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Michael & Debre. (2009).
Factors Influencing Healthy Eating Habits Among

College Students: An Application of the Health Belief Model. Retrieved March 3,
2019 from
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Factors Influencing Healthy Eating Habits Among College Students: An

Application of the Health Belief Model
Sameer Deshpande ,Michael D. Basil &Debra Z. Basil

Pages 145-164 | Published online: 30 Apr 2009
Abstract
Poor eating habits are an important public health issue that has large health and
economic implications. Many food preferences are established early, but because
people make more and more independent eating decisions as they move through
adolescence, the transition to independent living during the university days is an
important event. To study the phenomenon of food selection, the heath belief
model was applied to predict the likelihood of healthy eating among university
students. Structural equation modeling was used to investigate the validity of the
health belief model (HBM) among 194 students, followed by gender-based
analyses. The data
Some research has shown that the most important factors predicting food selection
among adults are: taste, cost, nutrition, convenience, pleasure, and weight control,
in that order (Glanz, Basil, Maibach, Goldberg, & Snyder 1998Glanz , K. , Basil
, M. , Maibach , E. ,Goldberg , J. , & Snyder , D. ( 1998 ).Why Americans eat what
they do: Taste, nutrition, cost, convenience, and weight control concerns as
influences on food consumption .Journal of the American Dietetic Association , 98
, 1118 – 1126 .[Crossref], [PubMed], [Web of Science ®], , [Google Scholar]).
Many studies have shown that people often establish these tastes and habits while
they are relatively young (Birch, 1999Birch , L. L. ( 1999 ). Development of food
preferences . Annual Review of Nutrition , 19
Evidence suggests early establishment of habits and preferences occurs for a
variety of behaviors including media use (Basil, 1990Basil , M.
D. ( 1990 ). Primary news source changes: Question wording, availability, and
cohort effects .Journalism Quarterly , 67 , 708 –722 . [Google Scholar]) and music
listening (Holbrook & Schindler, 1994Holbrook , M. B. , & Schindler , R.
M.( 1994 ). Age, sex, and attitude toward the past as predictors of consumers'
aesthetic tastes for cultural products . Journal of Marketing Research , 31
, 412 – 422.[Crossref], [Web of Science ®], , [Google Scholar]), as well as food
choice (Birch, 1999Birch , L. L. ( 1999 ). Development of food
preferences . Annual Review of Nutrition , 19
Therefore it is advisable to begin establishing good eating habits when people are
as young as possible. Importantly, however, for the very young many food
decisions are controlled by parents and preschools (Nicklas et al., 2001Nicklas , T.
A. , Baranowski , T. ,Baranowski , J. C. , Cullen , C. ,Rittenberry , L. , & Olvera
, N. ( 2001). Family and child-care provider influences on preschool children's
fruit, juice, and vegetable consumption . Nutrition Reviews , 59
Therefore, food choice for the youngest age groups may be constrained by a
number of factors.
An especially important time of life for food choice is when people step out
independently for the first time and begin to make all of their own food decisions.
For many people, this is the transition to college life. The transition to college or
university is a critical period for young adults, who are often facing their first
opportunity to make their own food decisions (Baker, 1991Baker
, S. ( 1991 ). College cuisine makes mother cringe . American Demographics , 13 (
9 ), 10 – 13 . [Google Scholar]; Marquis, 2005Marquis , M. ( 2005 ). Exploring
convenience orientation as a food motivation for college students living in
residence halls .International Journal of Consumer Studies , 29
, 55 – 63 .[Crossref], , [Google Scholar]) and this could have a negative impact on
students' eating behaviors (Marquis, 2005Marquis , M. ( 2005 ). Exploring
, 55 – 63 .[Crossref], , [Google Scholar]; Rappoport, 2003Rappoport
, L. ( 2003 ). How we eat. Appetite, culture, and the psychology of food . Toronto
,Canada : ECW Press . [Google Scholar]).
Previous literature has extensively discussed factors that influence eating behaviors
among college students. However, application of a behavioral model such as the
health belief model (HBM) has received less attention. Only three studies were
found that applied HBM in the college eating context (Garcia & Mann, 2003Garcia
, K. , & Mann , T. ( 2003 ).From ‘I wish’ to ‘I will’: Social-cognitive predictors of
behavioral intentions . Journal of Health Psychology , 8
, 347 – 360 .[Crossref], [PubMed], [Web of Science ®], , [Google Scholar]; Von
Ah, Ebert, Ngamvitroj, Park, & Kang, 2004Von Ah , D. , Ebert , S. , Ngamvitroj
,A. , Park , N. , & Kang , D.-H. ( 2004 ).Predictors of health behaviours in college
students . Journal of Advanced Nursing , 48
, 463 – 474 .[Crossref], [PubMed], [Web of Science ®], , [Google Scholar];
Wdowik, Kendall, Harris, & Auld, 2001Wdowik , M. J. , Kendall , P. A. ,Harris
, M. A. , & Auld , G. ( 2001 ).Expanded health belief model predicts diabetes self-
management in college students . Journal of Nutrition Education , 33
, 17 – 23 .[Crossref], [PubMed], , [Google Scholar]). These studies examined
avoiding dieting, a combination of eating and exercise, and diabetic students,
respectively. The present study provides valuable insights into how health beliefs
impact eating behaviors for college students—a population at the crucial stage of
transitioning into independent nutritional practices.
EATING BEHAVIOR OF COLLEGE STUDENTS
Numerous studies have shown that college students often have poor eating habits.
Students tend to eat fewer fruits and vegetables on a daily basis and report high
intake of high-fat, high-calorie foods (Brevard & Ricketts, 1996Brevard , P. B. ,
& Ricketts , C. D. (1996 ). Residence of college students affects dietary intake,
physical activity, and serum lipid levels . Journal of the American Dietetic
Association , 96 ( 1 ), 35 –38 .[Crossref], [PubMed], [Web of Science
®], , [Google Scholar]; Driskell, Kim, & Goebel, 2005Driskell , J. A. , Kim , Y.-
N. , & Goebel , K. J. ( 2005 ). Few differences found in the typical eating and
physical activity habits of lower-level and upper-level university students . Journal
of the American Dietetic Association , 105 , 798 –801 .[Crossref], [PubMed], [Web
of Science ®], , [Google Scholar]; Racette, Deusinger, Strube, Highstein, &
Deusinger, 2005Racette , S. B. , Deusinger , S. S. ,Strube , M. J. , Highstein , G.
R. , &Deusinger , R. H. ( 2005 ). Weight changes, exercise, and dietary patterns
during freshman and sophomore years of college .Journal of American College
Health, 53 , 245 – 251 .[Taylor & Francis Online], [Web of Science ®], , [Google
Scholar]). According to the American College Health Association (2006American
College Health Association . ( 2006 ). American College Health Association-
National College Health Assessment (ACHA-NCHA) spring 2004 reference group
data report (abridged) . Journal of American College Health , 54 , 201 –
211 .[Taylor & Francis Online], [Web of Science ®], , [Google Scholar]), a 2004
study revealed that only 7.3% of students ate five or more servings of fruits and
vegetables daily. The transition to college life often worsens dietary habits among
students (Grace, 1997Grace , T. W. ( 1997 ). Health problems of college
students .Journal of American College Health, 45 , 243 – 250 .[Taylor & Francis
Online], [Web of Science ®], , [Google Scholar]) which could contribute to weight
problems especially during the first year of college or university (Anderson et
al., 2003Anderson , D. A. , Shapiro , J. R. , &Lundgren , J. D. ( 2003 ). The
freshman year of college as a critical period for weight gain: An initial
evaluation . Eating Behaviors, 4 , 363 – 367 .[Crossref], [PubMed], , [Google
Scholar]) and continue during later years of life (Centers for Disease
Control, 1997Grace , T. W. ( 1997 ). Health problems of college students .Journal
of American College Health, 45 , 243 – 250 .[Taylor & Francis Online], [Web of
Science ®], , [Google Scholar]; Racette et al., 2005Racette , S. B. , Deusinger , S.
S. ,Strube , M. J. , Highstein , G. R. , &Deusinger , R. H. ( 2005 ). Weight changes,
exercise, and dietary patterns during freshman and sophomore years of
college .Journal of American College Health, 53 , 245 – 251 .[Taylor & Francis
Online], [Web of Science ®], , [Google Scholar]).
Determinants of Eating Behavior
Previous studies have shown a link between demographic and psychographic

characteristics with dietary behavior of college students. Driskell et al.
(2005Driskell , J. A. , Kim , Y.-N. , & Goebel , K. J. ( 2005 ). Few differences
found in the typical eating and physical activity habits of lower-level and upper-
level university students . Journal of the American Dietetic Association , 105
, 798 –801 .[Crossref], [PubMed], [Web of Science ®], , [Google Scholar])
revealed few differences among lower and upper level students in terms of their
dietary habits, suggesting that habits established in the first year or two likely carry
forward into later college years. However, where a student lives seems to affect his
or her dietary habits and diet-related health (Brevard & Ricketts, 1996Brevard , P.
B. , & Ricketts , C. D. (1996 ). Residence of college students affects dietary intake,
physical activity, and serum lipid levels . Journal of the American Dietetic
Association , 96 ( 1 ), 35 –38 Students living off-campus reported a higher
percentage of energy from protein. Similarly, serum triglyceride level and the ratio
of total cholesterol to high-density lipoprotein were also higher among students
living off-campus. The authors conclude that students living off campus are
choosing different foods than those living on campus.
Gender differences also exist (Racette et al., 2005Racette , S. B. , Deusinger , S.

