AMERICAN JOURNAL OF HEALTH EDUCATION

2016, VOL. 47, NO. 1, 3241

http://dx.doi.org/10.1080/19325037.2015.1111179

Routledge
Taylor & Francis Group

Differences in Health Behaviors of Overweight or Obese College Students

Compared to Healthy Weight Students
M. Rachel Harringtona and Melinda J. lckesb
Eastern Kentucky University

University of Kentucky

ABSTRACT

Background: Obesity continues to be an epidemic in college students, yet research is warranted

to determine whether obesity increases the likelihood of risky health behaviors in this
population. Purpose: The purpose of this study was to examine the association between body
mass index (BMI) and health behaviors in college students. Methods: A sample of 758 college
students who completed an online health behavior survey were categorized based on their
BMI. Chi-square analysis was used to examine the association between health behaviors and
BMI. Summative health risk scores were compared using independent samples f test. Results:
With the exception of sexual practices, there were few differences in reported health behaviors
between BMI classification; however, a statistical significance [P .024) was found between BMI
groups on the Health Risk subscale. Discussion: The results of this study revealed little differences
between BMI and health behaviors in college students and reinforced previous findings that
college students, in general, do not seem to be concerned with meeting recommendations for
improved health. Translation to Health Education Practice: The findings support the need for
cost-effective, comprehensive programming aimed at improving health behaviors in all college
students, not just a particular subgroup.

Background
Obesity continues to be an epidemic in the United States,
with 66% of the adult population overweight and more
than a third of U.S. adults considered obese.' Equally
disturbing is the estimation that 30% 35% of college
students are overweight or obese.' Obesity has been
shown to increase the risks of many chronic diseases,
including cardiovascular disease, cancer, stroke, chronic
pulmonary heart disease, asthma, and sleep apnea.' There
are also numerous personal and social costs associated
with being overweight or obese. It is estimated that the
obesity epidemic costs our
nation $117 billion per year in direct medical expenses
3 Obese
and indirect costs, including lost productivity
4
individ- uals are rated as less employable have
lower
and face discrimination in school6 and in
selfesteem,'
7
health care In
sum, many college students may be placed at significant
risks for chronic diseases, emotional trauma, and
discrimination due to their overweight or obese status.'
College can also be a time of rapid changes in
physical,
cognitive, and social development. According to the
National Center for Educational Statistis,9 3 1 million
students were enrolled in college in 2011 (42% of 18- to
24- yearolds). Young adults in college experience a
growing

CONTACT M. Rachel Harrington

mrba237 g.uky.edu
Avenue, Richmond, KY 40475-3102.
2016 SHAPE America

ARTICLE HISTORY
Submitted 3 August 2015
Accepted 25 September
2015

independence in behavior. They show an increase in the

capacity for abstract thought, an interest in moral
reasoning, as well as a struggle with their sense of
identity." Peers and social pressures dominate this era,
encouraging young adults to challenge the status quo as
well as those with authority, oftentimes leading to risky
behaviors.' ' Recent evidence suggests that the mere
presence of peers increases risk-taking among
adolescents and collegeaged people." This increase in
risktaking, coupled with the concerning prevalence of
obesity among youth, warrants attention. Previous
research supports the link between obesity and risky
health behavior in adolescents," but there is a need to
further explore this issue among college students.
Healthy Campus 2020 (HC2020) can be used as a
framework for investigating health behaviors among
college students. HC2020 is an initiative that provides an
agenda for improving the overall health status of college
campuses to decrease chronic disease risks, including
obesity, and addresses many of the risky behaviors in
which college students often participate.' The goals and
objectives within HC2020 aim to promote health and
support students academic success. Investigating health
behaviors targeted

Nutrition and Food Sciences, Eastern Kentucky University, 102 Burrier Building, 521 Lancaster

OBESITY AMONG COLLEGE STUDENTS

within HC2020 will enable campus health professionals

to develop tailored health promotion programs for
subsets of the college population that may be most at
risk.

