“Good Food to Go,” a FRUVED Intervention Targeting the College Campus Obesity

Epidemic

Wing Yee Cheung, Grace Kim, and Lauren Rubin

Queens College Dietetic Internship

Abstract

Rates of obesity and overweight status have reached epidemic proportions across all age

groups in the United States. One of the most understudied, yet significant, groups affected by the

issue of obesity are college campus students. Although everyone dreads the “Freshman 15,”

minimal research and interventions has been created to control and prevent obesity on college

campuses. As more than one third of college students are overweight or obese, college campuses

are an ideal environment for the implementation of fruits and vegetables education (FRUVED)

interventions. FRUVED is an ​USDA grant-funded research project ​that aims to ​help students live

healthy lives through educational nutrition interventions. ​Queens College, one of the

participating research schools, created a quantitative, cross-sectional research design to assess

the impact of a nutritious cooking demonstration on the food choices of its students. A

pre-survey was administered to quantify students’ eating behaviors, nutrition knowledge and

readiness to make healthy lifestyle choices. Upon completion of the intervention, a post-survey

was conducted to evaluate changes and effects of the intervention. The results were analyzed

using Microsoft Excel. As a significant number of students are unfamiliar with preparing healthy

lunches, campus-wide interventions are crucial in motivating and educating students on the

importance of healthy lifestyles. The successes of the intervention can be used as a model for

application, extending the healthy messages to more college campuses.

Introduction

The expression “Freshman 15” refers to the belief that college students commonly gain

15 pounds during their freshman year. The dreaded experience is a real issue college students

face today. According to the College Health Association, the percent of overweight (Body Mass

Index of 25-29.9) and obese (Body Mass Index of >30) college students in America has

increased from 27.4% in 2006 to 29.2% in 2011. At this rate, it has been predicted that by 2030,

the rates of obesity will rise to over 50% of the college population (1).

The number of overweight and obese people have reached epidemic proportions in all

age groups in the United States. According to the Centers for Disease Control and Prevention,

obesity affects one third of the adult population and an estimated 12.7 million children and

adolescents in the United States (2). Over the past 20 years, a significant increase in obesity and

obesity-related complications have been seen amongst people in their teens and twenties (3).

Weight gain has been found to be in greater incidences in college students due to lifestyle

changes and the transition from living at home to college. It has been suggested that the increase

in independence and the freedom has contributed to the poor eating behaviors and choices of

college students (4). Parents are no longer around to guide or limit choices, inclining busy

college students to choose foods that are quick to prepare, cheap and oftentimes unhealthy.

The​ ​College Weight Gain and Behavior Study found that 25% of both college male and

females gained more than 2.3 kg of body weight in an 8 month period (5). Minimizing weight

gain is critical because overweight college students are at a greater risk for becoming obese

adults. By preventing weight gain at an early stage, the rates of adult obesity can be reduced.

Adult obesity is dangerous as it can lead to the further development of complications such as
hypertension, type 2 diabetes, cancer and cardiovascular disease. With early intervention, the risk

of chronic diseases can be minimized.

As more than one third of college students are overweight or obese, the college campus

setting is an ideal place to implement programs that are tailored to their needs and lifestyles (6).

The establishment of campus-wide initiatives that promotes health and weight management are

needed to tackle the “Freshman 15” and improve the overall college experience.

Although being overshadowed by programs targeting alcohol, drugs and sexual

harassment (3) the obesity epidemic on college campuses is a real issue that must be addressed; it

is a threat that compromises the health of students in the present and even more significantly in

the future. Besides addressing the serious public health issue, capitalizing on the lifestyle issues

and creating behavioral interventions benefits the college itself. The programs highlight the

college’s values of responsibility, ethics and health. Participation will help students develop into

graduates who are well-rounded on a professional, academic and social level.

One of the greatest challenges college students face is adapting a healthy lifestyle,

including incorporating good food choices, proper sleeping habits and physical activity into their

daily routines. The various lifestyle factors all contribute to weight gain and obesity. Research

has shown that obesity is an issue far greater than physical health itself; obesity also impacts the

emotional and social well-being of the person. The emotional effects of obesity include anxiety,

depression and lowering of the self-esteem. ​Students become more self-conscious of their weight

gain, taking away time and energy from their studies (7). ​Often, the psychological distress leads

to an uncontrolled cycle of overeating and weight gain to soothe and combat the feelings of

depression, isolation and low self-image.

