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

Wiley
Journal of Obesity
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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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... Further, some scholars have also argued that unhealthy dietary behaviors are contagious, hence individuals who consume fast foods and are less physically active are likely to influence their partners to indulge in the same behavior (Averett, Sikora, and Argys 2008;Teachman 2016). Contrary to prior findings on marital transitions (Dinour et al. 2012), our study found that urban women who were formerly in marital unions (divorced, widowed, or separated) were likely to be overweight/obese. Evidence suggests that lack of social support, stress, and depression associated with individuals transitioning out of marriage may lead to changes in diet which may in turn lead to weight loss (Dinour et al. 2012;Roohafza et al. 2014). ...
... Contrary to prior findings on marital transitions (Dinour et al. 2012), our study found that urban women who were formerly in marital unions (divorced, widowed, or separated) were likely to be overweight/obese. Evidence suggests that lack of social support, stress, and depression associated with individuals transitioning out of marriage may lead to changes in diet which may in turn lead to weight loss (Dinour et al. 2012;Roohafza et al. 2014). However, studies have also shown that psychological distress can also lead to weight gain by stimulating uncontrolled eating behavior and distorting individual's weight concerns (Block et al. 2009;Roohafza et al. 2014). ...
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We examined rural and urban prevalence and correlates of overweight/obesity among women of reproductive age using survey data from Nigeria. Overweight and obesity prevalence increased from 16.1% and 6.1% in 2008 to 18.2% and 10.0% in 2018, while underweight prevalence consistently averaged at 12%. Regardless of the residential setting, age, marital status, education, occupation, wealth, and year were associated with higher risk of overweight/obesity, whereas breastfeeding showed a protective effect. Unique risk factors for overweight/obesity in urban areas were higher parity and female-headed households, while ethnicity, media exposure, and state of residence were unique risk factors in rural areas.
... This phenomenon, commonly referred to as "happy fat", has been substantiated by numerous cohort studies conducted in developed Western countries. For instance, Dinour et al. (2012) and Werneck et al. (2020) reviewed 20 and 11 published works, respectively, investigating the relationship between marital status and physical health among residents of the United States, Australia, and European countries. Most of the studies supported a significant positive correlation between marriage and BMI. ...
... Numerous empirical studies have examined the relationship between marriage and BMI in developed Western countries. While there is evidence of increased BMI after marriage, the extent of this increase and its dynamic effects are not entirely consistent across these studies (Dinour et al., 2012;Werneck et al., 2020). On the other hand, cohort studies suggest that marriage contributes positively to overall health, as indicated by factors like mortality rate or chronic disease prevalence (Kiecolt-Glaser and Wilson, 2017). ...
... Both direct and indirect pathways link marital transitions and CVD risk, with health-promoting behaviors as an indirect mechanism [11]. Indeed, marriage is perhaps one of the strongest social influences on individual food choices and other health-related behaviors among older populations [57]. People who are married consume more fruits and vegetables than people who are not married, and those who have lost a partner appear to have poorer nutrition than those who have not experienced this loss [29]. ...
