Psychological attachment in obesity: the significance for bariatric surgery

Obesity is a complex health problem, which has proven difficult to prevent and treat. It is now clear that the aetiology of obesity concerns not only genetic and current environmental but also psychological factors. Among the most enduring psychological influences are early repeated interactions with significant others that result in enduring ways of reacting to stress and dealing with negative affectivity. An influential theoretical framework is attachment theory, which specifics that individuals internalize early childhood interactions with primary caregivers in enduring beliefs and expectations about how others behave towards oneself and how oneself behaves towards others. These enduring expectations are referred to as attachment representations or internal working models and are thought to be the mechanisms by which the influence of childhood experiences is sustained into adulthood. Attachment representations have been linked to obesity in both children and adults and may also promote or obstruct a successful outcome after bariatric surgery. The aim of this thesis was to examine social and emotional aspects of bariatric surgery and obesity. Particular attention was given to the role of patients' attachment representations. The thesis includes a theoretical review and a series of concurrent prospective analyses using preoperative and postoperative data. It examines the significance of attachment representations for mental and physical health, adherence, health care utilization, and the weight outcome of patients with morbid obesity before and after gastric bypass surgery and their cohabiting family.