The Association between Marital Transitions, Body Mass Index, and Weight: A Review of the Literature

Table 1

Description of studies addressing BMI or weight change during marital transitions.

Reference	Participants^1	Dataset	Data collection methods	Time parameters	Marital transition^2	Key findings	Limitations
Anderson et al. 2004 [17]	𝑁=44 (22 couples); Age range: 19 to 33 years; Race: no detail reported; Response rate: 77%; Country: Scotland	N/A	Semi-structured individual interviews; measured body weight	Time span: 6 to 12 months; TP1: 3 months before cohabitation; TP2: Approximately 3 months after cohabitation	(i) Into cohabitation	M: Into cohabitation: weight gain +1.63 kg (SD 2.7, 𝑃=0.02); F: Into cohabitation: weight gain +1.54 kg (SD 1.7, 𝑃<0.001)	No detail reported
Averett et al. 2008 [18]	N (M) = 5,243; N (F) = 5,180; Age range: 14 to 22 years; Race: nationally representative; oversampled Hispanics, African-Americans and low-income Whites; Response rate: approximately 87%; Country: USA	NLSY79	Surveys	Time span: 23 years; TP1: 1981; TP2: multiple time; points until 2004	(i) Never married and currently cohabiting; (ii) Became married; (iii) Married to divorced; (iv) Into divorced cohabiting	M: Never married and currently cohabiting: BMI increase +0.010 kg/m^2 (SE 0.002, 𝑃<0.01); Became married: BMI increase +0.015 kg/m^2 (SE 0.001, 𝑃<0.01); Married to divorced: no significant findings; Into divorced cohabiting: BMI increase +0.015 kg/m^2 (SE 0.003, 𝑃<0.01); F: Never married and currently cohabiting: BMI increase +0.006 kg/m^2 (SE 0.003, 𝑃<0.05); Became married: BMI increase +0.017 kg/m^2 (SE 0.002, 𝑃<0.01); Married to divorced: BMI decrease −0.007 kg/m^2 (SE 0.002, 𝑃<0.01); Into divorced cohabiting: no significant findings	No detail reported
Craig and Truswell; 1990 [19]	N (M) = 60; N (F) = 60; Age range: 20 to 37 years; Race: no detail reported; Response rate: no detail reported; Country: Australia	N/A	Interviews; self-reported body weight and height	Time span: 3 years; TP1: 1982 (before marriage); TP2: Approximately 5 months after marriage; TP3: Approximately 2.5 years after marriage	(i) Became married	M: Became married: average weight gain +2 kg; average BMI increase +0.7 kg/m^2; 8% increase in overweight or obese population; F: Became married: average weight gain +2 kg; average BMI increase +0.7 kg/m^2; 5% increase in overweight or obese population	Lack of a control group
Eng et al. 2005 [20]	N (M) = 38,865; Age range: 40 to 75 years; Race: no detail reported; Response rate: 77.1%; Country: USA	The Health Professionals Follow-up Study	Questionnaires	Time span: 4 years; TP1: 1986; TP2: 1990; or; TP1: 1990; TP2: 1994	(i) Married to divorced/separated; (ii) Married to widowed; (iii) Divorced/separated/ widowed to remarried	M: Married to divorced/separated: BMI decrease −0.31 kg/m^2 (𝑃<0.0001); Married to widowed: BMI decrease −0.35 kg/m^2 (𝑃<0.0001); Divorced/separated/widowed to remarried: BMI increase +0.25 kg/m^2 (𝑃<0.0001); F: No detail reported	Self-reported marital status; cohort not an adequate representation of population
Fogelholm et al. 2000 [21]	N (M) = 1,143; Age range: 36 to 88 years; Mean age: 53.3 years; Race: no detail reported; Response rate: 45%; Country: Finland	N/A	Questionnaires	Time span: 10 years; TP1: 1985; TP2: 1995	(i) Started cohabitating; (ii) Stopped cohabitating	M: Started cohabitating: (50 to 59 years): weight loss −2.89 kg (SE 1.36, 𝑃=0.03); Stopped cohabitating: no significant findings; F: No detail reported	Cohort not a random; representative population sample; participants were former elite athletes
