Discussion
anxiety
EVENTS
The current study aimed to examine the mediational role of self-esteem and health self-efficacy between attachment anxiety and avoidance and health behaviours (i.e., diet adherence and physical activity). This work could generate fresh insights into the mechanism between attachment and health behaviours, and how patients could be supported to follow a healthy lifestyle. We investigated this mechanism among bariatric surgery patients with a longitudinal dynamic model, allowing us to examine the relations between the study variables over time and obtain indications for the sequence of events. One of the more significant findings to emerge from this study is that post-operative self-esteem and health self-efficacy mediated the relationships between preoperative attachment anxiety and avoidance and 2-year post-operative diet adherence and physical activity. Yet, the full models explained only a small part of the variation in the outcome variables (8% of dietary adherence and 13% of physical activity).Interestingly, higher attachment anxiety was associated with better dietary adherence and more exercise behaviours when the mediators were held constant (positive direct effects), while the indirect effects were negative. Thus, patients equal on post-operative self-esteem and self-efficacy for eating and exercise behaviours but who were one unit higher on preoperative attachment anxiety were estimated to have 0.24 units better dietary adherence and 2.09 units more physical activity two years after bariatric surgery than patients scoring one unit less on preoperative attachment anxiety. In other words, patients equal on post-operative self-esteem and self-efficacy, but who were more anxiously attached preoperatively were estimated to have slightly better post-operative dietary adherence and to be more physically active. Even though the changes in the units are small, these results imply that greater attachment anxiety is associated with better diet and exercise behaviours for patients with similar self-esteem and health self-efficacy. The negative indirect effects indicate that higher attachment anxiety is associated with poorer dietary adherence and less physical activity through poorer self-esteem and eating self-efficacy. A possible explanation for these results could be that patients with similar self-esteem and self-efficacy level, yet more anxiously attached, can to turn their hyper-activated attachment system into their advantage. Perhaps these individuals are more self-compassionate or conscientious, and have an 