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Changes in relationship status following bariatric surgery

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Maja Bramming at University of Southern Denmark
Maja Bramming
Signe S. Hviid
Signe S. Hviid
Signe S. Hviid
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Ulrik Becker at National Institute of Public Health, Denmark
Ulrik Becker
Maja Bæksgaard Jørgensen at National Institute of Public Health, University of Southern Denmark
Maja Bæksgaard Jørgensen
  • National Institute of Public Health, University of Southern Denmark
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Background and objective Bariatric surgery is a major event associated with psychological changes such as improvements in self-esteem, increased autonomy, and better self-value. Such changes could affect the patient’s interpersonal relationships; however, little is known about the impact of bariatric surgery on changes in relationship status. In this paper, we aim to test the hypothesis that bariatric surgery is associated with changes in interpersonal relationships such as becoming single for those who were in a relationship or entering a relationship among those who were single before surgery. Methods This register-based cohort study consisted of 12,493 patients undergoing bariatric surgery (95% gastric bypass) from 2005 to 2013 and a reference group of 15,101 individuals with obesity between the age of 18–63 with a body mass index between 32 and 60 kg/m². Transitions between married, divorced, widowed, never-married single, and living with a partner without being married were analyzed by Poisson regression. Additionally, the outcome was dichotomized, and transitions between being single and being in a relationship were also analyzed. All analyses were weighted using inverse probability of treatment weighting based on propensity scores. Results The overall incidence rate ratio (IRR) of changing status from being single to in a relationship was 2.03 (95% CI: 1.18–2.28), and the overall IRR of changing status from being in a relationship to single was 1.66 (95% CI: 1.50–1.83). Conclusion Bariatric surgery is associated with a higher chance of finding a partner among single individuals, and a higher risk of separating from a partner among individuals in a relationship.
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International Journal of Obesity (2021) 45:1599–1606
https://doi.org/10.1038/s41366-021-00825-2
ARTICLE
Bariatric Surgery
Changes in relationship status following bariatric surgery
Maja Bramming1●Signe S. Hviid1●Ulrik Becker1,2 ●Maja B. Jørgensen1●Søren Neermark2,3 ●Thue Bisgaard4●
Janne S. Tolstrup1
Received: 24 August 2020 / Revised: 22 February 2021 / Accepted: 13 April 2021 / Published online: 30 April 2021
© The Author(s), under exclusive licence to Springer Nature Limited 2021
Abstract
Background and objective Bariatric surgery is a major event associated with psychological changes such as improvements
in self-esteem, increased autonomy, and better self-value. Such changes could affect the patient’s interpersonal relationships;
however, little is known about the impact of bariatric surgery on changes in relationship status. In this paper, we aim to test
the hypothesis that bariatric surgery is associated with changes in interpersonal relationships such as becoming single for
those who were in a relationship or entering a relationship among those who were single before surgery.
Methods This register-based cohort study consisted of 12,493 patients undergoing bariatric surgery (95% gastric bypass)
from 2005 to 2013 and a reference group of 15,101 individuals with obesity between the age of 18–63 with a body mass
index between 32 and 60 kg/m2. Transitions between married, divorced, widowed, never-married single, and living with a
partner without being married were analyzed by Poisson regression. Additionally, the outcome was dichotomized, and
transitions between being single and being in a relationship were also analyzed. All analyses were weighted using inverse
probability of treatment weighting based on propensity scores.
Results The overall incidence rate ratio (IRR) of changing status from being single to in a relationship was 2.03 (95% CI:
1.18–2.28), and the overall IRR of changing status from being in a relationship to single was 1.66 (95% CI: 1.50–1.83).
Conclusion Bariatric surgery is associated with a higher chance of finding a partner among single individuals, and a higher
risk of separating from a partner among individuals in a relationship.
Introduction
Bariatric surgery is an effective treatment for obesity and
also for weight-related health challenges [1]. Several studies
have investigated the physical effects of bariatric surgery
and weight loss [1,2], but in recent years, there has been an
emerging interest in the psychosocial aspects of obesity and
bariatric surgery such as interpersonal relationships [3–9].
Individuals with severe obesity have reported higher levels
of relationship strain compared with thinner individuals [10]
and 47% of participants with obesity in a different study
reported experiencing critique regarding their weight from
their spouses [11]. Therefore, individuals with obesity may -
in addition to the health implications - endure difficulties
with regards to romantic relationships, an area that for many
is an essential part of life as well as a source of well-being
and happiness [12].
