How Weight-Loss Drugs Can Upend a Marriage

You expect me to fire off some insensitive wisecrack about this? No...I'm not that sort of journalist. I have a deep empathy for the human condition.

I hope they don't ignore me again come Pulitizer time.

How Weight-Loss Drugs Can Upend a Marriage

Doctors warn about their physical side effects, but they can also have unexpected effects on intimacy.

By Lisa Miller

Lisa Miller interviewed more than two dozen people about the effects weight-loss drugs have had on their romantic relationships for this article.

Feb. 2, 2025

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.

“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.”

Jeanne and Javier agree that the past 10 months have been the hardest of their married life — harder than Jeanne’s postpartum depression or their decision that Javier would become a stay-at-home parent who is dependent on Jeanne’s corporate job. Each has been in individual therapy, off and on, for years; since Jeanne started Zepbound, they’re in couples therapy. “I’ve told her: ‘I don’t recognize you. I need a road map,’”Javier says. “I think she’s become a different person.”

Javier’s therapist recently sent him a link to a three-phase curriculum for couples who hope to jump-start their sex life. In the first phase, both partners remain fully clothed. One touches the other everywhere except the erogenous zones, while the receiving partner says what they do and don’t like. Then they switch roles. Jeanne and Javier tried it once, and Javier says he “enjoyed it very much.” But when he asked Jeanne if she wanted to do it again, she said no — she wasn’t ready. “I mean, that’s nerve-racking to me, because how can I reconnect physically with my wife when she doesn’t appreciate or like or want to be touched?” he says. Her body is “something new and exciting for me, and I would like to explore it.”

Jeanne, who leads with a generous smile, feels as if she’s molting. ‘I’m very much in flux,” Jeanne explains. “Like I haven’t caught up to my body.” She says her primary experience of the past year, aside from the radical diminishment of her appetite, has been a discovery of her own boundaries and an ability to assert them. She is a people-pleaser by temperament, and now Jeanne has noticed that it feels easier to say no — at work, in social situations and to extended family, as well as to Javier. The bedroom is where her new boundaries have emerged most clearly. She hasn’t wanted to have sex for at least five years, she told me, but until last March, she complied: “I felt like it was my responsibility, and I wanted to solve this problem.” She told me that she wants to want to have sex, but currently she does not.

Javier speculates that Jeanne’s current lack of interest in sex may be linked to the Zepbound, reasoning that a drug that reduces cravings for food may dampen interest in other pleasures as well. Some small observational studies have shown a reduction in sexual interest, especially among men on the medication. But according to the results of large-scale trials, published in 2024 in Diabetes, Obesity and Metabolism, GLP-1-agonist medications — the class of drugs that mimic the effects of the natural hormone that helps regulate blood sugar, digestion and appetite — can increase sex drive. Jeanne hopes as well that her diminished libido may have another cause: She has been on and off antidepressants since the birth of their child and recently went through menopause.

Their fights, in the meantime, have become more frequent and ferocious. A nothing disagreement over who said thank you and in what tone boils over, then simmers down to a base line détente, Javier retreating to the basement and his collection of state-of-the art Peloton machines and Jeanne to her work. Their fights have “a lot of charge,” Jeanne said in one conversation. Javier agreed. “It’s pent up. It’s something that has been bottled up, and all of a sudden, the dam has broken and it’s coming at you,” he said. “This last year has been very, very, very challenging in many ways.”

‘It never occurred to me to ask, Well, what does this mean for us?’

