Binge eating has a high prevalence among bariatric patients and is associated with post-surgical weight gain. This study examined the potential mediating role of emotion regulation difficulties in the relation between attachment insecurity and binge eating among this population. Participants were 1388 adult pre-bariatric surgery candidates from an accredited bariatric surgery assessment centre in Toronto, Ontario. Participants completed measures of psychological functioning, including attachment style and emotion regulation. Mediation analyses revealed that difficulties with emotion regulation mediated a positive association between insecure-anxious attachment and binge eating. An insecure-avoidant attachment was found to have a non-significant association with binge eating when examining the total effect. However, when difficulties with emotion regulation were controlled for in the model to examine its role as a mediator, this association became significant, and emotion regulation difficulties also mediated the relationship between attachment avoidance and binge eating. These findings suggest that difficulties in emotion regulation may be an important clinical issue to address in order to reduce binge eating in adult bariatric surgery candidates.
Bariatric surgery is considered the most effective means for substantial and sustained weight loss and resolution of medical co-morbidities (Buchwald et al., 2004) for morbidly obese individuals (BMI ≥ 40; Maggard et al., 2005). Adherence to a calorie-restricted and healthy post-surgical diet is required to maintain weight loss, and disordered eating (e.g., binge eating) can interfere with maintaining dietary recommendations long-term (Saunders, Johnson, & Teschner, 1998). Post-surgical binge eating has significantly predicted weight loss failure (Hsu et al, 1997, Livhits et al, 2010 and Meany et al, 2014) in terms of less excess weight loss (Kofman, Lent, & Swencionis, 2010) and greater weight regain (Colles et al, 2008, Hsu et al, 1997, Kofman et al, 2010 and Mitchell et al, 2001). Binge eating is frequently reported among bariatric surgery candidates, and binge eating prior to surgery is a risk factor for binge eating following surgery, which can emerge as late as two or more years post-surgery (Hsu et al, 1997 and Niego et al, 2007). Given that the reoccurrence of binge eating can undermine weight loss, delineating the psychological mechanisms involved in the development and maintenance of binge eating in bariatric candidates is necessary to better understand the aspects that need to be addressed to improve post-surgery outcomes. Insecure attachment styles have been found to be associated with both disordered eating (e.g., Tasca & Balfour, 2014) and emotion regulation difficulties (e.g., Han & Pistole, 2014). Thus, the current study examined whether the relationship between attachment insecurity and binge eating is mediated by emotion regulation difficulties in bariatric candidates.
