Personality change after bariatric surgery and bariatric divorce…

May 16

May, 16, 2024. Revised and updated. I’ve often been told that this post expanded awareness of how this elective surgery can impact couples and families.

Personality change after bariatric surgery is a fact, and a bariatric divorce is often the result. After bariatric surgery, hormone levels dramatically shift, and the post-surgery dietary regime changes serotonin levels and neurotransmitter activity in the brain.

Personality change after bariatric surgery can wreak havoc in marriage and leave spouses completely unprepared.

This is a fascinating social trade-off. In return for increasing the likelihood of divorce, you can quickly shed about 100 pounds. If you’re happily married and contemplating this surgery, it’s the quintessential Faustian Bargain.

What is the rate of divorce after bariatric surgery?

New research describes a post-surgery divorce rate as high as 75-85% in the aftermath of surgery (usually the first two years).

If the bariatric patient was obese prior to the relationship, then the risk of divorce may even higher.

Personality change after bariatric surgery… the bariatric divorce…

Research tells us that divorce rates for marriages where one partner has undergone bariatric surgery appear to spike during the first year of post-surgery recovery.

It’s a fact that 80% of bariatric surgery patients are women, and it’s also a fact that women initiate most divorce actions.

Despite the fact that men who undergo bariatric surgery often have a lower weight loss, and experience more medical complications, men report significantly higher satisfaction levels, and feel better psychologically post-surgery post-surgery than women.

But they also can experience profound and perplexing personality changes.

Research clearly shows that there is greater intra-psychic pressure on women undergoing bariatric surgery. For women, bariatric surgery is a decision fraught with personal and cultural expectations.

Why Is bariatric divorce such a frequent outcome after surgery?

Bariatric surgery impacts troubled marriages in several ways at the same time. Women who have had the surgery tend to become impatient and dissatisfied with the constraints of their former life, while their husbands who witness their wives ‘ transformation often feel threatened by their “new” spouse.

Bariatric surgery is a fast track to personal transformation. The sudden nature of this surgical remedy for obesity can become a profound stressor on the patient’s intimate life.

After surgery, the brain, as well as the body, are adjusting to a new normal. Personality change after bariatric surgery can leave the spouses of these patients bewildered and unable to grasp the sudden onset of discontent in their now thinner partner.

Personality change after bariatric surgery operates on a neurological, chemical, interpersonal, and intra-psychic level. The marriages that survive have a strong sense of “we-ness,” these more resilient couples typically avail themselves of counseling before and after bariatric surgery.

Emotional and social impacts of bariatric surgery…

These couples also pay closer attention to the information they are given about the emotional and social impact of the surgery. They understand that personality change after bariatric surgery is an inevitable part of sudden transformation.

The stronger the marriage before surgery, the more resilient the couple will be during recovery. But even ostensibly strong marriages can collapse into a bariatric divorce. New possibilities promote discontent.

But why is Bariatric divorce such a threat? After bariatric surgery, patients have an enhanced self-image. There are the expected improvements in health and well-being, but more importantly, depressive symptoms fade.

Not enough is known about the hormonal changes after bariatric surgery, but many patients report feeling powerful waves of intense emotion.

You might wonder why improved self-esteem, body image, and mental health would threaten a marriage. But the reality is that personal transformation at such a profound level promotes a reassessment of one’s life and everyone in it.

What kind of personality change after bariatric surgery are we talking about?

Research shows us that some spouses may become less accommodating and selfless about a year after the surgery.

They may advocate for themselves in rather direct ways that are not in keeping with their former selves.

This new pattern of assertiveness can sometimes seem abrupt, blunt, and somewhat confrontational.

Perception is everything. Personality change after bariatric surgery can also be positive.

Some chronic health issues remain…

Chronic health problems that had been part of previous lived experiences remain.

Diabetes, sleep apnea, high blood pressure, depression, and symptoms of Developmental Trauma do not magically disappear from the patient’s now thinner body.

Medical follow-up for pre-surgical co-morbidities is essential.

Additional weight loss is not as rapid during the first recovery year while new habits and lifestyle changes are becoming established.

However, patients during the first year of recovery often lean into these problems and focus on improving their lifestyle.

They also enjoy an expanded sense of themselves inhabiting a new, thinner body. This abrupt shift in focus is sometimes unappreciated by their partners.