I spoke to about two dozen people about the effects of GLP-1 medications on their relationships and was struck at how often they referred to the disruption (or anxiety in anticipation of disruption) of ordinary habits established long ago. People talked about missing a cherished cocktail hour, grocery-shopping dates at Wegman’s, regular sex, restaurant meals. “No one wants to take me to dinner and watch me eat half a piece of bread,” one 40-year-old New Yorker told me. Food and physical intimacy are, of course, essential human needs, but they also signify so much more — safety, pleasure, comfort, love, a mutual sense of giving and receiving — so the sudden upset of these routines can translate as a loss of shared identity. Couples spoke about losing a sense of themselves as “foodies” or “party people” or “sexy people” or “athletes” or “the people who eat waffles on weekends.” The most contented couples, who attested to the least domestic friction, seemed to cohabitate with a looseness around the silent expectations of coupledom. They didn’t hold up dinnertime as sacrosanct. They didn’t cling too tightly to preconceived ideas about frequency of sex. They could prepare a prized lasagna without feeling affronted that a formerly voracious partner only nibbles.

More often, though, couples are blindsided by the upheaval the weight-loss drugs can cause — sometimes before anyone takes a single dose. I spoke with two women in Virginia who met as elite, competitive canoe racers. Both are heavyset, but only one qualifies to be prescribed the medication. “I feel worthless and forgotten and left behind,” said the one who can’t get a prescription. Both are anxiously anticipating the disparity in their appetites. A young mother in Ohio, in recovery from an eating disorder, watches with some alarm as her husband fields constant compliments about how great he now looks after losing weight on the medication. A university professor told me that he finds his wife’s bigness erotic, and while he never wants to impose any judgment on her choices concerning her body, he worries about their sexual connection as she becomes smaller. A 29-year-old woman from the South described how losing almost 60 pounds has made her feel suddenly encumbered by her older husband. Now that she feels more attractive and more her own age, her husband — with his overhanging belly and elderly grandmother in need of constant care — holds less appeal, and she is distracted by an ongoing flirtation with a family friend. A lawyer in Washington State left her husband after losing 50 pounds on Zepbound. It dawned on her that her bigger body gave him “a sense of security”: He liked that she did not feel confident or attractive, she told me. “He was like: ‘Cool. She’s not going to leave me.’”

I spoke to a couple in Orlando, Fla., who were struggling to rebalance their once-predictable home life. Vincent Hsu was prescribed Mounjaro in December 2022, after his diabetes markers rose to a concerning level. Hsu, who is a physician in Orlando, has since lost 40 pounds, an achievement that has made him feel “like I have powers I never had before,” he told me on a video call. A casual runner when he was heavier, Hsu joined a running club with hospital colleagues in the spring of 2023. Since then, he has run six half marathons and two full marathons and — lighter now and without joint pain — was quick enough to win an age-group prize. Talking about the blanket he won in the Air Force Half Marathon in September 2024, he looked like a proud child, gazing away from the camera on our video call, then up at me beaming. “I just never thought that I could win awards for physical activity, you know, and I was almost in tears.”

The weight loss and running have caused tension in his marriage. “Grace will say things like: ‘What? You’re running again?’” Onscreen, Grace, a nurse administrator who is a little bit plump, was seated behind him and started to laugh. At his skinniest, Hsu, who is 5-foot-10, had dropped to 125 pounds. “Vincent thought it was attractive,” Grace explained, “but no, he was starting to look gaunt, like an old man.” He was always running and was cranky at home, and Grace became worried about him. His libido dwindled, and so did their sex life. When she grabbed his butt, she could feel bone.

Under pressure from his wife, and on their shared, untested theory that the loss of muscle mass had depleted his testosterone, Hsu started weight training and boosting the protein in his diet. He has also begun to space out his doses of Mounjaro more than his doctor prescribes and has regained 10 pounds. Neither of the Hsus would say the sex is back to its previous levels, but it is more frequent, and the quality, Grace assured me, is good. But Hsu, who is a medical doctor, remains astonished at the silence around the topic of weight-loss drugs and intimacy. “You’re going to have to manage your relationships,” he said. “And I did not recognize this before.”

