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25-04-2024 | Bariatric Surgery | Original Contributions

Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery

Authors: Susan Wnuk, Batool Azim, Tim H. Guimond, Lorraine Gougeon, Sanjeev Sockalingam

Published in: Obesity Surgery

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Abstract

Purpose

Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery.

Materials and Methods

We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used.

Results

Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor.

Conclusion

Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.

Graphical Abstract

Literature
1.
go back to reference DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–9.PubMedCrossRef DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–9.PubMedCrossRef
3.
go back to reference Toussi R, Fujioka K, Coleman KJ. Pre- and postsurgery behavioral compliance, patient health, and post-bariatric surgical weight loss. Obesity. 2009;17:996–1002.PubMedCrossRef Toussi R, Fujioka K, Coleman KJ. Pre- and postsurgery behavioral compliance, patient health, and post-bariatric surgical weight loss. Obesity. 2009;17:996–1002.PubMedCrossRef
4.
go back to reference Hood MM, Corsica J, Bradley L, et al. Managing severe obesity: understanding and improving treatment adherence in bariatric surgery. J Behav Med. 2016;39:1092–103.PubMedCrossRef Hood MM, Corsica J, Bradley L, et al. Managing severe obesity: understanding and improving treatment adherence in bariatric surgery. J Behav Med. 2016;39:1092–103.PubMedCrossRef
5.
go back to reference Robinson AH, Adler S, Stevens HB, et al. What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? SOARD. 2014;10:697–704. Robinson AH, Adler S, Stevens HB, et al. What variables are associated with successful weight loss outcomes for bariatric surgery after 1 year? SOARD. 2014;10:697–704.
6.
go back to reference Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg. 2007;246:1034–9.PubMedCrossRef Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg. 2007;246:1034–9.PubMedCrossRef
7.
go back to reference Yanos BR, Saules KK, Schuh LM, et al. Predictors of lowest weight and long-term weight regain among Roux-en-y gastric bypass patients. Obes Surg. 2015;25:1364–70.PubMedCrossRef Yanos BR, Saules KK, Schuh LM, et al. Predictors of lowest weight and long-term weight regain among Roux-en-y gastric bypass patients. Obes Surg. 2015;25:1364–70.PubMedCrossRef
8.
go back to reference Raftopoulos I, Bernstein B, O’Hara K, et al. Protein intake compliance of morbidly obese patients undergoing bariatric surgery and its effect on weight loss and biochemical parameters. SOARD. 2011;7:733–42. Raftopoulos I, Bernstein B, O’Hara K, et al. Protein intake compliance of morbidly obese patients undergoing bariatric surgery and its effect on weight loss and biochemical parameters. SOARD. 2011;7:733–42.
9.
go back to reference Noria SF, Shelby RD, Atkins KD, et al. Weight regain after bariatric surgery: Scope of the problem, causes, prevention, and treatment. Curr Diab Rep. 2023;23:31–42.PubMedPubMedCentralCrossRef Noria SF, Shelby RD, Atkins KD, et al. Weight regain after bariatric surgery: Scope of the problem, causes, prevention, and treatment. Curr Diab Rep. 2023;23:31–42.PubMedPubMedCentralCrossRef
10.
go back to reference Wheeler E, Prettyman A, Lenhard MJ, et al. Adherence to outpatient program postoperative appointments after bariatric surgery. SOARD. 2008;4:515–20. Wheeler E, Prettyman A, Lenhard MJ, et al. Adherence to outpatient program postoperative appointments after bariatric surgery. SOARD. 2008;4:515–20.
12.
go back to reference Taube-Schiff M, Van Exan J, Tanaka R, et al. Attachment style and emotional eating in bariatric surgery candidates: the mediating role of difficulties in emotion regulation. Eat Beh. 2015;18:36–40.CrossRef Taube-Schiff M, Van Exan J, Tanaka R, et al. Attachment style and emotional eating in bariatric surgery candidates: the mediating role of difficulties in emotion regulation. Eat Beh. 2015;18:36–40.CrossRef
13.
go back to reference Shakory S, Van Exan J, Mills JS, et al. Binge eating in bariatric surgery candidates: the role of insecure attachment and emotion regulation. Appetite. 2015;91:69–75.PubMedCrossRef Shakory S, Van Exan J, Mills JS, et al. Binge eating in bariatric surgery candidates: the role of insecure attachment and emotion regulation. Appetite. 2015;91:69–75.PubMedCrossRef
14.
go back to reference Aarts F, Geenen R, Gerdes VE, et al. Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery. Obes Surg. 2015;25:666–72.PubMedCrossRef Aarts F, Geenen R, Gerdes VE, et al. Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery. Obes Surg. 2015;25:666–72.PubMedCrossRef
15.
go back to reference Sunil S, Santiago VA, Gougeon L, et al. Predictors of vitamin adherence after bariatric surgery. Obes Surg. 2017;27:416–23.PubMedCrossRef Sunil S, Santiago VA, Gougeon L, et al. Predictors of vitamin adherence after bariatric surgery. Obes Surg. 2017;27:416–23.PubMedCrossRef
16.