S. ,Strube , M. J. , Highstein , G. R. , &Deusinger , R. H. ( 2005 ). Weight changes,
exercise, and dietary patterns during freshman and sophomore years of
college .Journal of American College Health, 53 , 245 – 251 .[Taylor & Francis
Online], [Web of Science ®], , [Google Scholar]). Female college students tend to
eat more fatty foods than male students, although their fruit and vegetable
consumption tends to remain similar. As discussed earlier, according to Brevard &
Ricketts (1996Brevard , P. B. , & Ricketts , C. D. (1996 ). Residence of college
students affects dietary intake, physical activity, and serum lipid levels . Journal of
the American Dietetic Association , 96 ( 1 ), 35 –38 .[Crossref], [PubMed], [Web
of Science ®], , [Google Scholar]), residence on or off campus made a difference,
but it also interacted with gender. Higher energy from protein was more prevalent
among men living off campus than on campus. For women, higher serum
triglyceride and ratio of total cholesterol to high-density lipoprotein was found
among those who lived off campus. Horacek & Betts (1998Horacek , T. M. ,
& Betts , N. M. (1998 ). Students cluster into 4 groups according to the factors
influencing their dietary intake .Journal of the American Dietetic Association , 98
, 1464 – 1467 .[Crossref], , [Google Scholar]) clustered male and female college
students by dietary intake differences. Four clusters were found: students
influenced by internal (hunger and taste) and external cues (friends and media), by
budget, by health, and neither of the factors. Males tended to be equally
represented in all the four clusters with a somewhat higher percentage in the cues
group, while female students tended to cluster in the cues group (55%) followed by
health factors (28%). In a study by Mooney & Walbourn (2001Mooney , K. M. ,
& Walbourn , L. (2001 ). When college students reject food: Not just a matter of
taste . Appetite , 36 , 41 – 50 .[Crossref], [PubMed], [Web of Science ®], , [Google
Scholar]), females avoided certain foods for their concern for weight, health and
ethical reasons (especially when avoiding meat) more significantly than males.
Marquis (2005Marquis , M. ( 2005 ). Exploring convenience orientation as a food
motivation for college students living in residence halls .International Journal of
Consumer Studies , 29 , 55 – 63 .[Crossref], , [Google Scholar]) similarly reported
that females were more significantly motivated by convenience, pleasure, price,
and weight concerns than male students. We can thus conclude that the dietary
intake of male and female college students is influenced by different factors.
Motives influencing eating behaviors among college students have been studied as
well. House, Su, and Levy-Milne (2006House , J. , Su , J. , & Levy-Milne
, R. (2006 ). Definitions of healthy eating among university students .Canadian
Journal of Dietetic Practice and Research , 67 , 14 – 18. [Google Scholar])
investigated what benefits college students believed result from a healthy diet. In
this study, students at a Canadian university reported healthy eating to be helpful in
providing a healthy appearance (in terms of weight, skin, physique, and so forth),
providing positive feelings, and preventing disease. Although the results in this
study were based on a focus group finding with 15 students (9 students were
studying to be dieticians) there are nonetheless similarities with studies conducted
among general adults (Steptoe, Pollard, & Wardle, 1995Steptoe , A. , Pollard , T.
M. , &Wardle , J. ( 1995 ). Development of a measure of the motives underlying
the selection of food: The food choice questionnaire .Appetite , 25
Horacek & Betts (1998Horacek , T. M. , & Betts , N. M. (1998 ). Students cluster
into 4 groups according to the factors influencing their dietary intake .Journal of
the American Dietetic Association , 98 , 1464 – 1467 .[Crossref], , [Google
Scholar]) found that taste, time sufficiency, convenience, and budget influenced
students' eating habits in that order. These seem to act more as barriers to healthy
eating as revealed from the focus group (House et al., 2006House , J. , Su , J. ,
& Levy-Milne , R. (2006 ). Definitions of healthy eating among university
students .Canadian Journal of Dietetic Practice and Research , 67
, 14 – 18. [Google Scholar]). One could assume that these barriers may be more
influential than benefits given the prevalence of eating habits among college
students.
Other factors associated with poor eating habits among college students include a
higher perception of stress (Cartwright, Wardle, Steggles, Simon, Croker, &
Jarvis, 2003Cartwright , M. , Wardle , J. ,Steggles , N. , Simon , A. E. , Croker
,H. , & Jarvis , M. J. (2003). Stress and dietary practices in adolescents.Health
Psychology , 22, 362–369.[Crossref], [PubMed], [Web of Science ®], , [Google
Scholar]), and low self-esteem (Huntsinger & Luecken, 2004Huntsinger , E. T. ,
& Luecken , L. J. (2004 ). Attachment relationships and health behavior: The
mediation role of self-esteem . Psychology and Health , 19 , 515 – 526 .[Taylor &
Francis Online], [Web of Science ®], , [Google Scholar]). Previous studies have
also reported a low level of nutrition knowledge (Barr, 1984Barr , S.
I. ( 1984 ). Nutrition knowledge of female varsity athletes and university
students .Journal of the American Dietetic Association , 87 , 1660 – 1664 . [Google
Scholar]; Van den Reek & Keith, 1984Van den Reek , M. , & Keith
, R. (1984 ). Knowledge and use of United Stated dietary goals by university
students . Nutrition Reports International , 29 , 559 –564 . [Google Scholar]). Lack
of indepth nutrition knowledge has been attributed to reliance on sources that
provide inadequate information on nutrition (Thomsen, Terry, &
Amos, 1987Thomsen , P. A. , Terry , R. D. , &Amos , R. J. ( 1987 ). Adolescents'
beliefs about and reasons for using vitamin/mineral supplements .Journal of the
American Dietetic Association , 87 , 1063 – 1065 . [Google Scholar]).
The Health Belief Model
Although studies have investigated demographic and psychographic characteristics

of healthy eating among college students, research is lacking in terms of comparing
the effectiveness of these predictors in a single model such as the HBM. The
HBM, developed in the 1950s (Rosenstock, 1974Rosenstock , I.
M. ( 1974 ). Historical origins of the health belief model .Health Education
Monographs , 2 ,328 – 335 .[Crossref], , [Google Scholar]), is a expectancy-value
model. It has been employed in a variety of public health settings over the years.
The HBM postulates that when an individual perceives a threat from a disease
(measured by susceptibility to the disease and the severity of disease), and
perceived benefits from preventive action exceed barriers then the individual is
likely to take preventive action. In the HBM, demographic characteristics and cues
to action moderate the effects of the above mentioned predictors.
While three studies were found to apply the HBM to eating among college
students, their findings were less useful to the current study because of differences
in the nature of the sample or the dependent variables. One study (Wdowik et
al., 2001Wdowik , M. J. , Kendall , P. A. ,Harris , M. A. , & Auld
, G. ( 2001 ).Expanded health belief model predicts diabetes self-management in
college students . Journal of Nutrition Education , 33
, 17 – 23 .[Crossref], [PubMed], , [Google Scholar]) applied HBM to understand
how diabetic students manage their problem and did not address the general
student population. The two student groups may differ from each other in their
perceptions of healthy diet. For example, the diabetic student population may
perceive benefits and barriers of healthy diet differently from general student
population. A second study (Garcia & Mann, 2003Garcia , K. , & Mann
, T. ( 2003 ).From ‘I wish’ to ‘I will’: Social-cognitive predictors of behavioral
intentions . Journal of Health Psychology , 8
, 347 – 360 .[Crossref], [PubMed], [Web of Science ®], , [Google Scholar])
employed the model to understand how students resist dieting, not how they
approach healthy eating. Finally, a third study (Von et al., 2004) investigated the
influence of HBM variables on physical activity and nutrition behavior among
other behaviors. Unfortunately, they combined physical and nutrition behaviors as
a single measure, although the two behaviors conceptually differ.
The applicability of the HBM has been reported in predicting healthy eating among
general adults (for example, Kloeblen & Batish, 1999Kloeblen , A. S. , & Batish
, S. S. (1999 ). Understanding the intention to permanently follow a high folate diet
among a sample of low-income pregnant women according to the health belief
model . Health Education Research , 14 , 327 – 338.[Crossref], [PubMed], [Web
of Science ®], , [Google Scholar]; Sapp & Jensen, 1998Sapp , S. G. , & Jensen , H.
H. ( 1998). An evaluation of the health belief model for predicting perceived and
actual dietary quality . Journal of Applied Social Psychology , 28
, 235– 248 . [Google Scholar]), especially nutrition behaviors (see Chew, Palmer,
& Kim, 1998Chew , F. , Palmer , S. , & Kim , S. (1998 ). Testing the influence of
the health belief model and a television program on nutrition behavior .Health
Communication , 10 , 227 –245 .[Taylor & Francis Online], [Web of Science
®], , [Google Scholar]). However, these findings may be less generalizable to the
college student population given the differences between students and the general
adult population in terms of lifestyle, income, social environment, and food
choices available on the campus. The current study will attempt to extend the
HBM's applicability to predicting nutrition behavior among college students. In the
present study, the HBM has been extended in accordance with the Sapp & Jensen
(1998Sapp , S. G. , & Jensen , H. H. ( 1998). An evaluation of the health belief
model for predicting perceived and actual dietary quality . Journal of Applied
Social Psychology , 28 , 235– 248 . [Google Scholar]) study to include additional
variables relevant to the eating behaviors of adults. These variables include
perception of current dietary quality, perceived importance of eating a healthy diet,
and environmental variables.
Self-Efficacy
The central purpose of this study was to test the predictive ability of the HBM on
the likelihood of eating healthy in the next two-week period among college
students. As discussed earlier, since dietary behavior and motives differ by gender,
we also intend to test HBM independently for male and female college students.
The period of two weeks was chosen in an effort to assure that subjects would be
able to remember their eating habits. Healthy eating was defined as “Eating a diet
that is low in bad fat, sodium, bad cholesterol and sugar and, high in fiber, fresh
fruits and vegetables.”
HBM as modified for an eating context was hypothesized to predict college

students' intentions to eat a healthy diet. Based on the above discussion, we
propose the following hypotheses:
H1: The importance of eating healthy will be positively influenced by dietary

status, perceived severity, perceived susceptibility, and cues.
H2: The importance of eating healthy will show a negative relationship with
barriers.
H3: The importance of eating healthy will show a positive relationship with eating
intentions.
H4: Food features will positively influence barriers.
H5: Food features will negatively influence benefits.
H6: Food features will positively influence efficacy.
H7: Barriers will negatively influence efficacy.
H8: Barriers will negatively influence behavior intention.
H9: Benefits will positively influence behavior intention.

H10: Self-efficacy will positively influence behavior intention.
See Figure 1 for a depiction of the modified HBM.

FIGURE 1 Model predicting likelihood of eating healthy.
Display full size

METHOD
Students were recruited at a Canadian university. The study was conducted by