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Background Social connections impact cardiovascular diseases (CVD) morbidity and mortality, but their role in hypertension, as a CVD risk factor, and their gender inequities is less understood. This review aimed to examine the longitudinal evidence on the impact of changes in social connections on risk of hypertension among aging adults, with a specific focus on gender. Methods A systematic search of peer-reviewed literature in Medline, Embase, Scopus, and CINAHL conducted until 10 June 2024. Prospective studies evaluating the effect of changes in living arrangement, marital status, social network, or social participation on changes in blood pressure or incident hypertension among adults aged 45 and above were included. Results We found 20,026 records (13,381 duplicates), resulting in 6645 eligible titles/abstracts for screening and 29 texts read in full. Only six studies from three countries met inclusion criteria, with four focused on marital transitions and two on changes in living arrangement. Overall, loss of close social connections had mixed effects on changes in blood pressure or risk of hypertension. More consistent adverse CVD outcomes were observed across studies for aging adults who entered marriage or became co-living (gain of close social connections). Similarly, persistent lack of close social connections appeared to result in greater increases in blood pressure or higher risk of hypertension. Two included studies were of high quality and the rest were medium quality. Excluded studies assessing change in either CVD risk or social tie transitions were also described (n = 9). Conclusions There is a surprising paucity of prospective evidence on social relationships as determinants of CVD risk in the aging population, despite ample research on social factors correlated with health. Limited research suggests that both gains and losses of close social connections as well as persistent lack of close social connections may alter CVD risk, but effects are specific to single-sex samples. Research and policy should prioritize causally robust high-quality studies to unravel social determinants of CVD risk as actionable evidence to inform social prescribing in CVD prevention and healthy aging strategies is still tenuous. The PROSPERO Registration CRD42022373196, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=373196.
... The data for these articles were gathered over a 40-year period, from 1966 to 2004. According to Dinour's results, marriages were associated with an increase in body weight, whereas divorces were associated with a decrease in body weight, both in males and females [9]. However, the relatively small sample size of the available research limited the scope of this review. ...
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Background: Obesity was included in the International Classification of Diseases in 1990 as a chronic disease characterized by the excessive accumulation of body fat and a body mass index (BMI) greater than 30 kg/m2. Aim: This systematic review was aimed to examine the role of marital status in determining body mass index and the risk of obesity. Methods: We performed a systematic literature search using three databases (PubMed (Medline), Embase, and Google Scholar) with the search query. Results: Of the 105 studies included in the systematic review, 76 studies (72%) reported a greater risk of obesity in married individuals compared to unmarried individuals. A meta-analysis of 24 studies included a total population of 369,499 participants: 257,257 married individuals (40,896 of whom had obesity) and 112,242 comparison subjects (single, divorced, or widowed individuals, 15,084 of whom had obesity). Odds ratios for obesity found a significant pooled odds ratio for obesity in married individuals compared with controls (OR 1.70; 95% CI 1.38–2.10). The socioeconomic environment was not the same throughout the period of studies analyzed. The odds of obesity in married individuals during economic crises was greater than during the period between crises: OR 2.56 (95% CI 2.09–3.13) during crises vs. OR 1.55 (95% CI 1.24–1.95) between crises. Conclusion: The results of this review confirm the importance of considering marital status in determining the risk of obesity.
... Encontramos estudios en el que vivir solo se correlaciona con niveles más altos de síntomas depresivos (Van Grootheest et al., 1999;Maciejewski et al., 2001). Sin embargo, no vivir con una pareja parecía estar relacionado con niveles más bajos de IMC (Dinour et al., 2012;Teachman, 2016). Nuestro estudio confirma que las personas que viven solas se sienten más desanimadas y tristes, no encontrando relaciones significativas con el IMC. ...
