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. Author manuscript; available in PMC: 2022 Sep 1.
Published in final edited form as: Womens Health Issues. 2021 Jun 12;31(5):462–469. doi: 10.1016/j.whi.2021.05.001

The timing of obesity matters: Associations between current versus chronic obesity since adolescence and romantic relationship satisfaction among young adult women

Aletha Y Akers a,1, Jennifer Harding b,2
PMCID: PMC8448928  NIHMSID: NIHMS1716903  PMID: 34127367

Abstract

BACKGROUND:

Although the social consequences of obesity for women are well documented, its stigmatizing effect on romantic relationships across the life course has seldom been explored. We examined whether having current or chronic obesity since adolescence is associated with romantic relationship satisfaction among women in early adulthood.

METHODS:

This is a secondary analysis of data from the National Longitudinal Study of Adolescent Health. Female participants completing Waves I and IV who self-reported their height and weight and were in a marital or cohabitating relationship at Wave IV were included. Relationship satisfaction was assessed using a seven-item measure. BMI at Wave IV was categorized as normal weight, overweight, obesity, or chronic obesity (at Waves I and IV). The odds of reporting low relationship satisfaction were estimated across BMI categories using multivariate regression that controlled for key covariates (age, race, ethnicity, education, income, lifetime partners, relationship duration, and depression) and accounted for the complex sampling design.

RESULTS:

Among the 3,582 respondents, 74.8% were White, 65.5% had less than a college degree, and 61.8% were in their relationship more than 3 years. At Wave IV, 38.2% had a normal BMI, 27.7% had overweight, 26.7% had obesity, and 7.5% had chronic obesity. Only having chronic obesity was associated with relationship satisfaction in early adulthood. Women with chronic obesity had 1.44 (95% CI: 1.03, 2.02) times the odds of reporting low relationship satisfaction compared to those categorized as normal weight.

CONCLUSIONS:

Chronic obesity since adolescence is associated with poor romantic relationship satisfaction in early adulthood.

Keywords: Obesity, body mass index, interpersonal relations, relationship satisfaction, dating

INTRODUCTION

Obesity is highly prevalent in the U.S., affecting nearly half of adults and one in five children and adolescents (Hales, Carroll, Fryar, & Ogden, 2020; Ogden, Carroll, Kit, & Flegal, 2014; Strauss & Pollack, 2001). The rise in childhood obesity reflects the convergence of biological, economic, and social factors (Strauss & Pollack, 2001). Regardless of the cause, individuals with obesity report lower health-related quality of life and are at increased risk of developing chronic conditions such as diabetes and hypertension (Dietz, 1998; Schwimmer, Burwinkle, & Varni, 2003). Obesity is also associated with negative psychosocial outcomes. In the romantic relationship domain, individuals with obesity report fewer dating, sexual, and marital relationships, with women more likely to experience these effects than men (Chiappori, Oreffice, & Quintana, 2012; Conley & Glauber, 2007; Oreffice & Quintana-Domeque, 2010; Sheets & Ajmere, 2005).

Healthy romantic relationship functioning is based on equality, mutuality, compromise, respect, and the absence of dominance and differential power and control (Gomez-Lopez, Viejo, & Ortega-Ruiz, 2019). For women in romantic relationships, whether dating or sexual, those with obesity report lower relationship functioning, particularly lower relationship satisfaction (Boyes & Latner, 2009). Understanding the factors that influence romantic relationship functioning is important because romantic relationships are where people often fulfill basic life needs (like food, shelter, reproduction, and companionship) and obtain socioemotional support when facing adversity (Feeney & Collins, 2015; Finkel, Hui, Carswell, & Larson, 2014; Fitzsimons, Finkel, & vanDellen, 2015). These benefits are far reaching with individuals in more satisfying romantic relationships reporting greater health, happiness, and meaning in their lives (Proulx, Helms, & Buehler, 2007; Robles, Slatcher, Trombello, & McGinn, 2014). Although a wealth of research on the social consequences of obesity among women exists, the stigmatizing effects of obesity on romantic relationship functioning has seldom been considered (Boyes & Latner, 2009; Dotson, 2014). Exploring how women with obesity might have different romantic experiences than women without obesity contributes to our understanding of how living in a culture that stigmatizes obesity in women affects women’s lives.

