Conclusions and clinical implications
’ [, anxiety
Taken together, the findings from this investigation suggest that while individuals with high pre-operative attachment anxiety are expected to have lower post-operative self-esteem and poorer self-efficacy for health behaviours, high self-esteem can support patients’ ability to control their eating and exercise behaviours, resulting in better diet adherence and more physical activity two years after bariatric surgery. The individual pathways between preoperative attachment avoidance, post-operative self-esteem, health self-efficacy and health behaviours were not significant. However, the relationships between preoperative attachment avoidance and 2-year post-operative diet adherence and exercise behaviours were significantly mediated through self-esteem and health self-efficacy.The findings reported here shed new light on the role of adult attachment in health behaviours and the potential of self-esteem in promoting health self-efficacy among bariatric surgery patients. Our results suggest that helping patients feel more worthy and reinforcing their beliefs about their own competences could lead to higher engagement with healthy lifestyle, better weight management skills, and adherence to treatment protocols, ultimately helping patients to achieve their bariatric surgery goals. It might be beneficial to consider patients’ attachment during the presurgical assessment and offer additional treatment opportunities, such as Group Psychodynamic Interpersonal Psychotherapy or ‘security- priming’ [