advertising $5 for those who were willing to participate in a 20-minute survey. The
final convenience sample consisted of 194 Canadian university undergraduate
students. The gender distribution was 45% female and 55% male (n = 88 and 106
respectively). Respondents were predominantly in the 18–25 year old range,
representing 84% of the sample (n = 162), predominantly Caucasian (75% of the
sample, n = 146) followed by Asians (20% of the sample, n = 38), and
predominantly earning less than $24,000 (68% of the sample, n = 133). Responses
to height and weight questions were used to calculate each respondent's body mass
index (BMI). The average BMI was 23 (for reference, a BMI of 25 or more
indicates an overweight person).
This research was part of a larger study containing an experiment that manipulated
participants' hypothetical health conditions and asked them to make food product
choices. The effects of the experimental manipulations were controlled while
calculating the effect of HBM variables for the present analysis to assure that they
did not impact the results.
Procedure
The study was first approved by the university's Human Subjects Committee.
Respondents were invited to a computer lab where they first took part in the
manipulated health concern portion of the research. They then completed the HBM
survey which is the focus of the present analysis. After completing the study they
were given $5 as promised compensation and a feedback sheet informing them of
the purpose of the study.
Independent Measures
All items were measured with a 7-point bipolar scale (−3 to 3) unless otherwise
noted. Questions for most variables were derived from Sapp & Jensen's (1998Sapp
, S. G. , & Jensen , H. H. ( 1998). An evaluation of the health belief model for
predicting perceived and actual dietary quality . Journal of Applied Social
Psychology , 28 , 235– 248 . [Google Scholar]) study. The ‘dietary status' variable
was measured with four questions (In your opinion, was your diet in the previous
two-week period lower or higher in nutrition or was it just about right compared
with Health Canada's recommended dietary guidelines? How healthy have your
food choices been in the last two weeks: Every meal/Never? In the course of the
previous two-week period, how often have you made good food choices? In the
course of the previous two-week period, how often have you made good food
choices: Never/Always?). These items produced an alpha of 0.80.
Perceived severity was measured using seven items (I will miss more than two
months of school or work; I will have long-lasting effects; I will be bed-ridden for
a long time, I will have medical expenses; I will harm my career; My social
relationships will suffer; I will hurt my family life) producing an alpha of
.86. Perceived susceptibility was a single item measure (Do you think some day
you will get seriously ill if you do not make good food choices?). The cues to
action variable was measured with three items (I would pay more attention to the
quality of my food choices if I read information in the mass media (news stories,
ads, other programs); I would pay more attention to my food choices if
recommended by a doctor; I would pay more attention to my food choices if
friends or family members suggested it) producing an alpha of .66. Importance of
eating a healthy diet was measured with two items (How important is it to you to
eat a diet high in nutrition? How important is nutrition to you when you shop for
food?) producing an alpha of .80 (r = .67).
The food features variable was measured with four constructs: price, taste, ease of
preparation, and convenience (price; taste; ease of preparation; convenience is
important to me when I shop for food) producing an alpha of 0.61. Benefits of
healthy eating was measured with five items (For me to eat a nutritious diet most
of the time in the next two-week period would be harmful/beneficial;
unpleasant/pleasant; bad/good; worthless/valuable; unenjoyable/enjoyable)
producing an alpha of .84. Barriers to healthy eating was measured with three
items (I don't like the taste of most foods that are high in nutrition; I think it would
take too much time to change my diet most of the time in the next two-week period
to include more foods high in nutrition; Over the next two weeks, I think it would
be too hard to change my diet to include more foods high in nutrition) producing
an alpha of .79. Efficacy to healthy eating was measured with two items (If I tried,
I am confident that I could maintain a diet high in nutrition most of the time in the
next two-week period; If I wanted to, I feel that I would be able to follow a diet
high in nutrition most of the time in the next two-week period) producing an alpha
of .88 (r = .80).
Dependent Measure
Likelihood of eating healthy' was measured with three items, each measured on a
seven-point scale: (a) I intend to eat a nutritious diet most of the time in the next
two-weeks, Extremely Unlikely/Extremely Likely; (b) In the course of the next
two-week period, how often will you make good food choices? Never/Every Meal;
(c) In the course of the next two-week period, how often will you make good food
choices? Never/Always] producing an alpha of .82.
Discriminant validity analysis was conducted to check for the extent to which a
construct was truly distinct from other constructs. Pearson correlations between
independent variables were observed. None of the correlation scores were strong
enough (maximum r = .52, p < .01) to warrant a merging or dropping of constructs.
Finally, to test for common method bias arising out of having a single source of
information from students, we conducted Harman's (1976Harman , H.
H. ( 1976 ). Modern factor analysis . Chicago , IL : University of Chicago
Press . [Google Scholar]) single-factor test (EFA) selecting varimax rotation and
principle components method with all the items across constructs. The results
revealed several factors with eigenvalues more than 1. We thus concluded that
there are many constructs available and that the items are measuring distinct
constructs, and found no evidence of a significant common method bias.
RESULTS AND ANALYSIS
A Pearson correlation analysis was conducted with the independent and the
dependent variables. The correlation scores ranged from −.60 to .62. Later, a
structural equation model was constructed to test the modified HBM among all
three samples (all, male, and female students) using AMOS 5.0. As mentioned
earlier, the effect of the experimental manipulations were controlled in order to get
a better understanding of the effect of the modified HBM variables. All subjects
participated in the experimental study and were assigned to one of the health
concern manipulations (diabetes, heart disease, and generally good health). The
control variable was allowed to covary with every independent variable and a
regression path on every dependent variable among all three samples. The
influence of the control variable largely lacked significance. In the all
student sample, the variable had a significant influence on the likelihood to eat
healthy, and had a significant covariance with the adequacy of current diet
variable. There was no significant relationship of the control variable in the female
student sample. In the male student sample, the control variable had significant
covariance only with adequacy of current diet and the severity construct. In order
to reduce the clutter, paths of the control variable are not shown in the figures.
Total Sample
The HBM for the all students sample was identified given the good fit indices
(N = 194, CFI = .99, RMSEA = .05). The four independent variables, dietary
status (M = 4.41, SD = 1.11, B = 0.44, p < .01), perceived severity (M = 4.85,
SD = 1.22, B = 0.17, p < .01), perceived susceptibility (M = 5.18, SD = 1.56,
B = 0.16, p < .01), and cues (M = 5.22, SD = 1.12, B = 0.22, p < .01) significantly
predicted the importance of eating a healthy diet. In turn, the importance variable
(M = 5.42, SD = 1.16) predicted barriers to eating healthy (B = −0.39, p < .01) and
likelihood to eat healthy with the regression weight of 0.57 (p < .01). Food features
(M = 5.53, SD = 0.90) had a significant influence on barriers (B = 0.15, p < .05)
and benefits (B = −0.14, p < .05) but no influence on efficacy (B = 0.09, n. s.). In
turn, barriers (M = 3.35, SD = 1.50) had a significant influence on likelihood to
eating healthy (B = −0.14, p < .05), while benefits (M = 5.98, SD = 0.91) did not
(B = 0.05, n. s.). Barriers had a strong influence on efficacy (B = −0.74, p < .01).
In turn, efficacy (M = 5.58, SD = 1.30) had a significant influence on the
likelihood variable (M = 5.28, SD = 1.10, B = 0.25, p < .01). Based on these
results, we conclude that the data supported all hypotheses except for H6 and H9.
See Figure 2.
FIGURE 2 Model predicting likelihood of eating healthy (all students).
Display full size

Female Sample
The HBM model was later tested for each gender. The HBM for the female
studentssample was identified given the good fit indices (N = 88,
CFI = .98,RMSEA = .07). As expected, the model was supported by the data. The
three independent variables, dietary status (M = 4.55, SD = 1.15,
B = 0.52, p < .01), perceived severity (M = 4.77, SD = 1.25, B = 0.27, p < .01),
and cues (M = 5.41, SD = 1.14, B = 0.17, p < .05) significantly predicted the
importance of eating a healthy diet. But the influence of perceived susceptibility
(M = 5.27, SD = 1.54) on importance of eating a healthy diet was not significant
(B = 0.10, n. s.). In turn, the importance variable (M = 5.64, SD = 1.15) predicted
barriers to eating healthy (B = −0.73, p < .01) and the likelihood to eat healthy with
the regression weight of 0.82 (p < .01). Food features (M = 5.59, SD = 1.01) did
not have a significant influence on barriers (B = 0.15, n. s.), nor on efficacy
(B = 0.02, n. s.) but a significant influence on benefits (B = −0.25, p < .01). In turn,
barriers (M = 3.28, SD = 1.62) had a significant influence on likelihood to eating
healthy (B = −0.46, p < 0.1), while benefits (M = 6.15, SD = 0.84) did not
(B = −0.31, n. s.). Barriers had a strong influence on efficacy (B = −0.55, p < .01).
In turn, efficacy (M = 5.73, SD = 1.19) had a significant influence on the
likelihood variable (B = 0.33, p < .05). See Figure 3.
FIGURE 3 Model predicting likelihood of eating healthy (female students).
Display full size

Male Sample
The HBM for the male students sample was identified with good fit indices
(N = 106, CFI = .97, RMSEA = .06). As expected, the model was supported by the
data. The three independent variables, dietary status (M = 4.30, SD = 1.07,
B = 0.37, p < .01), perceived susceptibility (M = 5.09, SD = 1.57,
B = 0.23, p < .01), and cues (M = 5.06, SD = 1.10, B = 0.16, p < .05) significantly
predicted the importance of eating a healthy diet. But perceived severity (M = 4.93,
SD = 1.20) failed to significantly influence the importance variable (B = 0.12, n.
s.). In turn, the importance variable (M = 5.25, SD = 1.14) significantly predicted
barriers (B = −0.30, p < .01) and the likelihood to eating healthy with the
regression weight of 0.45 (p < .05). Food features (M = 5.47, SD = 0.79) did not
statistically influence barriers (B = 0.07, n. s.), efficacy (B = 0.14, n. s.), and
benefits (B = 9.71, n. s.). Similarly, barriers (M = 3.41, SD = 1.39, B = −0.04, n. s.)
and benefits (M = 5.85, SD = 0.94, B = −0.01, n. s.) did not statistically influence
likelihood to eating healthy. However, barriers had a strong influence on efficacy
(B = −1.31, p < .01). In turn, efficacy (M = 5.45, SD = 1.38) had a significant
influence on the likelihood variable (B = 0.39, p < .01) (See Figure 4). Comparing
the chi-square value and support for the hypotheses for the male and female
samples, it seems the model fits the female group data slightly better (Chi-Sq. for
females = 18.89, Chi-Sq. for males = 23.94) despite a smaller sample size
(Females = 88, Males = 106).
FIGURE 4 Model predicting likelihood of eating healthy (male students).
Display full size
In addition, one-way ANOVA was conducted to compare the means of the HBM
variables by gender. Females had a higher intention (M = 5.52, SD = 1.06) to
intake a nutritious diet than males (M = 5.08, SD = 1.09, F = 7.80, p < .01). Among
independent variables, females similarly reported higher means than males among
all variables except for severity and barriers. However, there was a statistical
difference only among three variables. Females reported statistically higher means
for cues to action (M diff. = 0.34,F = 4.54, p < .05), importance of eating a healthy
diet (M diff. = 0.39, F = 5.50, p < .05) and benefits from a healthy diet (M
diff. = 0.30, F = 5.43, p < .05).
To summarize, for females, the intention to consume a healthy diet is indirectly
influenced by dietary status, severity, and cues through their effect on importance
of a healthy diet. The importance of a healthy diet also influences behavior
intention through its influence on barriers. Food features influences benefits, but
benefits failed to influence behavior, while barriers influence behavior directly as
well as via its effect on efficacy. For males, the intention to consume a healthy diet
is indirectly influenced by dietary status, susceptibility, and cues through their
effect on importance of a healthy diet, by importance through its effect on barriers,
and by barriers through its effect on efficacy.
In general, the relationship of dietary status and cues on behavior intention via
importance of a healthy diet, the relationship of importance with behavior intention
through its relationship with barriers, and the relationship of barriers with behavior
intention via the influence of efficacy seem to hold true among both males and
females. Similarly, food features failed to predict barriers and benefits failed to
predict behavior intention among both the samples. But males and females differed
on other variables. The severity construct among males and susceptibility among
females failed to influence importance of eating a healthy diet. Food features of
price, taste, ease of preparation, and convenience while shopping for healthy food
negatively influenced benefits among females, but not among males.
Finally, barriers significantly and negatively influenced behavior intention among
females but not among males. The barriers construct included two important items
of taste and time sufficiency. As Marquis (2005Marquis , M. ( 2005 ). Exploring
, 55 – 63 .[Crossref], , [Google Scholar]) suggested, these issues matter to females.
DISCUSSION
LIMITATIONS AND FUTURE RESEARCH

The main limitation of this study is that the experimental manipulation may have
influenced students' perceptions and heightened the importance of eating healthy.
However, the relationship of the control variable (experimental manipulation) was
significant with very few variables among all three samples, reducing the concern
of this extraneous variable. Second, this study was conducted only on one campus,
using convenience sample, and within one culture. Testing the influence of these
factors on other campuses and a more representative sample would increase the
generalizability of the study. Nutrition habits and predictors may vary by
geographical location and this could influence the tendency to eat healthy. Third,
our dependent variable on intention to eat healthy was asked at a global level. This
may have prevented us from understanding the predictors unique to each food
group. Studies for example by Brown et al. (2005Brown , L. B. , Dresen , R. K. ,
&Eggett , D. L. ( 2005 ). College students can benefit by participating in a prepaid
meal plan. Journal of the American Dietetic Association , 105
, 445 – 448 .[Crossref], [PubMed], [Web of Science ®], , [Google Scholar])
showed how a prepaid meal plan had a differential effect on each food group.
The moderate to high averages of many variables could be a result of social
desirability, nevertheless many of these results are consistent with other studies.
The zero-order correlation score of likelihood to eat healthy with a few variables
such as barriers and benefits are much higher than their standard regression
weights. This could be because there is a third variable moderating the influence.
Future research could be conducted to investigate this. Finally, in relation to factor
analysis, two limitations are noted. First, the alpha level for cues to action and food
features were under the .70 ceiling typically regarded as the minimum acceptable
level. Second, importance of eating healthy, and perceived susceptibility, scales
were formed on the basis of one or two items. Future studies should investigate
these constructs with multiple items to provide higher reliability.
The Kristal et al. (2001Kristal , A. R. , Hedderson , M. M. ,Patterson , R. E. ,