Obesity and romantic relationship satisfaction

Romantic relationship satisfaction—the positive evaluation of romantic involvement with another individual—is a marker of relationship quality (Ayduk & Gyurak, 2008; De Andrade, Wachelkeb, & Howat-Rodrigues, 2015). Measures of romantic relationship satisfaction assess a range of interpersonal dimensions, including mutual trust, respect, intimacy, emotional support, communication, conflict resolution, commitment, financial co-management, and shared household responsibilities (Wildsmith, Manlove, Steward-Streng, & Cook, 2013). Whether in married, cohabitating, or dating relationships, most women report high romantic relationship satisfaction (Wildsmith et al., 2013). A nationally representative sample of young adults ages 18 to 26 years found that 83% of married women and three-quarters of those in cohabitating and dating relationships reported being very satisfied in their current relationship (Wildsmith et al., 2013).

However, perspectives on relationships are not universal. Across the lifespan, women with obesity consistently report lower relationship satisfaction than their peers without obesity (Boyes & Latner, 2009; Burke, Randall, Corkery, Young, & Butler, 2012). A study among heterosexual dating and married couples found that women with higher weight reported lower quality relationships, predicted their relationships were more likely to end, described partners as less desirable, and were deemed less attractive by partners (Boyes & Latner, 2009). A study among college women also found that weight was negatively correlated with relationship satisfaction (Sheets & Ajmere, 2005). The similarity in findings among women at different life stages and within both committed and casual relationships suggests that the drivers of relationship dysfunction among women with obesity begin early and persist. Yet, few studies have examined relationship satisfaction among adolescents, and none explore how perceptions of relationship quality vary among adolescent women by weight. Despite this, a wealth of evidence demonstrates that dysfunctional romantic relationships emerge during adolescence (Carr & Friedman, 2006; Cawley, Joyner, & Sobal, 2006; Farhat, Haynie, Summersett-Ringgold, Brooks- Russell, & Iannotti, 2015; Mustillo, Hendrix, & Schafer, 2012; Pearce, Boergers, & Prinstein, 2002).

Adolescent Precursors of Adult Romantic Relationship Functioning

The prevalence of obesity during childhood has tripled since 1970, with high rates of obesity during childhood persisting into adulthood (Ferraro, Thorpe, & Wilkinson, 2003; Gordon-Larsen, The, & Adair, 2010; Ogden, Carroll, Fryar, & Flegal, 2015). Children with obesity are more likely to be bullied and stigmatized by peers and to report lower self-esteem, more depressive symptoms, and fewer friendships and romantic relationships (Ali, Amialchuk, & Rizzo, 2012; Cunningham, Vaquera, & Long, 2012; Eisenberg, Neumark-Sztainer, & Story, 2003; Erermis et al., 2004; Griffiths, Wolke, Page, Horwood, & Team, 2006; Wardle & Cooke, 2005). The capacity to develop close, reciprocal, supportive friendships during childhood is a developmental prerequisite for developing similarly high-quality romantic relationships in adolescence and beyond (Furman & Wehner, 1997). Constrictions in the social networks of adolescents with obesity limit their opportunities for developing interpersonal skills that can translate into romantic relationship skills in adulthood (Pearce et al., 2002).

