Psychologists' evaluation of bariatric surgery candidates influenced by patients' attachment representations and symptoms of depression and anxiety

This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists' evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surgery completed questionnaires to measure adult attachment and levels of depression and anxiety. Psychologists rated patients' suitability for bariatric surgery using the Cleveland Clinic Behavioural Rating System (CCBRS), unaware of the results of the completed questionnaires. Attachment anxiety (OR = 2.50, p = .01) and attachment avoidance (OR = 3.13, p = .001) were found to be associated with less positive evaluations on the CCBRS by the psychologists, and symptoms of depression and anxiety mediated this association. This study strongly supports the notion that patients' attachment representations influence a psychologist's evaluation in an indirect way by influencing the symptoms of depression and anxiety patients report during an assessment interview. The clinical implications of these findings are discusse

Coping style as a mediator between attachment and mental and physical health in patients suffering from morbid obesity

The presence of mental health problems and limitations in physical functioning is high in patients suffering from morbid obesity. The purpose of the current study was to examine the mediating role of coping style in the relationship between attachment representations and mental health and physical functioning in a morbidly obese population. A total of 299 morbidly obese patients who were referred to the Slotervaart bariatric surgery unit in Amsterdam, the Netherlands, completed self-report questionnaires assessing adult attachment style (Experiences in Close Relationship-Revised Questionnaire), coping style (Utrecht Coping List), and patients physical functioning and mental health (Short Form-36). Attachment anxiety (beta = -.490, p <.001) and attachment avoidance (3 = -.387, p <.001) were both found to be related to mental health. In addition, attachment anxiety was also found to be related to physical functioning (beta = - .188,p <.001). Coping style partly mediated these associations. Findings suggest that coping mediates the association between attachment anxiety and attachment avoidance on the one hand and mental health and physical functioning in patients with morbid obesity on the other han

The Significance of Attachment Representations for Quality of Life One Year Following Gastric Bypass Surgery: A Longitudinal Analysis

Background: Quality of life after bariatric surgery may, among other things, depend on patients' attachment representations such as anxiety about rejection and abandonment (attachment anxiety) and avoidance of intimacy and interdependence (attachment avoidance). The aim of this study was to examine whether attachment representations, independent of body mass index (BMI), are associated with the level and course of physical functioning and mental well-being after gastric bypass surgery. Method: A total of 131 patients applying for a Roux-en-Y gastric bypass operation agreed to participate in this longitudinal study. Patients' attachment representations (ECR-R) were measured before surgery, and quality of life dimensions (physical functioning and mental well-being, SF-36) were measured before surgery and 1, 3, 6, and 12 months following surgery. Linear mixed effect models were used in analyses. Results: Physical functioning (p <0.001) improved, and mental well-being worsened (p = 0.002) in the postoperative interval. Both attachment anxiety (p = 0.005) and attachment avoidance (p <0.001) were associated with a lower level of mental well-being, but not with the postoperative course of quality of life. Conclusions: Our study suggests that bariatric surgery leads to improvement in physical functioning but not mental well-being. Results highlight that patients with insecure attachment representations should be protected against unrealistic expectations regarding improvement of mental well-being after surgery

The Significance of Attachment Quality for Obesity:A Meta-Analytic Review

Theoretical considerations and empirical results suggest that attachment quality is relevant to obesity. This study used meta-analytic methods to systematically examine the empirical, peer-reviewed evidence regarding the relationship between attachment quality and body mass index (BMI) in separate meta-analyses for children and adults. Relevant peer-reviewed literature published between 1990 and 2013 was obtained from PubMed, PsycINFO, and reference lists of included articles. Results of the meta-analysis for studies with adults indicated a small but statistically significant association between attachment quality and BMI (absolute value of weighted average r = .05, p = .03; 95% confidence interval, CI [.004 to .09]; number of independent studies [k] = 7; N = 2,135). Specifically, BMI was negatively associated with attachment security. Publication bias analyses did not demonstrate cause for concern about the results. Results of the meta-analysis for studies with children indicated a small association between attachment quality and BMI that fell just short of statistical significance (absolute value of weighted average r = .08, p = .06; 95% CI [−.004 to .16]; k = 5; N = 8,602). Several moderator variables were examined using the aggregated sample including both adults and children, but none of the analyses yielded statistically significant results. Possible explanations for an impact of attachment quality on obesity might involve the underdevelopment of emotion-regulation and heightened psychophysiological responsiveness, which point to avenues for future research