Harris et al. 2010 [22]	N (M) = 4,331; N (F) = 4,827; Age range: 12 to 19 years; Race: African American (F=15.0%, M=12.1%); White (F=37.7%, M=35.2%); Response rate: 44.1%; Country: USA	ADD Health	Interviews; questionnaires; self-reported body weight and height	Time span: 6 to 8 years; TP1: 1994 to 1995; TP2: 2001 to 2002	(i) Into cohabitation; (ii) Became married	M: Into cohabitation: no significant findings; Became married: African American males BMI increase +1.982±0.505 kg/m^2 (𝑃<0.001); no significant findings for White males; F: Into cohabitation: no significant findings; Became married: African American BMI increase +1.628±0.641 kg/m^2 (𝑃<0.05) and White females BMI increase +1.186±0.334 kg/m^2 (𝑃<0.01)	No detail reported
Jeffery and Rick 2002 [23]	N (M) = 1,209; N (F) = 1,319; Mean age: late 30s; Race: no detail reported; Response rate: 68%; Country: USA	N/A	Surveys; measured body weight and height; spouse report of partner’s body weight and height	Time span: 2 years; TP1: 1987; TP2: 1991	(i) Became married; (ii) Became unmarried	M: Became married: BMI increase +0.70±0.24 kg/m^2 (𝑃<0.01); Became unmarried: no significant findings; F: Became married: BMI increase +0.96±0.30 kg/m^2 (𝑃<0.01); Became unmarried: BMI decrease −0.63±0.27 kg/m^2 (𝑃<0.01)	Reliance on spousal reports for height and weight measures; no information on spouse's eating behaviors
Kahn and Williamson 1990 [24]	N (M) = 1,552; Age range: 25 to 44 years; Race: 98% Black or White; Response rate: 77%; Country: USA	NHANES-I; NHEFS	Interviews; measured body weight and height	Time span: 10-year; TP1: 1971–1975; TP2: 1982–1984	(i) Became married; (ii) Marriage ended	M: Became married: increased odds of major weight gain (≥4.0 kg/m^2) OR 3.3 (95% CI 1.7, 6.3); Marriage ended: increased odds of major weight loss (≥2.0 kg/m^2) OR 1.8 (95% CI 1.0, 3.3); F: No detail reported	Weight fluctuations during the 10-year follow-up period not reported; differential loss to follow-up could have influenced BMI changes
Kahn et al.; 1991 [25]	N (F) = 3,284; Age range: 25 to 44 years; Race: 84.3% White; 15.7% Black; Response rate: 76%; Country: USA	NHANES-I; NHEFS	Interviews; surveys; measured body weight and height	Time span: 10.1±1.2 years; TP1: 1971–1975; TP2: 1982–1984	(i) Became married; (ii) Marriage ended	M: No detail reported; F: Became married: average weight gain +2.1 kg (95% CI 0.6, 3.4); Marriage ended: average weight loss −1.0 kg (95% CI −1.9, −0.2)	Weight fluctuations during the 10-year follow-up period not reported
Kahn and Williamson 1991 [26]	N (M) = 1,552; N (F) = 3,344; Age range: 25 to 44 years; Race: 85.2% White; 14.8% Black; Response rate: 77.2%; Country: USA	NHANES-I; NHEFS	Surveys; measured body weight and height	Time span: 10 years; TP1: 1971–1975; TP2: 1982–1984	(i) Became married; (ii) Marriage ended	M: Became married: increased odds of major weight gain (≥4.0 kg/m^2) OR 3.3 (95% CI 1.7, 6.3); Marriage ended: increased odds of major weight loss (≤−2.0 kg/m^2) OR 1.8 (95% CI 1.0, 3.3); F: Became married: increased odds of major weight gain (≥5.0 kg/m^2) OR 1.8 (95% CI 1.0, 3.1); BMI increase +0.8 kg/m^2 (95% CI 0.2, 1.3); Marriage ended: Increased odds of major weight loss (≤−2.5 kg/m^2) OR 1.2 (95% CI 0.8, 1.9); BMI decrease −0.4 kg/m^2 (95% CI −0.7, −0.1)	No detail reported
Lee et al.; 2005 [27]	N (F) = 80,944; Age range: 46 to 71 years; Race: no detail reported; Response rate: no detail reported; Country: USA	NHS	Questionnaires; FFQs; self-reported body weight and height	Time span: 4 years; TP1: 1992; TP2: 1996	(i) Married to divorced/ separated; (ii) Married to widowed; (iii) Unmarried to remarried	M: No detail reported; F: Married to divorced/separated: average weight loss −0.65 kg/m^2 (𝑃<0.001); Married to widowed: average weight loss −0.44 kg/m^2 (𝑃<0.001); Unmarried to remarried: average weight gain +0.41 kg/m^2 (𝑃<0.001)	Exact timing of marital transition and behavioral changes were not precise; self-reported dietary intake
