The Present Research
anxiety
SEVERE OBESITY
The studies reviewed above remain narrow in focus dealing only with individual relations between the variables, and have relied mostly on cross-sectional data. Based on attachment theory and empirical literature on bivariate associations between attachment, self-esteem and self-efficacy are posited as serial mediators in the association between attachment anxiety and avoidance and health behaviours (i.e., diet adherence and physical activity) in bariatric surgery patients. To study this longitudinally, we included preoperative attachment anxiety and avoidance as predictors, 1-year post-operative self-esteem and 2-year post-operative self-efficacy for eating and exercise behaviours as mediators, and dietary adherence and physical activity two years after bariatric surgery as the outcome variables. The conceptual model is depicted in Fig. Based on recent research findings, we expected higher preoperative attachment anxiety to be associated with poorer post-operative self-esteem and health self-efficacy. As the literature is less clear about the associations between attachment avoidance and self-esteem and health self-efficacy, we will explore these relationships. Secondly, we hypothesised higher preoperative attachment anxiety and avoidance to be associated with poorer 2- year post-operative dietary adherence and less physical activity. Lastly, we hypothesised that post-operative self-esteem and health self-efficacy would be a mediator for the relationship between attachment anxiety and dietary adherence and physical activity. These mediating pathways will also be explored for attachment avoidance. This study is the first to assess these factors in a longitudinal setting among patients with severe obesity and could provide valuable insight and recommendations for aiding patients in adhering to healthier lifestyles, ultimately leading to stable health outcomes following bariatric surgery.
Serial multiple mediation model of attachment anxiety on health behaviour, as mediated by self-esteem and self-efficacy for a specific health behaviour, while controlling for attachment avoidance. Model 1–2: Y = Diet adherence, Model 3–4: Y = Physical activity