 Although many factors contribute to college campus obesity, eating habits and food

choices are the driving force behind the challenging epidemic. Research has shown that the most

important influencing factors that impact food selection on college campuses are taste, cost and

convenience (8). Little to no attention is focused on the nutrition and health consequences of the

foods. One study showed that a high percentage of surveyed college students who were

overweight engaged in unhealthy eating habits, such as a diet low fruit, vegetable and fiber

intake (9). Another study noted the excessive intake of fatty foods and alcohol amongst U.S

college students (10).

College students turn to fast foods and processed foods because of their convenience and

low cost. With busy schedules and little time to prepare food, on average, students consume fast

food 1-3 times a week (11). However, these food choices are oftentimes high in fat, salt and

energy. In addition, high consumption of fast foods and processed foods is associated with

decreased intake of fruits and vegetables. According to the American College Health Association

(11),​ ​only 7.3% of students ate five or more servings of fruits and vegetables a day.

Compared to the cheap fast food, the pricier cost of fresh and healthy food is another

determinant of poor eating behaviors of college students. One such study was performed to

understand the effects of price on the consumption of fruits and salads in a cafeteria setting. The

results showed that by reducing the prices in half, intake nearly nearly tripled and as soon as the

original price was returned, consumption went back to its original levels (12). These and other

research studies suggest the need for greater attention to diet and healthy eating interventions for

the college student population.

 Since the weight gain of the college population significantly contributes to the rise in

obesity nationwide, an important strategy in tackling the obesity epidemic would be to target this

population with lifestyle interventions that improve diet and overall health. College programs

have the unique opportunity to lay the foundation and create a supportive environment for

lifelong healthy habits and choices. Resources to help students can be provided in a

nonjudgmental, sensitive and helpful manner. To target the obesity epidemic on college

campuses, this study will aim to increase the intake of fruits of vegetables of Queens College

students. The FRUVED intervention will educate students about the physical and emotional

health benefits of making good food choices. The intervention will be a cooking demonstration

that teaches college students how to prepare meals and snacks that are tasty, quick and cheap.

College students should be encouraged to improve eating habits through interventions that teach

them how to implement healthful changes into their daily lives.

Methods

Research Design:

A quantitative, cross-sectional research design was utilized to assess the impact of a

nutritious cooking demonstration on Queens College students. As a cross-sectional study, the

study collected data on the population subset at a single point in time (13). The study was used to

measure knowledge gained in a nutrition intervention through a pre and post survey. A pre

survey assessment was conducted immediately before a cooking demonstration intervention to

evaluate the participants’ nutrition-based knowledge. The pre survey was used to quantify their

eating behaviors, nutrition knowledge and preparedness to make healthy lifestyle choices. The

post survey assessment was conducted immediately after the intervention to evaluate changes in
nutrition knowledge, the level of confidence and readiness to change. The change in pre and

post survey reflected the effectiveness of the intervention in increasing nutrition knowledge and

willingness to change.

Method and Location:

The data collection and intervention occurred at the Queens College cafeteria. The

intervention occurred during the Spring 2018 semester. Three researchers set up a table with

cooking ingredients and equipment. Researchers created a poster as an educational tool to

explain the purpose of the intervention. ​As students walked by, researchers offered a healthy

lunch sample to recruit the subjects.

A pre and post survey was developed before the intervention. A pre-assessment survey

was designed to measure the students’ nutrition-related knowledge and self-efficacy before the

cooking demonstration. Students completed the survey prior to viewing the cooking

demonstration. After the pre-assessment survey was completed, the cooking demonstration was

conducted and the participants were educated on healthy food choices. The rainbow salad

(APPENDIX C) cooking demonstration taught students how to prepare a healthy, quick and

affordable lunch. Healthy portion sizes, recommendations for food groups and nutritional

benefits of fruits and vegetables were taught throughout the lesson (APPENDIX D). Upon

completion of the cooking demonstration, the post survey was conducted. Using the data,

changes in knowledge and self-efficacy were measured. As a giveaway, recipe cards

(APPENDIX E) with additional healthy recipes and the MyPlate handout (APPENDIX F) were

provided to the participants.