Rauschenbach et al. 1995 [28]	N (M) = 861; N (F) = 1,332; Age range: 20 to 64 years; Race: M = 91% White; F = 89% White; Response rate: 81%; Country: USA	NSPHPC	Phone interviews; self-reported body weight	Time span: 1 year; TP1: 1979; TP2: 1980	(i) Became married; (ii) Became unmarried	M: Became married: no significant findings; Became unmarried: no significant findings; F: Became married: average weight gain +4.89 lbs (𝑃=0.040); Became unmarried: no significant findings	Assessed people between 20 and 64 years; weight and marital change self-reported
Rissanen et al. 1991 [29]	N (M) = 6,504; N (F) = 6,165; Age range: 25 to 64 years; Race: no detail reported; Response rate: no detail reported; Country: Finland	N/A	Interviews; surveys; measured body weight and height; self-reported body weight change	Time span: average 5.7 years; TP1: 1966 to 1972; TP2: 1973 to 1976	(i) Became married; (ii) Married to divorced; (iii) Married to widowed	M: Became married: increased risk of weight gain (>5 kg) RR 1.8 (95% CI 1.3, 2.5); Married to divorced: no significant findings; Married to widowed: decreased risk of weight gain (>5 kg) RR 0.5 (95% CI 0.2, 1.3); F: Became married: increased risk of weight gain (>5 kg) RR 2.1 (95% CI 1.4, 3.2); Married to divorced: no significant findings; Married to widowed: decreased risk of weight gain (>5 kg) RR 0.6 (95% CI 0.4, 0.9)	No detail reported
Schulz et al. 2001 [30]	N (M) = 31; N (F) = 98; Age range: 66 to 96 years; Race: 90% White; 10% Black; Response rate: no detail reported; Country: USA	CHES	Personal interviews; measured body weight and height; medical history obtained from the caregiver	Time span: 4 years; TP1: 1993; TP2: 1998	(i) Married to widowed	M/F noncaregivers: Married to widowed: average weight loss −3.8 lbs; (95% CI −6.4, −1.1; 𝑃=0.005); M/F caregivers: Married to widowed: no significant findings	No detail reported
Shahar et al. 2001 [31]	N (M) = 20; N (F) = 96; Mean age = 77.6 years; Race: no detail reported; Response rate: no detail reported; Country: USA	CHS	Interviews; 3-day food diaries	Time span: 5–7 years; TP1: 1989–1990; TP2: 1995–1996	(i) Married to widowed	M/F: Married to widowed: average weight loss −2.03±8.13 lbs (𝑃=0.045)	Retrospective study design; potential selection bias in widowed group; under representation of men in sample
Sobal et al.; 2003 [6]	N (M) = 3,500; N (F) = 5,543; Age range: 17 to 74 years; Race: no detail reported; Response rate: no detail reported; Country: USA	NHANES-I; NHEFS	Personal interviews; physical examination; measured body weight and height	Time span: 10 years; TP1: 1971–1975; TP2: 1982–1984	(i) Unmarried to married; (ii) Married to divorced/separated; (iii) Married to widowed	M: Unmarried to married: no significant findings; Married to divorced/separated: average weight loss −2.5 lbs (SE 1.1, 𝑃<0.05); Married to widowed: average weight loss −4.1 lbs (SE 1.7, 𝑃<0.05); F: Unmarried to married: average weight gain +4.7 lbs (SE 1.7, 𝑃<0.01); Married to divorced/separated: no significant findings; Married to widowed: no significant findings	Self-reported marriage and demographic variables
