Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery
Open accessAbstract
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 bootstrapping 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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- Authors
- Aarts, F., Geenen, R., Gerdes, V. E. A., van de Laar, A., Brandjes, D. P. M., & Hinnen, C.
- Affiliations
- Slotervaartziekenhuis (NL)
- Utrecht University (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Aarts, Floor
- Venue
- Obesity Surgery
- Published
- 2014-09-10
- Volume
- 25
- Issue
- 4
- Pages
- 666-672
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W2013491379
- Cited by
- 37
- References
- 49
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 1 · 2017: 6 · 2016: 4 · 2015: 1
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- www.springer.com/tdm (tdm)
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Keywords
- attachment anxiety, dietary adherence
- MeSH terms
- Adolescent, Adult, Aged, Anxiety, Diet, Female, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Morbid, Object Attachment, Patient Compliance, Postoperative Period, Prognosis, Surveys and Questionnaires, Gastric Bypass, Weight Loss, Treatment Outcome, Young Adult, Recommended Dietary Allowances
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