In conversations with her therapist, Jeanne is beginning to understand that her anger at Javier is erupting in the context of her fury at the wider world, where she feels newly visible and acceptable. She has worked at her job for four years, but the marketing department has only recently discovered her skills as a public speaker. It is offering her to the media as a talking head, and her bosses are asking her, with increasing frequency, to explain department goals and strategy to the board and senior management. The exposure has been great for her contact list — so good, in fact, that she is considering a job change. “But I feel like there’s this different perception of me, when I’m the same person,” she says. “I’m just 60 pounds lighter.”

Recently she was traveling home in the window seat on a flight from Chicago. It had been a long day, Jeanne was tired and the man next to her said, by way of opening chat, “I’m so glad I’m sitting next to a small person.” Then he went on to elucidate his discomfort when seated between two passengers who are big — as if, as Jeanne understood it, they were both members of the small team. “And so, on the one hand: ‘Yay! I’m a small person!’” Jeanne says. But she was also “really pissed off,” because the man’s comments confirmed her darkest, most perpetual fear: that the countless times she has been on a plane “trying to have a nice conversation” and leaning away from her seatmate so as not to “ooze over the arm,” all the seatmate was thinking was, “I’m just stuck next to this fat person.”

Now that Jeanne is thin, her fury is omnipresent; she can see the exact extent to which the world blames and recoils from people who are big. When holding hands in public with Javier, Jeanne admits that now “I feel less embarrassed.” She’s no longer guarding against the disapproving looks directed at her — and also at him. “It’s like you’re not with — I’ll use the ‘fat’ word — a fat person.” Jeanne says to Javier: “I always thought about how somebody would see you. Especially at your most fit. They would think, What is he doing with her?”

Jeanne and Javier went to high school together and had a mutual crush. “I was 17 and fat,” Jeanne recalls; already she had learned to compensate for her weight by always being supernice, as well as reliable and competent. She worked on the yearbook and the school newspaper and in the student government, and when Javier expressed interest in her back then, Jeanne could not believe he was sincere. Javier was also big, and as a teenager he developed a habit of smoothing the front of his polo shirt when he sat down so it didn’t bunch up and accentuate his belly. But he was a football player, an offensive lineman. He was proud, he says, puffing out his arms, of feeling big and strong. When they reconnected 20 years later, after their first marriages ended, Javier was the heaviest he had ever been, at about 260 pounds. Jeanne, who was attending boot camp five days a week, was at her thinnest — 160 pounds.

‘When one person changes, it changes the system. It does break that unspoken contract.’

The first time they had sex, Javier remembers feeling surprised that Jeanne came across as so bold. He thought that she might be shy. “I was delighted that she had no problem disrobing before me. She didn’t say, ‘Don’t look at me’ or ‘I’m ashamed of this’ or ‘My boobs are too big’ or ‘My butt is too big’ or ‘I don’t like this roll,’” he says. “So I kind of assumed she was happy in her body.”

With Javier sitting beside her, I asked Jeanne about her memory of their first time. “I’m always self-conscious,” she said. “But, I mean, I had this crush on him. For 20 years. And here we are. It’s like a dream come true. So I think I was just happy in the moment, but probably horrified by how I looked.”

No, Javier insisted, adamant now, disbelieving. “You made yourself very vulnerable,” he said. As he remembers it, Jeanne made no move to hide or cover herself. “We were dancing naked.”

“I don’t remember that,” Jeanne said.

What she does remember acutely are the decades of grueling dieting, boot camps and triathlon training, the years she spent cringing and condemning herself for being unable to maintain weight loss. “I didn’t have the willpower or the determination,” she says, “or I didn’t want it badly enough.”

This new class of weight-loss medications has the potential to upset widespread assumptions not just about disease and intervention but also about the locus of self-control. While their effects on behavior are not yet fully understood, they have been shown to be useful in treating addiction to alcohol and, in rats, a dependence on cocaine. Anecdotally, users report reductions in other compulsions, including shopping, binge eating and hair pulling. Whether the drugs work directly on brain chemistry in these instances, or whether the ability to control eating opens a door to other kinds of self-discipline, is not known. But for some people it can feel as if the drugs are “empowering them to have more autonomy” over their lives, “or control over things that they may have been struggling with,” says Scott Hagan, an internist at the University of Washington who researches and frequently prescribes the drugs.