Purpose
Given the realities of the obesity epidem

14

and the

number of young adults in college, an examination of

the relationship between overweight or obese college
students and their engagement in risky health behaviors
as compared to their healthy weight' counterparts is

prudent. The purpose of this study was to (1) describe the

prevalence of select health behaviors in a sample of

college students and (2) determine whether there was a

significant difference in select health behaviors when

comparing healthy weight and overweight/obese college

students.

Methods
Sample and design
Students who were enrolled at a large southeastern
university were randomly selected from a total of 29 000
students to participate in an electronic general health
survey. A random sample of 7000 students from enrollees
for the Fall 2013 semester was provided by the university
registrar. To overcompensate for low response rates from
underclassmen in prior studies, freshman and sopho
mores were oversampled utilizing stratification by
academic status (2000 surveys each were sent to
freshman and sophomores and 1000 surveys each were
sent to juniors, seniors, and graduate students). There
were no exclusions based on gender or ethnicity. A total
of 837 students completed the survey, yielding a response
rate of 12%. For the purposes of this study, respondents
with missing height or weight values or those classified
as underweight were eliminated from the sample ( u =
79), yielding a total sample of 758 participants.
By utilizing a random sample of registered students,
the sample reflected the diversity of the university
population. The university student population includes
48. 1% male and 51.9% female; 75.2% white, 6.8% African
American, 3.0% Hispanic, and 2.9% Asian; 19.7%
freshman, 15.3% sophomores, 16% juniors, and 20.7%
seniors." The analyzable sample included an over
representation of females (67.3%, u = 509) compared to
the general student population. Race/ethnicity demo
graphic variables were similar to the general student
population, with a slightly higher percentage of white
students represented; 81.9% were white (n = 621), 6. I %
were African American (n = 46), 4. 1% were Hispanic
(n - 31), 3.8% were Asian ( n = 29), and 3.9% listed
other racial/ethnic groups (n 30). The students age

33

range was 17 69 years (M = 24.5; SD = 4.82), with

80.3% of the sample between the ages of 18 and 24
years. First-year students were the most widely
represented (34.4%; u = 261) and overrepresented
compared to the general student population, whereas
seniors were under- represented (10.2%, n = 77). There
were 17.3% sopho
mores (n 131), 15.4% juniors (n = 117), and 22.3%
graduate or other ( u = 169) students in the sample.

Procedures
The study was approved by the Institutional Review
Board. Potential participants received an email explain
ing the purpose of the study, the importance of
participating, and that completing and submitting the
online survey implied consent to participate. Reminder
e-mails were sent 1 week after the first e-mail to
participants who had not yet completed the survey.
Those who did not complete the survey after 2 weeks
were considered nonresponders. As an incentive to
encourage participation, all respondents who completed
the survey were entered into a drawing for a Kindle Fire.
At the end of the survey, respondents were directed to
an embedded link that redirected them to a separate
optional online questionnaire to complete contact
information for the drawing. The survey was administered using Qualtrics Labs, Inc., software," which assigns
participants a number as an identifier to protect privacy.
Respondents answers were confidential; all data were
compiled in aggregate for reporting purposes.

Measures
The instrument used was an adaptation of
previous surveys performed at the university
and the American College Health Association
National College Health Assessment.' Items
included information about a variety of health
behaviors that impact college students,
including sleep habits, eating and body image,
physical activity, alcohol and drug use, stress,
and sexual practices. For the purpose of this
study, a subset of 26 items was used to explore
the prevalence of health behaviors among
college students based on the HC2020
objectives': (1) general health, (2) health
impediments to academic performance,
(3) mental and emotional health, (4) nutrition,
including disordered eating, (5) physical
activity, (6) sexual health, and (7) substance
abuse and tobacco use.

CieneraI health
Students were asked a broadspectrum question about
how they would describe their general health. Response
options included excellent, very good, good, fair, and
poor.

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