The and Gordon-Larsen 2009 [32]	N (M) = 3,321; N (F) = 3,628; Age range: 18 to 27 years; Race: 61% White; 39% others; Response rate: no detail reported; Country: USA	ADD Health	Questionnaires; measured body weight and height	Time span: 5-6 years; TP1: 1996; TP2: 2001 to 2002	(i) Single/dating to cohabiting; (ii) Single/dating to married	M: Single/dating to cohabiting: increased odds of obesity OR 1.30 (95% CI 0.81, 2.09); Single/dating to married: increased odds of obesity OR 2.07 (95% CI 1.33, 3.25); F: Single/dating to cohabiting: increased odds of obesity OR 1.63 (95% CI 1.14, 2.32); Single/dating to married: increased odds of obesity OR 2.27 (95% CI 1.54, 3.34)	Direct factors that change in romantic relationships (e.g., dietary factors, social obligations, weight control) were not measured
Umberson; 1992 [33]	N (M) = 1,705; N (F) = 1,911; Age range: 24 years and older; Race: no detail reported; Response rate: no detail reported; Country: USA	ACL	Face-to-face interviews; surveys; self-reported body weight and height	Time span: 3 years; TP1: 1986; TP2: 1989	(i) Unmarried to married; (ii) Married to unmarried	M: Unmarried to married: no significant findings; Married to unmarried: BMI decrease −0.039 kg/m^2 (𝑃<0.01); F: Unmarried to married: no significant findings; Married to unmarried: BMI decrease −0.047 kg/m^2 (𝑃<0.001)	Data do not include measures of indirect mechanisms such as responsibility and facilitation of health behavior
Umberson; et al. 2009 [10]	N (M) = 690; N (F) = 810; Mean age: 42.67 years; Race: 91% White; 9% Black; Response rate: no detail reported; Country: USA	ACL	Face-to-face interviews; surveys; self-reported body weight and height	Time span: 15 years; TP1: 1986; TP2: 1989; TP3: 1994; TP4: 2001	(i) Unmarried to married; (ii) Married to divorced; (iii) Married to widowed	M/F: Unmarried to married: no significant findings; Married to divorced (between TP1 and TP2): decreased BMI −0.734 kg/m^2 (𝑃≤0.05) at TP2 (loss is temporary and nonsignificant at TP3 and TP4); Married to widowed (between TP2 and TP3): decreased BMI −0.712 kg/m^2 (𝑃≤0.05) at TP3 and −1.295 kg/m^2 (𝑃≤0.05) at TP4; (between TP3 and TP4): decreased BMI −0.993 kg/m^2 (𝑃≤0.001) at TP4	Small sample size for some marital transitions; mortality and survey attrition greater for those at highest and lowest weight levels (underestimation of observed effects)
Wilcox et al. 2003 [34]	N (F) = 72,247; Age range: 50 to 79 years; Race: 85.4% White; 14.6% others; Response rate: no detail reported; Country: USA	WHI	Questionnaires; physical and health behavior data collected at clinic visit	Time span: 3 years; TP1: 1992; TP2: 1993 to 1998	(i) Married to widowed; (ii) Widowed to remarried	M: No detail reported; F: Married to widowed: significantly more likely to report unintentional weight loss >5 lb (𝑃<0.01); Widowed to remarried: weight gain +1.562 kg (SE 0.753, 𝑃=0.05)	Longer follow up time needed; depressed were screened out; women could have experienced a marital transition not captured by assessments; selective volunteer population; fairly young sample

ACL: Americans Changing Lives, ADD Health: National Longitudinal Study of Adolescent Health, ADS: Adult Development Study, BMI: Body Mass Index, CHES: The Caregiver Health Effects Study, CHS: Cardiovascular Health Study, F: female, FFQ: Food Frequency Questionnaire, kg: kilograms, lbs: pounds, m: meters, M: male, M/F: findings reported males and females combined, N/A: not applicable, NHANES: National Health and Nutrition Examination Survey, NHS: Nurses Health Study, NHEFS: NHANES I Epidemiological Follow-Up Study, NLSY79: National Longitudinal Survey of Work Experience of Youth (1979 cohort), NSPHPC: National Survey of Personal Health Practices and Consequences, TP1: time point 1, TP2: time point 2, TP3: time point 3, TP4: time point 4, WHI: Women’s Health Initiative.
¹N and age ranges represented from time point 1.
²Marital transition terminology reported in table was used by authors of the respective articles.