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The Association between Marital Transitions, Body Mass Index, and Weight: A Review of the Literature

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Objective. To examine the association between different marital transitions and changes in body mass index (BMI) and body weight. Methods. A systematic literature search was conducted for peer-reviewed articles published between January 1990 and December 2011. Longitudinal studies were included if they compared dependent variables, such as BMI or weight, before and after a change in marital status. Results. Twenty articles were included: 4 articles described only transitions into marriage and/or cohabitation, 2 articles described only transitions out of marriage and/or cohabitation, and 14 articles described both. Overall, transitions into marriage were associated with weight gain, whereas transitions out of marriage were associated with weight loss. No major differences were observed between genders or across specific marital transition states. Conclusions. Additional research is warranted to better understand this phenomenon and the impact of marital transitions on obesity and obesity-related behaviors. This paper highlights potential opportunities to incorporate programs, practices, and policies that aim to promote and support healthy weights and lifestyles upon entering or leaving a marriage or cohabiting relationship.
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... Transitions in both family life and employment status have been associated with weight gain. In a systematic review of studies conducted in western populations, in nine out of the twelve studies, entering marriage was associated with weight gain [5]. Similarly, becoming a parent has been associated with weight gain in US populations [6,7]. ...
... We observed that the transition into marriage is associated with an average weight gain of about 1.6 kg and nearly 2-fold higher odds of major weight gain in women. This finding is consistent with results from a systematic review of 20 studies in US and European populations, in terms of the amount of weight gained in relation to the time span studied [5]. However, in contrast to these western studies, we did not observe a significant association between marriage and weight gain in Asian males. ...
... The lack of association between the transition of becoming divorced, separated, or widowed and weight change suggests that time is required for the impact of the change to become apparent. Changes in social support, depression, and stress may accompany a transition out of marriage and lead to changes in dietary intake and body weight [5]. In contrast to our findings, a review of marital transition and weight change reported that transition out of marriage was associated with weight loss in both men and women [5]. ...
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Identifying when most weight gain occurs throughout the life course can inform targeted public health interventions. We evaluated the association of childbirth, marriage, and employment changes with weight changes in a multi-ethnic Asian cohort. Singapore Multi-Ethnic Cohort participants ≥21 years (n = 9655) who identified as ethnic Chinese, Malay, or Indian were weighed and interviewed about marital status, employment, and number of children at baseline and after about four years. We used multivariable regression to evaluate life transitions in relation to weight change and major gain (≥5 kg), and adjusted for socio-demographic covariates. Weight gain was 3.55 kg (95% CI 3.17, 3.94) higher in young adults (21–30 years) compared with participants older than 60 years at baseline. Getting married was associated with weight gain in women, but not men (p interaction < 0.01). Women who got married gained 1.63 kg (95% CI 0.88, 2.38) more weight and were more likely to gain ≥5 kg (OR 1.99, 95% CI 1.35, 2.93) than those remaining unmarried. Having children was not associated with weight gain. Only among ethnic Indians, remaining a homemaker was associated with less weight gain than remaining employed. In this multi-ethnic Asian population, obesity prevention efforts should target young adulthood and, in women, the transition into marriage.
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... Previous researches suggested that marriage was associated with weight gain and that divorce and widowhood were associated with weight loss [24,25]. While a review indicated that marital transi-tions are more important than marital status in predicting change in body weight, it was found that transition into marriage appears to be associated with weight gain, whereas transition out of marriage is associated with weight loss [26]. Further research is needed to illustrate the relationships between marital transitions and body weight in our study area. ...
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Context Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative.Objective To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death.Design and Setting Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998.Participants One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52).Main Outcome Measures Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies–Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants.Results Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P = .76), while these scores increased for both noncaregivers (4.74 vs 8.25; F1,116 = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F1,116 = 4.35; P = .04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P = .05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F1,118 = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P = .99] and 0.46 vs 0.27 [P = .39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F1,101 = 8.12; P = .005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P = .41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P = .12], respectively).Conclusions These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss. Figures in this Article More than 2 million persons die in the United States each year. The large majority of these deaths occur among older persons with 1 or more disabling conditions that compromise their ability to function independently prior to death. As a result, a typical death is preceded by an extended period of time during which 1 or more family members provide health and support services to their disabled relative.1- 2 Although researchers have repeatedly documented the psychiatric and physical health effects of family caregiving,3- 4 caregivers are rarely followed up long enough to assess the effect of the death of the disabled relative on the caregiver.5 Similarly, bereavement researchers rarely explore the extent to which family members were involved in care prior to the death of their relative as a factor affecting bereavement outcomes. 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Although bereavement in the elderly is generally associated with increased depression6 and weight loss,7 2 opposing hypotheses have been proposed to predict the effects of bereavement in the context of caregiving: exposure to the chronic stresses of caregiving depletes the emotional and social resources of caregivers and thus makes them more vulnerable to negative outcomes when their spouses die; alternatively, the loss of a disabled spouse may lead to an improvement in mental and physical health outcomes because of the reduced caregiving burden. Studies addressing these hypotheses are inconclusive because of a lack of appropriate comparison groups,8- 11 small sample sizes with respect to the number of bereaved cases,10,12 or a focus on select subgroups such as caregivers of patients with the human immunodeficiency virus.11 In addition, published studies are often based on retrospective accounts of caregiving involvement.8 The Caregiver Health Effects Study (CHES), an ancillary study of the Cardiovascular Health Study (CHS), a large population-based study of elderly persons, affords a unique opportunity to examine the effects of bereavement in the context of caregiving. It has a relatively large sample size (approximately 400 spousal caregivers and 400 matched controls) and measures of quality of life and physical and psychological health outcomes. In this article we examine prospectively the effects of spousal death on depression symptoms, antidepressant medication use, health risk behaviors, and weight as a function of level of involvement in caregiving prior to death. We examine bereavement effects among noncaregivers, caregivers who report no strain associated with caregiving, and caregivers who report strain.
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