Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 4/2015

01-04-2015 | Original Contributions

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

Authors: Floor Aarts, Rinie Geenen, Victor E. A. Gerdes, Arnold van de Laar, Dees P. M. Brandjes, Chris Hinnen

Published in: Obesity Surgery | Issue 4/2015

Login to get access

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 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.
Literature
1.
2.
Elkins G, Whitfield P, Marcus J, et al. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg. 2005;15:546–51.CrossRefPubMed
3.
Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4:640–6.CrossRefPubMedCentralPubMed
4.
Sarwer DB, Moore RH, Spitzer JC, et al. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Surg Obes Relat Dis. 2012;8:561–8.CrossRefPubMed
5.
Ritz SJ. The bariatric psychological evaluation: a heuristic for determining the suitability of the morbidly obese patient for weight loss surgery. Bariatr Surg Pract Patient Care. 2006;1:97–105.CrossRef
6.
7.
Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Surg Obes Relat Dis. 2006;2:171–9.CrossRefPubMed
8.
van Hout GC, Vreeswijk CM, van Heck GL. Bariatric surgery and bariatric psychology: evolution of the Dutch approach. Obes Surg. 2008;18:321–5.CrossRefPubMed
9.
Fabricatore AN, Crerand CE, Wadden TA, et al. How do mental health professionals evaluate candidates for bariatric surgery? Survey results. Obes Surg. 2006;16:567–73.CrossRefPubMed
10.
Aarts F, Hinnen C, Gerdes VEA, et al. Psychologists’ evaluation of bariatric surgery candidates influenced by patients’ attachment representations and symptoms of depression and anxiety. Journal of Clinical Psychology in Medical Settings 2014.
11.
Gorin AA, Raftopoulos I. Effect of mood and eating disorders on the short-term outcome of laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;19:1685–90.CrossRefPubMed
12.
Bowlby J. Attachment and loss: retrospect and prospect. Am J Orthopsychiatry. 1969;52(4):664–78.CrossRef
13.
Bennett JK, Fuertes JN, Keitel M, et al. The role of patient attachment and working alliance on patient adherence, satisfaction, and health-related quality of life in lupus treatment. Patient Educ Couns. 2011;85(1):53–9.CrossRefPubMed
14.
Ciechanowski PS, Katon WJ, Russo JE, et al. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry. 2001;158(1):29–35.CrossRefPubMed
15.
Hunter JJ, Maunder RG. Using attachment theory to understand illness behavior. Gen Hosp Psychiatry. 2001;23:177–82.CrossRefPubMed
16.
Maunder RG, Hunter JJ. Attachment relationships as determinants of physical health. J Am Acad Psychoanal Dyn Psychiatry. 2008;36:11–32.CrossRefPubMed
17.
Maunder RG, Hunter JJ. Attachment and psychosomatic medicine: developmental contributions to stress and disease. Psychosom Med. 2001;63:556–67.CrossRefPubMed
18.
Wilkinson LL, Rowe AC, Bishop RJ, et al. Attachment anxiety, disinhibited eating, and body mass index in adulthood. Int J Obes. 2010;34:1442–5.CrossRef
19.
20.
Maunder RG, Hunter JJ. Assessing patterns of adult attachment in medical patients. Gen Hosp Psychiatry. 2009;31:123–30.CrossRefPubMed
21.
Florian V, Mikulincer M, Bucholtz I. Effects of adult attachment style on the perception and search for social support. Int J Psychol. 1995;129:665–76.
22.
Priel B, Shamai D. Attachment style and perceived social support: effects on affect regulation. Personal Individ Differ. 1995;19:235–41.CrossRef
23.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
24.
Fraley RC, Waller NG, Brennan KA. An item response theory analysis of self-report measures of adult attachment. J Pers Soc Psychol. 2000;78:350–65.CrossRefPubMed
25.
Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36:717–31.CrossRefPubMed
26.
MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behav Res. 2004;39:99.CrossRefPubMedCentralPubMed
27.
Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40:879–91.CrossRefPubMed
28.
Hayes AF. Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr. 2009;76:408–20.CrossRef
29.
Maunder RG, Lancee WJ, Nolan RP, et al. The relationship of attachment insecurity to subjective stress and autonomic function during standardized acute stress in healthy adults. J Psychosom Res. 2006;60:283–90.CrossRefPubMed
