Formation mechanisms, interrelationships, and effects of cognitive factors on diet and physical activity during the post-bariatric surgery period: a cross-sectional study based on compensatory carry-over action model

Abstract

Background Diet and physical activity (PA) are the two most important behaviors to control energy balance after bariatric surgery, post-bariatric patients need dual behavioral management, and these behaviors are jointly affected by various cognitive factors. This study applied compensatory carry-over action model (CCAM) to investigate the effects of cognitive factors on behaviors, and the effects of behaviors on subjective health outcomes. Methods This cross-sectional study was conducted among patients at the third month after bariatric surgery in China. We collected patients’ data of status of diet and PA, behavioral cognitive factors (intention, self-efficacy, compensatory belief, transfer cognition), and subjective health outcomes (perceived stress, well-being, quality of life). Structural equation model (SEM) were established to test the hypotheses in CCAM and the mediation relationships. Results A total of 239 patients data were collected. The results of SEM analysis showed: (1) Among the antecedent cognitive factors, only compensatory belief had a significant effect on diet (P<0.001). (2) Both intention and self-efficacy formed direct associations with their corresponding behaviors, compensatory belief exerted significant effects on intention, transfer cognition exerted significant effects on self-efficacy(P<0.05), which were consistent with the original hypotheses in CCAM. (3) PA demonstrated significant influence only on perceived stress (P=0.004), diet demonstrated significant effects on all subjective health outcomes (P<0.05). (4) The results of mediation analysis showed intention exerted partial mediating effects on the relationship between compensatory belief and diet and exerted complete mediating effects on the relationship between compensatory belief and PA, self-efficacy exerted complete mediating effects on the relationship between transfer cognition and diet and between transfer cognition and PA. Conclusion Among the antecedent cognitions, the carry-over effect of transfer cognition did not directly affect the behaviors, and interventions should mainly focus on improventment of diet through inhibition of compensatory belief. The associations between behaviors and subjective health outcomes showed that diet exerted more critical effects on the overall health than PA. Overall, based on the analysis of CCAM and from the perspective of joint promotion of behaviors after bariatric surgery, dietary intervention had a higher priority than PA intervention.