In the U.S. and other Western cultural settings, adolescent women with obesity are often stigmatized in the dating arena, resulting in fewer dating opportunities (Cawley et al., 2006). Although these associations have been observed across racial groups, differences exist, with African American and Latina women and girls with higher body mass indices (BMI) less likely to be perceived as unattractive by partners of the same race compared to their White peers (Akers et al., 2009). Regardless of race, internalized obesity stigma may result in women with obesity being more accepting of less satisfying romantic relationships as a way to develop the emotional closeness not otherwise available to them (Wingood, DiClemente, Harrington, & Davies, 2002). These findings provide evidence that the precursors of romantic relationship dysfunction in adult women with obesity likely originates in adolescence. This raises the possibility that obesity present since adolescence (i.e., chronic obesity) may have a greater impact on adult romantic relationship functioning than obesity that develops in adulthood. Theories about chronic stress and social disadvantage support this premise by positing that sustained stigma and marginalization impairs functioning and outcomes more than recent adversity and that the earlier such negative experiences begin, the more deleterious the effects (Ferraro & Kelley-Moore, 2003).

Study Aims

Using a large, nationally representative dataset, we examined the relationship between weight and romantic relationship satisfaction in young adult women. We hypothesized that young women with higher BMI would report lower relationship satisfaction. We further hypothesized that young women with chronic obesity would be more likely to report romantic relationship dysfunction than those with obesity experienced only in adulthood.

MATERIAL AND METHODS

Study Design

This secondary analysis used the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative sample of U.S. adolescents. Add Health used a multistage, stratified, school-based, cluster sampling design with five waves of data collection (Harris et al., 2009). Wave I randomly sampled students in Grades 7 through 12 in 1994–1995 (n=20,745, ages 12–18 years). Wave II was completed in 1996 (ages 13–20 years), Wave III in 2001–2002 (ages 18–26 years), Wave IV in 2007–2008 (ages 24–32 years), and Wave V in 2016–2018 (ages 32–42 years). Participants provided written informed consent per the University of North Carolina’s Institutional Review Board (IRB) guidelines (Harris et al., 2009). This analysis was exempted from review by the Children’s Hospital of Philadelphia IRB.

Participants and procedures

The analytic sample included female respondents completing Waves I and IV who provided a valid height and weight, answered all items used to define the relationship satisfaction outcome, and reported at least one romantic relationship at Wave IV. Wave V data were omitted since the aim was to examine outcomes in early rather than later adulthood. Respondents who were underweight, reported a race other than Black or White, or who were non-heterosexual were excluded due to their negligible sample size. The main analysis included only married or cohabitating women to restrict the sample to women in more committed relationships, thereby minimizing biasing point estimates based on relationship type. This yielded a final sample size of 3,582 respondents.

Measures

Primary Outcome.

Romantic relationship satisfaction was assessed using a seven-item scale. Respondents were asked how much they agreed with statements about their current romantic relationship that assessed enjoyment doing ordinary activities, partner support, partner expressions of affection, perceived partner faithfulness, satisfaction with conflict resolution, financial management, and sex life. The five response options ranged from “strongly agree” to “strongly disagree” with a neutral midpoint. Factor analysis found all seven items loaded on a single factor with good internal consistency (Cronbach’s alpha=0.91). Responses were summed to create scores that ranged from seven (low satisfaction) to 35 (high satisfaction). Consistent with prior research, the data were highly right skewed, with most women report high relationship satisfaction. Although using a continuous variable increases power, due to the right-skew we categorized the outcome to allow comparisons among women reporting low, intermediate, and high relationship satisfaction and facilitate drawing meaningful conclusions. Responses were grouped into three categories reflecting low (score <25), medium (score ≥25 but <34), or high satisfaction (score ≥34).

Predictor Variable.

BMI was calculated at each wave from self-reported height and weight using the Centers for Disease Control (CDC) definitions for children (Wave I) and adults (Wave IV) and categorized as normal at Wave IV, overweight at Wave IV, obesity at Wave IV (but not at Wave I), or having chronic obesity (obesity at Waves I and IV) (Ogden & Flegal, 2010). These categories were selected because prior analyses using this dataset showed that two-thirds of women classified as normal weight at Wave I remained normal weight at Wave IV, while a quarter developed obesity (Gordon-Larsen et al., 2010). We found most participants (94%) with obesity at Wave I still had obesity at Wave V, while obesity reversal was rare (1.3%). Women who experienced obesity reversal were not examined as a separate group due to their negligible sample size and evidence that women with obesity during childhood who experience obesity reversal have psychosocial outcomes similar to those with chronic obesity (Mustillo, 2012).

