Abstract
Previous research has shown that attachment anxiety is a good predictor of body mass index. This relationship is significantly mediated by disinhibited (over-) eating and is likely to reflect a specific form of affect regulation. This study explored whether obese bariatric surgery candidates (BSC; N=34) and bariatric surgery recipients (BSR; N=15) would show higher levels of attachment insecurity (higher attachment anxiety and/or higher attachment avoidance) than a group of age and gender-matched lean controls (N=54). Mediation analyses showed that compared to lean controls (M=2.96, SE=0.1), both BSC (M=3.5, SE=0.2) and BSR (M=3.4, SE=0.2) groups had a more insecure attachment orientation. These relationships were significantly mediated by disinhibited eating (BSC: lower limit confidence interval (LLCI)=0.06 and upper limit confidence interval (ULCI)=0.62; BSR: LLCI=0.02 and ULCI=0.76). There was no such relationship when the BSC and BSR groups were compared (LLCI=−0.15 & ULCI=0.3). These observations suggest that attachment insecurity may be a risk factor for obesity and bariatric surgery because of associated disinhibited eating. Moreover, these factors may be important to consider when bariatric surgery results in poor outcomes.
Highlights
‘Attachment orientation’ reflects an individual’s expectations and beliefs about themselves and their interpersonal relationships
Previous research has shown that attachment 'anxiety' is a good predictor of body mass index (BMI).[5]. This relationship is significantly mediated by disinhibited eating and is likely to reflect a specific form of affect regulation; individuals who are high in attachment anxiety tend to be poorer at regulating their emotions/stress and are more likely to rely on external sources of affect regulation such as food.[6]
We hypothesised that the attachment anxiety and disinhibited eating scores of a lean control group would be significantly lower than bariatric surgery candidates (BSC) and bariatric recipient groups
Summary
‘Attachment orientation’ reflects an individual’s expectations and beliefs about themselves and their interpersonal relationships. Previous research has shown that attachment 'anxiety' is a good predictor of body mass index (BMI).[5] This relationship is significantly mediated by disinhibited eating (general propensity to engage in overeating) and is likely to reflect a specific form of affect regulation; individuals who are high in attachment anxiety tend to be poorer at regulating their emotions/stress and are more likely to rely on external sources of affect regulation such as food.[6] In other words, in the absence of sufficient social reinforcement, food is used instead to manage emotion/ mood Consistent with this finding, recent research has shown that attachment anxiety is associated with measures of binge eating,[7] emotional eating[8] and higher BMI (than reference group)[9] in bariatric surgery candidates (BSCs). We hypothesised that disinhibited eating would significantly mediate group differences in attachment anxiety
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