Qualitative studies have reported that a motivational
factor for undergoing bariatric surgery –besides obesity-
related complications and health issues –is the desire to
increase social activities, find a life partner, and have chil-
dren [5–7]. Additionally, patients generally report
improvements in self-esteem and personal body-image
following bariatric surgery [13,14], which could improve
chances of finding a new partner. Other studies have
focused on investigating the impact of bariatric surgery on
the patient´s intimate relationships, and results indicate that
patients who are married or in a relationship may experience
tension or changes in the dynamics of the relationship as a
consequence of surgery, possibly leading to separation or
divorce [3,8,15]. Only one quantitative study has inves-
tigated changes in relationship status following bariatric
*Janne S. Tolstrup
jest@sdu.dk
1National Institute of Public Health, University of Southern
Denmark, Copenhagen K, Denmark
2Gastrounit Medical Division, Copenhagen University Hospital
Hvidovre, Hvidovre, Denmark
3Center of Planning, Danish Board of Health, Copenhagen S,
Denmark
4Zealand University Hospital, Region Zealand, Køge, Denmark
1234567890();,:
1234567890();,:
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... In an additional cohort study using data from the Scandinavian Obesity Surgery Registry (SOReg) of the general population, 14.4% of the surgery group reported divorce, whereas 8.2% of the control group reported divorce after 4 years [13] . A Danish study also reported divorce rates among bariatric surgery (15%) to be higher than nonsurgical groups (8%) [183,184] . An American study measured the cumulative incidence of divorce after bariatric surgery over five years and presented evidence of an increased separation and divorce rate (8%) among married people who had bariatric surgery in comparison to the general US adult population (3.5%) [183] . ...
... A Danish study also reported divorce rates among bariatric surgery (15%) to be higher than nonsurgical groups (8%) [183,184] . An American study measured the cumulative incidence of divorce after bariatric surgery over five years and presented evidence of an increased separation and divorce rate (8%) among married people who had bariatric surgery in comparison to the general US adult population (3.5%) [183] . These findings are consistent with the Swedish studies' conclusion that an increased divorce rate is associated with bariatric surgery. ...
... Additionally, there is an increased risk of divorce among couples in which one or both partners experience mental illness [189] . Moreover, starting psychiatric medication after surgery is associated with an increased divorce rate in the postoperative period [183] . Therefore, as some patients may be more likely to experience mental health issues after surgery, this could increase the risk of divorce in the postoperative period. ...
Long-term complications of significant weight loss: lessons learned from bariatric surgery
Article
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  • Mar 2024
The increasing prevalence of worldwide obesity calls for a comprehensive understanding of available treatment options. Bariatric surgery remains a very effective obesity treatment, showing substantial effects on obesity-related complications, including type 2 diabetes mellitus and cardiovascular disease, mainly related to significant long-term weight loss. Besides the benefits, weight loss can lead to some deleterious consequences, such as gallstones, constipation, muscle mass loss, bone fractures, vitamin deficiencies, peripheral neural palsy, suicide, eating disorders, alcohol dependency syndrome, and increased divorce. Those consequences may also be seen after long-term effective pharmacotherapy for obesity. Understanding these risks will lead to improved awareness and successful treatment with both surgical and nonsurgical treatments.
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... to the correct habits, to obtain success in the results of the surgical intervention, without compromises. 22,23 Also, as a result of this study, the addition of a greater number of meals per day was directly proportional to the increase in postoperative time. The food organization of a patient after bariatric surgery consists of both the selection of healthy and better tolerated foods, as well as the fractioning of meals. ...
... Therefore, the readjustment of the organic functioning with the advancement of time contributes to the increase of the individual's disposition for greater amounts of daily meals after bariatric surgery. [20][21][22][23][24] It was shown that the frequency of individuals who reported consuming alcohol gradually increased over time. There is evidence that Roux-en-Y gastric bypass (RYGB) surgery increases the risk of developing alcohol use disorders. ...
NUTRITIONAL AND CLINICAL STATUS OF PATIENTS SUBMITTED TO BARIATRIC SURGERY
Article
Full-text available
  • May 2022
Objective: to analyze the clinical and nutritional status of patients submitted to bariatric surgery. Methods: this is an observational epidemiological study, with a cross-sectional design, guided by the STROBE tool. It was carried out between 2015 and 2016, with data from patients undergoing Roux-en-Y bariatric surgery in the years 2012 to 2014, in a private hospital in Minas Gerais. Data collection took place through a semi-structured questionnaire developed by the researchers. To verify the existence of an association between the variables of nutritional and clinical status and the time after surgery, Pearson's chi-square test or Fisher's exact test was used for categorical variables. And for continuous ones, the Kruskal-Wallis or Mann-Whitney tests. Results: there was statistical significance for the variables: ‘weakening of nails’ (p=0.002), ‘emesis’ (p=0.018), ‘frequency of alcohol consumption’ (p=0.018) and ‘number of daily meals’ (p=0.028) in the female group. Conclusion: this study revealed changes in the clinical and nutritional component of patients undergoing bariatric surgery. There were statistically significant associations in the female group, including changes in the clinical profile of greater episode of emesis and greater frequency of alcohol consumption. Regarding the nutritional profile, female patients had higher proportions in the number of meals and more weakening of the nails after the surgical procedure. The importance of monitoring and continuous nutritional and psychological guidance, pre- and post-surgical, is reinforced, minimizing the negative impacts of this result on the health of individuals.