& Neuhauser , M. L. ( 2001 ). Predictor of self-initiated, healthful dietary
change .Journal of the American Dietetic Association , 101 , 762 – 766 . [Google
Scholar]) study conducted among an adult population showed that stage of change
was one of the strongest predictors of decreased fat intake. Individuals in the
maintenance stage were highly likely to change their diet. Richards et al.
(2006Richards , A. , Kattelmann , K. K. , &Ren , C. ( 2006 ). Motivating 18- to 24-
year-olds to increase their fruit and vegetable consumption .Journal of American
Dietetic Association , 106 , 1405 – 1411 .[Crossref], , [Google Scholar]) study
showed favorable influence of tailoring messages by stages of change of students
on their consumption of fruits and vegetables. It might be worthwhile to
understand the predictors using HBM at various stages. This would also enable
campaign managers to better tailor their campaigns appropriately.
As a follow up study, it would be useful to compare the influence of each social

change strategy (education only, education combined with counseling, and social
marketing) in influencing students' healthy eating habits. This will enable
campaign managers to effectively appropriate funds. Two surprising results were
that food features failed to influence barriers and, secondly benefits failed to
influence behavior intention. Future studies should investigate the nature of these
relationships, or lack thereof. Since efficacy played an important role in
influencing the behavior intention and showed a significant relationship with the
barrier variable, future studies should investigate the role of two types of efficacy
as discussed by Witte (1992Witte , K. ( 1992 ). Putting the fear back into fear
appeals: The extended parallel process model .Communications Monograph , 59
,329 – 349 .[Taylor & Francis Online], [Web of Science ®], , [Google Scholar]):
self-efficacy and response-efficacy.
The authors wish to acknowledge financial support from the University of

Lethbridge's Faculty of Management and the University of Lethbridge Centre for
Socially Responsible Marketing. The authors also thank the three anonymous
reviewers of the 2007 Society for Consumer Psychology Conference for their
valuable comments.
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Najat.Y (2008). Eating habits and obesity among Lebanese university students.
Retrieved March 3, 2019 from
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-7-32.
Eating habits and obesity among Lebanese university students
 Najat Yahia,
 Alice Achkar,
 Abbass Abdallah and
 Sandra RizkEmail author
Nutrition Journal20087:32
https://doi.org/10.1186/1475-2891-7-32
© Yahia et al; licensee BioMed Central Ltd. 2008
 Received: 01 April 2008

 Accepted: 30 October 2008
 Published: 30 October 2008
Open Peer Review reports
Abstract
Background
In the past year Lebanon has been experiencing a nutritional transition in food
choices from the typical Mediterranean diet to the fast food pattern. As a
consequence, the dietary habits of young adults have been affected; thus,
overweight and obesity are increasingly being observed among the young. The
purpose of this study is to assess the prevalence of overweight and obesity on a
sample of students from the Lebanese American University (in Beirut) and to
examine their eating habits.
Methods
A cross-sectional survey of 220 students (43.6% male and 56.4% female), aged 20
± 1.9 years, were chosen randomly from the Lebanese American University (LAU)
campus during the fall 2006 semester. Students were asked to fill out a self-
reported questionnaire that included questions on their eating, drinking and
smoking habits. Also, their weight, height, percentage body fat and body mass
index were measured. Body mass index (BMI) was used to assess students' weight
status. Statistical analyses were performed using the Statistical Package for Social
Sciences software (version 13.0) to determine overweight and obesity among
students and to categorize eating habits.
Results
This study showed that the majority of the students (64.7%) were of normal weight
(49% male students compared to 76.8% female students). The prevalence of
overweight and obesity was more common among male students compared to
females (37.5% and 12.5% vs. 13.6% and 3.2%, respectively). In contrast, 6.4%
female students were underweight as compared to 1% males. Eating habits of the
students showed that the majority (61.4%) reported taking meals regularly. Female
students showed healthier eating habits compared to male students in terms of
daily breakfast intake and meal frequency. 53.3% of female students reported
eating breakfast daily or three to four times per week compared to 52.1% of male
students. There was a significant gender difference in the frequency of meal intake
(P = 0.001). Intake of colored vegetables and fruits was common among students.
A total of 30.5% reported daily intake of colored vegetables with no gender
differences (31.5% females vs. 29.2% males). Alcohol intake and smoking were
not common among students.
Conclusion
In spite of the overall low prevalence of overweight and obesity in the studied
sample, results indicate that university students would possibly benefit from a
nutrition and health promotion program to reduce the tendency of overweight and
obesity, especially among male students, and to improve students' eating habits.
Background
Lebanon has been experiencing a nutritional transition in food choices during the
past years from the typical Mediterranean diet into the fast food pattern [1].
Dietary habits of young adults are affected by the fast-food market. As a
consequence, overweight and obesity are increasingly observed among the young.
Obesity in combination with unhealthy life style, such as smoking and physical
inactivity, may increase the risk of chronic diseases. In this regard, nutritional
knowledge may act as a deterrent against fast-food trend. Thus, universities may
contribute significantly in reducing the prevalence of obesity among the young
population through the promotion of healthy eating habits. Universities may
provide an ideal forum for reaching out to a large number of young adults through
nutrition education programs that may positively influence students' eating habits
by advocating for the adoption of healthy food choices. The purpose of this study
was to assess the prevalence of overweight and obesity in a sample of students
from the Lebanese American University and examine their eating habits. Assessing
students' weight status and eating habits will help health educators to develop
proper nutrition-related education programs that promote healthy food choices and
good eating habits.
Results
Characteristics of the students' sample and BMI values
Characteristics of the participated students are presented in Table 1. A total of 220
students (96 males and 124 females), with a mean age of 20 ± 1.9 years,
participated in this study. The average weight and height of the participated
students were 67.7± 15.8 kg and 168.0 ± 10.0 cm, respectively. Mean BMI and
percentage body fat were 23.6 ± 4.1 and 23.7 ± 8.2, respectively.
Table 1
Characteristics of the participants (means ± SD)
Variable Total Males Females

Number of Students N = 220 N = 96 N = 124
Age (years) 20 ± 1.9 20 ± 2.0 20 ± 1.8
Weight (kg) 67.7 ± 15.8 79.6 ± 12.8 58.6 ± 11.2
Height (cm) 168.0 ± 10.0 177.0 ± 10.0 162.0 ± 10.0
BMI 23.6 ± 4.1 25.3 ± 3.7 22.2 ± 3.9
% Body Fat 23.7 ± 8.2 17.8 ± 4.5 28.3 ± 7.4
Students' weight status based on BMI categories and percentage body fat
The outcome of this study indicated that the majority of the students (64.7%) were
of normal weight (49% of the male students compared to 76.8% of the female
students) as indicated in Table 2. Based on BMI classification, the prevalence of
overweight and obesity was more common among male students compared to
females (37.5% and 12.5% vs. 13.6% and 3.2%, respectively). In contrast, 6.4%
female students were underweight as compared to 1.0% males. Students of normal
weight had at the same time normal percentage of body fat (14.4% males vs.
26.7% females). Similarly, the obese male students had at the same time higher
values of percentage body fat (24.4%) while the overweight male students had a
percentage body fat that was slightly higher than the normal range (20.1%)
(Table 3). In the underweight category, female students also had a lower
percentage of body fat (16.9%) (Table 3).
Table 2
Prevalence of obesity among students based on BMI by gender
Males Females Total

Weight Status N= Percentage N= Percentage N= Percentage
Underweight* 1 1.0 8 6.4 9 4.1
Normal** 47 49.0 96 76.8 143 64.7
Overweight*** 36 37.5 17 13.6 53 24.0
Obese**** 12 12.5 4 3.2 16 7.2
Underweight (BMI ≤ 18.5), ** Normal (BMI between 18.5 – 24.9), ***
Overweight (BMI between 25–29.9), **** Obese (BMI ≥ 30).
Table 3
Students' percentage body fat by gender
Males Females P value