When personality change after bariatric surgery leads to bariatric divorce

Some personality change after bariatric surgery is unarguably positive. Research tells us that many patients report the following benefits:

Improved self-image
A decrease in depression
Improved body-image and self-esteem
More healthy lifestyle changes
Increased vibrancy and vitality

Main causes of bariatric divorce after bariatric surgery:

The pre-surgery marriage was unhappy. Perhaps there was emotional abuse, open conflict, or an uneasy peace characterized by diminished expectations. These expectations often come back to life in the personality change after bariatric surgery.

Other marriages may not have been openly conflictual but were more “settled” into an unhealthy and somewhat unconscious lifestyle around food. Marital conflict in these marriages often arises out of the sudden mismatch between the wants and needs of the two partners.

After bariatric surgery, they may be suddenly and uncomfortably out of sync. Relationships with food, activity levels, and leisure activities are no longer shared. If the patient is to maintain their weight loss, their lifestyle must change radically, and bewildered spouses might be impatient and resistant.

Personality change after bariatric surgery and science-based couples therapy

If your marriage is stressed by personality change after bariatric surgery, science-based couples therapy can help.

The best approach is to start couples therapy before the surgery and get on the same page. This therapy should include psych-educational elements of the predictable physiological and psychological shifts that this surgery will initiate.

Research shows that personality changes after bariatric surgery are handled better if couples have Generative Conversations and actively anticipate growth and change.

Couples who collaborate on lifestyle changes and offer mutual support have a better experience during the post-surgery recovery period. Couples who do not prepare are often startled, overwhelmed, and blindsided by the sudden changes.

Take a hard look at your lifestyle before surgery. What are your shared values around food and activity levels? One of the common personality changes after bariatric surgery is a sudden burst of energy and a lust for life.

The patient might suddenly be treated differently by others at work. And this may present a profound challenge to the marriage.

Sexy and beautiful for the first time?

Research also tells us that the most significant pitfall for marriage after bariatric surgery is that the patient may suddenly, perhaps for the first time, find themselves seen as an “attractive other.”

In an unhappy marriage, sexual acting out can be a significant marital stressor, particularly in cases where the patient was obese during their teenage years. They may feel that they are making up for “lost time.”

This acting out behavior can be particularly problematic if the patient was also overweight for the duration of the marriage as well as while a teenager.

Personality change after bariatric surgery for these patients, who may be experiencing the sexual attention of attractive others consistently… for the first time.

Patient Expert Cheryl Ann Borne reports that the odds of these marriages collapsing within two years after the surgery is an incredible 80 to 85 percent.

Struggles with identity

Ironically, the husbands of these women may have chosen them for who they are and not for their sex appeal.

And yet, the power of feeling sexually desired is intoxicating and often propels these women into an uneasy crisis of identity after bariatric surgery.

It may not be politically correct, but it is sometimes true. Women struggle more profoundly with their identity after bariatric surgery than men who undergo the same procedure despite experiencing less weight loss and more medical complications.

This crisis of desire and identity is the most predictable and preventable issue that can be explored in a science-based couple’s assessment (such as our State of the Union Clinical Assessment) before the decision to undergo bariatric surgery.

Diet and personality change after bariatric surgery

Post-surgery dietary protocols can completely upend the patient’s relationship to food. Most diets require either limiting or eliminating carbohydrate intake. The surgery itself results in significant physiological changes, altering the absorption rate of nutrients.

These restrictions typically change serotonin levels and neurotransmitter activity in the brain. Many patients report mood changes due to changes in their serotonin levels. Sometimes, depression and anxiety manifest as less positive personality changes after bariatric surgery. It’s a curious fact that after bariatric surgery, some patients become less depressed, and others become more depressed.

Alcohol use disorder and bariatric surgery

Recent studies have shown that some patients may show an uptick in alcohol consumption. Alcohol use disorder (AUD) after bariatric surgery is an area of emerging research that is somewhat controversial.

We don’t yet know enough about the effect of bariatric surgery on alcohol metabolism.

But we do know that some patients will become problem drinkers when they weren’t problem drinkers before.

We also know that some former problem drinkers who had managed themselves well before bariatric surgery experience a post-surgical relapse.