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... This may suggest that it is insufficient to account for structure alone (that is, marital status; 8-10). Instead, the degree to which a marriage is well-functioning may better predict post-surgical outcomesin accordance with findings of increased divorce rates following bariatric surgery (20,21). ...
... For example, we only examined preoperative family support. Although this strategy allows clinicians to forecast post-surgical weight trajectories, family support is dynamic and may change following surgery (20,21). Similarly, we did not factor family members' weight status and weight loss journeys (e.g., whether they had undergone bariatric surgery), nor considered support from persons outside the nuclear family. ...
Examining spousal and family support as predictors of long-term weight loss and remission of type 2 diabetes following bariatric surgery
Preprint
Full-text available
  • Jul 2021
Background: Postoperative outcomes vary considerably across bariatric patients and may be related to psychosocial factors. In this study, we examined whether a patients family support predicts weight loss and the remission of type 2 diabetes (T2DM) up to 5 years following surgery. Methods: Between 2008 to 2018, 359 patients completed a pre-surgical questionnaire before undergoing gastric bypass or sleeve gastrectomy. As part of the questionnaire, patients described their family support in terms of structure (marital status, number of family members in the household) and function (marriage satisfaction, family emotional support, family practical support). These were applied as predictors to percent total weight loss (%TWL) and T2DM remission at 1, 2, 3, 4, and 5 years following surgery. Results: Marital satisfaction was found to be a significant predictor of post-surgical weight trajectories. Namely, patients who reported higher marital satisfaction were more likely to sustain weight loss than patients who reported lower marital satisfaction. Conclusions: Given the link between marital support and long-term weight outcomes, providers could consider asking patients about their spousal relationships during pre-surgical counselling.
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... Our results regarding the women's partners are ambivalent, because while they seem to experience improvements in their sex life after the women undergo bariatric surgery, female empowerment leads the men to feel insecure. Indeed, studies such as that of Braming et al. (2021) have found that bariatric surgery is associated with increased likelihood of finding a partner for single people and increased risk of separation from a partner for those in a relationship [43]. Our participants agreed that the improvement of female self-concept and body image can lead to a lack of trust in their relationship as the men fear that their partners will leave them [17]. ...
Sexuality and self-concept of morbidly obese women who are sexually attracted to men after bariatric surgery: a phenomenological study
Article
Full-text available
  • Mar 2024
  • BMC Wom Health
Background Morbid Obesity (MO) is a public health problem that affects a person’s physical, psychological and sexual well-being. Women with MO are affected by their body image and self-concept, and obesity stigma may affect women in social and sexual relationships. Objective To describe and understand the experiences of morbidly obese heterosexual women (who are sexually attracted to men) in relation to their body image and sexuality after bariatric surgery. Methodology Qualitative study using Merleau-Ponty’s hermeneutic phenomenology as a philosophical framework. Data collection took place between 2020 and 2021 in a southern Spanish province. A total of 22 in-depth interviews were conducted using open-ended questions until data saturation was reached. Results Two main themes were identified: (1) “Escaping from a cruel environment”: weight loss to increase self-esteem; with the sub-themes: ‘I love myself now’, and ‘Body image and social relationships; a vicious circle; (2) “Now, I am truly me”: accepting my body to reclaim my sexuality, with the sub-themes: ‘The body as the focal point of sexuality’, and ‘When regaining your sex drive reignites your sex life and relationship’. Conclusion Weight loss and body acceptance radically change morbidly obese women’s sex lives after bariatric surgery. They rediscover their bodies, have increased self-esteem, and see improvements in their social relationships and sexuality. These women feel seen, loved and desired, and now value their body image and femininity. As they go through continuous improvements following bariatric surgery, they gradually regain self-esteem, acceptance of their bodies and control over their sex life. Even though the women’s partners benefit from these improvements, they seem to be afraid of being left.