Weight Status N= Mean ± SD N= Mean ± SD
*Underweight* 1 12.00 8 16.9 ± 2.11 0.0000
Normal** 47 14.4 ± 3.13 96 26.7 ± 4.75 0.0000
Overweight*** 36 20.1 ± 1.94 17 39.0 ± 2.25 0.0000
Obese**** 12 24.4 ± 2.29 4 42.4 ± 1.91 0.0000
* Underweight (BMI ≤ 18.5), ** Normal (BMI between 18.5 – 24.9), ***
Overweight (BMI between 25–29.9), **** Obese (BMI ≥ 30).
Students' eating habits
Eating habits of the students were compared by gender (Table 4). The majority
(61.4%) reported taking meals regularly. Female students showed healthier eating
habits compared to male students in terms of breakfast intake and meal frequency.
53.3% female students reported eating breakfast daily or three to four times per
week compared to 52.1% male students. There was a significant gender difference
in the frequency of meal intake (P = 0.001). The majority of students (52.7%)
reported eating two meals per day. Among females, 56.5% reported eating two
meals per day as compared to 47.9% males. Intake of colored vegetables and fruits
was common among students. A total of 30.5% of the students reported daily
intake of colored vegetables with no gender differences (31.5% females vs. 29.2%
males). 27.3% of the students reported daily intake of fruits. Male students tend to
eat more fruits daily as compared to females (29.2% vs. 25.8% respectively).
Alcohol intake was not common among students. 25.3% of the studied students did
not consume alcohol at all and the majority (57%) of students reported drinking
alcohol rarely whereas 17.2% reported two/three times per week. The unhealthy
eating practice was indicated by the fact that the majority (57.3%) of the students
reported eating fried food more than three times per week. Among females, 54%
reported eating fried food daily or three to four times per week compared to 61.4%
males. Daily intake of snacks apart from regular meals was more common among
females than males (55.6% vs. 50% respectively). Eating daily with friends and
family was common among students (42.7%) with no differences in gender.
Smoking was not common among students. 62.4% of the students reported that
they do not smoke, 7.2% were ex-smokers and 30.3% were current smokers.
Table 4
Student's response to questions related to their lifestyle practices including eating
habits, meal patterns, fruits and vegetables intake, fried food, alcohol
consumptions and smoking habit.
Males Females
Questions Levels Total N= % N= % P
N= Value
Do you take your Always regular 135 62 64.6 73 58.9 > 0.05
meals regularly?
Irregular 85 34 35.4 51 41.1
Do you take Daily 70 31 32.3 39 31.5 > 0.05
breakfast?
Three or four 46 19 19.8 27 21.8
times per week
Once or twice 37 18
per week
rarely 67 28 29.2 39 31.5
Males Females
N= Value
How many times do One time 17 8 8.3 19 15.3 =
you eat meals except 0.001
snacks?
Two times 116 46 47.9 70 56.5
Three times 55 24 25 31 25
Four times 22 18 18.8 4 3.2
How often do you Daily 117 48 50 69 55.6 > 0.05
take snacks apart
from regular meals?
Three or four 45 23 24 22 17.7
times per week
Once or twice 35 13 13.5 22 17.7
per week
rarely 23 12 12.5 11 8.9
How often do you eat Daily 67 28 29.2 39 31.5 > 0.05
green, red or yellow
colored vegetables?
Three or four 68 26 27.1 42 33.9
times per week
Once or twice 55 26 27.1 29 23.4
per week
rarely 30 16 16.7 14 11.3
fruits?
Three or four 48 19 19.8 29 23.4
times per week
Males Females
N= Value
Once or twice 60 27
per week
rarely 52 22 22.9 30 24.2
fried food?
Three or four 84 39 40.6 45 36.3
times per week
Once or twice 60 24 25 36 29
per week
rarely 34 13 13.5 21 16.9
with friends and
family?
Three or four 75 33 34.4 42 33.9
times per week
Once or twice 46 18 18.8 28 22.6
per week
rarely 5 4 4.2 1 0.8
What type of food do Mainly meat 19 9 9.4 10 8.1 > 0.05
you think you should
eat to have a balanced
nutrition?
Mainly 25 8 8.3 17 13.7
vegetables
Meat, 164 74 77.1 90 72.6
vegetables and
Males Females
N= Value
other variety of
foods
others 12 5 5.2 7 5.6
How often do you Two or three 39 21 21.9 18 14.5 > 0.05
drink alcohol? times per week
Never 56 25 26 31 25
Rarely 125 50 52.1 75 60.5
Please state your Current smoker 67 33 34.4 34 27.2 > 0.05
smoking history (30.3%)
Ex-smoker 16 9 9.4 7 5.6
(7.2%)
Never smoke 138 54 56.3 84 67.2
(62.4%)
Discussion
The purpose of this study was to assess the prevalence of overweight and obesity
and examine eating habits in a sample of Lebanese University students. Body mass
index was used to assess weight status. Based on BMI classification of weight
status, findings of this study indicate that the majority of students were of normal
weight. Normal weight was more prevalent among females (76.8%) as compared
to males (49%), whereas, overweight and obesity were more common among male
than female students. Students in the normal weight category had at the same time
normal values of percentage body fat. Prevalence of overweight was 37.5% in
males as compared to 13.6% in females. Obesity was more common among male
students than females in the studied population. A total of 12.5% of the males were
obese compared to 3.2% of the females. Moreover, obese students had at the same
time higher values of percentage body fat. The lower rate of obesity among female
students is expected since females are more cautious about their weight status than
males, due to society perceptions which encourage females to be slender. This
assumption was supported by the fact that only 1% of males were underweight as
compared to 6.4% of females in this studied sample. Obviously, pictures of movie
stars and models in fashion magazines and mass media have a strong impact on
girls' body shape and image perception [4]. University girls see the shape and
weight of fashion models as the ideal body shape and figure to attain. Girls with
such strong body weight perception can be at risk of developing eating disorders
[5]. Similar findings of prevalence of obesity among male university students were
reported in recent studies [6, 7]. In a study conducted among 749 students (68%
females and 32% males) recruited from the State University of the Basque
Country, prevalence rate of overweight and obesity was 25% in males compared to
13.9% in females [6]. Another study conducted among 989 medical students (527
men, 462 women) from the University of Crete reported that approximately 40%
male students and 23% female students had BMI > 25 kg/m2 [7]. High prevalence
rate of overweight and obesity was also reported in a study conducted in Kuwait
University among 842 students [8], at 32% and 8.9%, respectively. In the United
Arab Emirates, a cross-sectional survey conducted among 300 male students
reported that the prevalence rate of obesity was 35.7% in males and this figure was
higher than the rate in females [9]. In terms of eating habits, university students
usually do not follow healthy eating habits. The typical university student diet is
high in fat and low in fruits and vegetables [10]. Students often select fast food due
to its palatability, availability and convenience. A previous survey by the American
Dietetic Association indicated that obesity, or being severely overweight, is a fast-
food related issue [11]. The Healthy people 2010 objectives include a focus on
nutrition and obesity prevention [12]. In this study, data analyses of students'
eating habits revealed that the majority of students eat meals regularly and eat
breakfast daily or three to four times per week. 52.7% of the students eat meals two
times per day. However, there was a significant gender difference in the frequency
of meal intake in the studied sample (P = 0.001). As expected, intake of colored
vegetables and fruits was also common among students. Alcohol intake and
smoking were not common among students. The majority of students believe that
eating meat, vegetables and other foods will provide them with a balanced diet.
77% male students and 73% female students in this study agreed that it is
important to eat a variety of foods to have a balanced and nutritious diet. A study
conducted at Midwestern University among 105 male and 181 female students,
reported that 94.4% of the students agreed that it is important to eat a variety of
foods for good health [13]. In another study, healthful diet was classified as a diet
that included more fruits and vegetables, and less fat [14]. Daily intake of snacks
was reported by the majority of students. The unhealthy eating habit of students
was noticed in the intake of fried food (majority reported eating fried food three or
four times per week). Frequent snacking and eating fried food can adversely affect
students' health status, given the abundance of energy dense and high fat
ingredients they contain. Improving students' knowledge about nutrition and
healthy eating habits may promote healthy body weight management among
students and reduce the prevalence of overweight and obesity. A recent study
conducted among college students reported that increased knowledge of dietary
guidance, Dietary Guidelines for Americans 2005, appeared to be positively
related to more healthy eating patterns thus the better eaters had a higher level of
knowledge about nutrition[15]. Therefore, developing nutrition education
programs that promote healthy eating habits for university students should be
encouraged. Alcohol intake and smoking were not common in our sample of
students. National data on alcohol intake and the prevalence of smoking among
university students in Lebanon are limited. A previous study conducted among
1850 Lebanese university students reported that the prevalence of drinking alcohol
was found to have increased through the 1990s. However, the author stated that
protective factors, such as belief in God (irrespective of the students' religion),
practice of faith, and family or peer negative attitudes towards excessive drinking,
were associated with less frequent experimentation with alcohol [16]. A previous
study conducted among 2443 students from 13 public and private schools in
Greater Beirut reported that the prevalence rate of cigarette smoking was 2.5%
[17]. In a recent study, namely the Lebanon Global Youth Tobacco Survey
(GYTS), conducted among 5035 students aged 13–15 years from 50 schools
reported that the prevalence rate of students who were current cigarette smokers
was 8.6% and 33.9% were current water-pipe smokers. The GYTS indicated that
half of students who were current smokers expressed their desire to stop smoking
[18].
Limitations
The findings of this study are limited by the use of a sample of students from just
one university which may not be a representative of all university students in
Lebanon. Furthermore, students attending the Lebanese American University are
usually of high socio-economic standards; therefore, samples from different
universities may provide a more inclusive picture of university students taking into
consideration religion and socio-economic status. However, baseline information
about weight status and eating habits among a sample of university students was
certainly obtained from the present study.
Conclusion
Despite the low prevalence of overweight and obesity in the studied university
students' sample, results indicate that university students would benefit from a
nutrition and health promotion program to reduce the tendency of overweight and
obesity among students, particularly males, and to improve students' eating habits.
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Abdallah S.A. (2010). Obesity and eating habits among college students in
Saudi Arabia: a cross sectional study. Retrieved March 3, 2019 from
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-9-39.
Obesity and eating habits among college students in Saudi Arabia: a cross
sectional study
 Abdallah S Al-Rethaiaa†Email author,

 Alaa-Eldin A Fahmy† and
 Naseem M Al-Shwaiyat†
†
Contributed equally
Nutrition Journal20109:39
https://doi.org/10.1186/1475-2891-9-39
© Al-Rethaiaa et al; licensee BioMed Central Ltd. 2010
 Received: 11 May 2010

 Accepted: 19 September 2010
 Published: 19 September 2010
Open Peer Review reports
Abstract
Background
During the last few decades, the Kingdom of Saudi Arabia (KSA) experienced
rapid socio-cultural changes caused by the accelerating economy in the Arabian
Gulf region. That was associated with major changes in the food choices and
eating habits which, progressively, became more and more "Westernized". Such "a
nutritional transition" has been claimed for the rising rates of overweight and
obesity which were recently observed among Saudi population. Therefore, the
objectives of the current work were to 1) determine the prevalence of overweight
and obesity in a sample of male college students in KSA and 2) determine the
relationship between the students' body weight status and composition and their
eating habits.
Methods
A total of 357 male students aged 18-24 years were randomly chosen from College
of Health Sciences at Rass, Qassim University, KSA for the present study. A Self-
reported questionnaire about the students' eating habits was conducted, and their
body mass index (BMI), body fat percent (BF%), and visceral fat level (VFL) were
measured. Data were analyzed using SPSS statistical software, and the Chi-square
test was conducted for variables.
Results
The current data indicated that 21.8% of the students were overweight and 15.7%
were obese. The total body fat exceeded its normal limits in 55.2% of the
participants and VFL was high in 21.8% of them. The most common eating habits
encountered were eating with family, having two meals per day including
breakfast, together with frequent snacks and fried food consumption. Vegetables
and fruits, except dates, were not frequently consumed by most students.
Statistically, significant direct correlations were found among BMI, BF% and VFL
(P < 0.001). Both BMI and VFL had significant inverse correlation with the
frequency of eating with family (P = 0.005 and 0.007 respectively). Similar
correlations were also found between BMI and snacks consumption rate (P =
0.018), as well as, between VFL and the frequency of eating dates (P = 0.013).
Conclusions
Our findings suggest the need for strategies and coordinated efforts at all levels to
reduce the tendency of overweight, obesity and elevated body fat, and to promote
healthy eating habits in our youth.
Background
Obesity is often defined as a condition of abnormal and excessive fat accumulation
in adipose tissue to the extent that health may be adversely affected [1]. The
prevalence of obesity is increasing worldwide at an alarming rate in both
developing and developed countries. It has become a serious epidemic health
problem, estimated to be the fifth leading cause of mortality at global level [2].
Moreover, it is a risk factor for many diseases such as certain cancers,
hypertension, type II diabetes mellitus, dyslipidemia, metabolic syndrome and
coronary heart disease [3, 4, 5, 6]. The rapid cultural and social changes that have
occurred in the Arabian Gulf region, since the discovery of oil and the economic
boom during the 1970's and 1980's, were associated with an alarming increase in
obesity [7, 8, 9, 10, 11]. One of the major causes of obesity is the changes in the
diet, in terms of quantity and quality, which has become more "Westernized" [12].
In the Kingdom of Saudi Arabia (KSA), recent studies revealed increasing
consumption of animal products and refined foods in the diet at the expense of
vegetables and fruits [13, 14]. These dietary changes were accused for increasing
the prevalence of both overweight and obesity observed among Saudi children,
adolescences and adults in the last few decades [15, 16, 17, 18].
College students are highly exposed to unhealthy eating habits leading to body
weight gain [19]. According to WHO, obesity is generally more common among
women than men [1]. However, studies on college students revealed higher rates of
obesity in males than in females [19, 20]. In KSA, Rasheed et al [21] documented
that 30.6% of female health college students were either overweight or obese. In
contrast, no study was found in our literature search regarding obesity prevalence
in Saudi male college students. Therefore, the aim of the current work is to assess
overweight and obesity rates among male college students in KSA and to correlate
their body weight status and composition with their eating habits.
Results
Students' characteristics
A total of 357 male students, with an average age of 20.4 ± 1.3 years, participated
in the current study. The mean weight and height of the students were respectively
69.9 ± 15.6 kg and 168.8 ± 6.1 cm. The average BMI, BF% and VFL of the
participants were respectively 24.6 ± 5.2, 22.4 ± 9.2 and 6.5 ± 4.3 (Table 1).
Table 1
Characteristics of the participants (means ± SD).
Variable Total
Number of Students 357
Age (years) 20.4 ± 1.3
Weight (kg) 69.9 ± 15.6
Height (cm) 168.8 ± 6.1
BMI (kg/m2) 24.6 ± 5.2
BF% 22.4 ± 9.2
Variable Total
VFL (1-30) 6.5 ± 4.3
Anthropometry
The measurements of BMI indicated that the majority of students (57.4%) had
normal weight. Overweight and obese subjects represented 21.8% and 15.7% of
the students respectively, compared to 5.0% for underweight subjects. Most of the
obese students (11.5% of all participants) fall in grade 1 obesity whereas, grade 2
and grade 3 obese students represented 3.4% and 0.8% of the whole sample,
respectively (Table 2). Based on BF%, 41.7% of the students had normal body fat,
which was low in 3.1%, high in 16.8% and very high in 38.4% of them (Table 3).
Visceral fat was normal in more than three fourth of the participants (78.2%)
(Table 4). The correlations among these anthropometric measurements (BMI, BF%
and VFL) were found to be direct and significant (P < 0.001). Body fat exceeded
its normal limits not only in all overweight and obese subjects, but also in 30.7% of
those with normal BMI. In contrast, high levels of visceral fat were observed in all
obese and in 28.2% of the overweight students. Moreover, these high VFL's were
confined to 56.9% of students with very high BF% (Table 5).
Table 2
Prevalence of obesity among participants based on BMI categories [Total
(Percent)] and their mean and range BF% and VFL.
BMI categories Total BMI BF% VFL

