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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 27
| Issue : 1 | Page : 60-64 |
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Eating behavior and stress levels among college students
Mitravinda Aneesh, Rinnu Roy
Department of Nutrition and Dietetics, Mount Carmel College (Autonomous), Bengaluru, Karnataka, India
| Date of Submission | 04-Jan-2022 |
| Date of Decision | 05-Feb-2022 |
| Date of Acceptance | 12-Feb-2022 |
| Date of Web Publication | 13-Aug-2022 |
Correspondence Address:
Dr. Mitravinda Aneesh
Department of Nutrition and Dietetics, Mount Carmel College (Autonomous), Bengaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmhhb.jmhhb_1_22
Background: Eating behavior of college students is very dynamic. College students tend to have erratic eating patterns because of long study hours in college, high workload, and lack of time. Aim: The purpose of the study was to assess the eating behavior and the stress level they experience. Materials and Methods: A cross-sectional study was conducted on 237 college-going students aged 18–24 years selected via convenience sampling. Information regarding age, sex, household income, place of stay, and self-reported weight and height was collected via an online survey. Three-Factor Eating Questionnaire was used to assess eating behavior and Perceived Stress Scale was used to assess stress levels. Results: Two-third of the students had normal body mass index (BMI). Majority of the participants (81.4%) had moderate stress levels. We found that uncontrolled eating (UE) (45%) was the most predominant eating behavior among college students. Linear regression analysis indicated that male gender and perceived stress predicted UE and emotional eating behavior, respectively. On the other hand, female gender and BMI predicted cognitive restraint eating behavior. Conclusion: Our study found that distinct eating behaviors are prevalent during the college years itself. Deep-rooted eating behaviors can make way for health risks in the near future. Hence, it is imperative to educate the college students about food and nutrition and also teach healthy stress management strategies.
Keywords: College students, eating behavior, perceived stress
How to cite this article:
Aneesh M, Roy R. Eating behavior and stress levels among college students. J Mental Health Hum Behav 2022;27:60-4 |
| Introduction | |  |
College life marks the transition from adolescence to adulthood. Students experience several changes in their life owing to academic challenges, college/university environment, peers, being away from parents/family, societal expectations, and personal aspirations. College life is embroiled with a surge of emotions including stress, loneliness, worry, issues of self-esteem, and depression.[1],[2],[3] Alongside, their dietary habits and eating behavior may also undergo some changes.
Eating behavior is a complex interaction of physiologic, psychological, social, and genetic factors that can affect meal timing, quantity of food intake, and food preference. Human eating behavior develops in the formative years, i.e., infancy to early childhood. Poor dietary intake, unhealthy food choices, consumption of convenience foods, skipping meals and overall lack of nutritious foods at meals are common.[3],[4],[5] Students who stay away from home for education tend to rely heavily on ready-to-eat packaged foods and/or foods from restaurants, road-side eateries, and so on. Most of these foods are loaded with simple carbohydrates, fat, and sodium and lack protein and micronutrients.
Through the lifespan, many factors influence the development of eating behavior. Literature suggested that eating behavior during adolescence and college years was influenced by home environment, which encompassed types of foods stocked at home, types of foods available and accessible, and parental eating/food behavior.[6],[7],[8] In addition to this, social media and mass media were also seen to influence the eating behavior.[5],[7]
An individual's emotional state has also been recognized to be instrumental in determining their eating behavior. The transition from high school to college or university is itself likely to precipitate stress among students. Majority of the studies on college students in India have been conducted among medical students. A systematic review by Sarkar et al.[9] reported that the pooled prevalence of stress from 28 Indian studies on medical students was 51.3%. Studies indicated that body dissatisfaction, loneliness, and stress were associated with emotional eating (EE) and eating disorders among adolescents and college students.[2],[3],[10] In view of the current evidence, we conducted a study with an aim to assess the eating behavior among the nonmedical college students and examine the relationship between stress and eating behavior.
| Materials and Methods | | |
Ethics approval
The study was approved by the Institutional Human Ethics Committee, Mount Carmel College Autonomous, Bengaluru (IHEC-MCC No. 009 M.Sc./2020-21).