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... 21 Observa-se, então, de forma concreta, a importância da conscientização, aconselhamento, acompanhamento e orientação nutricional e psicológica contínuas, pré e pós-cirúrgicas, com o intuito de esclarecer e preparar o paciente para as repercussões possíveis da cirurgia, assegurando melhor adesão aos hábitos corretos, para a obtenção de sucesso nos resultados da intervenção cirúrgica, sem comprometimentos. 22,23 Ainda como resultado deste estudo, a adição de maior número de refeições realizadas por dia foi diretamente proporcional ao aumento do tempo pós-cirúrgico. A organização alimentar de um paciente pós-cirurgia bariátrica consiste tanto na seleção dos alimentos saudáveis e mais bem tolerados, assim como no fracionamento das refeições. ...
ESTADO NUTRICIONAL E CLÍNICO DE PACIENTES SUBMETIDOS À CIRURGIA BARIÁTRICA
Article
Full-text available
  • Jan 2022
Objetivo: analisar o estado clínico e nutricional de pacientes submetidos à cirurgia bariátrica. Métodos: trata-se de estudo epidemiológico observacional, com delineamento transversal, norteado pela ferramenta STROBE. Foi realizado entre 2015 e 2016, com dados de pacientes submetidos à cirurgia bariátrica em Y de Roux nos anos de 2012 a 2014, em um hospital privado de Minas Gerais. A coleta de dados ocorreu por meio de questionário semiestruturado, elaborado pelos pesquisadores. Para verificar a existência da associação entre as variáveis do estado nutricional e clínico e o tempo pós-cirúrgico, utilizou-se o teste qui-quadrado de Pearson ou exato de Fisher para as variáveis categóricas. E para as contínuas, os testes Kruskal-Wallis ou Mann-Whitney. Resultados: verificou-se significância estatística para as variáveis: “enfraquecimento de unhas” (p=0,002), “êmese” (p=0,018), “frequência de consumo alcoólico” (p=0,018) e “número de refeições diárias” (p=0,028) no grupo feminino. Conclusão: este estudo revelou alterações no componente clínico e nutricional das pacientes submetidos à cirurgia bariátrica. Houve associações estatisticamente significativas no grupo feminino, incluindo mudanças no perfil clínico de maior episódio de êmese e maior frequência no consumo de álcool. Em relação ao perfil nutricional, pacientes do sexo feminino apresentaram maiores proporções no número de refeições e mais enfraquecimento nas unhas após o procedimento cirúrgico. Reforça-se a importância do acompanhamento e da orientação nutricional e psicológica contínuas, pré e pós-cirúrgicas, minimizando os impactos negativos deste resultado na saúde dos indivíduos.
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On power and its corrupting effects: the effects of power on human behavior and the limits of accountability systems
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  • Aug 2023
Power is an all-pervasive, and fundamental force in human relationships and plays a valuable role in social, political, and economic interactions. Power differences are important in social groups in enhancing group functioning. Most people want to have power and there are many benefits to having power. However, power is a corrupting force and this has been a topic of interest for centuries to scholars from Plato to Lord Acton. Even with increased knowledge of power's corrupting effect and safeguards put in place to counteract such tendencies, power abuse remains rampant in society suggesting that the full extent of this effect is not well understood. In this paper, an effort is made to improve understanding of power's corrupting effects on human behavior through an integrated and comprehensive synthesis of the neurological, sociological, physiological, and psychological literature on power. The structural limits of justice systems' capability to hold powerful people accountable are also discussed.
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Examining spousal and family support as predictors of long-term weight loss and remission of type 2 diabetes following bariatric surgery in Singapore: a retrospective cohort study
Article
Full-text available
  • May 2023
Objectives Postoperative outcomes vary considerably across bariatric patients and may be related to psychosocial factors. In this study, we examined whether a patient’s family support predicts postsurgical weight loss and the remission of type 2 diabetes mellitus (T2DM). Design Retrospective cohort study in Singapore. Setting Participants were recruited from a public hospital in Singapore. Participants Between 2008 and 2018, 359 patients completed a presurgical questionnaire before undergoing gastric bypass or sleeve gastrectomy. Outcome measures As part of the questionnaire, patients described their family support in terms of structure (marital status, number of family members in the household) and function (marriage satisfaction, family emotional support, family practical support). Linear mixed-effects and Cox proportional-hazard models were used to examine whether these family support variables predicted percent total weight loss or T2DM remission up to 5 years postsurgery. T2DM remission was defined as glycated haemoglobin (HbA1c) <6.0% without medications. Results Participants had a mean preoperative body mass index of 42.6±7.7 kg/m ² and HbA1c (%) of 6.82±1.67. Marital satisfaction was found to be a significant predictor of postsurgical weight trajectories. Namely, patients who reported higher marital satisfaction were more likely to sustain weight loss than patients who reported lower marital satisfaction (β=0.92, SE=0.37, p=0.02). Family support did not significantly predict T2DM remission. Conclusions Given the link between marital support and long-term weight outcomes, providers could consider asking patients about their spousal relationships during presurgical counselling. Trial registration number NCT04303611 .