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El objetivo de este estudio fue evaluar si la actividad física junto a la adherencia de la dieta mediterránea es adecuada o limita la calidad de vida de los alumnos del Aula de Mayores de la Universidad de Cádiz. Para ello, se realizó una encuesta en línea y formato impreso, que incluyó preguntas sociodemográficas relacionadas con enfermedades crónicas, uso de medicación y limitaciones para la realización de actividad física. La actividad física se analizó mediante el International Physical Activity Questionnaire (IPAQ), la adherencia a la dieta mediterránea mediante el cuestionario PREDIMED. La calidad de vida relacionada con la salud se analizó con el cuestionario SF-12. Nuestros resultados revelan que una dieta inadecuada se relaciona con un estado de salud general regular o insuficiente (p = .05) y una mayor percepción del dolor corporal (p = .021). La relación de la calidad de vida y la actividad física es significativa en casi todas las dimensiones, destacando una buena salud general, emocional y mental junto a una menor percepción del dolor corporal (p < .001). Los hombres son los que dedican mayor tiempo y días a la realización de actividad física intensa (p = .003). La medicación crónica sólo es estadísticamente significativa en el caso de la salud física (p < .001), por lo que tomar o no medicación es independiente del nivel de salud mental. En conclusión, la mayoría de los alumnos son activos, con entusiasmo y predisposición para continuar educándose y formándose. Palabras clave: calidad de vida, actividad física, dieta mediterránea, aula de mayores, envejecimiento activo, adultos mayores, mediana edad, alumnos. Abstract. The objective of this study was to evaluate whether physical activity together with adherence to the Mediterranean diet is adequate or limits the quality of life of students in the Senior Classroom of the University of Cádiz. To this end, an online survey in printed format was conducted, which included sociodemographic questions related to chronic diseases, medication use and limitations for physical activity. Physical activity was analyzed using the International Physical Activity Questionnaire (IPAQ), adherence to the Mediterranean diet using the PREDIMED questionnaire. Health-related quality of life was analyzed with the SF-12 questionnaire. Our results reveal that an inadequate diet is related to a regular or insufficient general health status (p = .05) and a greater perception of body pain (p = .021). The relationship between quality of life and physical activity is significant in almost all dimensions, highlighting good general, emotional and mental health along with a lower perception of bodily pain (p < .001). Men are the ones who dedicate more time and days to intense physical activity (p = .003). Chronic medication is only statistically significant in the case of physical health (p < .001), so whether or not taking medication is independent of mental health level. In conclusion, most students are active, with enthusiasm and predisposition to continue educating and training. Key words: quality of life, physical activity, Mediterranean diet, senior classroom, active aging, older adults, middle age, students.
... From the anecdotal evidence, it is known that cohabiting relationships are a common practice in the study area. According to the study of Dinour and colleagues in 2012, they found that marital status is one of strong socio-demographic factors that greatly influence health-related behaviours and outcomes [37]. However, studies emanating from sub-Saharan African countries merge cohabitation and marriage into one category of marital status and, this is because pregnant women are reluctant to report the status of cohabitation because of stigma [38]. ...
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Poor dietary intake among pregnant women has serious detrimental consequences for pregnancy and offspring both in developed and developing countries. This study aimed to assess dietary intake and associated risk factors among pregnant women. A cross-sectional study was conducted in Mbeya, Tanzania with a sample size of 420 pregnant women attending antenatal clinics to assess the factors associated with dietary intake. Dietary intake was assessed using a piloted questionnaire of the Prime Diet Quality Score. A tested standard questionnaire was also used to collect factors that are associated with dietary intake among pregnant women. The strengths of the associations between the dependent and independent variables were tested using the Pearson chi-square tests and the multivariate log-binomial regression method was performed to calculate the adjusted risk ratios (ARR) and 95% confidence interval (CI). The study revealed that out of 420 pregnant women who participated in this study only 12.6% and 29.3% consumed at least four servings of fruits and vegetables per week respectively. Poor dietary intakes were less likely among cohabiting pregnant women [Adjusted RR 0.22 (95% CI 0.09–0.50)] and; those who reported taking Fansidar tablets during the pregnancy [Adjusted RR 0.55 (95% CI 0.31–0.96)]. Further, we found that poor dietary intakes were more likely among pregnant women who were classified as overweight and obesity by the MUAC above 33cm [Adjusted RR 3.49 (95% CI 1.10–11.06)]. The study results affirm that cohabitation and obesity affect dietary intakes among pregnant women differently compared to married women in rural settings of Tanzania. Further research is needed to investigate the social aspects that link dietary intake outcomes for developing a tailored gestational intervention to improve maternal and birth outcomes in sub-Saharan African countries.