Covariates.

We included control variables to reduce overestimation of the effect of BMI on relationship satisfaction. Covariates associated with obesity (race, ethnicity, education, household income), romantic relationship functioning (age, number of lifetime sex partners, romantic relationship duration) or both (depression) were included. Wave IV covariates were used so outcomes and covariates were assessed contemporaneously. Three age groups were created (ages 24 to 26 years, 27 to 29 years, and 30 to 32 years) to control for cohort effects based on age and developmental stage at Wave I. Age was modeled as a continuous and categorical variable with no difference in point estimates noted, thus age group data are presented for ease of interpretation. Respondents were classified as non-Hispanic White, non-Hispanic Black, and Hispanic. Education was dichotomized as less than a college degree versus a college degree or higher based on categories available in the dataset. Self-reported gross household income was categorical and recorded as < $15,000, $15,000 to $39,999, $40,000 to $74,999, > $75,000, or missing. The number of lifetime sex partners was collapsed into four categories: one partner, two to three partners, four to six partners, or ≥ seven partners. To assess depressive symptoms, respondents were asked if a health provider had diagnosed them with depression, and if they experienced depressive symptoms in the prior seven days. Participants were classified as having depressive symptoms if they responded “yes” to the first item or endorsed depressive symptoms “a lot of the time,” “most of the time,” or “all the time.”

Statistical Analysis

To account for the stratified, clustered sampling design and non-response bias, sample weights and survey analysis techniques were applied. Descriptive statistics were calculated and inferential statistics used to test the hypothesis that women with higher BMI or chronic obesity would be more likely to report low relationship satisfaction using multivariate ordered logistic regression models. A cumulative logit link function with a multinomial distribution was used to estimate crude and adjusted odd ratios (ORs) with 95% confidence intervals (CIs) using a robust variance estimator and Taylor series linearization. Hierarchical regression modeling was used with Model 1 estimating crude odds ratios (ORs), Model 2 adjusting for demographic characteristics, and Model 3 further adjusting for relationship factors and depressive symptoms.

We performed sensitivity analyses among women who were currently pregnant (but not married or cohabitating), currently dating, or not currently in a relationship at Wave IV. The latter were asked to consider their most recent romantic partnership when answering the relationship satisfaction items. Bivariate comparisons were performed to assess differences between these women (N=1,657) and those in the main analysis and three hierarchical ordinal logistic regression models were again fit.

Analyses were conducted using SAS (Release 9.4, SAS Inc., NC), and all tests were two- sided with a significance level of p < 0.05.

RESULTS

Most participants were non-Hispanic White (74.8%), had less than a college degree (65.5%), had a household income of $40,000 or more (70.1%), reported four or more lifetime sex partners (64.6%), reported a romantic relationship duration of three or more years (61.8%), and did not report depressive symptoms (79.3%) (see Table 1). At Wave IV, 38.2% of respondents met criteria for a normal BMI, 27.7% had overweight, 26.7% had obesity, and 7.5% had chronic obesity. Almost one in five respondents reported low relationship satisfaction (18.4%), 51.7% reported medium relationship satisfaction, and 29.9% reported high relationship satisfaction.