Study design and setting
This cross-sectional was conducted during the first wave of COVID-19 in India, i.e., December 2020 to February 2021. Owing to the pandemic situation, physical data collection was not feasible; therefore, online data collection mode was adopted.
Sample selection
The sample size of the study was 237 college-going students. College students from different parts of the country were invited to participate in the study using the convenience sampling method. Students were selected based on the following criteria for inclusion and exclusion.
Criteria for inclusion
- College-going students aged between 18 and 24 years of age either pursuing regular undergraduate and postgraduate programs
- Students who had access to electronic devices, either a smartphone or tab or a computer.
Criteria for exclusion
- Students who had certain medical conditions because of which they were on a specific type of diet and those who were undergoing any psychiatric treatment or psychological therapy
- Students who were pursuing distance education and/or were working part time.
We approached nonmedical participants who were pursuing graduation or postgraduation through the primary and secondary contacts of the researchers. We collected information from all the participants regarding their age, mode of education, if they were on any special diet, and if they were undergoing any psychiatric treatment or counseling. Only the data of those participants who satisfied the inclusion and exclusion criteria were considered for the study. In all, we excluded around 37 participants, and finally, data of 237 students were included for the analysis.
Measurements
Eating behavior
We used Three-Factor Eating Questionnaire (TFEQ) to assess the eating behavior of the participants. TFEQ is a self-assessment scale mostly used to measure cognitive and behavioral components of eating.[11] The tool identified three domains, mainly uncontrolled eating (UE), cognitive restraint (CR), and EE. The TFEQ contains 21 questions. The questions are scored on a 4-point Likert Scale for items 1–20 and an 8-point Numerical Rating Scale for item 21. Before calculating domain scores, questions 1 to 16 were reverse scored and questions from 17 to 20 were directly scored. Mean of all the questions within every domain was considered as domain scores. Domain scores are ranged from 1 to 4, higher scores are the indicative of greater CR, UE, and EE.
Stress
Perceived Stress Scale (PSS) was used to assess the stress level of the participants. PSS is the most widely used tool for measuring the perception of stress.[12] For each question, there were four options such as 0 – never, 1 – almost never, 2 – sometimes, 3 – fairly often, and 4 – very often. Questions from one to three were directly scored, while four to eight were reverse scored. By adding up the scores of each item, PSS was calculated. Individual scores of the PSS ranged from 0 to 40, with higher scores indicating higher perceived stress. In addition to the PSS, two questions were added. These questions explored the potential events that trigger the participants' emotional well-being.
General information
Participant's personal information such as date of birth, gender, family size, household income, place of stay, class duration, and study hours was collected. Owing to the current pandemic situation, it was not feasible to measure the height and weight of the participants. Therefore, self-reported height and weight were considered.
Data collection
Data were collected between December 2020 and March 2021. A self-administrated questionnaire was developed using Google Forms for the purpose of data collection. Owing to the pandemic situation, physical data collection was not feasible; therefore, online data collection mode was adopted. Along with the Google Forms, an information sheet regarding the objective of the study and information required was shared with the participants. The participants were assured about the confidentiality of the data and that the information collected would be used strictly for research purposes only. Participants were included in the study after obtaining electronic informed consent.