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Among healthcare professionals (HCPs), the demanding nature of their work, irregular schedules, and high-stress environments can significantly influence their eating behaviors. This study’s objectives were to assess the relationship between cognitive restraint (CR), emotional eating (EE), uncontrolled eating (UE), and body mass index (BMI) and identify the sociodemographic factors associated with CR, EE, and UE among HCPs. A cross-sectional study and a simple random sampling technique were employed. Data on sociodemographic characteristics and anthropometric measurements were gathered using a self-administered online questionnaire. Eating behaviors (CR, EE, UE) were assessed using the Three-Factor Eating Questionnaire—Revised 18 Items. Of the 400 HCPs, 37.3% of their BMIs fell within the overweight range, and 22.5% fell within the obesity range. The overall mean score of CR among participants was 67.5 ± 26.4, UE was 42.1 ± 22.8, and EE was 38 ± 26.9. BMI was significantly associated with UE (B = 0.523, p = 0.026) and EE (B = 0.612, p = 0.014), suggesting that higher BMI levels are related to greater tendencies toward both behaviors. These findings underscore the need for tailored interventions and support programs to address these eating behaviors among HCPs. Such interventions are vital to promote healthier eating behaviors, improve overall well-being, and ultimately enhance the quality of healthcare these professionals provide.
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Background Social relationships impact health and may affect proximal determinants such as obesity. Our review examined empirical evidence of the impact of changes in social relationships on risk of obesity in aging adults, with attention to gender. Methods We systematically searched Medline, EMBASE, Scopus, CINAHL, and ProQuest Dissertations and reference lists of relevant reviews and papers published up to November 2022. Longitudinal studies examining changes in marital status, living arrangement, social participation, and social networks and anthropometric changes or incident obesity were deemed eligible. Relevant data were extracted and synthesized narratively. Results We identified 41,910 eligible titles, resulting in 252 full texts and 7 included studies. All studies were conducted in the United States and assessed marital transitions only; 3 studies included both women and men. Overall, compared with people who remain non‐married, entering marriage leads to a significant increase in body mass index (BMI) for both genders. Conversely, transitioning out of marriage through widowhood or divorce leads to a decrease in weight (kg/lbs), waist circumference, and BMI for both genders. All seven studies were deemed to be of medium quality. Conclusions Our review revealed a paucity of prospective evidence on social connections as determinants of obesity among aging adults. There is limited evidence that marital transitions are associated with changes in anthropometric measurements in aging individuals, but no evidence on the effects of changes in living arrangements, social participation, and social networks on anthropometric measurements. More research attention to the social determinants of obesity is warranted.
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Purpose Body mass index (BMI) is an important predictor of one's physiological health. China is a family‐centric nation compared to Western societies and has already entered an aged society. Exploring the characteristics and patterns of BMI changes during household events in China provides critical insights into the biological and social determinants of health, which can help enhance the scientific validity of health promotion measures and contribute to the realization of healthy aging goals in China. Methods Using data from the China Health and Nutrition Survey (CHNS) from 1993 to 2015, this article utilizes two‐level growth curve models with piecewise spline specifications for age to examine the effects of family life cycle events on BMI trajectories for age groups and gender differences. Results Compared to continuing status, experiencing transition in an individual's family life cycle could lead to more fluctuating variations in their BMI trajectories, generally, there is a faster increase in BMI during youth and a faster decline during old age. As for gender heterogeneity, males are more affected by divorce, widowhood, and empty nest, whereas females' BMI changes are influenced by entering/maintaining marriage and parenthood. Conclusions A long‐term perspective has revealed the significance of family events on BMI throughout the life course. Future research should focus on the nutrition and health of specific populations, especially elderly individuals in vulnerable groups.
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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. To better understand the role of caregiving in adjustment to bereavement, we examine predeath to postdeath changes in both self-report and objective health outcomes including depression symptoms, antidepressant medication use, health risk behaviors, and weight among husbands and wives providing varying levels of care to their spouse prior to death. These outcomes were selected because of their known association with caregiving and/or bereavement. 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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