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Role of bariatric surgery on psychological and social outcomes of patients: A systematic review
Article
  • Nov 2022
b> Aim: We aimed to systematically review the psychological and social outcomes of patients after bariatric surgery. Material and methods: The comprehensive search using keywords yielded 1224 records utilizing search engines: PubMed and Scopus. After a careful analysis, 90 articles were found to be eligible for complete screening that collectively reported the use of 11 different BS procedures among 22 countries. Results: This review is unique in that we collectively presented the result of various psychological and social outcome parameters (depression and anxiety, self-confidence, self-esteem, marital relationship, and personality traits) after BS. Regardless of the BS procedures performed, most studies over months to years presented a positive outcome of the parameters considered, while few presented contrasting unsatisfactory results. Thus, the surgery was not a cessation factor for these results to be permanent and thus suggested psychological interventions and long-term monitoring for assessing the psychological effects after BS. Additionally, the patient's endurance to check weight and eating habits after surgery is ultimately necessary.</br
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Changes in Marital Status Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A US Multicenter Prospective Cohort Study
Article
Full-text available
  • Jul 2022
Among a US cohort followed 5 years after Roux-en-Y gastric bypass or sleeve gastrectomy, cumulative incidence of marriage and separation/divorce were 18% among unmarried (N=614) and 13% among married (N=827) participants, respectively. Preoperative predictors of marriage included younger age, college degree, lower BMI and cohabitating or being separated (versus single). Objectives:. To describe changes in marital status following Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Background:. Spousal encouragement and finding a life partner are self-reported motivators for undergoing bariatric surgery. Methods:. This study included 1441 US adults enrolled in a 6-center prospective cohort study who underwent RYGB or SG (2006–2009) and self-reported marital status preoperatively and annually postoperatively for ≤5 years. Time to change in marital status was analyzed with Kaplan–Meier estimates of cumulative incidence and Cox proportional-hazard models. Results:. Preoperative, 57% of participants (79% female, median age 47 years, median body mass index [BMI] 47 kg/m2) were married, 5% cohabitating, 4% separated, 15% divorced, 2% widowed, and 17% always single. The 5-year cumulative incidence of marriage among unmarried participants (N = 614) was 18%. Cohabitating (hazard ratios [HR] = 5.25) or being separated (HR = 3.03) versus always single, younger age (HR = 1.69/10 years), having a college degree versus ≤high school (HR = 2.36), lower BMI (HR = 1.54/10kg/m2), and fewer depressive symptoms (HR = 1.47/10 Beck Depression Inventory points) preoperative independently predicted (P < 0.05) higher chance of marriage. The 5-year cumulative incidence of separation/divorce among married participants (N = 827) was 13%. Female sex (HR = 2.08), younger age (HR = 1.84/10 years), household income
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Depression and Suicide After Bariatric Surgery
Article
Full-text available
  • Aug 2019
  • Curr Psychiatr Rep
Purpose of Review Individuals with morbid obesity benefit from bariatric surgery with respect to weight loss and decreases in obesity-related somatic disorders. This paper focuses on psychosocial outcomes and provides a narrative review of recent meta-analyses and controlled studies concerning postoperative depression and suicide. Recent Findings Considerable evidence shows short- and medium-term improvement in depressive symptoms after surgery. However, a subgroup of patients exhibits erosion of these improvements or new onset of depression in the long run. Some studies have found an increased risk for suicide among postoperative patients. Summary Prospective longitudinal examinations of factors contributing to the increased risk for postoperative depression and suicide and the interaction between these factors are warranted. The inclusion of mental health professionals in bariatric teams would help to monitor patients for negative psychosocial outcomes and to identify those patients who are vulnerable to depression, suicide, and any other forms of deliberated self-harm following surgery.
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Readmissions After Bariatric Surgery in France, 2013–2016: a Nationwide Study on Administrative Data
Article
Full-text available
  • Nov 2019
  • OBES SURG
Background Readmission rate is considered an indicator of quality of care, which is already used in some countries to impose financial penalties on hospital with readmissions in excess of the national average. Nevertheless, this indicator presents some controversial drawbacks. The objective of this study was the assessment of readmission rate after bariatric surgery. Methods This is a retrospective observational study on a national administrative claims database, the Information Systems Medicalization Program, PMSI, which is a nationwide billing tool collecting information on all hospital discharges in France. All adult patients operated of bariatric surgery from January 1, 2013, through December 31, 2016, were included. The main outcome was unplanned 30-day readmission rate. Secondary outcome was the analysis of reasons for readmission. Results During the study period, out of 187,000 bariatric interventions, the unplanned readmission rate was 4.7%. A significant difference was found between bariatric procedures (gastric banding 3.1%, sleeve gastrectomy 4.5%, gastric bypass 5.7%, p < 0.001). The most important risk factors are the Charlson comorbidity index, the occurrence of a complication after the initial intervention, and the bariatric technique type itself. The main causes of return to the hospital are abdominal pain, peritonitis, nausea/vomiting, and bleeding. After adjustment for confounders, the rate of rehospitalization varies between 1.0% and 16.0% among all French hospitals. Conclusions Approximately 5 % of patients undergoing bariatric surgery suffered a readmission within 30 days. We identified common causes and identified patients at high risk for such an event. These information could be useful for developing strategies to improve in- and outpatient care in bariatric population.
