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When Jeanne began to seriously consider taking Zepbound, one of the new-generation weight-loss drugs, she had the briefest of conversations with her husband, Javier. They were in their bedroom at the time, hastily dressing and brushing teeth during that compressed morning interval before their 12-year-old son left for school and Jeanne’s workday began. The exchange was not so much a discussion as the routine conveyance of domestic data, along with the Costco shopping list.
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“I’d like to try this,” Jeanne said to Javier.
“OK,” Javier said.
For both Jeanne and Javier, the decision was easy. Jeanne, who is 53, has struggled with her weight since fifth grade, and blood work from a recent physical exam indicated the worsening of fatty-liver disease. “That was the catalyst,” Javier told me, standing in the large kitchen of their comfortable house in New England, where through a picture window an empty hammock swung wildly in the freezing January wind. From her study nearby, Jeanne was audible on a conference call. At the time of their decision, in late 2023, the effects of the drug were still conceptual, and Javier’s perspective was uncomplicated. He was “all in,” he said. Javier, who is also 53, regards himself as a “glass half full” kind of person, with a deep drive to be helpful to others and a steady support to his wife. “It never occurred to me to ask, Well, what does this mean for us?”
Jeanne took her first dose of Zepbound on March 7, 2024. Since then, she has lost 60 pounds; a recent liver scan showed no signs of disease. Jeanne now uses words like “life-changing” and “miraculous” to describe the results. But neither Jeanne nor Javier (who asked to use their middle names to protect their privacy) could have anticipated the upheaval her use of the medication would create in their 15-year marriage — a disruption that has not just radically changed her weight and her appetites but has also seemingly forced a total renegotiation of their marital terms. They are grappling, minute by minute, with a reconsideration of what they love about each other, how they feel when they look in the mirror, what turns them on. They haven’t had sex since she started Zepbound.
Javier comes across as bewildered by the changes in his wife. He is grieving, he says, the loss of the woman he married, starting with her physical self. “I used to love feeling her body, her big body, next to me in bed, the softness of it. The extra tummy and extra booty was comforting and reassuring,” he says. “I miss that. The voluptuousness, being able to lean up next to her and feel her, for lack of a better word, draping over me or onto me. That’s no longer an option.”
Before prescribing these drugs, responsible clinicians will advise patients of the well-known side effects — diarrhea, constipation, nausea, vomiting, headache — as well as the need for modifications in diet and exercise. They will explain the dosage schedule and may discuss cost. That, more or less, is where the professional guidance ends. But the effects of extreme weight loss on love relationships can be profound. The first and most substantive research related to the subject goes back to 2018, when a team of Swedish epidemiologists published a study of the impact of bariatric surgery on marriage. After surgery, they found, married couples were more likely than those in a control group to divorce or separate, whereas single people were more likely to marry. In couples, “there’s such a drive to keep things the same,” says Robyn Pashby, a clinical psychologist who specializes in issues related to weight loss or gain. “When one person changes, it changes the system. It does break that unspoken contract.”