go back to reference Sockalingam S, Cassin S, Hawa R, et al. Predictors of post-bariatric surgery appointment attendance: the role of relationship style. Obes Surg. 2013;23:2026–32.PubMedCrossRef Sockalingam S, Cassin S, Hawa R, et al. Predictors of post-bariatric surgery appointment attendance: the role of relationship style. Obes Surg. 2013;23:2026–32.PubMedCrossRef
17.
go back to reference Bowlby J. Attachment and loss, vol. 1: Attachment. New York: Basic Books; 1969. Bowlby J. Attachment and loss, vol. 1: Attachment. New York: Basic Books; 1969.
18.
go back to reference Hunter JJ, Maunder RG. Using attachment theory to understand illness behavior. Gen Hosp Psychiatry. 2001;23:177–82.PubMedCrossRef Hunter JJ, Maunder RG. Using attachment theory to understand illness behavior. Gen Hosp Psychiatry. 2001;23:177–82.PubMedCrossRef
19.
go back to reference Maunder RG, Hunter JJ. Attachment relationships as determinants of physical health. J Am Acad Psychoanal Dyn Psychiatry. 2008;36:11–32.PubMedCrossRef Maunder RG, Hunter JJ. Attachment relationships as determinants of physical health. J Am Acad Psychoanal Dyn Psychiatry. 2008;36:11–32.PubMedCrossRef
20.
go back to reference Maunder RG, Hunter JJ. Assessing patterns of adult attachment in medical patients. Gen Hosp Psychiatry. 2009;31:123–30.PubMedCrossRef Maunder RG, Hunter JJ. Assessing patterns of adult attachment in medical patients. Gen Hosp Psychiatry. 2009;31:123–30.PubMedCrossRef
21.
go back to reference Leung SE, Wnuk S, Jackson T, Cassin SE, Hawa R, Sockalingam S. Prospective study of attachment as a predictor of binge eating, emotional eating and weight loss two years after bariatric surgery. Nutrients. 2019;11(7):1625. https://doi.org/10.3390/nu11071625. Leung SE, Wnuk S, Jackson T, Cassin SE, Hawa R, Sockalingam S. Prospective study of attachment as a predictor of binge eating, emotional eating and weight loss two years after bariatric surgery. Nutrients. 2019;11(7):1625. https://​doi.​org/​10.​3390/​nu11071625.
22.
go back to reference Sockalingam S, Cassin S, Crawford SA, et al. Psychiatric predictors of surgery non-completion following suitability assessment for bariatric surgery. Obes Surg. 2013;23:205–11.PubMedCrossRef Sockalingam S, Cassin S, Crawford SA, et al. Psychiatric predictors of surgery non-completion following suitability assessment for bariatric surgery. Obes Surg. 2013;23:205–11.PubMedCrossRef
23.
go back to reference Sogg S, Mori DL. The Boston interview for gastric bypass: determining the psychological suitability of surgical candidates. Obes Surg. 2004;14:370–80.PubMedCrossRef Sogg S, Mori DL. The Boston interview for gastric bypass: determining the psychological suitability of surgical candidates. Obes Surg. 2004;14:370–80.PubMedCrossRef
24.
go back to reference Gormally J, Black S, Daston S, et al. The assessment of binge eating severity among obese persons. Addict Behav. 1982;7:47–55.PubMedCrossRef Gormally J, Black S, Daston S, et al. The assessment of binge eating severity among obese persons. Addict Behav. 1982;7:47–55.PubMedCrossRef
25.
go back to reference Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54.CrossRef Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41–54.CrossRef
26.
go back to reference Lo C, Walsh A, Mikulincer M, et al. Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief experiences in close relationships scale. Psycho-Oncol. 2009;18:490–9.CrossRef Lo C, Walsh A, Mikulincer M, et al. Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief experiences in close relationships scale. Psycho-Oncol. 2009;18:490–9.CrossRef
27.
go back to reference Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: An integrative overview. In: Simpson JA, Rholes WS, (editors). Attachment theory and close relationships. The Guilford Press; 1998. p. 46–76. Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: An integrative overview. In: Simpson JA, Rholes WS, (editors). Attachment theory and close relationships. The Guilford Press; 1998. p. 46–76.
28.
go back to reference Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1982;1991(32):705–14. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1982;1991(32):705–14.
29.
go back to reference Tarlov AR, Ware JE, Greenfield S, et al. The medical outcomes study. An application of methods for monitoring the results of medical care. JAMA. 1989;262:925–30.PubMedCrossRef Tarlov AR, Ware JE, Greenfield S, et al. The medical outcomes study. An application of methods for monitoring the results of medical care. JAMA. 1989;262:925–30.PubMedCrossRef
30.
go back to reference Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.PubMedCrossRef Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.PubMedCrossRef
32.
go back to reference Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. Can Med Assoc J. 2012;184:E191–6.CrossRef Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis. Can Med Assoc J. 2012;184:E191–6.CrossRef
33.
go back to reference R Core Team. R: A language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2022. Available from: https://www.R-project.org/. Accessed Apr 2023. R Core Team. R: A language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2022. Available from: https://​www.​R-project.​org/​. Accessed Apr 2023.
