Food and Behaviour Research

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Attachment and eating: A meta-analytic review of the relevance of attachment for unhealthy and healthy eating behaviors in the general population

Faber A, Dubé L, Knäuper B (2018) Appetite.  2018 Apr;123: 410-438. doi: 10.1016/j.appet.2017.10.043. Epub 2017 Nov 26. 

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Attachment relationships play an important role in people's wellbeing and affliction with physical and mental illnesses, including eating disorders.

Seven reviews from the clinical field have consistently shown that higher attachment insecurity-failure to form trusting and reliable relationships with others-systematically characterized individuals with eating disorders. Nevertheless, to date, it is unclear whether (and if so how) these findings apply to the population at large. Consequently, the objective of the present meta-analysis is to quantify the relationship between attachment and unhealthy and healthy eating in the general population.

Data from 70 studies and 19,470 participants were converted into r effect sizes and analysed. Results showed that higher attachment insecurity (r = 0.266), anxiety (r = 0.271), avoidance (r = 0.119), and fearfulness (r = 0.184) was significantly associated with more unhealthy eating behaviors, ps = 0.000; conversely, higher attachment security correlated with lower unhealthy eating behaviors (r = -0.184, p = 0.000). This relationship did not vary across type of unhealthy eating behavior (i.e., binge eating, bulimic symptoms, dieting, emotional eating, and unhealthy food consumption). The little exploratory evidence concerning healthy eating and attachment was inconclusive with one exception-healthy eating was associated with lower attachment avoidance (r = -0.211, p = 0.000).

Our results extend previous meta-analytic findings to show that lack of trusting and reliable relationships does not only set apart eating disordered individuals from controls, but also characterizes unhealthy eating behaviors in the general population. More evidence is needed to determine how attachment and healthy eating are linked and assess potential mechanisms influencing the attachment-eating relationship.