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Attachment Anxiety Predicts Poor Adherence to Dietary Recommendations: an Indirect Effect on Weight Change 1 Year After Gastric Bypass Surgery

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Abstract

Background

Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients’ attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whether attachment representations are associated with dietary adherence, (2) whether dietary adherence and weight loss are correlated and (3) whether dietary adherence mediates the relation of attachment representations with weight reduction after gastric bypass surgery. Besides attachment representations, psychological problems are examined.

Methods

This longitudinal study included 105 patients who had a laparoscopic Roux-en-Y gastric bypass operation. Current and past psychological problems and attachment representations were assessed before surgery. Dietary adherence was assessed 6 and 12 months postsurgery. Patients’ weight and height were collected from medical records. Multiple linear and logistic regression analyses and mediation analyses using bootstrap** resampling procedures were conducted.

Results

Of all examined predictor variables, attachment anxiety, i.e. fear of social rejection and abandonment, was most strongly associated with low dietary adherence at both 6 months (p = 0.009) and 12 months (p = 0.006) postsurgery. Dietary adherence 6 months postsurgery was associated with weight loss 1 year after the operation (p = 0.003). Dietary adherence at 6 months (β = 0.51; 95 % confidence interval (CI) = 0.19–1.04) mediated the association between preoperative attachment anxiety and postoperative weight loss.

Conclusions

The results suggest that more anxiously attached patients are less adherent to dietary recommendations 6 months after gastric bypass surgery, influencing weight loss in a negative way during the first year after surgery.

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Acknowledgments

Conflict of Interest

Floor Aarts, Rinie Geenen, Victor E.A. Gerdes, Arnold van de Laar, Dees P.M. Brandjes and Chris Hinnen declare no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

    Floor Aarts, Victor E. A. Gerdes & Dees P. M. Brandjes

  2. Department of Medical Psychology/Hospital Psychiatry, Slotervaart Hospital, Amsterdam, The Netherlands

    Floor Aarts & Chris Hinnen

  3. Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands

    Rinie Geenen

  4. Department of Vascular Medicine, Academic Medical Centre (AMC), Amsterdam, The Netherlands

    Victor E. A. Gerdes & Dees P. M. Brandjes

  5. Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands

    Arnold van de Laar

  6. Health Psychology Section, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

    Chris Hinnen

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  1. Floor Aarts
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Correspondence to Floor Aarts.

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Aarts, F., Geenen, R., Gerdes, V.E.A. et al. Attachment Anxiety Predicts Poor Adherence to Dietary Recommendations: an Indirect Effect on Weight Change 1 Year After Gastric Bypass Surgery. OBES SURG 25, 666–672 (2015). https://doi.org/10.1007/s11695-014-1423-7

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  • DOI: https://doi.org/10.1007/s11695-014-1423-7

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