30.
Raynes E, Auerbach C, Botyanski NC. Level of object representation and psychic structure deficit in obese persons. Psychol Rep. 1989;64:291–4.CrossRefPubMed
31.
Evers C, Marijn Stok F, de Ridder DT. Feeding your feelings: emotion regulation strategies and emotional eating. Pers Soc Psychol Bull. 2010;36:792–804.CrossRefPubMed
32.
Spoor ST, Bekker MH, Van Strien T, et al. Relations between negative affect, coping, and emotional eating. Appetite. 2007;48:368–76.CrossRefPubMed
33.
Vandewalle J, Moens E, Braet C. Comprehending emotional eating in obese youngsters: the role of parental rejection and emotion regulation. Int J Obes (Lond) 2013.
34.
Zijlstra H, van Middendorp H, Devaere L, et al. Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery. Psychol Health 2012; 27: 1375–1387.
35.
36.
Pecoraro N, Reyes F, Gomez F, et al. Chronic stress promotes palatable feeding, which reduces signs of stress: feedforward and feedback effects of chronic stress. Endocrinology. 2004;145:3754–62.CrossRefPubMed
37.
Peters A, Pellerin L, Dallman MF, et al. Causes of obesity: looking beyond the hypothalamus. Prog Neurobiol. 2007;81:61–88.CrossRefPubMed
38.
Onaka T, Takayanagi Y, Yoshida M. Roles of oxytocin neurones in the control of stress, energy metabolism, and social behaviour. J Neuroendocrinol. 2012;24:587–98.CrossRefPubMed
39.
Mikulincer M, Orbach J. Attachment style and repressive defensiveness: the accessibility and architecture of affective memories. J Pers Soc Psychol. 1995;68:917–25.CrossRefPubMed
40.
Turan B, Osar Z, Turan JM, et al. Dismissing attachment and outcome in diabetes: the mediating role of coping. J Soc Clin Psychol. 2003;22:607–26.CrossRef
41.
Fraley RC, Shaver PR. Adult attachment and the suppression of unwanted thoughts. J Pers Soc Psychol. 1997;73:1080–91.CrossRefPubMed
42.
Vetere A, Myers LB. Repressive coping style and adult romantic attachment style: is there a relationship. Personal Individ Differ. 2002;32:799–807.CrossRef
43.
Ciechanowski PS, Katon WJ, Russo JE, et al. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry. 2001;158:29–35.CrossRefPubMed
44.
Colles SL, Dixon JB, O'Brien PE. Grazing and loss of control related to eating: two high-risk factors following bariatric surgery. Obesity (Silver Spring). 2008;16:615–22.CrossRef
45.
Fraley RC, Waller NG. Attachment theory and close relationships. In: Simpson JA, Rholes WS, editors. Adult attachment patterns: a test of the typological model. New York: Guilford Press, 1998: 77–114.
46.
Maunder RG, Hunter JJ. A prototype-based model of adult attachment for clinicians. Psychodyn Psychiatry. 2012;40:549–73.CrossRefPubMed
47.
Heinicke CM, Levine MS. In H. Steele & M. Steele (Eds.) Clinical applications of the adult attachment interview. New York: 2008.
48.
van IJzendoorn MH. Adult attachment representations, parental responsiveness, and infant attachment: a meta-analysis on the predictive validity of the adult attachment interview. Psychol Bull. 1995;117:387–403.CrossRefPubMed
Metadata
Title
Attachment Anxiety Predicts Poor Adherence to Dietary Recommendations: an Indirect Effect on Weight Change 1 Year After Gastric Bypass Surgery
Authors
Floor Aarts
Rinie Geenen
Victor E. A. Gerdes
Arnold van de Laar
Dees P. M. Brandjes
Chris Hinnen
Publication date
01-04-2015
Publisher
Springer US
Published in
Obesity Surgery / Issue 4/2015
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1423-7

Other articles of this Issue 4/2015

Obesity Surgery 4/2015 Go to the issue

Original Contributions

Fixed-Dose Enoxaparin After Bariatric Surgery: The Influence of Body Weight on Peak Anti-Xa Levels

Original Contributions

Primary Hyperparathyroidism After Roux-en-Y Gastric Bypass

Original Contributions

Effectiveness of B Vitamin Supplementation Following Bariatric Surgery: Rapid Increases of Serum Vitamin B12

Original Contributions

Duodenal-Jejunal Bypass Restores Insulin Action and Βeta-Cell Function in Hypothalamic-Obese Rats

Other

Standardized Outcomes Reporting in Metabolic and Bariatric Surgery

Review Article

Measurement Properties of Eating Behavior Self-Assessment Tools in Adult Bariatric Surgery Populations: a Systematic Review