Statistical analysis
Data were analyzed using IBM SPSS Statistics version 20 (IBM Corp., Armonk, NY, USA). Descriptive analysis including frequency distribution was carried out for all the variables. We used t-test to compare the eating behavior between males and females. We performed linear regression to identify the predictors of the three eating behaviors – UE, EE, and CR. The independent variables included in the analysis were body mass index (BMI), PSS, and gender.
| Results | | |
In all, 237 nonmedical college students participated in the study, the age group of the participants ranged from 18 to 24 years. The mean age of the participants was 21.78 ± 0.7 years. Out of all subjects, 58.6% of the participants were females and 40.9% of the participants were males. One participant did not wish to disclose their gender. More than half of the participants were pursuing undergraduate degrees, while the remaining were doing postgraduation degree. Nearly 40% of the participants were from Kerala, followed by 35% from Karnataka and the remaining 25% from Delhi, Kolkata, and Mumbai. Owing to the ongoing pandemic, online was the mode of learning. The timings of all the participants were erratic and extended over 10–14 h, including classes and assignments.
The mean self-reported height and weight of the participants was 165.41 ± 9.5 cm and 60.65 ± 12.7 kg, respectively. The mean BMI of the participants was found to be 22.04 ± 3.46 kg/m2 with a minimum of 14.45 kg/m2 and a maximum of 34.52 kg/m2. Males had a significantly greater BMI than the female students (male: 23.12 ± 3.5 kg/m2, female: 21.29 ± 3.2 kg/m2, t = −4.132, P < 0.001). Nearly two-third of the participants (n = 161) had normal BMI. Sixteen percent (n = 38) of the students were underweight, while 13% (n = 31) were overweight and 3% (n = 7) were obese. We found no difference in the BMI statuses between the males and females (χ2 = 11.260, P = 0.081).
Eating behavior of the participants
Based on the scores of the eating behavior domains, it was found that UE was the most predominant eating behavior among the participants. Of the 223 participants, 45.3% (n = 101) had UE behavior (2.30 ± 0.5), 43% (n = 96) had CR (2.28 ± 0.5), and 11.7% (n = 26) had EE behaviors (1.85 ± 0.7).
In the Three-Factor Eating Questionnaire (TFEQ), nine statements were used to understand the tendency of UE behavior. Among these, over two-third of the participants felt like eating with someone who is eating, while 62.5% found it hard to resist the sight of favorite food and 64.6% felt hungry at the sight of the delicious food [Table 1]. Over half the participants indulged in binge eating when not hungry. We found that male participants showed more UE behavior than female participants (male: 2.39 ± 0.45, female: 2.24 ± 0.57, t = 1.984, P = 0.04). More male participants reported being “always hungry” as compared to females (χ2 = 12.382, P = 0.054). Likewise, more men were “hungry at the sight of delicious food” (χ2 = 12.848, P = 0.046) and “felt like eating with someone who was eating” (χ2 = 12.540, P = 0.051).
Six statements were used to explore the tendency of EE among the participants. Less than 20% of the participants experienced majority of the EE behaviors [Figure 1]. Nearly 40% of the participants ate when they felt anxious. No differences were seen between the EE scores of male and female respondents (male: 1.86 ± 0.71, female: 1.83 ± 0.64, t = 0.354, P = 0.724).
Five statements were used to explore CR eating behavior. As shown in [Figure 2], nearly 60% of the participants ate less to control their weight and over 40% practiced other restraint behaviors such as held back while eating to control weight, made efforts to eat less, and avoided stocking up. No differences were seen between the CR scores of male and female respondents (male: 2.20 ± 0.45, female: 2.33 ± 0.52, t = 1.824, P = 0.069). | Figure 2: Participant responses regarding cognitive restraint eating behavior
Click here to view |
The overall mean score of PSS was 19.5 ± 5.015. The maximum score obtained in the PSS score was 37 and the minimum score was 4. Out of all, 10.9% had low stress, 81.4% had moderate stress, and 7.5% had high stress. The mean perceived stress score of female students was 20.40 ± 5.452 and that of male students was 18.37 ± 4. 073. Female participants had significantly higher stress levels than their male counterparts (t = 3.102, P = 0.010).