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Women’s Satisfaction with and Reasons to Seek Bariatric Surgery—a Prospective Study in Sweden with 1-Year Follow-up
Article
Full-text available
  • Jul 2019
  • OBES SURG
Background/Objectives Despite profound weight loss after bariatric surgery, some patients are dissatisfied with the results. Pre-surgery expectations, as well as post-surgery items of satisfaction, need to be clarified. The main objective in this study was to investigate the primary reasons to seek bariatric surgery and assess items of satisfaction 1-year post-surgery. Subjects/Methods This is a prospective cohort study of women (n = 50) undergoing bariatric surgery in Stockholm, Sweden. Pre-surgery assessment included reasons to seek surgery, expected weight loss, co-morbidities, and quality of life. Post-surgery assessment included items of satisfaction, weight loss, co-morbidities, and quality of life. In total, two women did not undergo surgery, and 40 women had complete data from all pre- and post-surgery assessments. Results Mean change in body mass index (BMI) pre- and post-surgery was − 12.9 (3.7) kg/m². At 1-year post-surgery, the mean percent of excess weight loss (%EWL) was 86.9 (26.3). Pre-surgery, the most reported reason to seek surgery was “weight loss” (47.9%), while the most reported item of satisfaction post-surgery was “improved self-esteem” (55.6%). Satisfaction with the result 1-year post-surgery was associated with the extent of %EWL. Satisfied patients (n = 32) had a mean %EWL of 94.6 (22.9), while those not satisfied (n = 8) had a mean %EWL of 59.9 (17.6). Conclusions The primary reason to seek bariatric surgery was weight loss. However, despite profound weight loss, improved self-esteem was the item of most satisfaction post-surgery. Our findings may be useful in the clinical setting when informing patients pre-surgery about what to expect as well as when meeting a patient post-surgery to discuss results.
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Psychosocial Concerns Following Bariatric Surgery: Current Status
Article
Full-text available
  • Mar 2019
Purpose of Review The purpose of this paper is to review the current status of research on psychosocial concerns following bariatric surgery. Recent Findings Bariatric surgery has a positive overall impact on weight and obesity-related comorbidities, as well as a positive short-term impact on mental health and psychosocial functioning. Nonetheless, research has documented a number of different psychosocial concerns that may emerge following surgery including maladaptive eating, substance use disorders, suicide, lack of social support, and excess skin. Moreover, special populations of patients may have distinctive psychosocial concerns based on sociodemographic factors such as age or severity of obesity. Available studies suggest that psychosocial interventions have a positive impact on post-surgery outcomes, particularly maladaptive eating. However, research is limited, and long-term data are lacking. Summary Monitoring patients after bariatric surgery for negative psychosocial outcomes is warranted. Research is needed to develop and evaluate personalized approaches to optimize long-term weight loss and psychosocial adjustment.
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Patient experiences of outcomes of bariatric surgery: A systematic review and qualitative synthesis
Article
Full-text available
  • Mar 2017
  • OBES REV
Although bariatric surgery is the most effective treatment for severe and complex obesity, less is known about its psychosocial impact. This systematic review synthesizes qualitative studies investigating the patient perspective of living with the outcomes of surgery. A total of 2,604 records were screened, and 33 studies were included. Data extraction and thematic synthesis yielded three overarching themes: control, normality and ambivalence. These were evident across eight organizing sub-themes describing areas of life impacted by surgery: weight, activities of daily living, physical health, psychological health, social relations, sexual life, body image and eating behaviour and relationship with food. Throughout all these areas, patients were striving for control and normality. Many of the changes experienced were positive and led to feeling more in control and 'normal'. Negative changes were also experienced, as well as changes that were neither positive nor negative but were nonetheless challenging and required adaptation. Thus, participants continued to strive for control and normality in some aspects of their lives for a considerable time, contributing to a sense of ambivalence in accounts of life after surgery. These findings demonstrate the importance of long-term support, particularly psychological and dietary, to help people negotiate these challenges and maintain positive changes achieved after bariatric surgery.
