Cognitive Dissonance Based Intervention to Promote Multivitamin Adherence on Bariatric Patients

According to the World Health Organization (WHO), in 2016, 650 million people around the world were already obese, for their part in 2013 the Organization for Economic Cooperation and Development (OCDE) indicated that globally Mexico and the United States had the highest rate of overweight and obesity in adults. Mexico is the second country, after the United States, with the highest obesity, almost one third of Mexican adults (32.4%) suffered from obesity in that year, a significant increase from 24% in 2000.

According to the National Health and Nutrition Survey the states of northern Mexico, as is the case of Baja California, occupy the first places of obesity index nationwide. Morbid Obesity (MO) poses a high health risk in those who suffer from it, as multiple complications arise from it, therefore it is of uttermost importance that this disease is successfully treated and controlled, however, conventional weight loss therapeutics guided by the implementation of behavioral therapy, physical activity, low calorie diet and drug treatment , has shown short-term unsuccessful results. A treatment alternative is Bariatric Surgery (BS) which, according to recommendations issued in 1991 by the U.S. National Institutes of Health (NIH), is considered the treatment of choice for this pathology. While BS has proven to be a successful treatment for long-term sustained weight loss, it is accompanied by major complications such as micronutrient deficiency, which is attributed to intrinsic and extrinsic factors, intrinsic factors refer to deficiencies recorded prior to BS and are related to MO or to the surgical technique itself that induces changes in metabolism in addition to reducing the ability to food in the stomach, limit digestion and cause malabsorption. For their part, extrinsic factors correspond to the lack of adherence in terms of diet and prescribed multivitamin supplementation.

Lack of adherence is related to the level of knowledge about the supplementation and behavior of the morbid patient on decision-making, as they tend to present negative thoughts about the prescribed treatment that are usually accompanied by lack of ability to make changes in both attitude and behavior, which will hardly change even after surgery; this is consistent with the results reported in various studies that indicate that the main behavioral factors of non-adherence to treatment in this population are the low self-efficacy and attitudes that the patient adopts towards treatment on self-care, as well as low self-esteem and distortion of self-concept.

As described, BS can be considered a process of adaptation that can pose a challenge for those who experience it as the person must be aware of the impact of surgery on the body in order to effectively adhere to the agreed treatment plan, making decisions in conjunction with health professionals in order to reduce risk factors , focusing therefore on prevention and timely intervention of them.

In this sense, psychology turns out to be a science that allows to develop instruments that evaluate the congruence between attitudes, thought and behavior, as well as the creation of strategies that promote health promoting the congruence between attitude and behavior. Leon Festinger in 1957 proposed the theory of Cognitive Dissonance, which states that people tend to change their attitudes and behaviors or justify them as a result of the divergence of two cognitions manifested at the same time; according to this theory, the individual strives to achieve consistency within himself. Opinions and attitudes tend to be present in groups that are internally consistent.