Table 1: Description of studies addressing BMI or weight change during marital transitions.

ReferenceParticipants1DatasetData collection methodsTime parametersMarital transition2Key findingsLimitations

Anderson et al. 2004 [17] (22 couples)
Age range: 19 to 33 years
Race: no detail reported
Response rate: 77%
Country: Scotland
N/ASemi-structured individual interviews; measured body weightTime span: 6 to 12 months
TP1: 3 months before cohabitation
TP2: Approximately 3 months after cohabitation
(i) Into cohabitationM: Into cohabitation: weight gain +1.63 kg (SD 2.7, )
F: Into cohabitation: weight gain +1.54 kg (SD 1.7, )
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
NLSY79SurveysTime 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/m2 (SE 0.002, )
Became married: BMI increase +0.015 kg/m2 (SE 0.001, )
Married to divorced: no significant findings
Into divorced cohabiting: BMI increase +0.015 kg/m2 (SE 0.003, )
F: Never married and currently cohabiting: BMI increase +0.006 kg/m2 (SE 0.003, )
Became married: BMI increase +0.017 kg/m2 (SE 0.002, )
Married to divorced: BMI decrease −0.007 kg/m2 (SE 0.002, )
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/AInterviews; self-reported body weight and heightTime span: 3 years
TP1: 1982 (before marriage)
TP2: Approximately 5 months after marriage
TP3: Approximately 2.5 years after marriage
(i) Became marriedM: Became married: average weight gain +2 kg; average BMI increase +0.7 kg/m2; 8% increase in overweight or obese population
F: Became married: average weight gain +2 kg; average BMI increase +0.7 kg/m2; 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 StudyQuestionnairesTime 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/m2 ( )
Married to widowed: BMI decrease −0.35 kg/m2 ( )
Divorced/separated/widowed to remarried: BMI increase +0.25 kg/m2 ( )
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/AQuestionnairesTime 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, )
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 ( , ); White ( , )
Response rate: 44.1%
Country: USA
ADD HealthInterviews; questionnaires; self-reported body weight and heightTime 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 +  kg/m2 ( ); no significant findings for White males
F: Into cohabitation: no significant findings
Became married: African American BMI increase +  kg/m2 ( ) and White females BMI increase +  kg/m2 ( )
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/ASurveys; measured body weight and height; spouse report of partner’s body weight and heightTime span: 2 years
TP1: 1987
TP2: 1991
(i) Became married
(ii) Became unmarried
M: Became married: BMI increase +  kg/m2 ( )
Became unmarried: no significant findings
F: Became married: BMI increase +  kg/m2 ( )
Became unmarried: BMI decrease −  kg/m2 ( )
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; NHEFSInterviews; measured body weight and heightTime 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/m2) OR 3.3 (95% CI 1.7, 6.3)
Marriage ended: increased odds of major weight loss (≥2.0 kg/m2) 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; NHEFSInterviews; surveys; measured body weight and heightTime span: 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; NHEFSSurveys; measured body weight and heightTime 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/m2) OR 3.3 (95% CI 1.7, 6.3)
Marriage ended: increased odds of major weight loss (≤−2.0 kg/m2) OR 1.8 (95% CI 1.0, 3.3)
F: Became married: increased odds of major weight gain (≥5.0 kg/m2) OR 1.8 (95% CI 1.0, 3.1); BMI increase +0.8 kg/m2 (95% CI 0.2, 1.3)
Marriage ended: Increased odds of major weight loss (≤−2.5 kg/m2) OR 1.2 (95% CI 0.8, 1.9); BMI decrease −0.4 kg/m2 (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
NHSQuestionnaires; FFQs; self-reported body weight and heightTime 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/m2 ( )
Married to widowed: average weight loss −0.44 kg/m2 ( )
Unmarried to remarried: average weight gain +0.41 kg/m2 ( )
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
NSPHPCPhone interviews; self-reported body weightTime 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 ( )
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/AInterviews; surveys; measured body weight and height; self-reported body weight changeTime 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
CHESPersonal interviews; measured body weight and height; medical history obtained from the caregiverTime span: 4 years
TP1: 1993
TP2: 1998
(i) Married to widowedM/F noncaregivers: Married to widowed: average weight loss −3.8 lbs; (95% CI −6.4, −1.1; )
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
CHSInterviews; 3-day food diariesTime span: 5–7 years
TP1: 1989–1990
TP2: 1995–1996
(i) Married to widowedM/F: Married to widowed: average weight loss − lbs ( )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; NHEFSPersonal interviews; physical examination; measured body weight and heightTime 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, )
Married to widowed: average weight loss −4.1 lbs (SE 1.7, )
F: Unmarried to married: average weight gain +4.7 lbs (SE 1.7, )
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 HealthQuestionnaires; measured body weight and heightTime 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
ACLFace-to-face interviews; surveys; self-reported body weight and heightTime 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/m2 ( )
F: Unmarried to married: no significant findings
Married to unmarried: BMI decrease −0.047 kg/m2 ( )
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
ACLFace-to-face interviews; surveys; self-reported body weight and heightTime 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/m2 ( ) at TP2 (loss is temporary and nonsignificant at TP3 and TP4)
Married to widowed (between TP2 and TP3): decreased BMI −0.712 kg/m2 ( ) at TP3 and −1.295 kg/m2 ( ) at TP4
(between TP3 and TP4): decreased BMI −0.993 kg/m2 ( ) 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
WHIQuestionnaires; physical and health behavior data collected at clinic visitTime 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 ( )
Widowed to remarried: weight gain +1.562 kg (SE 0.753, )
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.