(Percent)
mean ± mean ± range mean ± range
SD SD SD
Underweight N = 18 17.9 ± 8.2 ± 6.5- 1.1 ± 1-2
(5.0%) 0.4 1.2 10.1 0.2
Normal N = 205 21.6 ± 17.3 ± 5.5- 4.0 ± 1-7
(57.4%) 1.9 4.8 28.5 1.8
Overweight N = 78 27.2 ± 28.6 ± 22.5- 9.0 ± 7-12
(21.8%) 1.4 2.9 36.0 1.1
Obese N = 56 34.0 ± 37.1 ± 29.8- 14.1 ± 11-20
(15.7%) 3.5 4.0 46.5 2.3
BMI categories Total BMI BF% VFL
(Percent)
mean ± mean ± range mean ± range
SD SD SD
Obese N = 41 32.1 ± 35.4 ± 29.8- 12.9 ± 11-15
grade 1 (11.5%) 1.4 2.7 41.7 1.1
Obese N = 12 37.9 ± 40.6 ± 35.5- 16.6 ± 15-18
grade 2 (3.4%) 1.4 3.0 44.6 1.0
Obese N = 3 (0.8%) 43.3 ± 45.5 ± 44.6- 20 ± 0.0 20-20
grade 3 1.0 1.0 46.5
Table 3
Prevalence of obesity based on BMI categories cross tabulated with BF%
categories [Total (Percent)].
BMI BF% categories* Total

categories (Percent)
Low Normal High Very High
Underweight N=8 N = 10 N=0 N=0 N = 18
(2.2%) (2.8%) (0.0%) (0.0%) (5.0%)
Normal N=3 N = 139 N = 52 N = 11 N = 205
(0.8%) (38.9%) (14.6%) (3.1%) (57.4%)
Overweight N=0 N=0 N=8 N = 70 N = 78
(0.0%) (0.0%) (2.2%) (19.6%) (21.8%)
Obese N=0 N=0 N=0 N = 56 N = 56
(0.0%) (0.0%) (0.0%) (15.7%) (15.7%)
Total N = 11 N = 149 N = 60 N = 137 N = 357
(Percent) (3.1%) (41.7%) (16.8%) (38.4%) (100%)
* P < 0.001
Table 4
Prevalence of obesity based on BMI categories cross tabulated with VFL
categories [Total (Percent)].
BMI categories VFL categories* Total (Percent)
Normal High
Underweight N = 18 (5.0%) N = 0 (0.0%) N = 18 (5.0%)
Normal N = 205 (57.4%) N = 0 (0.0%) N = 205 (57.4%)
Overweight N = 56 (15.7%) N = 22 (6.2%) N = 78 (21.8%)
Obese N = 0 (0.0%) N = 56 (15.7%) N = 56 (15.7%)
Total (Percent) N = 279 (78.2%) N = 78 (21.8%) N = 357 (100%)
* P < 0.001
Table 5
BF% categories cross tabulated with VFL categories [Total (Percent)].
BF% categories VFL categories* Total (Percent)

Normal High
Low N = 11 (3.1%) N = 0 (0.0%) N = 11 (3.1%)
Normal N = 149 (41.7%) N = 0 (0.0%) N = 149 (41.7%)
High N = 60 (16.8%) N = 0 (0.0%) N = 60 (16.8%)
Very High N = 59 (16.5%) N = 78 (21.8%) N = 137 (38.4%)
Total (Percent) N = 279 (78.2%) N = 78 (21.8%) N = 357 (100%)
* P < 0.001
Eating habits
Although irregular meals consumption was reported in 63.3% of students, the vast
majority of them (88.6%) have breakfast at least three times per week. Most of the
participants (55.7%) eat two meals per day, while 31.4% of them eat three meals.
Eating snacks was a common habit among students and its daily consumption was
reported in 31.7% of them. With the exception of dates which are taken at least
three times weekly by 60.5% of students, vegetables and fruits were not frequently
consumed. In fact the percentage of students who rarely eat vegetables and fruits
were respectively 32.2 and 36.1, and those who eat them once or twice per week
were 32.2% and 40.3%. Almost half of participants (46.8%) eat fried foods at least
thrice a week. Sharing meals with family was a common habit among the students;
66.4% of them eat daily with their families. In addition, the majority of students
(59.7%) was aware of the types of food they should eat in order to have a balanced
nutrition. We also found that 86.8% of the students were non-smokers and 95.8%
of them never drink alcohol (Table 6).
Table 6
Participants response for eating, drinking and smoking habits questionnaire.
Questions Asked Answer Levels Total

(Percent)
Q1. Do you take your meals regularly? A. Always regular N = 131
(36.7%)
B. Irregular N = 226
(63.3%)
Q2. Do you take breakfast? A. Daily N = 178
(49.9%)
B. Three or four times per N = 138
week (38.7%)
C. Once or twice per week N = 29
(8.1%)
D. Rarely N = 12
(3.4%)
Q3. How many times do you eat meals A. One time N = 40
except snacks? (11.2%)
B. Two times N = 199
(55.7%)
C. Three times N = 112
(31.4%)
D. Four times N=6
(1.7%)
Q4. How often do you take snacks A. Daily N = 113
apart from regular meals? (31.7%)
(Percent)
week (24.9%)
(23.8%)
D. Rarely N = 70
(19.6%)
Q5. How often do you eat green, red or A. Daily N = 40
yellow colored vegetables? (11.2%)
week (24.4%)
(32.2%)
D. Rarely N = 115
(32.2%)
Q6. How often do you eat dates?* A. Daily N = 129
(36.1%)
week (24.4%)
(19.0%)
D. Rarely N = 73
(20.4%)
Q7. How often do you eat fruits except A. Daily N = 16
dates?* (4.5%)
week (19.0%)
(Percent)
(40.3%)
D. Rarely N = 129
(36.1%)
Q8. How often do you eat fried food? A. Daily N = 46
(12.9%)
week (33.9%)
(34.5%)
D. Rarely N = 67
(18.8%)
Q9. How often do you eat with family? A. Daily N = 237
(66.4%)
week (21.0%)
(10.1%)
D. Rarely N=9
(2.5%)
Q10. What type of food do you think A. Mainly meat N = 55
you should eat to have a balanced (15.4%)
nutrition?
B. Mainly vegetables N = 66
(18.5%)
C. Meat, vegetables and N = 213
other varieties of food (59.7%)
(Percent)
D. Others N = 23
(6.4%)
Q11. Please state your smoking A. Current smoker N = 32
history? (9.0%)
B. Ex-smoker N = 15
(4.2%)
C. Never smoke N = 310
(86.8%)
Q12. Did you ever drink alcohol? A. Yes N = 15
(4.2%)
B. Never N = 342
(95.8%)
* Dates were excluded from fruits in a separate question because they are a staple
food in KSA.
Correlations between anthropometry and eating habits
Correlating students anthropometric measurements with their eating habits
(Tables 7, 8 and 9) revealed that both BMI and VFL had significant inverse
correlations with the frequency of eating with family (P = 0.005 and 0.007
respectively). Similar correlations were also found between BMI and snacks
consumption rate (P = 0.018), as well as, between VFL and the frequency of eating
dates (P = 0.013).
Table 7
Correlations between BMI categories and eating habits [Total (Percent)].
Questions Answer BMI categories Total P

(Percent) Valu
Asked** Levels** Underweight Normal Overweight Obese
Q1. A. N = 2 (0.6%) N = 83 N = 27 N = 19 N = 131 0.090
(23.2%) (7.6%) (5.3%) (36.7%)
(Percent) Valu
B. N = 16 N= N = 51 N = 37 N = 226
(4.5%) 122 (14.3%) (10.4%) (63.3%)
(34.2%)
Q2. A. N = 12 N= N = 37 N = 26 N = 178 0.075
(3.4%) 103 (10.4%) (7.3%) (49.9%)
(28.9%)
B. N = 6 (1.7%) N = 82 N = 26 N = 24 N = 138
(23.0%) (7.3%) (6.7%) (38.7%)
C. N = 0 (0.0%) N = 15 N=8 N=6 N = 29
(4.2%) (2.2%) (1.7%) (8.1%)
D. N = 0 (0.0%) N=5 N=7 N=0 N = 12
(1.4%) (2.0%) (0.0%) (3.4%)
Q3. A. N = 0 (0.0%) N = 25 N = 12 N=3 N = 40 0.108
(7.0%) (3.4%) (0.8%) (11.2%)
B. N = 13 N= N = 46 N = 34 N = 199
(3.6%) 106 (12.9%) (9.5%) (55.7%)
(29.7%)
C. N = 5 (1.4%) N = 72 N = 19 N = 16 N = 112
(20.2%) (5.3%) (4.5%) (31.4%)
D. N = 0 (0.0%) N=2 N=1 N=3 N=6
(0.6%) (0.3%) (0.8%) (1.7%)
Q4. A. N = 3 (0.8%) N = 72 N = 19 N = 19 N = 113 0.018
(20.2%) (5.3%) (5.3%) (31.7%)
B. N = 9 (2.5%) N = 55 N = 19 N=6 N = 89
(15.4%) (5.3%) (1.7%) (24.9%)
C. N = 5 (1.4%) N = 43 N = 22 N = 15 N = 85
(12.0%) (6.2%) (4.2%) (23.8%)
(Percent) Valu
D. N = 1 (0.3%) N = 35 N = 18 N = 16 N = 70
(9.8%) (5.0%) (4.5%) (19.6%)
Q5. A. N = 1 (0.3%) N = 19 N = 14 N=6 N = 40 0.753
(5.3%) (3.9%) (1.7%) (11.2%)
B. N = 6 (1.7%) N = 54 N = 15 N = 12 N = 87
(15.1%) (4.2%) (3.4%) (24.4%)
C. N = 6 (1.7%) N = 65 N = 23 N = 21 N = 115
(18.2%) (6.4%) (5.9%) (32.2%)
D. N = 5 (1.4%) N = 67 N = 26 N = 17 N = 115
(18.8%) (7.3%) (4.8%) (32.2%)
Q6. A. N = 8 (2.2%) N = 83 N = 24 N = 14 N = 129 0.378
(23.2%) (6.7%) (3.9%) (36.1%)
B. N = 5 (1.4%) N = 48 N = 22 N = 12 N = 87
(13.4%) (6.2%) (3.4%) (24.4%)
C. N = 2 (0.6%) N = 35 N = 16 N = 15 N = 68
(9.8%) (4.5%) (4.2%) (19.0%)
D. N = 3 (0.8%) N = 39 N = 16 N = 15 N = 73
(10.9%) (4.5%) (4.2%) (20.4%)
Q7. A. N = 0 (0.0%) N=9 N=5 N=2 N = 16 0.479
(2.5%) (1.4%) (0.6%) (4.5%)
B. N = 6 (1.7%) N = 34 N = 14 N = 14 N = 68
(9.5%) (3.9%) (3.9%) (19.0%)
C. N = 6 (1.7%) N = 91 N = 31 N = 16 N = 144
(25.5%) (8.7%) (4.5%) (40.3%)
D. N = 6 (1.7%) N = 71 N = 28 N = 14 N = 129
(19.9%) (7.8%) (3.9%) (36.1%)
(Percent) Valu
Q8. A. N = 2 (0.6%) N = 27 N = 10 N=7 N = 46 0.538
(7.6%) (2.8%) (2.0%) (12.9%)
B. N = 9 (2.5%) N = 61 N = 33 N = 18 N = 121
(17.1%) (9.2%) (5.0%) (33.9%)
C. N = 4 (1.1%) N = 77 N = 24 N = 18 N = 123
(21.6%) (6.7%) (5.0%) (34.5%)
D. N = 3 (0.8%) N = 40 N = 11 N = 13 N = 67
(11.2%) (3.1%) (3.6%) (18.8%)
Q9. A. N = 10 N= N = 52 N = 34 N = 237 0.005
(2.8%) 141 (14.6%) (9.5%) (66.4%)
(39.5%)
B. N = 3 (0.8%) N = 49 N = 15 N=8 N = 75
(13.7%) (4.2%) (2.2%) (21.0%)
C. N = 4 (1.1%) N = 13 N = 10 N=9 N = 36
(3.6%) (2.8%) (2.5%) (10.1%)
D. N = 1 (0.3%) N=2 N=1 N=5 N=9
(0.6%) (0.3%) (1.4%) (2.5%)
Q10. A. N = 3 (0.8%) N = 34 N=9 N=9 N = 55 0.986
(9.5%) (2.5%) (2.5%) (15.4%)
B. N = 4 (1.1%) N = 34 N = 17 N = 11 N = 66
(9.5%) (4.8%) (3.1%) (18.5%)
C. N = 10 N= N = 47 N = 33 N = 213
(2.8%) 123 (13.2%) (9.2%) (59.7%)
(34.5%)
D. N = 1 (0.3%) N = 14 N=5 N=3 N = 23
(3.9%) (1.4%) (0.8%) (6.4%)
(Percent) Valu
Q11. A. N = 1 (0.3%) N = 19 N=6 N=6 N = 32 0.876
(5.3%) (1.7%) (1.7%) (9.0%)
B. N = 0 (0.0%) N=9 N=3 N=3 N = 15
(2.5%) (0.8%) (0.8%) (4.2%)
C. N = 17 N= N = 69 N = 47 N = 310
(4.8%) 177 (19.3%) (13.2%) (86.8%)
(49.6%)
Q12. A. N = 0 (0.0%) N=8 N=3 N=4 N = 15 0.475
(2.2%) (0.8%) (1.1%) (4.2%)
B. N = 18 N= N = 75 N = 52 N = 342
(5.0%) 197 (21.0%) (14.6%) (95.8%)
(55.2%)
* Indicate statistically significant correlation.
** Questions asked and answer levels were presented in Table 6.
Table 8
Correlations between BF% categories and eating habits [Total (Percent)].
Questions Answer BF% categories Total P

