Why Bariatric Surgery Can Fail (Part 3)

Bariatric surgery is certainly life changing – for better or for worse!

This can lead to some unexpected consequences that can include an important (positive or negative) impact on friendships and romantic relationships.

Any reader of the past few posts will by now have realised that despite all of its potential benefits, undergoing bariatric surgery is certainly no walk in the park.

Having good social support and being in a happy and stable relationship has been shown to be a good prognostic factor for success. In our program we ask patients to bring their spouses or partners to visits with the surgeons – we will often see the whole family if need be – bring a close friend – whoever. You cannot do this without their support – their support will determine your outcome. (Not telling your family or friends or even your family doctor about your plans to have surgery (e.g. on a quick trip to Mexico) – is NOT A GOOD IDEA!).

To be clear – there is an overwhelming amount of evidence that most patients will experience positive improvements in virtually all dimensions of health and quality of life – from mobility and pain to energy levels, self-esteem and sexual function.

However, there are important exceptions!

In fact, the 1997 Guidelines of the American Society for Bariatric Surgery already notes, “Marital satisfaction increases, but only if marital satisfaction existed before surgery. If marital discord exists preoperatively, the improved self image may lead to divorce postoperatively“.

This, may well be an understatement!

There is no doubt that anecdotally, very significant partnership problems can arise resulting in all kinds of complex psychodynamic issues, including passive-aggressive behaviours, intimate sabotage, and ultimately divorce.

While a full analysis of this problem is beyond the scope of this post – the problem is by no means trivial but perhaps not that hard to understand.

Bariatric surgery is not simply life changing for the patient – it is also life changing for their partners, families, and anyone they may have a close relationship to.

This, perhaps not unexpectedly, can lead to significant relationship problems that many couples may not be able to overcome.

One commonly reported problem is jealousy that develops when the operated spouse begins receiving new and positive attention. As post-surgical patients develop a more positive self-image and a whole new appearance and outlook at life, their partners can very often feel threatened and insecure.

As post-surgical patients begin to change their life, gain confidence and experience increased energy levels, they begin exploring new interests and, understandably, often seek to catch up on the many years lost to obesity. Unfortunately, however, their partners may sometimes have no such ambitions or goals and be unwilling to accept the impact that these changes may have on their own lifestyles.

Finally, with improved self-esteem and new found confidence (and perhaps financial independence that comes with returning to work or getting a promotion), some patients may no longer find their spouse acceptable or may simply refuse to endure any mistreatment or abuse that they may have been willing to put up with prior to surgery.

The magnitude and impact of these changes are not limited to just their immediate partners or family.

Bariatric surgical patients have been know to abandon and ‘break-out’ of their entire social network and seek new lifestyles – certainly always a decision that brings new challenges.

Although there is substantial anecdotal literature on these issues (the bariatric blogs are rife with both heart-wrenching and inspirational stories), very little systematic research appears to have been done on this issue.

Thus, to my knowledge, there is no sound data that quantifies the actual risk or provides proper guidance on how such relationship issues should be monitored or assessed.

Clearly, when identified, relationship counselors may be able to provide support. However, I am guessing that this is hardly routine practice in most surgical programs.

There is of course little doubt that when relationships break up, maladaptive behaviours can emerge that may well have a negative impact on patients’ ability to adhere to the substantial lifestyle changes that bariatric surgery requires.

Fortunately, in my own anecdotal experience with patients, irresolvable partnership issues happily remain the exception and in some cases, moving on and leaving a dysfunctional partnership, despite the heart-wringing and challenges involved, may not be the worst possible outcome.

On the other hand, pretending that bariatric surgery will not pose an important challenge to any existing relationship, is naive and I truly believe that a frank discussion about these issues prior to surgery should be part of routine practice.

Given the paucity of systematic research in this area, I would certainly love to hear from my readers on this important issue and how they may have dealt with it in their practice (or lives).

Edmonton, Alberta