New research shows that weight stigma—and not weight itself—has the biggest impact on mental health and healthy behaviors in the years after weight-loss surgery.

Researchers found that patients who had gone through weight-loss surgery tended to experience much less weight stigma, and that this reduction in weight stigma—but not lower BMI—was associated with healthier eating habits and better mental health. On the other hand, continuing to experience stigma after surgery was associated with higher risks of depression, anxiety, and disordered eating.

“We think of a lot of health issues for these patients as being a given,” says Larissa McGarrity, PhD, the first author on the study and a clinical psychologist in physical medicine and rehabilitation at University of Utah Health. “But the cumulative effect of stigma and discrimination actually contributes to a large part of the physical and mental health problems that we disproportionately see for patients with obesity compared to the general population.”

The results are published in Health Psychology.

How weight-loss surgery affects quality of life

Metabolic bariatric surgery, commonly called weight-loss surgery, is the most effective evidence-based treatment for severe obesity. It reduces many health risks that are more common in people with obesity, including type 2 diabetes, heart disease, and all-cause mortality risk.

But many people expect weight-loss surgery to be a panacea for quality of life, and that’s not true. Some aspects of life, like social support and satisfaction with romantic relationships, tend to get worse.

People tend to experience significantly lower levels of weight stigma—shame, blame, and guilt around their body weight or shape—in the years following surgery, the researchers found in a survey of nearly 150 people.

McGarrity, who is also an associate professor in the Spencer Fox Eccles School of Medicine at the University of Utah, says that the change in experienced weight stigma was striking. “The degree of change far exceeded clinically established norms in terms of what’s meaningful for a patient’s life and the impact they would notice,” she says.

This reduction in weight stigma was linked to notable improvements in both mental and physical health. Previous research had established that the chronic stress of weight stigma directly contributes to many of the health risks associated with obesity, and sure enough, people who experienced less stigma in the years following surgery had lower levels of anxiety and depression. They were also less at risk for disordered eating, such as binge eating. And people who experienced less weight stigma were more likely to lose more weight and maintain the loss.

Lingering risks

Importantly, McGarrity notes, weight loss itself wasn’t associated with these positive changes to health. Change in BMI did not correlate with depression, anxiety, or dysregulated eating—implying that social factors, rather than innate biological ones, make a huge contribution to the mental and physical health of people with obesity.

And not every patient who went through weight loss surgery experienced a decrease in bias and stigma. For about 40% of patients, weight stigma continued to impact their quality of life, leading to increased risk of mental health concerns, disordered eating, and weight recurrence.

Since the survey targeted patients who were treated at U of U Health, future research will be needed to test whether the results hold true in broader populations.

The researchers say their work emphasizes the critical need to reduce weight stigma, both within health care settings and without. “The wide-ranging effects of weight stigma are one of the most important things I’m thinking about from both a research and clinical perspective,” McGarrity says. “Weight loss is helpful for a whole lot of things, but that change in weight stigma may actually be the more powerful thing for mental health and quality of life over time.”

Higher levels of wellbeing may help reduce the risk of memory loss in middle age, suggests new research, which tracked more than 10,000 over 50-year-olds across a 16-year span.

Findings that are published in the peer-reviewed journal Aging & Mental Health found those who said they had higher wellbeing were more likely to subsequently have better scores on memory tests.

These people – all of whom were determined as having ‘healthy brains’ – also reported a greater sense of control, independence, and freedom to make choices.  

This association between psychological wellbeing and better recall was small but significant. The link was also independent of depressive symptoms, according to the researchers.

However, the analysis by a cohort of 15 experts across the UK, US and Spain found no evidence to suggest better memory was linked with later higher wellbeing, although the authors say the possibility cannot be discounted.

The academics add that the results highlight that psychological and social factors affect brain health, and wellbeing may protect against cognitive impairment. Interventions to promote psychological wellbeing such as mindfulness could maintain mental functions such as memory as people age.  

“In the context of an ageing population, understanding factors that may protect and maintain healthy cognitive function is critical for enhanced population health and health policy development,” explains lead author Dr Amber John, a Lecturer in Psychology at the University of Liverpool and a current Alzheimer’s Research UK Fellow, who specialises in research on ageing, with a specific focus on mental health, neurodivergence, and dementia.

“While, in this research, we can’t examine and understand the relationship between causes and effects, determining if one event leads to another (causality), our findings are important in proposing that good wellbeing predates better memory rather than vice versa. This suggests that the link between wellbeing and memory is not just because people with poor memory have poor wellbeing and that, if causality is demonstrated, improving wellbeing could protect against subsequent memory decline.”

Co-author Joshua Stott, a Professor of Ageing and Clinical Psychology at UCL, adds: “This study represents an important step toward understanding the interplay between wellbeing and memory over time. It offers new insights into how self-rated wellbeing is associated with memory and vice versa.

“While our findings are preliminary, they highlight the importance of considering psychosocial influences on brain health such as memory.”

Depression and anxiety are widely recognised as risk factors in faster decline of brain health and dementia. A key global healthcare priority is now to prevent dementia.

Wellbeing is defined as emotional health combined with being able to function effectively. Happiness, confidence, a sense of purpose and control over life are among the elements of wellbeing.

Existing studies have suggested a positive link between wellbeing, age-related decline in mental processes in the brain, and mild impairment of these functions. Memory is regarded as a cornerstone of an individual’s mental processes.