A close friend of mine described the “utter helplessness” he used to feel when faced with a plate of French fries. To inject oneself with a medicine and then be able to decide to eat just five fries and leave the rest feels like a miracle, he explained. And in light of that miracle, what other improvements or breakthroughs might people be capable of with pharmaceutical help? “When people start losing weight — I’m not pretending this is a good thing — they tend to think into a higher level of self-worth,” says Pashby, the psychologist. “What does it mean to lean into feeling good about yourself? It changes everything in your life. Do you go for the promotion? Fool around with the guy? Do you show up at the party? Go to the gym?”

For Jeanne, that means tapping into a truer sense of herself. During the pandemic, she began to realize the degree to which her extroverted personality was an adaptation she made to be more pleasing. Once quarantine gave her permission to sit on the couch with her Kindle, she was amazed at how much she liked it. Now that she is thinner, she is nurturing her inner homebody, preferring, on business trips, to read in her hotel room rather than carouse at the restaurant. She is consigning some of her Louis Vuitton handbags and is considering trading her Porsche coupe for a Subaru. She no longer needs to gild herself so that others will admire her.

Jeanne and Javier used to enjoy drinking alcohol together; they stored their wine collection in a 200-bottle fridge and loved ritualistically marking the end of a day by uncorking a bottle. And then Zepbound ruined Jeanne’s taste for alcohol.

Now when they are invited to game night at their friends’ house, Jeanne negotiates their departure time before they leave. They frequently used to stay and drink past midnight. “I could go to 1 or 3 or whatever,” Javier says. These days, they settle on 11 p.m. at the latest.

“I’m doing mocktails now,” Jeanne says. “Other people start getting sloppy drunk, and I just … ” she trails off and shrugs. She doesn’t miss the late nights or the lost sleep, but she feels as if she isn’t fun. “Do we match anymore?” she asked aloud. Javier is “the life of the party. Everybody loves him. I was never that. And I am less of that now.”

Javier says he doesn’t begrudge her sobriety — he’s drinking less, too, and he sees the benefits — but still he chafes at their new routine. He misses the days when an evening with other couples used to wind down organically and they would ramble home.

“I think he misses his drinking buddy,” Jeanne said.

Jeanne, Javier and I had dinner one night at a traditional old New England place with a roaring fire and four kinds of steak. They navigated the menu carefully and settled on sharing the filet mignon. At dinner, Jeanne told me she intends to start doing volunteer advocacy work on behalf of people with obesity. During the pandemic, she enrolled online at George Washington University, receiving a master’s degree in public-health policy. And it was there that she became fluent in the cultural and political arguments around obesity, the face-off between those who consider it a chronic, largely genetic condition — a disease — and those who see it as a moral failing, a dereliction of discipline, healthy habits and will. She and Javier began exploring their differing approaches to the use of medication before she started taking the drug, within the relative safety of an intellectual debate.

Every time they have this conversation, “it’s turned into a fight,” Javier said at dinner, before eagerly going into a clarification of his position. Javier used to believe that obesity and being overweight could be managed solely through exercise and diet, he said. He was a calories-in-calories-out kind of guy. But he insists that his experience of living with Jeanne, watching her gain and lose as much as 70 pounds over and over, has changed his mind. He is now 100 percent on Team Jeanne, he said, and calls the new drugs “a godsend.” He pressed on. Even when his thinking was immature and he did regard weight gain as a failure of discipline, he never considered people in bigger bodies to be failures themselves.

‘When people start losing weight — I’m not pretending this is a good thing — they tend to think into a higher level of self-worth.’