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Exploring Partners’ Experiences in Living with Patients Who Undergo Bariatric Surgery
Article
Full-text available
  • Aug 2017
  • OBES SURG
Background Bariatric surgery is effective in assisting persons with severe obesity in achieving significant weight loss and improved health; however, success depends on one’s lifelong commitment to lifestyle modifications post-operatively. Life partners can be essential to the success of bariatric patients as they can serve as a primary resource to patients and healthcare teams. This study aimed to explore bariatric patients’ partner’s experiences in order to help inform clinical practice in bariatric care to better address patient and partner needs. Methods This study utilized a grounded theory analysis of ten semi-structured interviews of male partners of bariatric surgery patients to form a general explanatory framework of the partner experience. ResultsParticipants described three interconnected processes of change that followed after their spouses surgeries: (1) effort put forth to engage in the surgical process with their spouses, (2) adoption of the behavioural changes made by their spouses and (3) adjustment to a “new normal”. For those who engaged in all three processes, optimism for the future and an enriching and synergistic harmonized lifestyle with their spouse was reached. Conclusions Bariatric surgery in one partner can impact couples’ dietary behaviours, physical and leisure activities, physical and emotional intimacy and relationship quality as a whole. Pursuing bariatric surgery as a couple is a unique process. This study highlights the necessity to approach bariatric care in a way that targets the whole spousal unit as engaging both members in lifestyle modification may improve the quality of both their health and relationship overall.
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Bariatric surgery and risk of alcohol use disorder: a register-based cohort study
Article
  • Oct 2020
  • INT J EPIDEMIOL
Background: Bariatric surgery has been associated with altered alcohol metabolism. We examined whether patients undergoing bariatric surgery have a higher risk of developing alcohol use disorder (AUD) compared with individuals with obesity who have not received bariatric surgery. Methods: In this prospective cohort study, we followed 13 430 patients undergoing bariatric surgery (95% gastric bypass) between 2005 and 2013 and a reference group of 21 021 individuals with obesity for a median of 6.9 years (5th-95th percentile: 4.0-9.8). Four different approaches were used to account for baseline differences between the two groups: (i) adjustment; (ii) inverse probability of treatment weighting (IPTW); (iii) 1:1 matching based on propensity scores; and (iv) before-and-after analysis comparing the bariatric surgery group with itself 5 years before and after surgery. Cox proportional hazard modelling was used to estimate hazard ratios of AUD defined from national registers. Results: When applying the IPTW approach, the hazard ratio (HR) of AUD for bariatric surgery patients was 7.29 [95% confidence interval (CI): 5.06-9.48] compared with individuals without surgery. When employing different approaches (adjustment for baseline variables, matching on propensity scores, before-and-after analyses), results were of similar magnitude. Analysis stratified by time after surgery revealed a higher risk of AUD already within the first year following surgery [HR: 2.77 (95% CI: 1.39-5.53)]. Conclusions: Patients undergoing bariatric surgery have a higher risk of developing AUD compared with individuals without bariatric surgery. The higher risk observed in this group of patients cannot be explained by differences in baseline characteristics such as socioeconomic factors. Despite the higher risk of AUD, only few individuals developed AUD. Individuals with disabling obesity should therefore not rule out surgery based on these results but rather be aware of negative implications.
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Health and appearance: Factors motivating the decision to seek bariatric surgery
Article
  • Apr 2019
  • SURG OBES RELAT DIS
Background: Few studies have examined the motivating factors and people that lead patients to seek bariatric surgery. Bariatric surgery helps to improve body image, but little is known about patients' desired changes in the appearance of specific body parts. Objectives: To identify key factors and people motivating patients' decision to seek bariatric surgery, and to assess body dissatisfaction and desire for surgery to change the appearance of specific body parts. Setting: U.S. university-based hospital clinic. Methods: Patients seeking bariatric surgery (N = 208, 78.4% women, 52.4% black, mean age = 42.0 ± 12.3 yr, mean body mass index = 46.7 ± 8.5 kg/m2) completed the Reasons for Bariatric Surgery questionnaire before their preoperative Psychosocial-behavioral evaluation. Participants rated (1-10) the importance of 15 potential reasons and 7 potential people motivating their decision to seek bariatric surgery. Participants also rated their dissatisfaction and desire for surgery to change the appearance of 11 body parts. Results: Mean scores of motivating factors were highest for Physical Health (9.9 ± .4), followed by Longevity (9.7 ± .9). Patients reported high body dissatisfaction and desire for surgery to change the appearance of several body parts, including stomach and thighs. "Myself" was the highest-rated motivating person, followed by healthcare providers, family, and someone who had undergone bariatric surgery. Conclusions: Health is the primary reason reported by patients for seeking bariatric surgery. Patients also report a strong desire for surgery to change the appearance of their body. Patients are self-driven to pursue surgery but are also influenced by healthcare providers, family, and people who have undergone surgery. (Surg Obes Relat Dis 2019;X:XXX-XXX.) © 2019 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Mental health quality of life after bariatric surgery: A systematic review and meta‐analysis of randomized clinical trials