What we do know from the latest research is that bariatric surgery results in:

Accelerated alcohol absorption (you get impaired faster)
Higher maximum alcohol concentration
Longer time to eliminate alcohol in both men and women (you remain impaired longer).
You may have an increased risk of developing AUD (Alcohol Use Disorder).
Different Types of Bariatric Surgery

Some kinds of surgery are less problematic than others. The jury is still out on the procedure known as “sleeve gastrectomy,” and research tells us that there is, at this point, insufficient evidence to suggest that alcohol absorption is negatively impacted by the procedure known as “gastric banding”.

Sleeve gastrectomies are increasingly more popular, so more research is needed.

Active AUD is a contraindication for bariatric surgery. If you’re currently a problem drinker, your doctor is going to discourage you from undergoing bariatric surgery.

Bariatric surgery and marital stress leading to bariatric divorce

Marital stress from the experience of bariatric surgery is an emerging issue for couples therapists. Dedicated science-based couples therapists will keep up with the research in this area.

Some of the problems I’ve mentioned conspire to compound marital stress in these families. For example, a new, developing dependence on alcohol can impair judgment and increase the likelihood of infidelity or other impulsive behaviors.

The couples therapists working with these spouses need to get up to speed on the science behind the emotional complexities brought about by a personality change after bariatric surgery.

Values can shift

For instance, I recently had a conversation with a bewildered, heartbroken husband whose wife had bariatric surgery about a year ago.

He described her as “once a good Christian woman” who was an excellent mother to their three children. As a result of the surgery, she lost over a hundred pounds.

He is confused and hurt by her personality change after bariatric surgery.

His “new” wife now disappears for hours at a time, flirts, bar-hops, vigilantly guards her Smart Phone… and has become a problem drinker. He has reason to believe she lies about secret relationships with other men.

“I just don’t understand it,” he said. “We were encouraged to enroll in the counseling before the surgery, but we didn’t think it was important at the time. Now I see that was a huge mistake.”

Over 210,000 people in the United States will have some gastric bypass surgery this year. That’s a huge number of marriages and families that will be impacted.

Those numbers are growing in direct proportion to our waistlines. According to the National Institute for Health, more than 1 in 3 Americans are obese, and more than 1 in 20 fits the definition of “morbidly obese.”

The special problem of addiction transfer after surgery

New research has expressed concerns that Addiction Transfer or cross-addiction is a personal risk for some patients after bariatric surgery. The definition of “Addiction Transfer” specifically refers to trading compulsive eating for new and different compulsive behavior, often another process addiction, such as sex or love.

There is also strong evidence of a biological reason for cross-addiction. New research reveals various forms of transfer addiction in almost 30% of patients who have had bariatric surgery. Another research project puts the rate even higher.

Post-surgery patients can no longer turn to food as a source of comfort. An intra-psychic pressure builds, and a replacement addiction presents itself.

One of the challenges of process addictions such as food and sex is that they can serve many emotional purposes, rewards, and many levels of distraction.

9 known risk factors for process addiction and bypass surgery

There’s a Faustian Bargain in bariatric surgery for some people. Many individuals who suffer from binge eating disorder will explore having bariatric surgery as a way of managing their weight once and for all.

Process addiction transfer from food to sex addiction is a newly documented risk. We’ve also seen in post-surgery, newly-formed addictions to drugs and alcohol. and other forms of drug abuse. A small population of patients during post-surgery experience a return of their food addiction as well.

Watch out for These 9 risk factors:

If you’re contemplating having bypass surgery think twice if any of these situations describe you:

First and foremost, is there a history of compulsive eating or eating disorders in your family? How central is food in your life?
is there a distinct family history of alcohol or drug abuse?
Regular consumption of alcohol before bariatric surgery. Existing alcohol problems can be made worse with bariatric surgery.
Do you have a co-occurring issue with chronic pain? Are you on pain meds? Are you currently taking drugs for pain management? How responsible have you been in taking that medication?
Do you have a history of childhood sexual abuse, or other developmental trauma or multi-event PTSD?
Is there a History of depression, anxiety disorders, or other mood disorders in your family?
Do you lack support or feel lonely?
Are you emotionally avoidant? Are strong feelings something you’d rather avoid?
Do you tend to blow yourself up in self-sabotaging behaviors?

Yup…this sounds like me…now what?

If you’re contemplating bariatric surgery and have a more than average risk of experiencing a transfer addiction, it is important for you to put the pre-operative process on hold and address your addiction issues first.

Here’s something you might not know. One researcher has shown that over half of all bariatric surgery patients seeking weight loss have a binge eating disorder. But it’s important to note that studies vary widely on how big a problem this is.

