Weight loss surgery (WLS) patients can encounter diverse relationship issues as they consider, undergo, and live with bariatric surgery. This article explores ways in which WLS affects romantic relationships before and after surgery, as well as provides suggestions for clinicians to assist patients to plan healthy lifestyle changes within the context of a romantic partnership. WLS issues for couples can stem from the patients' and their partners' expectations, the patients' increase in energy, their enhanced confidence, and changes in appearance. Changes in sexual intimacy and beliefs about the stability of the relationship and risk of divorce after WLS are also common concerns. Overall, research suggests that WLS patients report improvements in relationship satisfaction and weight-related sexual quality of life after surgery, while experiencing minimal disruption to their marital relationships. Finally, suggestions are made for providers working with WLS patients on their relationship issues. These suggestions pertain to communication, the importance of accurate information, recruiting support, and obtaining psychological counseling when needed. © Copyright 2008, Mary Ann Liebert, Inc.