Table 1:

Sample characteristics, by relationship satisfaction group (N=3,582)

Sample Characteristics Total Sample
N=3,582
n (%) 		Low Satisfaction
n=655
n (%) 		Medium Satisfaction
n=1,871
n (%) 		High Satisfaction
n=1,056
n (%)
Age at Wave IV
 24 – 26 years 538 (19.0) 80 (14.7) 279 (49.9) 179 (35.4)
 27 – 29 years 1848 (49.4) 336 (18.7) 972 (52.0) 540 (29.3)
 30 – 32 years 1196 (31.6) 239 (20.1) 620 (52.3) 337 (27.6)
Race/Ethnicity***
 White, non-Hispanic 2265 (74.8) 350 (15.8)a 1174 (51.8)b 741 (32.5)b
 Black, non-Hispanic 688 (13.5) 184 (27.0)a 360 (51.8)b 144 (21.2)a
 Hispanic 629 (11.7) 121 (25.2)a 337 (51.1)b 171 (23.8)a
Education***
 Less than college degree 2318 (65.5) 512 (22.6)a 1185 (50.2)b 621 (27.2)a
 College degree 1264 (34.5) 143 (10.5)a 686 (54.5)b 435 (35.0)b
Household Income***
 Less than $15,000 204 (6.31) 66 (31.5)a 90 (46.1)b 48 (22.5)a
 $15,000 – $40,000 666 (19.5) 177 (26.2)a 325 (48.4)b 164 (25.4)a
 $40,000 – $75,000 1356 (36.9) 216 (17.3)a 756 (53.2)b 384 (29.4)a
 $75,000 or More 1209 (33.2) 153 (11.1)a 631 (53.5)b 425 (35.5)b
Number of Lifetime Sexual Partners
 1 partner 620 (16.1) 56 (8.8)a 327 (51.5)b 237 (39.7)b
 2 – 3 partners 706 (19.2) 108 (15.4)a 392 (55.1)b 206 (29.5)b
 4 – 6 partners 1053 (29.7) 196 (19.0)a 538 (50.3)b 319 (30.7)b
 7 or more partners 1203 (34.9) 295 (23.9)a 614 (51.1)b 294 (25.0)a
Duration of Current Relationship***
 1 year or less 552 (15.3) 80 (15.3)a 267 (43.9)b 205 (40.8)b
 2 – 3 years 849 (23.0) 134 (14.1)a 457 (53.9)b 258 (32.1)b
 4 – 6 years 1073 (30.1) 213 (19.5)a 553 (53.2)b 307 (27.3)a
 7 or more years 1108 (31.7) 228 (21.9)a 594 (52.5)b 286 (25.6)a
% With Depressive Symptoms* 690 (20.7) 195 (30.1)a 347 (48.8)a 148 (21.1)b
BMI Category***
 Normal BMI at Wave IV 1329 (38.2) 228 (17.3)a 680 (49.9)b 421 (32.8)a
 Overweight at Wave IV 1000 (27.7) 171 (16.8)a 512 (52.1)b 317 (31.0)a
 Obesity at Wave IV only 976 (26.7) 178 (18.5)a 534 (53.4)b 264 (28.1)a
 Chronic obesity 277 (7.5) 78 (29.1)a 145 (53.3)b 54 (17.6)a
Relationship Satisfaction***
 Low 655 (18.4) --- --- ---
 Medium 1871 (51.7) --- --- ---
 High 1056 (29.9) --- --- ---
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1

Percentages may not sum to 100% where there is missing data.

a, b

Notations indicate significant between-group differences, based on pairwise z-tests for proportions or t-test for means. All cells with the same notation were not found to exhibit between-group differences.

*

p<.05

***

p < .001

Bivariate associations with relationship satisfaction

Respondents were more likely to report low relationship satisfaction if they had chronic obesity, were Black or Hispanic (the only non-White racial/ethnic groups examined), or had lower education, lower household income, more than one lifetime sex partner, a relationship duration of ≥seven years, or depressive symptoms (Table 1). Respondents were more likely to report high relationship satisfaction if they were non-Hispanic White, were college educated, were in the highest income category, or did not report depressive symptoms.

Figure 1 shows differences in the proportion of respondents reporting low relationship satisfaction for each BMI category. The proportion reporting low relationship satisfaction was similar among those who met criteria for normal weight at Wave IV (17.3%,), overweight at Wave IV (16.8%), and obesity at Wave IV (18.5%), but was almost twice as high among those who met criteria for chronic obesity (29.1%, p<0.001). The proportion reporting medium relationship satisfaction was the same across all four groups. The proportion reporting high relationship satisfaction was similar among those who met criteria for normal weight at Wave IV (32.8%), had overweight at Wave IV (31.0%), or had obesity at Wave IV (28.1%), but was reduced by almost half among those who met criteria for chronic obesity (17.6%, p<0.001).