 Subject Recruitment:

A random sampling was used to gather students for the intervention. Participants were

recruited as they passed the intervention table and were invited to attend the cooking

demonstration. Eligible participants were 18 to 24-year-old undergraduate Queens College

students, enrolled in the Spring 2018 semester. Due to FRUVED’s mission to improve health of

college undergraduate students, staff members and graduate students were excluded from the

study. Informed consent was given by all participants of the study (APPENDIX G).

Resources and Funding:

Ingredients for the rainbow salad (see Appendix C) were reimbursed by FRUVED. The

cooking equipment and the poster were provided by the researchers. A table and space were

provided by Queens College Nutrition Department.

Statistical Evaluation:

The raw data was collected from the participants and analyzed using Microsoft Excel.

Because the research design is a pre and post test, the mean differences between the pre and post

were compared. Averages of fruit and vegetable intake were analyzed using Excel to understand

eating habits amongst the Queens College participants.

Gantt Chart:

The Gantt Chart outlining the breakdown of activities can be found in APPENDIX H.

Letter Granting Permission:

IRB approval was not required for this research project.

Results

A total of fifty students participated in the FRUVED nutrition intervention. After initial

screening of the surveys, it became clear that majority of the participants were Queens College

undergraduate students; their responses were included in the final results. However, because the

intervention targeted the Queens College undergraduate population, the responses of the four

Queens College staff participants were removed from the final study.

Using Microsoft Excel, the results of the pre-survey were analyzed. A number of

questions were solely intended to become familiar with the participants of the study and to

understand their baseline level of nutritional knowledge. When asked the source of reliance for

nutrition information, a total of 50% of the participants reported that they rely on the internet as

their primary source of nutrition information, 18% rely on reading food labels and 18% do not

look for nutrition information. A mere two participants reported that they depend on their

Queens College professors of nutrition for diet and nutrition information. The data showed that

only 12% of the participants prepared lunch at home on a daily basis. As the students were

asked, “How often do you cook a meal for yourself,” a total of 22% reported that they actually

cook for themselves everyday.

Four questions were used in the pre and post-survey to evaluate the effectiveness of the

nutrition intervention. The first question asked “What is the recommended servings of fruits per

day?” In the pre-survey, 54% answered 1-2 cups. In the post-survey, 78% answered 1-2 cups

(refer to Table 1). The second question asked “What is the recommended servings of vegetables

per day?” In the pre-survey, 62% answered 3-4 cups. In the post-survey, 72% answered 3-4 cups

of vegetables per day (refer to Table 2).The third question asked students to look at a specific
meal instead of a daily intake. Question 3 asks, “How much of your plate should be fruits and

vegetables?” In the pre-survey, 56% answered with the correct choice of half your plate and in

the post-survey, 94% answered half (refer to table 3). The final question, asking, “How confident

do you feel you can prepare a healthy lunch at least once this week,” 48% answered very

confident in the pre-survey and after the nutrition intervention 66% felt very confident (refer to

table 4).

Discussion

Upon comparison of the pre- and post-survey answers, the increased percentages of

confidence and correct answers, reflects the effectiveness of the FRUVED intervention. The

impact of the nutritional intervention on the Queens College undergraduate students was

significant. Various educational and counseling techniques were used to impact the students and

their effectiveness is reflected in the results. The rainbow salad demonstration was able to

increase nutritional knowledge and self-efficacy in the participating students. After the

demonstration, there was an 18% increase in self-efficacy of lunch preparation. Another method

of information dissemination was the use of educational handouts; every participant received a

MyPlate guide with appropriate serving sizes of each food group. The students were asked a

knowledge-based question (question 3) to evaluate the effectiveness of the handout. The 38%

increase of the correct answer in the post-survey, suggests that the participants understood and

retained the information from both, the handout and the presentation.

Based off questions 1 and 2, assessing recommended portion sizes of fruits and

vegetables, the 24% increase in correct answers for fruit servings, and the 10% increase in

vegetable servings, demonstrates the effectiveness of the nutrition intervention in teaching

students the recommended daily amounts. Helping students understand the daily

recommendations demonstrates that the guidelines are realistic and achievable. Proven by the

results of the post-survey, the impact of the FRUVED intervention is one step in targeting the

obesity epidemic across college campuses in the United States.

Strengths of this intervention include the simplicity of the surveys and recipes, a

well-placed intervention site in a busy cafeteria and the use of a variety of teaching techniques.

Verbal, demonstrative, and printed methods were used to educate the participants. Weaknesses

of the intervention include the inability to track long-term change and effectiveness.