(Percent) Value*
Asked** Levels** Low Normal High Very
High
Q1. A. N=2 N = 57 N = 23 N = 49 N = 131 0.594
(0.6%) (16.0%) (6.4%) (13.7%) (36.7%)
B. N=9 N = 92 N = 37 N = 88 N = 226
(2.5%) (25.8%) (10.4%) (24.6%) (63.3%)
Q2. A. N=5 N = 77 N = 28 N = 68 N = 178 0.464
(1.4%) (21.6%) (7.8%) (19.0%) (49.9%)
(Percent) Value*
High
B. N=6 N = 58 N = 26 N = 48 N = 138
(1.7%) (16.2%) (7.3%) (13.4%) (38.7%)
C. N=0 N = 10 N=6 N = 13 N = 29
(0.0%) (2.8%) (1.7%) (3.6%) (8.1%)
D. N=0 N=4 N=0 N=8 N = 12
(0.0%) (1.1%) (0.0%) (2.2%) (3.4%)
Q3. A. N=0 N = 17 N=9 N = 14 N = 40 0.795
(0.0%) (4.8%) (2.5%) (3.9%) (11.2%)
B. N=7 N = 83 N = 30 N = 79 N = 199
(2.0%) (23.2%) (8.4%) (22.1%) (55.7%)
C. N=4 N = 48 N = 20 N = 40 N = 112
(1.1%) (13.4%) (5.6%) (11.2%) (31.4%)
D. N=0 N=1 N=1 N=4 N=6
(0.0%) (0.3%) (0.3%) (1.1%) (1.7%)
Q4. A. N=4 N = 49 N = 21 N = 39 N = 113 0.275
(1.1%) (13.7%) (5.9%) (10.9%) (31.7%)
B. N=5 N = 43 N = 13 N = 28 N = 89
(1.4%) (12.0%) (3.6%) (7.8%) (24.9%)
C. N=2 N = 33 N = 12 N = 38 N = 85
(0.6%) (9.2%) (3.4%) (10.6%) (23.8%)
D. N=0 N = 24 N = 14 N = 32 N = 70
(0.0%) (6.7%) (3.9%) (9.0%) (19.6%)
Q5. A. N=1 N = 10 N=7 N = 22 N = 40 0.283
(0.3%) (2.8%) (2.0%) (6.2%) (11.2%)
(Percent) Value*
High
B. N=5 N = 41 N = 15 N = 26 N = 87
(1.4%) (11.5%) (4.2%) (7.3%) (24.4%)
C. N=2 N = 49 N = 18 N = 46 N = 115
(0.6%) (13.7%) (5.0%) (12.9%) (32.2%)
D. N=3 N = 49 N = 20 N = 43 N = 115
(0.8%) (13.7%) (5.6%) (12.0%) (32.2%)
Q6. A. N=3 N = 65 N = 20 N = 41 N = 129 0.483
(0.8%) (18.2%) (5.6%) (11.5%) (36.1%)
B. N=3 N = 32 N = 18 N = 34 N = 87
(0.8%) (9.0%) (5.0%) (9.5%) (24.4%)
C. N=2 N = 23 N = 12 N = 31 N = 68
(0.6%) (6.4%) (3.4%) (8.7%) (19.0%)
D. N=3 N = 29 N = 10 N = 31 N = 73
(0.8%) (8.1%) (2.8%) (8.7%) (20.4%)
Q7. A. N=0 N=5 N=3 N=8 N = 16 0.580
(0.0%) (1.4%) (0.8%) (2.2%) (4.5%)
B. N=3 N = 27 N=8 N = 30 N = 68
(0.8%) (7.6%) (2.2%) (8.4%) (19.0%)
C. N=5 N = 66 N = 28 N = 45 N = 144
(1.4%) (18.5%) (7.8%) (12.5%) (40.3%)
D. N=3 N = 51 N = 21 N = 54 N = 129
(0.8%) (14.3%) (5.9%) (15.1%) (36.1%)
Q8. A. N=1 N = 21 N=8 N = 16 N = 46 0.935
(0.3%) (5.9%) (2.2%) (4.5%) (12.9%)
(Percent) Value*
High
B. N=4 N = 43 N = 24 N = 50 N = 121
(1.1%) (12.0%) (6.7%) (14.0%) (33.9%)
C. N=4 N = 54 N = 18 N = 47 N = 123
(1.1%) (15.1%) (5.0%) (13.2%) (34.5%)
D. N=2 N = 31 N = 10 N = 24 N = 67
(0.6%) (8.7%) (2.8%) (6.7%) (18.8%)
Q9. A. N=6 N = 97 N = 43 N = 91 N = 237 0.113
(1.7%) (27.2%) (12.0%) (25.5%) (66.4%)
B. N=2 N = 40 N = 11 N = 22 N = 75
(0.6%) (11.2%) (3.1%) (6.2%) (21.0%)
C. N=3 N = 10 N=5 N = 18 N = 36
(0.8%) (2.8%) (1.4%) (5.0%) (10.1%)
D. N=0 N=2 N=1 N=6 N=9
(0.0%) (0.6%) (0.3%) (1.7%) (2.5%)
Q10. A. N=1 N = 23 N = 13 N = 18 N = 55 0.819
(0.3%) (6.4%) (3.6%) (5.0%) (15.4%)
B. N=3 N = 24 N = 10 N = 29 N = 66
(0.8%) (6.7%) (2.8%) (8.1%) (18.5%)
C. N=6 N = 91 N = 35 N = 81 N = 213
(1.7%) (25.5%) (9.8%) (22.7%) (59.7%)
D. N=1 N = 11 N=2 N=9 N = 23
(0.3%) (3.1%) (0.6%) (2.5%) (6.4%)
Q11. A. N=0 N = 13 N=6 N = 13 N = 32 0.925
(0.0%) (3.6%) (1.7%) (3.6%) (9.0%)
(Percent) Value*
High
B. N=0 N=6 N=3 N=6 N = 15
(0.0%) (1.7%) (0.8%) (1.7%) (4.2%)
C. N= N= N = 51 N= N = 310
11 130 (14.3%) 118 (86.8%)
(3.1%) (36.4%) (33.1%)
Q12. A. N=0 N=5 N=3 N=7 N = 15 0.772
(0.0%) (1.4%) (0.8%) (2.0%) (4.2%)
B. N= N= N = 57 N= N = 342
11 144 (16.0%) 130 (95.8%)
(3.1%) (40.3%) (36.4%)
* No statistically significant correlations were found.
Table 9
Correlations between VFL categories and eating habits [Total (Percent)].
Questions Answer VFL categories Total P

