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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).

AMS
Edmonton, Alberta

5 Comments

  1. as you hav said, weight loss surgery changes the dynamic of a relationship in unpredictable ways, and we do try to ge tthe spouse involved before surgery, but we don’t know who needs what kind of help before and even after surgery. This kind of counseling may take months or even years of intense individual and couples work. So this is a major project for the future. In the mean time we tell out patients about the issues witrh relationships but I’m not sure they really care, they want the health benefits of the surgery.

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  2. I agree with this article – and aside from a spouse, many other relationship dynamics are affected.
    As a post WLS patient who has lost 82 pounds, my mother and my sister-in-law have felt threatened by the change in my shape. I think that they are afraid to be bigger than me- when they were never before the biggest woman in the room. They have made comments to this affect and also have asked me to “stop” losing weight as I am getting too “skinny” – although I am only 2/3rds through my weight loss process.
    Close friends have also become distant – while other colleagues and peers have suddenly become very engaging and friendly. I know that I was a friendly person before WLS but am truly shocked at the attention and openness I receive now that I am not so visibly obese – from those that know me and total strangers.
    The social ramifications and managing the speed of these relationship dynamic changes has been one of the toughest things for me, as a former people-pleaser. I try now to advocate for what I want and what I feel – and mitigate feelings of negativity, jealousy, and any personal attempt to internalize feelings, since this was part of my weight gain cycle.
    It’s emotionally exhausting but I am proud of myself and the people I choose to keep close to me now.
    Thanks Dr. Sharma – your clinic has changed my life for the better.

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  3. This rings very true with me. I’ve lost about 110lbs without bariatric surgery (and probably won’t have it) and I am experiencing much of what Dr Sharma mentions about catching up on all the lost years.

    My wife also struggles with her weight – although she is very much an emotional eater, there are other factors (such as the steriods she takes for ashtma) at play. Even though she’s been on a similar quest to lose weight, she hasn’t been able to…mostly for the aforementioned reasons.

    At this point, I’m experiencing a lot of success and receiving many compliments and congratulations, while she is not. I’m sure that this is causing her no end of stress (even though she would never admit it) that she’s treating (even if subconsciously) by eating.

    I’m not sure what to do to help her. When I try to share the credit for my success with her, I think she thinks others are thinking that if she can help me lose weight, why can’t she? And on it goes. I hope I can figure out some way to help her.

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  4. This post in particular I find most interesting.
    Nine months post-op (Roux-en-Y) I have lost 93 pounds and have reached my surgeon’s goal. I intend to continue losing a few more pounds to reach my personal goa, but if I lost no more, I would be content.

    However my social circle is changing somewhat, and it is all in reaction to the “obsession” with food/eating/restrictions I have gone through in the past year.

    In an urban environment, with a circle of friends who are all professionals and active, a social life frequently consists of “meeting for dinner”. That’s not surprising given our time (and family) constraints.

    Most of the friends have been glad to adapt for my sake – they see the benefit of improved health and have happily changed our pattern to smaller meals and less alcohol, in somewhat more entertaining locales (where the focus is not on volume of food).

    However, one or two seem to resent this tendency and are miserable when asked to change or accommodate – and they are increasingly rejecting requests to get together.

    My reaction of course is to honour their preference – if they are more interested in bingeing than in friendship, I have a different set of priorities and will plan accordingly.

    A pity, but somewhat predictable if your post is any indicator.

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  5. This series of articles on bariatric surgery bring several very important points to the forefront. However, there is one aspect I believe needs more attention. “Vanessa” had weighed well into the 300 lb. range for years. Her mother called her “heavy set,” but Vanessa was, indeed, morbidly obese.

    When her sister-in-law went to Mexico for the lap-band procedure, Vanessa decided to explore the possibilities of bariatric surgery with a physician in Texas. After paying the $12,000 up front, she had blood work, a physical exam and ONE visit to a psychologist. She also was required to lose about 35 pounds.

    After the surgery, Vanessa was left with a stomach the size of a banana. She had TWO follow-up visits.

    Now, five years later, Vanessa is morbidly obese and eats a diet of fast food and lots of Mexican (cheesy) dishes.

    It would appear that the surgeon was so focused on getting his money, he cared nothing about Vanessa finding the reason for her obesity (possibly sexual abuse by one of her mother’s many boyfriends).

    Now, she has no further alternatives. She is obviously using food in a harmful way.

    In my opinion, her surgeon should be charged with malpractice. He may have cured the symptom or the outcome, but didn’t bother to identify the cause of her obesity. In the U.S., bariatric surgery seems to eventually fail for this very reason. However, for the present (and pardon my choice of words), it appears to be a cash cow for money-hungry physicians.

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