[The impact of attachment style for the success of bariatric surgery - results of a long-term follow-up].

Obesity is a chronic disease that can be associated with a variety of physical and psychological comorbidities, such as metabolic syndrome or depression. Bariatric surgery is recommended in the S3 guideline as a treatment option from a BMI≥40 kg/m2 without comorbidities or from a BMI≥35 kg/m2 with at least one obesity-associated comorbidity. Bariatric surgery is an important therapeutic approach, the long-term success of which can be influenced by psychosocial factors. This longitudinal study investigates the influence of attachment style on the long-term success of surgery. The sample comprises N=30 participants with obesity (M/SD age=56.2/8.6 years, 83.3% female) who underwent bariatric sleeve gastrectomy between 2010 and 2015. Data was collected preoperatively (approx. 3 months before the operation) and postoperatively at the end of 2019/beginning of 2020. In addition to socio-demographic data, weight-related data and psychosocial stress factors were collected. The success of the operation was defined on the basis of the weight reduction achieved, the improvement in quality of life and the reduction in depression, anxiety and overall psychological stress. Postoperatively, the attachment style (categorised as secure-attached and insecure-attached) was assessed. Questionnaires were used except for the weight-related data. The attachment style is relevant for postoperative success in relation to the variables of depression and overall psychological stress. Securely attached participants showed significant improvements in these variables, while insecurely attached participants showed stagnating or slightly worsening values postoperatively. Regarding BMI, significant postoperative improvements were observed in all participants, regardless of attachment style. The results indicate that the attachment groups do not benefit equally from the operation in terms of psychosocial variables in the long term. It is therefore necessary to identify vulnerable patients preoperatively in order to ensure customised support. Individualised, attachment-oriented care appears to be particularly effective.