However, most studies have only tested this link between wellbeing and memory in one direction or another. The aim of this research was to provide longer-term insights into the relationship between wellbeing and memory in people who have yet to experience significant cognitive decline.  

Data was based on 10,760 men and women who took part in the English Longitudinal Study of Ageing Self-reported. This existing long-term research project involves UK adults over the age of 50 and includes attitudes to well-being.

Participants were assessed on wellbeing and memory every two years – a total of nine times during the 16-year study period stretching back to 2002.

Researchers used a learning task to check participants’ ability to recall ten words immediately and after a delay. Wellbeing was assessed using a quality-of-life questionnaire. Participants scored themselves based on satisfaction of specific needs – pleasure, control, autonomy, and self-realisation. Questions included ‘I can do the things that I want to do’, and ‘I feel that life is full of opportunities’.

The authors excluded anyone with a dementia diagnosis at the start of the study.

Results showed a small but significant association between higher wellbeing and better memory. In addition, the study found that the impact of wellbeing on memory was significant even after adjusting for depression. The authors say this suggests links between wellbeing and memory exist independent from depressive symptoms.

Biological factors such as cardiovascular disease and those linked to lifestyle – such as physical activities – are among possible reasons for the effect of wellbeing on memory, say the authors. Age, gender, lifestyle, and socioeconomic status may also have a negative or positive impact on the relationship between wellbeing and memory function.

Despite the lack of evidence for memory affecting wellbeing, the authors say this cannot be ruled out. They say lower psychological wellbeing may be a sign of ‘oncoming cognitive impairment’ before symptoms become apparent.

The research was funded by Alzheimer’s Research UK; Medical Research Council (a part of UKRI); National Institute on Aging; and National Institute for Health and Care Research (NIHR).

Emma Taylor, Information Services Manager at Alzheimer’s Research UK, comments: “Loving your heart, staying sharp and keeping connected are key to protecting our brain health as we age. 

“There are 14 established health and lifestyle risk factors for dementia, including lack of physical exercise, social isolation, and depression, which are linked to wellbeing. 

“This study found that people over 50 who reported they felt happier and more fulfilled in life had a better memory over time. However, this research is observational – and more work is needed to understand how a positive wellbeing and memory are connected and whether this has a knock-on effect on dementia risk.

“Looking after our mental wellbeing plays an important part in our overall health. And it’s never too late to start taking steps to keep our brains healthy throughout our lives and lessen the devastating impact of dementia.”

As with all long running longitudinal studies, one limitation of this paper is sample attrition over the follow-up period. However, the team used a research methodology which enabled use of use of all available information in the observed data, without imputation or discarding cases.

To conclude, authors say their results could provide the basis for further research into what factors can enhance brain health in aging populations.

Co-author Dr Emily Willroth, an Assistant Professor of Psychological & Brain Sciences at Washington University, in St Louis, Missouri, adds: “Going forwards it would be fantastic if this research can build on the foundations of ongoing memory research to potentially inform strategies supporting cognitive health in ageing populations – that is the aim.”

It’s no secret that women often become less interested in sex with age. However, orgasm and satisfaction have been shown to not decline significantly with age. A new study suggests regular sexual activity may limit vulvar pain, irritation, and dryness, which are all common reasons women have less sex as they get older. Results of the study are published in Menopause, the journal of The Menopause Society.

Estrogen deficiency during and after menopause may reduce the life expectancy of women and impair their quality of life through a condition called genitourinary syndrome of menopause (GSM). In 2014, GSM was defined as a collection of symptoms and signs associated with decreased estrogen and sex steroid levels. GSM includes genital, sexual and urinary symptoms—all of which can affect the frequency of sexual activity for women aged in their 40s to 70s.

In this study involving more than 900 women aged 40 to 79 years, researchers sought to examine the association between sexual regularity and vulvovaginal-related problematic menopause symptoms. The vulva refers to the external female genitalia, and the vagina to the internal anatomy. Common problems experienced with menopause include itching, burning, pain, decreased lubrication, and changes in skin appearance.

Engaging in sexual activity in the past 3 months was defined as regular sexual activity, whereas engaging in sexual activity in the past year (but not in the past 3 months) was considered lower sexual activity. Not surprisingly, the researchers confirmed that the proportion of women having regular sexual activity decreased significantly with age, which aligns with the fact that Female Sexual Function Index scores for sexual desire, arousal, and lubrication also significantly decreased with age. The Female Sexual Function Index consists of 19 questions on female sexual function under six domains. Noteworthy, however, was that the scores for orgasm and satisfaction did not change with age.

Based on the results of the study, the researchers determined that some sexual functions and symptoms change with age but may be maintained in women who engage in more regular sexual activity. This study also revealed that women with regular sexual activity showed a low prevalence of GSM-related symptoms.

Study results are published in the article “Cross-sectional study of the association between regular sexual activity and sexual function and genitourinary syndrome of menopause-related symptoms.”

“The findings highlight the importance of diagnosing and treating GSM. Only 2.9% of the participants reported using hormone therapy. Local low-dose vaginal estrogen therapy is safe and highly effective at alleviating bothersome vulvovaginal symptoms contributing to pain and avoidance of intercourse. And although optimal sexual health is integral to overall well-being, it is also imperative to recognize the effect these symptoms can have on women who aren’t sexually active. Treatment should be offered to anyone with symptoms, whether engaging in sexual activity or not. Normalizing use of local low-dose estrogen therapy should be a thing,” says Dr. Monica Christmas, associate medical director for The Menopause Society.