(Percent) Value
Asked** Levels** Normal High
Q1. A. N = 104 N = 27 N = 131 0.666
(29.1%) (7.6%) (36.7%)
B. N = 175 N = 51 N = 226
(49.0%) (14.3%) (63.3%)
Q2. A. N = 142 N = 36 N = 178 0.482
(39.8%) (10.1%) (49.9%)
B. N = 105 N = 33 N = 138
(29.4%) (9.2%) (38.7%)
C. N = 21 (5.9%) N = 8 (2.2%) N = 29 (8.1%)
(Percent) Value
D. N = 11 (3.1%) N = 1 (0.3%) N = 12 (3.4%)
Q3. A. N = 31 (8.7%) N = 9 (2.5%) N = 40 (11.2%) 0.060
B. N = 156 N = 43 N = 199
(43.7%) (12.0%) (55.7%)
C. N = 90 N = 22 N = 112
(25.2%) (6.2%) (31.4%)
D. N = 2 (0.6%) N = 4 (1.1%) N = 6 (1.7%)
Q4. A. N = 87 N = 26 N = 113 0.091
(24.4%) (7.3%) (31.7%)
B. N = 77 N = 12 N = 89 (24.9%)
(21.6%) (3.4%)
C. N = 66 N = 19 N = 85 (23.8%)
(18.5%) (5.3%)
D. N = 49 N = 21 N = 70 (19.6%)
(13.7%) (5.9%)
Q5. A. N = 31 (8.7%) N = 9 (2.5%) N = 40 (11.2%) 0.694
B. N = 71 N = 16 N = 87 (24.4%)
(19.9%) (4.5%)
C. N = 86 N = 29 N = 115
(24.1%) (8.1%) (32.2%)
D. N = 91 N = 24 N = 115
(25.5%) (9.7%) (32.2%)
Q6. A. N = 110 N = 19 N = 129 0.013*
(30.8%) (5.3%) (36.1%)
(Percent) Value
B. N = 71 N = 16 N = 87 (24.4%)
(19.9%) (4.5%)
C. N = 48 N = 20 N = 68 (19.0%)
(13.4%) (5.6%)
D. N = 50 N = 23 N = 73 (20.4%)
(14.0%) (6.4%)
Q7. A. N = 12 (3.4%) N = 4 (1.1%) N = 16 (4.5%) 0.416
B. N = 51 N = 17 N = 68 (19.0%)
(14.3%) (4.8%)
C. N = 119 N = 25 N = 144
(33.3%) (7.0%) (40.3%)
D. N = 97 N = 32 N = 129
(27.2%) (9.0%) (36.1%)
Q8. A. N = 36 N = 10 N = 46 (12.9%) 0.882
(10.1%) (2.8%)
B. N = 95 N = 26 N = 121
(26.6%) (7.3%) (33.9%)
C. N = 98 N = 25 N = 123
(27.5%) (7.0%) (34.5%)
D. N = 50 N = 17 N = 67 (18.8%)
(14.0%) (4.8%)
Q9. A. N = 186 N = 51 N = 237 0.007*
(52.1%) (14.3%) (66.4%)
B. N = 65 N = 10 N = 75 (21.0%)
(18.2%) (2.8%)
(Percent) Value
C. N = 24 (6.7%) N = 12 N = 36 (10.1%)
(3.4%)
D. N = 4 (1.1%) N = 5 (1.4%) N = 9 (2.5%)
Q10. A. N = 42 N = 13 N = 55 (15.4%) 0.883
(11.8%) (3.6%)
B. N = 50 N = 16 N = 66 (18.5%)
(14.0%) (4.5%)
C. N = 168 N = 45 N = 213
(47.1%) (12.6%) (59.7%)
D. N = 19 (5.3%) N = 4 (1.1%) N = 23 (6.4%)
Q11. A. N = 25 (7.0%) N = 7 (2.0%) N = 32 (9.0%) 0.899
B. N = 11 (3.1%) N = 4 (1.1%) N = 15 (4.2%)
C. N = 243 N = 67 N = 310
(68.1%) (18.8%) (86.8%)
Q12. A. N = 10 (2.8%) N = 5 (1.4%) N = 15 (4.2%) 0.271
B. N = 269 N = 73 N = 342
(75.4%) (20.4%) (95.8%)
* Indicate statistically significant correlation.
Discussion
The purpose of this study was to assess overweight and obesity rates among male
college students in KSA and to correlate their body weight status and composition
with their eating habits. The current data demonstrated that more than one third of
the students were above the normal body weight. Overweight students represented
21.8% of the sample whereas, 15.7% were obese. These findings were consistent
with the results of similar studies in other Middle East and some Western
countries. In Lebanon, the prevalence of overweight and obesity among male
college students was 37.5% and 12.5%, respectively [20]. In Kuwait the
corresponding percentages were 32% and 8.9% [29], while in the United States
and the United Arab Emirates overweight and obese accounted for about 35% of
the male college students [19, 30, 31]. In contrast, only 7.9% of Iranian male
college students were above the normal body weight [32]. That rate decreased to
2.9% among Chinese college students with a percentage of obesity as low as 0.4
[23]. Despite the small sample sizes and the fact that self-reported height and
weight were used in some of the above mentioned studies, their findings still
reflect differences in the severity of obesity problems among young adults across
nations.
Recently, obesity has been defined in terms of adiposity, rather than the relation of
body weight to height and, in turn, body composition became a more desirable
determinant of obesity than BMI [33, 34]. That goes well with our results which
confirmed that 38.4% of students are obese according to their BF% compared to
15.7% on basis of their BMI. The present work also demonstrated that the total
body fat exceeded its normal values in more than half of the participants and the
VFL was elevated in more than one fifth of them. Compared to those of similar
studies, our results also revealed that normal, overweight and obese Saudi college
students have on average more fat in their bodies than their Lebanese fellows [20],
and their average BF% was higher than that in USA male college students of
different ethnicities [35]. Moreover statistical analysis of the current data showed
linear relationship between BF% and VFL among students. Health threatening
values of VFL (≥ 10) were only found in subjects with very high BF% (≥ 25) and
showed up in all obese and more than one fourth of overweight students. In
literature, visceral fat has been closely linked to non-communicable diseases such
as type II diabetes mellitus and coronary heart disease [36, 37]. Therefore, urgent
dietary management going hand in hand with regular medical follow up should be
considered to overcome or, at least, minimize the risk of the above mentioned
diseases in Saudi college students with high VFL [38].
The results of our study showed that most of the students have irregular meals with
two main meals per day. With the exception of dates, which are a staple food in
KSA, the majority of the students eat vegetables and fruits twice per week in
maximum. As well, about half of the students eat fried foods three times per week
in minimum. These habits need to be corrected using educational programs to
promote healthy eating habits in KSA. On the other hand, most of the students take
breakfast and snacks daily, eat with their families, are aware of the balanced
nutrition and never smoke or drink alcohol. These habits ought to be encouraged.
Comparing our results with equivalent studies from Lebanon and China [20, 23],
for students of the same gender, revealed diversity in eating habits among male
college students in different societies. Most of Saudi students (63.3%) eat irregular
meals while 64.6% of Lebanese and 81.6% of Chinese male students take regular
meals. About half of Saudi students have breakfast daily compared to one third of
Lebanese and two thirds of Chinese students. In KSA and Lebanon most of
students (55.7% and 47.9% respectively) eat only two meals per day. In contrast,
the vast majority of Chinese students (74.3%) eat meals thrice a day. Eating snacks
was a daily habit in about one third of Saudi, half of Lebanese and only about one
tenth of Chinese college students. Vegetables and fruits consumption was
uncommon habit among Saudi students. On the other hand, 83.5% of Chinese and
56.3% of Lebanese male students consume vegetables three times or more per
week. Moreover, 49% of Lebanese students eat fruits at the same rate. Most Saudi
and Lebanese students eat with family, while most Chinese students eat alone.
It is well documented that vegetables and fruits are low in energy density because
of their high water and fiber content. Therefore, adding them to a diet reduces its
overall energy intake, thus, helping in weight management [39]. However, the
current data showed insignificant (P > 0.05) correlation between BMI, BF% or
VFL on one hand and vegetables and fruits consumption on the other hand. That
could be explained by two factors; 1) inadequate intake of these foods and 2) the
unhealthy habits entitled in their consumption. Eating raw vegetables and fruits in
the course of a meal is uncommon among Saudi population. In addition, the
vegetables content in most of the traditional Saudi dishes (e.g. Kabsa, Margog,
Mandy) is too small to have an impact on the overall energy density of the diet.
Moreover, fruits are usually taken as a dessert at the end of meals, thus, losing their
"satiety effect" that tends to lower the overall energy intake of the diet. The term
"snack" refers to all foods and drinks taken outside the context of the three main
meals [40]. Although increased snacks consumption is often accused for increased
prevalence of obesity, yet, a clear cut relation between snacking and BMI is still
unsettled. Spanos and Hankey [41] examined the habitual meal and snaking
patterns of university students and found no correlation between BMI and
snacking. On the other hand, de Graaf [40] reported that snacks consumption may
contribute to a positive energy balance and increased body weight. Contrarily,
results of the present study revealed an inverse relationship between BMI and
snacks eating rate. That can be explained by the high-calorie larger meals taken by
the students in absence of snacks. This is supported by several epidemiological
studies, as cited by Bellisle et al [42], which revealed an inverse relationship
between habitual frequency of eating and BMI, leading to the assumption that
increased eating of both meals and snacks frequency i.e. "nibbling meal pattern"
helps in avoidance of obesity rather than the "gorging meal pattern". Moreover, a
recent study on rats demonstrated that obesity development is associated with
increased Calories per meal rather than per day, suggesting that the large size of
meal, but not the overnutrition, could be responsible for obesity [43]. Similarly,
significant inverse correlations were detected between both BMI and VFL, and the
frequency of eating with family. This could be due to the fact that students, eating
away from home, depend mainly on fast food high in Calories and fats and low in
vegetables and fruits. This is supported by the results of earlier studies which
reported that diets of the university students living away from the family are
characterized by a number of undesirable practices affecting their healthy
lifestyles. Significant decrease in the consumption of fruits, fresh and cooked
vegetables, seafood and pulses together with increased intake of sugar and fast
foods were the major dietary changes reported for university students living away
from the family home. In addition, it has been suggested that the lack of experience
in planning meals, and assuming responsibility for food purchasing and preparing
for the first time are the main factors underlying the unhealthier dietary choices of
these students [44, 45]. Moreover, a unique finding in the present work was the
significant inverse correlation between VFL and dates eating frequency. Dates are
one of the main fruits frequently consumed by Saudis as snacks between meals and
prior to main meals on social gatherings. It is well known that consuming the
whole fruits promotes satiety and reduces energy intake at the next meal [39]. This
may explain the inverse correlation between VFL and the frequency of dates
consumption.
Conclusions
In short, our findings showed high rates of overweight and obesity among male
college students in KSA. Furthermore, BF% was elevated among more students,
increasing the obesity prevalence by more than two times when used for defining
adiposity rather than BMI. In contrast, the majority of the students possess normal
VFL. High VFL's were encountered only in the extremely overweight and obese
participants and, thus, can be used as a warning indicator for life threatening health
problems associated with obesity such as diabetes and heart attack. Irregular and
infrequent meals together with low vegetables and fruits intake were the most
common unhealthy eating habits of the participants. Eating with family and
frequent snacking were found to have a negative effect on BMI. Furthermore, VFL
was inversely correlated with the frequency of both eating with family and dates'
consumption. The university and college arenas represent the final opportunity for
nutritional education of a large number of students. Our findings suggest the need
for strategies and coordinated efforts at all levels (family, university, community
and government) to reduce the tendency of overweight and obesity among college
students and to promote healthy eating habits in our youth.
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Factors Influencing Healthy Eating Habits Among

Factors Influencing Healthy Eating Habits Among College Students: An

Sameer Deshpande ,Michael D. Basil &Debra Z. Basil

EATING BEHAVIOR OF COLLEGE STUDENTS

Determinants of Eating Behavior

Previous studies have shown a link between demographic and psychographic

Gender differences also exist (Racette et al., 2005Racette , S. B. , Deusinger , S.

The Health Belief Model

Although studies have investigated demographic and psychographic characteristics

HBM as modified for an eating context was hypothesized to predict college

H1: The importance of eating healthy will be positively influenced by dietary

H7: Barriers will negatively influence efficacy.

H8: Barriers will negatively influence behavior intention.

H9: Benefits will positively influence behavior intention.

See Figure 1 for a depiction of the modified HBM.

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Students were recruited at a Canadian university. The study was conducted by

RESULTS AND ANALYSIS

FIGURE 2 Model predicting likelihood of eating healthy (all students).

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FIGURE 3 Model predicting likelihood of eating healthy (female students).

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LIMITATIONS AND FUTURE RESEARCH

The Kristal et al. (2001Kristal , A. R. , Hedderson , M. M. ,Patterson , R. E. ,

As a follow up study, it would be useful to compare the influence of each social

The authors wish to acknowledge financial support from the University of

1. American College Health Association . ( 2006 ). American College Health

Eating habits and obesity among Lebanese university students

 Received: 01 April 2008

Variable Total Males Females

Males Females Total

Males Females P value

 Abdallah S Al-Rethaiaa†Email author,

 Received: 11 May 2010

BMI categories Total BMI BF% VFL

BMI BF% categories* Total

BF% categories VFL categories* Total (Percent)

Questions Asked Answer Levels Total

Questions Answer BMI categories Total P

Questions Answer BF% categories Total P

Questions Answer VFL categories Total P

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