A call to include attachment-based concepts in tailored treatments for obesity

Abstract

Psychological contributing factors in obesity include attachment style and emotion dysregulation. Little is known about the relationship between attachment style and responses to treatment in obesity.This study set out to identify the average weight loss for a group treatment for obesity based on diet changes and cognitive behavioural therapy (CBT) strategies, investigate whether attachment style predicts weight loss, and explore participants’ experience of the group treatment.52 participants completed an attachment measure at the start of treatment. Body Mass Index (BMI) measures were taken at the start and end of treatment. The average weight loss was calculated and a backwards multiple regression tested whether the five attachment dimensions could predict participants’ change in BMI. Seven of the participants then took part in semi-structured interviews about the experience of the treatment. Transcripts were subjected to Interpretative Phenomenological Analysis (IPA).The average weight loss was 2.2 per cent of the starting body weight. Quantitative findings produced a model which showed that the participants who scored higher on attachment security lost less weight than those with insecure attachments. Qualitative findings centred around four themes regarding the group experience: Dependency; Identification; Comparison to Others; and Negative Aspects of the Group Experience. Participants also described having difficulties with self-soothing, having had unmet needs in childhood, and the experience of recurrent depression.This study demonstrates poor weight loss from group treatments for obesity based on diet changes and CBT strategies. However, it suggests that those with insecure attachment may be better suited to CBT-type courses than those who are securely attached. The qualitative themes offer possible explanations as to why the treatment did not result in significant weight loss and potential reasons for the well documented weight regain following treatment for obesity. The implications are that treatment for obesity should be tailor-made, consider attachment style, and consider the need to attend to emotion regulation.