For Better or Worse: Intimate Relationships After WLSMarch 18, 2016
Do intimate relationships change after WLS? How will my relationship change after I have surgery? Is bariatric surgery associated with divorce? These are common questions often asked by bariatric surgery patients.
Relationships with others may also change after surgery. Some changes may include:
- You may not want to go out to lunch with co-workers or to happy hour with friends as you did before WLS.
- You may have to learn to say “no” to Aunt Mary’s decadent chocolate cake (and potentially upset her) or learn ways to socialize without food.
- You may not frequent your favorite barista in the morning, stop getting your “usual,” and receive questions on how you’ve lost so much weight.
- You will have to carve out more time to take care of yourself (e.g., food preparation and exercise), which may mean less time for others.
Despite changing some patterns, most patients are happy they had surgery and feel better about their overall health and body. This leads to engagement in more social activities, less isolation, and less depression.
Patients feel excited that they can do things that they previously had difficulty such as going on walks, riding rides at amusement parks, fitting better in cars or planes, taking more trips, and wearing different clothing. When you take care of yourself, you're better able to be present with others in your life.
Understanding Potential Feelings Experienced By Your Partner
It is important for patients in intimate relationships to understand that your weight loss journey will not occur in a bubble; your new lifestyle and image will play a role in your relationships, especially your primary love relationship. Your partner may feel excited for and proud of you, may be your biggest cheerleader, may lose weight with you, and your relationship may improve. However, your weight loss journey may result in your partner having some negative feelings. Being aware of these feelings can help both of you recognize and combat potential pitfalls as soon as possible.
- ISOLATION: If your partner is overweight, he/she may feel left out in several ways. He/she may not receive compliments from others, may not be able to do active things that you can now do, and may be home alone while you are engaging in your more active life (e.g., at the gym). Your partner may also lose their “food buddy” not only in terms of eating favorite foods together but also other weight-related factors such as planning where you will go to eat on the weekends, sharing a bottle of wine or a beer, not watching as much TV time together, or discussions about common weight loss battles may become unfamiliar.
- GUILT: If your partner “should” be working on his/her weight loss but he/she is not, or if he/she eats “forbidden foods” in front of you, he/she may feel guilty. The partner may also feel guilty that you are losing weight and looking good but he/she is not doing this in return.
- UNCOMFORTABLE WITH NEW FAMILY FOOD HABITS: If you typically went out to eat but the patterns are now changing, your partner may need to find foods at home or be ok with not eating out as often, going to healthier restaurants, sharing meals, or you making different food choices. If you are the chef, you may change the meals that you prepare. You will either cook separate meals for yourself and your partner, your partner will have to fend for him/herself, or will have to adjust to what you prepare. If your partner is the chef, he/she may have to prepare foods differently now for you. If your partner is an emotional eater but has agreed to not keep “triggering” foods at home, he/she may not know how else to cope with emotions. If the partner does not want to make food changes, arguing may occur and/or you may feel triggered/sabotaged if the food is brought into the home.
- DECREASED SELF-ESTEEM AND BODY IMAGE: If you are doing great with your weight loss, your partner may feel bad about his/her own body, or they may feel jealous or resentful that you are losing weight. Even if your partner is losing weight, he/she will likely not be losing weight as quickly as you, which may lead them to feel like a failure (even though they are successfully losing). He/she may also feel upset if you are embarrassed by loose skin or excess gas, which sometimes happens post-operatively.
- FEAR AND JEALOUSY: Your partner may be concerned that you will leave them for someone else, particularly if your relationship is emotionally abusive or unhappy. Specifically, if patients become more confident or assertive, they may decide to leave the relationship. Ferriby and colleagues (2015) found that: 1) female patients became more assertive and husbands did not like this, 2) female patients viewed husbands as less interesting/social after surgery and husbands found patients too social.
- RESPONSIBLE FOR THE WLS PATIENT'S OUTCOMES: The partner may feel the need to be the food-police, which can lead to resentment and arguing.
WLS Can Improve Your Love Relationship
While these potential problems may happen, they are the exception to the rule. Try not to be fearful of this as there are many ways that the relationship may improve! First, as goes the saying, “A happy wife (sub “husband” here) is a happy life,” we know that when one partner is depressed, the other often “catches” depression. Therefore, if the patient feels less depressed after surgery, the couple may feel better as well.