Conclusion

The FRUVED intervention was successful in increasing knowledge, skills and

confidence of the Queens College undergraduate participants. Hopefully, the intervention will

encourage the students to improve eating habits and implement healthful changes. Choosing

fruits and vegetables is one small, individual step that can ultimately have a large impact on the

obesity epidemic of college campuses.

In the future, FRUVED should continue to implement nutrition interventions at Queens

College. The more exposure to nutritional knowledge and skills, the more likely lasting changes

will result. Future interventions should monitor the long-term impact of the programs and eating

habits of college students. In addition, there should be an increase in awareness of FRUVED as a

nutritional resource for students. The increase in nutrition interventions on college campuses will

serve as a more readily available and reliable source of nutritional information for students. The

implementation of this nutrition intervention across college campuses in America, and others
alike, can have a profound impact on the obesity epidemic, helping our people improve their

health and overall well-being.

APPENDIX

APPENDIX A: Pre-survey Test ID #

1. What is the recommended number of servings of fruits you should consume in one day?
a) 0 cup
b) 1-2 cups
c) 3-4 cups
d) 4 -5 cups
2. What is the recommended number of servings of vegetables you should consume in one day?
a) 0 cup
b) 1-2 cups
c) 3-4 cups
d) 4 -5 cups
3. How much of your plate should be fruits and vegetables?
a) 25%
b) 50%
c) 75%
d) 100%
4. How confident do you feel you can prepare a healthy lunch at least once this week?
a) I am very confident
b) I am kind of confident
c) I am not very confident
d) I am not confident at all

5. How often do you prepare lunch at home?

a) Never
b) 1-2 times per week
c) 3-4 times per week
d) 4-6 times per week
e) Every day
6. How often do you cook a meal for yourself?
a) Never
b) 1-2 times per week
 c) 3-4 times per week
d) 5-6 times per week
e) Everyday

7. What source do you rely on the most for information about food, diet, and nutrition?
a) Internet
b) Food/Nutrition Labels
c) Nutrition courses
d) Friends/peers
e) I don’t look
f) Other __________
8. How often do you buy food from the following places? (Circle one)
Dining hall: Always Most of the time About half the time Sometimes Never
Campus Cafe: Always Most of the time About half the time Sometimes Never
Restaurant: Always Most of the time About half the time Sometimes Never
Grocery Store: Always Most of the time About half the time Sometimes Never
Convenience : Always Most of the time About half the time Sometimes Never
APPENDIX B: Post-Survey Test ID #

1. What is the recommended number of servings of fruits you should consume in one day?
e) 0 cup
f) 1-2 cups
g) 3-4 cups
h) 4 -5 cups
2. What is the recommended number of servings of vegetables you should consume in one day?
e) 0 cup
f) 1-2 cups
g) 3-4 cups
h) 4 -5 cups
3. How much of your plate should be fruits and vegetables?
e) 25%
f) 50%
g) 75%
h) 100%
a)
4. How confident do you feel you can prepare a healthy lunch at least once this week?
e) I am very confident
f) I am kind of confident
g) I am not very confident
h) I am not confident at all
APPENDIX C: Cooking Demonstration Recipe

Rainbow Grain Salad:

Ingredients:

● 1 cup spinach/kale
● 1/2 beet
● 1 carrot
● 1/2 cup farro
● Dressing:
● 1/4 cup lemon juice
● 1/2 cup olive oil
● 1 Tablespoon chives (chopped)
● salt and pepper

Directions:
1. Shred beet and carrots with a box grater.
2. Cook grains according to package instructions.
3. For dressing mix together lemons juice, zest, chives, and salt/pepper.
4. Mix together the salad ingredients and dressing.
5. Store overnight for improved flavor.
APPENDIX D: Lesson Plan

Lesson Title:​ Healthy Lunch Initiative

Target Audience: ​Queens College Undergraduate Students
General Objective​:​ ​Teach students how to prepare healthy meals that meet dietary guidelines.
Date:​April
Duration: 10 minutes​- 1 min intro, 2 min pre-survey, 4 min demo, 2 min post-survey, 1 min
conclusion.