Article
  • Nov 2018
Recent literature has raised concerns regarding the risk of adverse psychiatric events among bariatric surgery patients. However, the relationship between weight loss therapy and psychiatric outcomes is confounded by baseline psychosocial characteristics in observational studies. To understand the impact of bariatric surgery on the risk of adverse mental health outcomes, we conducted a systematic review and meta‐analysis of randomized controlled trials that compared surgical and non‐surgical treatments and assessed mental health quality of life (QoL). We evaluated the PubMed, EMBASE, Web of Science PsycINFO, Clinicaltrials.gov and Cochrane databases through 7 March 2018. Pooled standardized mean differences (SMDs) for mental health QoL scores were estimated using random effects models. Eleven randomized trials with 731 participants were included in the final analyses. Surgery was not associated with an improvement in mental health QoL from baseline as compared to non‐surgical intervention (SMD: 0.02, 95% confidence interval [CI] −0.22 to 0.25). Final mental health QoL scores were similar for surgically and non‐surgically treated patients (SMD: 0.37, 95% CI −0.07 to 0.81). Subgroup analyses assessing the effect of specific surgical interventions, and varying lengths of follow‐up did not identify a beneficial effect of bariatric surgery on mental health QoL outcomes. These results, in conjunction with the fact that individuals who choose bariatric surgery tend to have high‐risk baseline characteristics, suggest that intensive mental health follow‐up following surgery should be routinely considered.
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Associations of Bariatric Surgery With Changes in Interpersonal Relationship Status: Results From 2 Swedish Cohort Studies
Article
  • Mar 2018
Importance Bariatric surgery is a life-changing treatment for patients with severe obesity, but little is known about its association with interpersonal relationships. Objectives To investigate if relationship status is altered after bariatric surgery. Design, Setting, and Participants Changes in relationship status after bariatric surgery were examined in 2 cohorts: (1) the prospective Swedish Obese Subjects (SOS) study, which recruited patients undergoing bariatric surgery from September 1, 1987, to January 31, 2001, and compared their care with usual nonsurgical care in matched obese control participants; and (2) participants from the Scandinavian Obesity Surgery Registry (SOReg), a prospective, electronically captured register that recruited patients from January 2007 through December 2012 and selected comparator participants from the general population matched on age, sex, and place of residence. Data was collected in surgical departments and primary health care centers in Sweden. The current analysis includes data collected up until July 2015 (SOS) and December 2012 (SOReg). Data analysis was completed from June 2016 to December 2017. Main Outcomes and Measures In the SOS study, information on relationship status was obtained from questionnaires. In the SOReg and general population cohort, information on marriage and divorce was obtained from the Swedish Total Population Registry. Results The SOS study included 1958 patients who had bariatric surgery (of whom 1389 [70.9%] were female) and 1912 matched obese controls (of whom 1354 [70.8%] were female) and had a median (range) follow-up of 10 (0.5-20) years. The SOReg cohort included 29 234 patients who had gastric bypass surgery (of whom 22 131 [75.6%] were female) and 283 748 comparators from the general population (of whom 214 342 [75.5%] were female), and had a median (range) follow-up of 2.9 (0.003-7.0) years. In the SOS study, the surgical patients received gastric banding (n = 368; 18.8%), vertical banded gastroplasty (n = 1331; 68.0%), or gastric bypass (n = 259; 13.2%); controls received usual obesity care. In SOReg, all 29 234 surgical participants received gastric bypass surgery. In the SOS study, bariatric surgery was associated with increased incidence of divorce/separation compared with controls for those in a relationship (adjusted hazard ratio [aHR] = 1.28; 95% CI, 1.03-1.60; P = .03) and increased incidence of marriage or new relationship (aHR = 2.03; 95% CI, 1.52-2.71; P < .001) in those who were unmarried or single at baseline. In the SOReg and general population cohort, gastric bypass was associated with increased incidence of divorce compared with married control participants (aHR = 1.41; 95% CI, 1.33-1.49; P < .001) and increased incidence of marriage in those who were unmarried at baseline (aHR = 1.35; 95% CI, 1.28-1.42; P < .001). Within the surgery groups, changes in relationship status were more common in those with larger weight loss. Conclusions and Relevance In addition to its association with obesity comorbidities, bariatric surgery–induced weight loss is also associated with changes in relationship status.
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