Ferriby and colleagues (2015) found that being married improved mental quality of life after surgery. The couple may enjoy new activities together due to weight loss, fewer health problems, and increased energy. These include going on walks, bike rides, to the park, or on vacation. Second, research shows that intimacy is actually better and more frequent.
The patient may feel better about his/her body and also be able to physically engage in sexual activities that he/she could not before, thus bringing the couple closer. These improvements are not only in sex, but have also been found in love, care, trust, affection, compatibility, cohesion, conflict resolution, etc. (Pories et al., 2015). Finally, diet, exercise, and weight changes in the patient, may also result in improvements in the partner’s weight and health.
In sum, does bariatric surgery lead to “for better or for worse?” There are actually no research studies that show that bariatric surgery leads to divorce or has a high divorce rate.
More Studies Needed
There were only 13 well-controlled published articles on bariatric patients and partners between 1990-2014 (which is very low for a 14 year span). These studies were reviewed by Ferriby and colleagues (2015) who found mixed results: some studies reported that the relationship quality changed for the better, others reported that it changed for the worse, and even others reported no change. Some studies found that being married was associated with less weight loss while others found no relationship between marriage and amount of weight loss.
According to Clark and colleagues (2014), 70% of their bariatric sample who were in relationships during surgery were in a relationship 8 years later, most reported that the quality of their relationship was stable or improved, overall sexual functioning was improved, and long-term weight loss maintenance was related to relationship satisfaction.
More research is definitely needed in this area before we can draw conclusions. About 50% of all marriages end in divorce, and to date, no study has compared divorce rates in bariatric patients to the general population. Many couples do great and even better than before the surgery.
3 Steps To Improve Intimate Relationships After WLS
One important factor is the relationship quality before the surgery. Perhaps good/stable relationships get better and bad/unstable relationships get worse. So, try not to worry about what you have heard from others and don’t be fooled by statistics that you read online – you can find anything out there if you search for it. If you are concerned about your relationship, some things that you can do include:
Develop Empathy for Each Other
Understand each other’s point of view. What is your partner feeling? How has his/her life changed? What does he/she need? Can you find a solution, talk it out, compromise?
Practice Positive Communication
When talking, use “I statements” and feeling words to avoid blaming the other person (e.g., “I feel ______________ when you __________________ because ______________”). If arguments become heated, take a break. Think about what the other is really saying and feeling and what you can do to better the situation (rather than what the other can do) so that you may reach a better understanding and compromise.
Whether the problems were present before surgery or if new issues arise, it can be helpful to seek therapy from someone who specializes in couple’s therapy and/or bariatric surgery. If relationship problems prior to surgery were falsely blamed on the weight (e.g., decreased activities together, little intimacy, etc) but do not resolve after weight loss, it may be time to address those problems. Couple’s therapy can be sought either prior to or after surgery to identify and make this a joint process.
Clark SM., Saules KK., Schuh LM., Stote J., Creel D. Eating Behaviors 09/2014; 15(4). DOI: 10.1016/j.eatbeh.2014.09.003
Megan Ferriby, Keeley J. Pratt, Elizabeth Balk, Katharine Feister, Sabrena Noria, Bradley Needleman. Marriage and Weight Loss Surgery: a Narrative Review of Patient and Spousal Outcomes. Obesity Surgery, 2015; 25 (12): 2436 DOI: 10.1007/s11695-015-1893-2
Pories, M.L. et al (2015). Following bariatric surgery: an exploration of the couples’ experience, Obesity Surgery. DOI 10.1007/s11695‐015‐1720‐9
ABOUT THE AUTHORDr. Jennifer Shapiro is a licensed clinical psychologist and certified eating disorders specialist (CEDS). Her practice (drjennifers.com) is exclusively devoted to eating disorders and obesity since 1999. She is on the Executive Board of the San Diego Chapter of IAEDP and a member of the Academy for Eating Disorders, The Obesity Society, National Eating Disorders Association, and the American Society of Metabolic and Bariatric Surgery.
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