title: Attachment style and emotional eating in bariatric surgery candidates: The mediating role of difficulties in emotion regulation.
abstract: OBJECTIVE
  Difficulties with emotion regulation is a hypothesized mechanism through which attachment insecurity may affect emotional eating. No studies have yet investigated this effect in the bariatric population. Because many obese individuals engage in emotional eating, difficulty regulating emotion may be an important underlying mechanism through which attachment insecurity is linked to emotional eating in bariatric surgery candidates.
  
  
  METHODS
  In this cross-sectional study, 1393 adult bariatric surgery candidates from the Toronto Western Hospital were recruited to complete the Emotional Eating Scale (EES), Patient Health Questionnaire-9 (PHQ9), Generalized Anxiety Disorder-7 (GAD7), Difficulties in Emotion Regulation Scale (DERS), Eating Disorder Examination Questionnaire (EDE-Q), and the Experiences for Close Relationships 16-item Scale (ECR-16) in order to explore the mediating role of emotion regulation on the relationship between attachment insecurity and emotional eating. Path analysis within a structural equation modeling framework examined direct and indirect effects of attachment insecurity on emotional eating.
  
  
  RESULTS
  The indices of this overall model indicated that the specified set of direct and indirect pathways and corresponding correlations were a good fit with the data (RMSEA<.06, CFI=1.00; SRMR<.08). Moreover, tests of all of the possible indirect pathways between attachment style and emotional eating were significant.
  
  
  CONCLUSIONS
  Findings suggest that difficulties in emotion regulation may be an important mechanism to consider when examining the association between attachment insecurity and emotional eating in adult bariatric surgery candidates. Although causality cannot be concluded, these results shed light on the important role that emotion regulation may have in predicting problematic eating in bariatric patients.
authors: Bariatric Surgery Program, Toronto Western Hospital, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada. Electronic address: marlene.taube-schiff@uhn.ca.
authors: Marlene
authors: M
authors: Taube-Schiff
authors: Bariatric Surgery Program, Toronto Western Hospital, Toronto, Canada. Electronic address: jessica.vanexan@uhn.ca.
authors: Jessica
authors: J
authors: Van Exan
authors: Department of Psychology, Arizona State University, Tempe, AZ, USA.
authors: Rika
authors: R
authors: Tanaka
authors: Bariatric Surgery Program, Toronto Western Hospital, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors: Susan
authors: S
authors: Wnuk
authors: Bariatric Surgery Program, Toronto Western Hospital, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors: Raed
authors: R
authors: Hawa
authors: Bariatric Surgery Program, Toronto Western Hospital, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
authors: Sanjeev
authors: S
authors: Sockalingam
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D003430:Cross-Sectional Studies; D004435:Eating / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology* / Q000601:surgery; D009769:Object Attachment
keywords: Bariatric surgery; Emotion regulation; Emotional eating