Figure 1: Relationship satisfaction by body mass category (N=3,582).

Figure 1:

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* Denotes a significant difference (p<0.001) between the low relationship functioning category for respondents with chronic obesity compared to all other BMI transition groups.

** Denotes a significant difference (p<0.001) between the high relationship functioning category for respondents with chronic obesity compared to all other BMI transition groups.

Associations between BMI category and relationship satisfaction

In all three hierarchical models, only having chronic obesity was associated with relationship satisfaction in adulthood (Table 2). In the unadjusted analysis, women with chronic obesity had 2.13 times the odds (95% CI: 1.56 to 2.89) of reporting low relationship satisfaction compared to those with a normal BMI at Wave IV. After adjusting for demographic characteristics, the adjusted OR (aOR) was attenuated to 1.46 (95% CI: 1.05, 2.05). Further adjusting for romantic relationship history and depressive symptoms did not appreciably change the point estimate (aOR 1.44; 95% CI: 1.03, 2.02).

Table 2:

Unadjusted and adjusted odds and 95% confidence interval (CI) of reporting low relationship satisfaction based on participant characteristics (N=3,582)

BMI category Model 1*
OR [95% CI]		 Model 2**
OR [95% CI]		 Model 3***
OR [95% CI]
 Normal BMI at Wave IV Reference Reference Reference
 Overweight at Wave IV 1.04 [0.85 to 1.28] 0.92 [0.74 to 1.14] 0.90 [0.72 to 1.11]
 Obesity at Wave IV 1.18 [0.97 to 1.43] 0.90 [0.73 to 1.11] 0.83 [0.67 to 1.01]
 Chronic Obesity 2.13 [1.56 to 2.89] 1.46 [1.05 to 2.05] 1.44 [1.03 to 2.02]
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*

Model 1: unadjusted

**

Model 2: adjusted for age, race, ethnicity, education, and income

***

Model 3: adjusted for age, race, ethnicity, education, income, the number of lifetime sexual partners, duration of the current relationship, and depressive symptoms

Sensitivity analysis

When the adjusted analysis was repeated among women who were currently pregnant, currently dating, and not currently in a relationship, the findings were similar. Only women with chronic obesity were more likely to report low relationship satisfaction compared to those with a normal BMI at Wave IV, with the adjusted odds ratio identical to that found among married and cohabitating women (aOR 1.44; 95%CI: 1.13, 1.83).

DISCUSSION

We examined the association between obesity and romantic relationship satisfaction in early adulthood using a nationally representative sample of married and cohabitating women. We found that women with chronic obesity since adolescence were more likely to report low relationship satisfaction than those with normal weight in early adulthood. However, women with overweight or obesity in early adulthood were no more likely to report low relationship satisfaction than those with normal weight in early adulthood. Sensitivity analysis showed similar findings for women who were currently pregnant, currently dating, or not currently in a relationship. This suggests that the factors underlying the association between obesity and relationship satisfaction operate across different types of romantic relationships rather than being uniquely linked to highly committed ones.

The notion that psychosocial adversity experienced during the formative childhood years exerts cumulative and long-lasting effects is hardly new (Nurius, Green, Logan-Greene, & Borja, 2015; Wardian, Thaller, & Urbaeva, 2015). What this study adds is the idea that chronic obesity since adolescence, more than current obesity, is associated with low romantic relationship satisfaction in early adulthood. This finding supports our hypothesis that chronic marginalization experienced by women with obesity predisposes them to be on a developmental pathway marked by worse romantic relationship dysfunction. Subsequent research should examine the durability of the observed effects into later adulthood and identify mitigating factors.

We did not find support for our other hypothesis that current overweight or current obesity would be associated with lower relationship satisfaction. This hypothesis was predicated on prior research showing that women with obesity endorse lower relationship satisfaction than women without obesity (Boyes & Latner, 2009). This discrepancy may relate to key differences between the current and prior studies. A prior study by Boyes and Latner (n=57) included only married couples from New Zealand (Boyes & Latner, 2009); the different sociocultural context and small, non-representative sample may explain some differences in findings. In contrast to our study, Boyes and Latner explored interpersonal factors within dyads, noting that dyads in which the woman (but not the man) had obesity tended to perceive one another as less attractive and less desirable than their ideal mate. This finding is consistent with prior work demonstrating that obesity stigma in the romantic arena is preferentially experienced by women, and that women with obesity may be more willing to accept relationships that are less fulfilling (Cawley et al., 2006; Wingood et al., 2002). It also argues for more research that explores how relationship context may differ among women of different weight indices and among women with and without weight discordance with their romantic partner.

Prior studies examining correlations between obesity and sexuality have almost exclusively examined differences in sexual risk-taking behaviors among women of different weight profiles rather than studying the romantic relationship context within which these behaviors occur (Akers et al., 2009; Averett, Corman, & Reichman, 2013). Furthermore, this research has almost exclusively used current obesity as the predictor. Few studies explore whether obesity trajectories play a role (Dotson, 2014). As our findings demonstrate, this is an important omission. Across the life course, impaired interpersonal functioning (such as negative self-concept) has been well documented among women living with obesity (Mustillo et al., 2012). Mustillo and colleagues found that women with chronic obesity since childhood have the lowest levels of self-esteem in adulthood and that those who became normal weight in early adulthood had self-esteem levels similar to those with chronic obesity. In other words, obesity stigma both persists and lingers. Examining relationship satisfaction from a life course perspective can contribute new perspectives on the origins of obesity-related disparities in reproductive health and relationship functioning (Mishra, Cooper, & Kuh, 2010). Future research should explore the effects of other weight trajectories on romantic relationship satisfaction, paying particular attention to identifying risk as well as protective factors that may serve as intervention targets.

Prior research examining associations between romantic relationship outcomes and obesity has focused on college-aged samples, adults, or married women. Our study provides evidence that a deeper examination of the adolescent precursors of adult romantic relationship functioning is warranted. Such research can help inform sexuality education programs for young people and programs to promote healthy adolescent romantic relationships. Such programs may ultimately yield higher quality adult romantic relationships and improve reproductive health outcomes, particularly in early adulthood when less desirable outcomes, such as unintended pregnancies and sexually transmitted infections, are highest (Centers for Disease Control and Prevention, 2016; Finer & Zolna, 2016). Promoting sexuality education programming is sorely needed in the U.S., as few youth receive medically accurate, comprehensive sexuality education, regardless of BMI (Hall, 2017). Moreover, few youth receive instruction on how to cultivate healthy relationships, leaving them to model what they see in their homes, peer-groups, or community or in the media (Gomez-Lopez et al., 2019).

Finally, we noted that low relationship satisfaction was associated with being Black or Hispanic (the only non-White racial/ethnic groups included in the analysis), lower education, lower income, more lifetime sex partners, greater relationship duration, and depressive symptomatology. Although these bivariate findings are provocative, they are limited by their descriptive nature. Research on the relationship between race/ethnicity and self-reported relationship satisfaction is limited and the findings inconclusive (Bonfils, Rand, Luther, Firmin, & Salyers, 2016; Bryant, 2010; Jackson, Krull, Bradbury, & Karney, 2017). Further inquiry is needed to validate and better understand the social relevance of these associations.

