Can the quality of our relationships play a role in obesity?   A new meta-analytic study suggests that it can (at least for adults).

Obesity has long been recognized as a major health issue around the world with the overall percentage of children and adults classified as overweight or obese soaring dramatically over the past thirty years.    According to one 2012 study, the estimated  percentage of overweight individuals in the United States is 68 percent and obese individuals (defined as a BMI greater than 35) at 38 percent.   The makes the United States the country with the highest average body mass index (BMI) of all high-income countries.  Not only has been obesity been linked to a wide range of serious medical conditions, including heart disease, cancer, and reduced mortality, but the economic costs associated with health care needs and lost work productivity are profound and will certainly increase in the years to come.

While researchers continue to explore the complex causes of obesity, including genetic factors, the psychological roots of obesity are just beginning to be understood.  Studies looking at obesity in children and adults have found that individuals prone to emotion- and stress-related eating are especially vulnerable to obesity and also have greater difficulty losing weight.  This ties in to additional research suggesting that attachment insecurity is strongly linked to many physical diseases, including obesity.

According to attachment theory, our relationships are shaped by beliefs and expectations about behaviour which we first form in early childhood and the kind of relationship we have with our primary caregiver. Researchers such as Mary Ainsworth and John Bowlby refer to  these expectations and beliefs as attachment representations which influence how comfortable we feel about being intimate with others and how we handle rejection and abandonment.   

While well-adjusted adults with high attachment security are more adaptive and able to use multiple coping strategies to deal with stress, individuals high in attachment anxiety are more prone to distress and tend to be "clingy" with others as a way of coping.  And then there are the individual who are high in attachment avoidance who prefer to distance themselves from others and repress any negative emotions they may be experiencing. 

People who are insecurely attached, whether they are high on attachment anxiety or avoidance (and sometimes both), are prone to stress-related health problems due to their inability to cope effectively with stress.  Along with other negative coping strategies, insecure individuals may also be more likely to engage in emotion- and stress-related eating which in turn may result in obesity.  

To examine this potential link further, a team of international researchers looked at different studies measuring the relationship between attachment quality and obesity in children and adults.  Led by Marc J. Diener at Long Island University, the study, which was recently published in the Canadian Journal of Behavioural Science, identified seven studies using adults and five studies using children.    The adult studies had a total of 2,135 participants while the child studies had nearly 9,000 participants.  Based on these studies, the researchers conducted two separate meta-analyses for children and adults.  

Though their results showed a negative relationship between relationship quality and BMI for both children and adults, the results were only significant for the adult analysis.  On the other hand, there didn't seem to be any significant difference regarding sex, age, or type of attachment measurement used.  Even for the adult analysis however, the overall effect size was smaller than what has been reported in previous studies.

As Diener and his fellow researchers point out, obesity has many different potential causes and the differences in the kind of attachments formed by adults and children may help explain why the findings were only significant for adults.    Even for adults however, establishing a link between attachment quality and obesity can be important since it highlights how insecure attachment can undermine good health.  

Among the possible explanations for this link they explore in their paper are:

  • the general role that attachment quality can play in managing stress -  previous research has shown that attachment anxiety can lead to hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and the release of cortisol and other glucocorticoids.  This hyperactivity can also cause fat deposits to accumulate which,  can lead to insulin resistance and changes in the body's metabolism.  Hunger stimulating hormones such as ghrelin and leptin can also be released leading to increased eating of high-calorie foods to reduce stress symptoms.
  • attachment quality can also affect how we regulate emotion -   People with secure attachments usually cope with stress by seeking comfort from significant others.  Insecurely-attached individuals however may find themselves overeating as  a form of "self-medication" to get their anxiety under control.

More research is definitely needed, especially in terms of how this link between attachment quality and obesity can change over time.  Is it possible to predict whether people will become obese as adults by the kind of attachment patterns they show in early childhood?   Adolescence has already been recognized as a critical life stage for the development of obesity, especially for girls.  Weight loss programs aimed at children and adolescents could also be made more effective by providing guidance for young people dealing with insecure attachments as well.  

Again, though attachment quality is just one of many factors that need to be considered in understanding obesity and how to help people lose weight, it is still something that has been largely neglected up to now.   Helping people overcome the kind of emotional problems that can come with insecure attachment may also be the key to a longer and healthier life. 

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