Changes in Marital Status Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A US Multicenter Prospective Cohort Study

Abstract

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/m 2 ) 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/m 2 ), 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 <$25,000 versus ≥$100,000 (HR = 2.48), smoking (HR = 1.76), and sexual desire ≥once/week versus never (HR = 2.12) preoperative independently predicted ( P ≤ 0.05) separation/divorce. Conclusions: Among a cohort of US adults, the majority did not change marital status within 5 years following RYGB or SG. Cumulative incidence of marriage and separation/divorce was 18% among unmarried and 13% among married participants, respectively. Several preoperative predictors of marriage and separation/divorce were identified.

Long-term complications of significant weight loss: lessons learned from bariatric surgery

“…Similar responses in the brain are triggered by alcohol, drugs, and food [12] . This aligns with the theory of 'addiction transfer' that suggests patients cannot fulfill the behavior of eating and experience its reward as they did before surgery, so it is replaced with a new behavior that achieves a similar reward, like drinking alcohol [12,182] . Patients can also have an increase in sensitivity to the hormone ghrelin after surgery, which may increase the rewarding properties of alcohol quicker and more frequently [12] .…”

“…Patients with RYGB are seen to have a decrease in dopamine D2 receptor availability, specifically in the ventral striatum and caudate nucleus, which are areas of the brain that play an important role in regulating the body's alcohol reward system [12] . Some individuals may be genetically predisposed to reduced dopamine signaling in the alcohol reward system [12,182] . Additionally, psychosocial factors such as depression, anxiety, smoking, and other substance abuse disorders may increase the likelihood of developing alcohol dependence in postoperative bariatric patients [12] .…”

Examining differences in long-term weight loss outcomes after bariatric surgery: The role of romantic relationship status.

“…Sexual orientation and gender identity could influence relationship functioning, body image, and weight loss (Hecht et al, 2019), which may limit the generalizability of the results. Romantic relationship status was assessed at presurgical evaluation only; relationship status may have changed after the presurgical evaluation (King et al, 2022). Finally, the study did not assess relationship quality, which limits the ability to discuss the day-to-day lived experience of these relationships as they relate to patients' weight.…”

“…These studies were older, rarely examined outcomes beyond 1-year postsurgery, and were limited to samples that assessed marital rather than romantic relationship status, meaning they may misclassify those in significant but not married relationships. More recently, a study found that among those who were married prior to surgery, there was a 1.40–1.66 incidence rate ratio of divorce 5-year postsurgery (King et al, 2022), suggesting that shifts may be occurring with the family system that leads to real-world changes for patients. Furthermore, Wedin et al (2014) found that being partnered at baseline was associated with greater odds of experiencing successful weight loss 2 years after bariatric surgery.…”