Some studies play down the risk of transfer addiction. As usual, your best approach to understanding research is to follow the money.

If you’re struggling with an active addiction right now…bariatric surgery is probably not a good idea.
Deal with your addiction issue first, and get a year of sobriety under your belt. Let’s be clear about why I’m saying this. The first year of addiction recovery has a very high relapse rate. If you possess the resilience and mental toughness to stay sober for a full year, revisit the notion of life-changing bariatric surgery.

Weight loss doesn’t solve the problem…

Unfortunately, sudden weight loss will not curb addictive behaviors. Because binge eating isn’t an easy behavior to revisit, other compulsive behaviors will present themselves for consideration.

Addiction Transfer is a predictable risk for some patients.

These transfer addictions include:

Sex and Love compulsivity
Alcohol and drug problems
Shopping
Gambling
Transfer addictions emerge to comfort the addict and provide the needed distraction previously satisfied by food.

Good couples therapy can help…

How can a routine medical procedure present such a threat to so many marriages? The experience of bariatric surgery is often highly stressful and emotional. Many couples feel a need for couples therapy to navigate the process.

Intimate relationships often change significantly due to a sudden, dramatic weight loss. Spouses of bariatric surgery patients soon realize that comfortably familiar lifestyle choices are no longer an option.

Change is often difficult, and conflict around food and leisure activities are common. During the first 6 to 9 months after surgery, marital bonds may be severely strained.

Bariatric patients report strong, intense emotional waves of anger, euphoria, and sadness. An innocent question from a spouse could provoke a fight, or an innocent compliment may cause anger, confusion, or mistrust.

Bariatric divorce in the first year…

Divorce rates appear to climb among couples with a bariatric surgery partner, especially in the first year after surgery, as patients may see their current partners as unworthy and incongruent with their new sense of themselves.

Another study noted that partners of bariatric patients can feel left behind by their new, thinner spouse.

Drastic physical transformations often lead to profound changes in how self and others are perceived.

As if this weren’t enough, many bariatric patients form a close emotional bond with new friends who have undergone the same procedure.

Research is clear that many bariatric divorces were troubled marriages beforehand.

Bariatric surgery and marital conflict

Weight loss surgery forces you to examine your lifestyle and intimate relationships carefully. A personality change after bariatric surgery is a sign that a new self-image is emerging.

Your notion of who you are, and what you want may undergo a profound shift. Some changes will be healthy and exciting; others may be bewildering and challenging. Preparation is the key.

If you have a serious hidden food addiction, it won’t remain hidden for long.

After your surgery, a startling new transfer addiction may wreak havoc. Be direct and forthcoming with your medical team about any addictive issues you may have before your surgery.

And when you’re considering bariatric surgery, find an excellent science-based couples therapist who understands the physiological and psychological stresses and shifts that bariatric surgery entails.

Consider any lingering, unresolved toxic issues that haven’t yet been addressed in your marriage.

Talk about the kind of marriage you have, and don’t be afraid to discuss the kind of marriage you want after the surgery. If you both work together, you can avoid bariatric divorce, and both enjoy a happier and healthier life together after bariatric surgery.

Be Well, Stay Kind, and Godspeed.

Because bariatric surgery is an option… but divorce Isn’t.

RESEARCH:

Bariatric Times, “Transfer of Addiction and Considerations for Preventive Measures in Bariatric Surgery: Part II”, Retrieved 21 Oct 2019, http://bariatrictimes.com/transfer-of-addiction-and-considerations-for-preventive-measures-in-bariatric-surgery-part-ii/

DeMaria EJ. “Bariatric Surgery for Morbid Obesity,” New England Journal of Medicine (May 24, 2007): Vol. 356, No. 21, pp. 2176–83.

Wadden TA, et al. “Psychosocial and Behavioral Status of Patients Undergoing Bariatric Surgery: What to Expect Before and After Surgery,” Medical Clinics of North America (May 2007): Vol. 91, No. 3, pp. 451–69.

Substance Abuse and Mental Health Services Administration (SAMHSA), “Co-Occurring Disorders”, Retrieved 21 Oct 2019, http://www.dpt.samhsa.gov/comor/co-occuring.aspx

Westerburg DP, Waitz M (November–December 2013). “Binge-eating disorder”. Osteopathic Family Physician 5 (6): 230–33. doi:10.1016/j.osfp.2013.06.003.

Daniel Dashnaw