The factors predicting the eating behavior among college students are presented in [Table 2]. As compared to females, male gender was significantly associated with UE behavior. On the other hand, female gender and BMI strongly predicted CR eating behavior. Perceived stress scores significantly influenced the EE behavior of the participants.
| Discussion | | |
We found that UE was the predominant eating behavior followed by CR among the college students. We found gender differences in the eating behaviors. Perceived stress and BMI were also identified as predictors of the eating behavior among college students.
The TFEQ identified three main behaviors – UE, EE, and CR. Of these, majority of our participants exhibited UE behavior followed by CR and EE. UE signifies a lack of control and high impulsiveness to consume food.[13] It has been associated with several factors such as BMI, body fat, and stress. However, we found that UE was strongly associated with male gender. Studies have reported conflicting findings. Several studies suggested that females showed a higher prevalence of binge eating and UE. In females, binge eating was related to stress and emotional concerns. Females were most likely to indulge in binge eating episodes when alone and experience stress or guilt post the episode. Males, on the other hand, were more likely to binge socially. In males, bingeing was related to substance use, exercise, and hunger.[14] In our study, more male participants reported being “always hungry,” “hungry at the sight of delicious food,” and “felt like eating with someone who was eating” as compared to females. Moreover, UE behavior was seemed to be influenced by BMI. Micali[2] found that body dissatisfaction and BMI z scores at the age of 10 years predicted bingeing in boys in their adolescence (β = 1.32, P < 0.001). Further, in overweight men, UE was strongly associated with PSS (r = 0.33, P = 0.0009) in adulthood.[15]
CR indicates cognitive effort to control food intake and regulate body weight. Individuals with such behavior exercise stricter regulation of energy intake and body weight. We found that CR behavior was associated with BMI and female gender. Female college students are highly conscious about their appearance, body image, and body weight. Higher BMI is commonly linked with unattractiveness, criticism from peers, rejection from the opposite sex, and limited clothing options. Owing to this, they are likely to attempt to maintain a lower BMI by controlling or restricting their food intake.[14] Micali et al.[2] reported that female adolescents (23.7%) depicted a higher prevalence of body dissatisfaction than males (19.7%). Moreover, a greater proportion of females (39.2%) reported “dieting” in the past 1 year as compared to males (12.4%). Further, body dissatisfaction and BMI z scores at the age of 10 years predicted restraint behavior in girls (β = 1.28, P < 0.0001).
EE relates to high responsiveness to emotional and external cues that elicit food intake.[14] In our study, EE behavior was positively associated with the perceived stress levels of the participants. Our findings are consistent with other studies conducted among college students[16],[17] and adults.[15] Several factors including social factors, college life, academics, and individual factors have been identified as contributors to stress during college years.[18] Stress has been associated with high cortisol levels, food cravings, food addiction scores, bingeing, poor eating regulation, and impulsiveness.[14] Stress has been noted to produce sensations of hedonic hunger, i.e., eating for pleasure in the absence of physiological hunger.[15] Evidence indicates that high stress increases the frequency of food intake, consumption of fast foods, ready-prepared meals, snacks, sweets, hot and spicy foods as well as alcohol intake.[3],[18] Foods that are high in fat and sugar are particularly consumed during times of stress as they were presumed to be more rewarding.[15]
Our study had some limitations. First, owing to the pandemic and the restrictions, we had to restrict to convenience sampling. We used social media for circulating our forms. As a result, the response rate remains unknown. Second, this was an observational study. Hence, we cannot ascertain any causal relations between the variables. Thirdly, due to the online nature of the study, we could not collect information on the dietary intake, eating pattern of the participants, and factors associated.
| Conclusion | | |
Trends in eating behavior are apparent during the college years. Eating behavior is associated with stress as well as BMI. The focus of students during college years is least on nutrition or diet. Food is either associated with pleasure or relieving stress. Body image concerns do also influence food intake and food choices. It is hence imperative for students to develop a healthy relationship with food. Awareness regarding food, nutrition, and food choices can help in this. Thus, nutrition literacy and stress management should be included as a part of the curriculum for students across the streams of study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]
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