What this study adds?
anxiety
This longitudinal study investigated the serial mediation between preoperative attachment and 2-years post-operative health behaviour through 1-year post-operative self-esteem and health self-efficacy. The relationships between preoperative attachment anxiety and avoidance and diet adherence and physical activity two years after bariatric surgery are mediated by post-operative self-esteem and self-efficacy for eating and exercise behaviours.The study contributes to our understanding of the mechanism between attachment and health behaviours, and suggests a potential pathway through self-esteem and self-efficacy. Promoting post-operative self-esteem may support patients’ ability to control their eating and exercise behaviours, which could be important for enhancing post-operative diet adherence and physical activity, especially among patients with high attachment anxiety or avoidance.