This study has several key limitations. BMI classification relied on self-report. However, these indices were measured in Wave II (one year after Wave I) with highly congruent results. We measured relationship satisfaction at a single point in time, but perceptions of relationship quality change over time; thus, we may have underestimated or overestimated the magnitude of the observed associations (Lavner & Bradbury, 2010). The consistency of our findings in highly committed (main analysis) and less committed (sensitivity analysis) relationships suggests this bias was minimal. Adolescents in the 1990s may differ from today’s youth in important ways. Although obesity remains highly stigmatizing, it is more prevalent today and exists in an era of robust health and social movements to destigmatize obesity. Whether the impact of obesity on adolescents’ psychosocial development differs today from when these data were collected is an area of further study.

Other important limitations have to do with the complex relationships among depression, obesity (particularly how it is defined), relationship context, and race. While we adjusted for depression, our measure does not correlate well with clinical pathology. We controlled for rather than examining differences by race; yet, prior research shows that obesity has more deleterious effects on romantic relationships among White and Hispanic women than Black women (Akers et al., 2009). Stratifying our results by race would have likely uncovered differences; yet, simply stratifying findings would inadequately account for race-based differences. To appropriately consider race requires thoughtfully building models with covariates likely to mediate such differences to appropriately contextualize the findings. Doing so would address a different question than the one we posed. For these reasons and given the paucity of research on our primary question, we focused attention on the relationship between obesity and relationship satisfaction and controlled for race, rather than highlighting race-based differences. We did not control for or examine the potential mediating role of peer or family support during adolescence. Prior work has shown that adolescents with obesity who have strong peer and family support networks have interpersonal experiences similar to their peers without obesity (Hensel, 2016). Finally, we did not examine the role of perceived rather than actual overweight. This is important because prior studies have shown that weight perceptions and misperceptions (discrepancies between actual and perceived weight) may be a stronger predictor of poor sexual health behaviors and outcomes than actual weight (Akers et al., 2016).

IMPLICATIONS FOR PRACTICE AND/OR POLICY

The study findings lend support to policy efforts to prevent obesity in childhood. In addition to the myriad of physical health benefits, obesity prevention could also reduce the negative romantic experiences that women with obesity face. Efforts must also address the root causes of weight-related stigma perpetuated in school yards and among health and social service providers, employers, and the media. The growing trend in programming for youth that educates about healthy relationships should continue to be promoted. Preventing weight-based stigmatization in the media, which influences preferences for dating and romantic partners, is also important, particularly for programming targeted at impressionable young children. Stronger educational programming and healthier media portrayals can improve social norms and reduce weight-based stigma.

CONCLUSIONS

This study provides support for the persistent effects of obesity-related stigma on early adult romantic relationship functioning. Additional research to better characterize how romantic relationships differ among women with and without obesity, and to identify risk and protective factors during adolescence, can inform youth-focused interventions to improve interpersonal relationships.

Acknowledgements:

Dr. Felipe Garcia was the lead statistician, was independent of the funder, had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. This research uses data from Add Health, a project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant (P01-HD31921) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Persons interested in obtaining Data Files from Add Health should contact Add Health, The University of North Carolina at Chapel Hill, Carolina Population Center, 206 W. Franklin Street, Chapel Hill, NC 27516-2524 (addhealth_contracts@unc.edu).

Funding:

This analysis was supported by the Eunice Kennedy Shriver Institute for Child Health and Human Development (5R01HD079419-03).

Conflict of Interest: During the time this work was performed, author Akers received funding for an investigator-initiated grant from Bayer Healthcare, from the Templeton Foundation as a co-investigator on an investigator-initiated grant, and served as a consultant for the Merck Inc. HPV Advisory Board and on the Mylan Women’s Health Advisory Board.

Author biography

Aletha Y. Akers, MD MPH is Vice President for Research at the Guttmacher Institute. When this work was performed, she was an Associate Professor of Pediatrics in the Craig Dalsimer Division of Adolescent Medicine at the Children’s Hospital of Philadelphia (CHOP) and an investigator at PolicyLab, a health policy research center at CHOP. She conducts health services research to improve reproductive health outcomes among adolescents and young adults domestically and globally.

Jennifer Harding, MPA is a project manager with research expertise in child and adolescent health.

Footnotes

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