Specific Objectives Procedure Learning Evaluation

(Use SMART (State how each specific Activity Method
criteria) objective will be met)

Introduction

-Three research introduce self Verbal Participant

-briefly state what the research group verbal
project is about discussion feedback
-Evaluate knowledge and
behavior barriers of packing lunch Pre-survey

Body of Lesson

1. Participant will be -Rainbow salad food -Recipe Verbal Q&A

able to state at least demonstration cards and
one healthy lunch demo
that they can prepare Post-survey
during the week

2. Participant will be Myplate serving size -MyPlate Post-survey

able to state the daily -demonstrate how to use this visual guide
recommended intake when meal prepping during the
for fruits and week.
vegetables.
 Conclusion

Summarize MyPlate and daily

serving intake

Materials List​ (attached page): i.e.: audio-visual equipment, food models, video, flip chart,
specific foods for food demo, pencils, paper, attendance sheet, pre/post tests, handouts
(specified), other visuals, etc.

1. Pre and post survey

2. Recipe cards
3. Food for demo (spinach, beets, lemons juice, zest, chives, olive oil, salt and pepper)
4. Equipment for demo (gloves, mixing bowl, box grater, sample cups and forks)
APPENDIX E: Recipe Cards

Buddha Bowls:

Ingredients:

● 1 medium sweet potato, peeled if

desired, cut into 1-inch chunks
● 3 tablespoons extra-virgin olive oil,
divided
● ½ teaspoon salt, divided
● ½ teaspoon ground pepper, divided
● 2 tablespoons tahini
● 2 tablespoons water
● 1 tablespoon lemon juice
● 1 small clove garlic, minced
● 2 cups cooked quinoa
● 1 15-ounce can chickpeas, rinsed
● 1 firm ripe avocado, diced
● ¼ cup chopped fresh cilantro or
parsley

Directions:

1) Preheat oven to 425°F.

2) Toss sweet potato with 1 tablespoon oil and ¼ teaspoon each salt and pepper in a medium
bowl. Transfer to a rimmed baking sheet. Roast, stirring once, until tender, 15 to 18 minutes.
3) Meanwhile, whisk the remaining 2 tablespoons oil, tahini, water, lemon juice, garlic and the
remaining ¼ teaspoon each salt and pepper in a small bowl.
4) To serve, divide quinoa among 4 bowls. Top with equal amounts of sweet potato, chickpeas
and avocado. Drizzle with the tahini sauce. Sprinkle with parsley (or cilantro).
Chicken Club Wraps:

Ingredients:

● ⅛ teaspoon salt
● 1 medium tomato, chopped
● 1 avocado, chopped
● 3 strips cooked bacon,
crumbled
● 8 large leaves red- or
green-leaf lettuce
● 4 10-inch flour tortillas,
preferably whole-wheat

Directions:

1. Preheat grill to medium-high.

2. Sprinkle chicken on both sides with ¼ teaspoon pepper.
3. Grill the chicken, turning once or twice, until an instant-read thermometer inserted into
the thickest part registers 165°F, 15 to 18 minutes. Transfer to a clean cutting board and
let cool for about 5 minutes.
4. Whisk together yogurt, vinegar, onion, oil, salt and the remaining ¼ teaspoon pepper in a
large bowl.
5. Chop the chicken into bite-size pieces and add to the bowl along with tomato, avocado
and bacon; toss to combine.
6. To assemble the wraps, place 2 lettuce leaves on each tortilla and top with chicken salad
(about 1 cup each). Roll up like a burrito.
7. Serve cut in half, if desired.
APPENDIX F: MyPlate Handout
 APPENDIX G: Informed Consent Form

Institution Queens College

Program Family, Nutrition, & Exercise Sciences

Sponsor FRUVED

Research Statement The purpose of this study is to determine the effectiveness of a cooking
and nutrition education intervention in changing nutrition-related
knowledge and willingness to change lifestyle habits.

Confidentiality & Subject may withdraw from the study at any time of the study, including
Voluntary Refusal and at the time of the pre-test, intervention, and post-test.
Right to Withdraw

Participant Printed Name: _______________________________________________________

APPENDIX H: Gantt Chart

Task/Date December January February March April May

Find out date of

Health Fair

Find out
FRUVED
reimbursement

Sign up for table

for health fair

Have ingredients
and materials

Health Fair &

data collection

Data analysis
Table 1: Comparison of Pre- and Post-Test Responses to Question #1

Table 2: Comparison of Pre- and Post-Test Responses to Question #2

Table 3: Comparison of Pre- and Post-Test Responses to Question #3

Table 4: Comparison of Pre- and Post-Test Responses to Question #4

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