35.
go back to reference Wickham H, Averick M, Bryan J, et al. Welcome to the tidyverse. JOSS. 2019;4:1686.CrossRef Wickham H, Averick M, Bryan J, et al. Welcome to the tidyverse. JOSS. 2019;4:1686.CrossRef
36.
go back to reference Gill H, Kang S, Lee Y, et al. The long-term effect of bariatric surgery on depression and anxiety. J Affect Disord. 2019;246:886–94.PubMedCrossRef Gill H, Kang S, Lee Y, et al. The long-term effect of bariatric surgery on depression and anxiety. J Affect Disord. 2019;246:886–94.PubMedCrossRef
37.
go back to reference Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: Baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. Obes Surg. 2019;29:782–95.PubMedCrossRef Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: Baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. Obes Surg. 2019;29:782–95.PubMedCrossRef
38.
go back to reference Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. SOARD. 2011;7:644–51. Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. SOARD. 2011;7:644–51.
39.
go back to reference Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. SOARD. 2008;4:640–6. Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. SOARD. 2008;4:640–6.
40.
go back to reference Elkins G, Whitfield P, Marcus J, et al. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg. 2005;15:546–51.PubMedCrossRef Elkins G, Whitfield P, Marcus J, et al. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg. 2005;15:546–51.PubMedCrossRef
41.
go back to reference Poole NA, Al Atar A, Kuhanendran D, et al. Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study. Obes Surg. 2005;15:261–5.PubMedCrossRef Poole NA, Al Atar A, Kuhanendran D, et al. Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study. Obes Surg. 2005;15:261–5.PubMedCrossRef
42.
go back to reference Barlow DH, Curreri AJ, Woodard LS. Neuroticism and disorders of emotion: a new synthesis. Curr Dir Psychol Sci. 2021;30:410–7.CrossRef Barlow DH, Curreri AJ, Woodard LS. Neuroticism and disorders of emotion: a new synthesis. Curr Dir Psychol Sci. 2021;30:410–7.CrossRef
43.
go back to reference Berry K, Danquah A. Attachment-informed therapy for adults: towards a unifying perspective on practice. Psychol Psychother. 2016;89:15–32.PubMedCrossRef Berry K, Danquah A. Attachment-informed therapy for adults: towards a unifying perspective on practice. Psychol Psychother. 2016;89:15–32.PubMedCrossRef
44.
go back to reference Beaulac J, Sandre D, Mercer D. Impact on mindfulness, emotion regulation, and emotional overeating of a DBT skills training group: a pilot study. EWD. 2019;24:373–7.PubMed Beaulac J, Sandre D, Mercer D. Impact on mindfulness, emotion regulation, and emotional overeating of a DBT skills training group: a pilot study. EWD. 2019;24:373–7.PubMed
45.
go back to reference Hany M, Elfiky S, Mansour N, et al. Dialectical behavior therapy for emotional and mindless eating after bariatric surgery: a prospective exploratory cohort study. Obes Surg. 2022;32:1570–7.PubMedCrossRef Hany M, Elfiky S, Mansour N, et al. Dialectical behavior therapy for emotional and mindless eating after bariatric surgery: a prospective exploratory cohort study. Obes Surg. 2022;32:1570–7.PubMedCrossRef
46.
go back to reference Sockalingam S, Leung SE, Ma C, et al. Efficacy of telephone-based cognitive behavioral therapy for weight loss, disordered eating, and psychological distress after bariatric surgery: a randomized clinical trial. JAMA Netw Open. 2023;6:e2327099.PubMedPubMedCentralCrossRef Sockalingam S, Leung SE, Ma C, et al. Efficacy of telephone-based cognitive behavioral therapy for weight loss, disordered eating, and psychological distress after bariatric surgery: a randomized clinical trial. JAMA Netw Open. 2023;6:e2327099.PubMedPubMedCentralCrossRef
47.
go back to reference Felske AN, Williamson TM, Rash JA, et al. Proof of concept for a mindfulness-informed intervention for eating disorder symptoms, self-efficacy, and emotion regulation among bariatric surgery candidates. Behav Med. 2022;48:216–29.PubMedCrossRef Felske AN, Williamson TM, Rash JA, et al. Proof of concept for a mindfulness-informed intervention for eating disorder symptoms, self-efficacy, and emotion regulation among bariatric surgery candidates. Behav Med. 2022;48:216–29.PubMedCrossRef
48.
go back to reference Wnuk SM, Du CT, Van Exan J, et al. Mindfulness-based eating and awareness training for post-bariatric surgery patients: a feasibility pilot study. Mindfulness. 2018;9:949–60.CrossRef Wnuk SM, Du CT, Van Exan J, et al. Mindfulness-based eating and awareness training for post-bariatric surgery patients: a feasibility pilot study. Mindfulness. 2018;9:949–60.CrossRef
Metadata
Title
Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery
Authors
Susan Wnuk
Batool Azim
Tim H. Guimond
Lorraine Gougeon
Sanjeev Sockalingam
Publication date
25-04-2024
Publisher
Springer US
Published in
Obesity Surgery
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-024-07246-w
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