Javier is obviously gratified by the work he puts into managing his weight and health. He spends as many as two hours each day in the basement with his Peloton machines and finishes in the top 10 percent of almost any class he takes. He maintains a resting pulse of 45 and doesn’t mind his belly, as long as he is strong. This belief in hard work and discipline infuses the family culture. Javier concedes that he used to encourage Jeanne to be more active in order to lose weight. He wishes the family would order less Grubhub. And he maintains some principled reservations about the drugs. “I think there’s still a lot of unknowns out there,” he said. “What’s it going to be like five, 10 years from now? It’s a novelty. Everyone’s jumping into it.”

But Javier finds it hard to say these things aloud without provoking a fight, and at dinner, he recollected a particular argument they had last summer. They were on vacation in Mexico, alone in the car and discussing their son. He is big, too. Both of his parents are anxious about his health. And they agree that they want to help him build good habits without also instilling shame around food or his body. In Mexico, as they were driving, Javier began to fret over what he saw as their son’s lack of willpower. Unthinking, he said, “He thinks it’s as easy as taking a pill.”

“And I got so angry,” Jeanne interjected in the restaurant.

Jeanne saw Javier’s reflexive comment as proof of her fear. Despite his avowals of wholehearted support, she believes that her husband revealed, in that moment, his deep-seated disapproval of her decision to take a weight-loss drug — “that what I’ve done is the easy button,” Jeanne told me.

At the table, in front of the fire, the tension between them rose, as if recalling the fight reignited it. Javier prickled that Jeanne took offense. “I’m her husband,” Javier said, looking at me. “I’m her partner.” He looked at Jeanne. “I’ve supported you in this path.” Why, he asked her, would he say anything to intentionally hurt her? For Javier, it felt as if the changes in their family were happening too fast — that their marriage was in a tenuous place. Suddenly, he felt, Jeanne held all the cards and their future wasn’t “up to him.”

Jeanne grew subdued as Javier pressed on. What about their son? he asked. Had she heard him say he wants to try weight-loss drugs? And there, in the cheerful hubbub of the restaurant, the crack between them widened.

She had, she conceded. In fact, Jeanne and Javier had spoken briefly about having him see a pediatric-obesity specialist, and she had made an appointment for later in the year. Sure, she said aloud, she agreed with Javier. Their child needed to sign up for a sport, any sport. He needed to eat fewer bagels, less Nutella. But she did not see the drugs as out of the question. “I worry about his weight, and having lived with body-image issues my whole life, it breaks my heart.”

“Mine, too,” Javier said.

The possibilities and consequences of weight-loss medication, which just a year ago had been abstract, now had bearing not only on Jeanne’s body and the mood of their marriage but also on the future health and happiness of their child. Javier is not in total opposition to the drugs, but he does see them as a last resort — after hormone-level tests, diet and exercise modifications and counseling. Jeanne is more attuned to helping their son silence the “food noise” that has defined her life. Both are nervous about introducing these drugs to their teenager. And this inevitably raised the stakes on everything in their marriage — the accumulation of leftovers in the fridge, the fact that Jeanne’s mother lives with them. It all became a potential conflict. Arguments, Javier said, “go from 0 to 60.”

Previously, Jeanne and Javier told me that they were working on their marriage, with the sexual disconnect as their priority and focus. At dinner they uttered the word “divorce.” It turned out the subject had come up before. After one of their fights, Jeanne, on her way upstairs from the basement, yelled, “‘Oh, and by the way, just so you know, my therapist suggested I talk to a divorce attorney just to know what my options are,’” Javier recalled. “Just to add more fuel to the flame.”

When I asked them to assess the health of their marriage, Javier maintained that they were invested in being a couple, raising their son together, having a future. He imagined them in five years, thinking about downsizing after their child went off to college. Jeanne told me she dreamed of traveling more, maybe cycling with Javier, maybe climbing Machu Picchu. “I don’t want to continue to be angry to the point where it damages our relationship,” she said.

“And I don’t want to be the punching bag,” Javier said.

A very long pause followed. Jeanne had angled herself slightly away from her husband. We were waiting for the server to pack up the leftover steak. “I am choosing to be quiet,” she finally said.