is moving away from them, says relationship therapist and clinical director Don Cole, a think tank focused on relationship science. People undergoing surgery may feel unsupported in their new journey if their partner has been promoting unhealthy habits, he said. And people who don’t have surgery may feel left out by their partner’s new health priorities.
Changes, even positive and healthy ones, can create a crisis in relationships, Cole said. It’s not just bariatric surgery. Bringing children home, infertility treatment and substance abuse recovery were all cited as positive changes and predictors of relationship dissatisfaction and divorce, he said.
A couple may have a range of emotions after a partner underwent bariatric surgery, Cole said. Unfortunately, “my experience as a therapist suggests they’re not that good [talking about it],” he said.
But bariatric surgery isn’t the only thing at play in these relationship changes, according to research. Interestingly, 5 years after surgery, married patients were much less likely to separate or divorce (13%) than unmarried but cohabiting patients (44%). Likewise, most people who have separated are either divorced or remarried. It’s as if surgery and lifestyle changes acted as catalysts for people who had already left (or entered) the door with one foot, Goldman said.
High libido after surgery is also a precursor to divorce. In fact, there are more factors that influence divorce before surgery than surgery-related changes. Many of these patients may be “already on a path to change,” King said. “Who knows how much surgery has to do with it.”
Goldman recalls a patient with very low self-worth before surgery. She wasn’t happy with her relationship, but admitted to staying because she didn’t believe she could do better than her current partner. After the surgery, her perspective changed radically. She started getting fitter, invested in her education, and changed jobs. She left when her partner refused to make the change with her. Perhaps some of these patients “are already thinking about leaving, but just don’t have the confidence,” Goldman said.
King said, though , it remains critical that patients receive more counseling about how choosing to undergo bariatric surgery affects their relationship before and after bariatric surgery. This should be the standard of care.
No relationship-specific counseling is currently required, Goldman said. Most programs do require a psychosocial assessment prior to surgery, “but they are very diverse.” Even in programs that mention relationships, there are often no psychologists or licensed mental health professionals on the team.
Since King’s previous research on substance abuse after bariatric surgery became common practice in the field, Goldman hopes this new data will have a similar impact, and relationship counseling will become normal.
Cole actually had bariatric surgery himself. He recalled briefly mentioning potential relationship issues. Someone at the clinic said that if his marriage was challenging, he should seek professional help, and that’s it.
For Cole, the negative emotions of shame and disappointment after marriage were unexpected. Operation. He felt extreme weight loss was something all his colleagues could talk about, and was very disappointed when his chronic pain didn’t change, which was the main reason for his surgery.
Luckily, he can talk to his wife about the emotional range, who also happens to be one of Gottman’s relationships therapist. “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,” Kerr said.
But these negative emotions can be the hardest things to talk about or hear from your partner. It’s hard to share our own negative feelings and hear others’ feelings, Cole said.
He suggested the creation of a new kind of “connection ritual: the moment when you plan to turn one to the other.”
This It could be a daily walk, where you deliberately talk about the surgery-related changes you’ve both gone through. Cole said to ask yourself, “Did we intentionally turn to each other during those [challenging] moments?”