title: Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery.
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.
authors.affiliation: Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands, Floor.Aarts@slz.nl.
authors.forename: Floor
authors.initials: F
authors.lastname: Aarts
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
authors.forename: Victor E A
authors.initials: VE
authors.lastname: Gerdes
authors.forename: Arnold
authors.initials: A
authors.lastname: van de Laar
authors.forename: Dees P M
authors.initials: DP
authors.lastname: Brandjes
authors.forename: Chris
authors.initials: C
authors.lastname: Hinnen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications / Q000453:epidemiology; D004032:Diet; D005260:Female; D015390:Gastric Bypass / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D009769:Object Attachment; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D011184:Postoperative Period; D011379:Prognosis; D064167:Recommended Dietary Allowances; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult