Disinhibited eating mediates differences in attachment insecurity between bariatric surgery candidates/recipients and lean controls

Previous research has shown that attachment anxiety is a good predictor of body mass index. This relationship is significantly mediated by disinhibited (over-) eating and is likely to reflect a specific form of affect regulation. This study explored whether obese bariatric surgery candidates (BSC; N=34) and bariatric surgery recipients (BSR; N=15) would show higher levels of attachment insecurity (higher attachment anxiety and/or higher attachment avoidance) than a group of age and gender-matched lean controls (N=54). Mediation analyses showed that compared to lean controls (M=2.96, SE=0.1), both BSC (M=3.5, SE=0.2) and BSR (M=3.4, SE=0.2) groups had a more insecure attachment orientation. These relationships were significantly mediated by disinhibited eating (BSC: lower limit confidence interval (LLCI)=0.06 and upper limit confidence interval (ULCI)=0.62; BSR: LLCI=0.02 and ULCI=0.76). There was no such relationship when the BSC and BSR groups were compared (LLCI=−0.15 & ULCI=0.3). These observations suggest that attachment insecurity may be a risk factor for obesity and bariatric surgery because of associated disinhibited eating. Moreover, these factors may be important to consider when bariatric surgery results in poor outcomes.