ABSTRACT
PERCEIVED OBESITY AND WEIGHT LOSS STRATEGIES
AMONG STUDENTS AT FRESNO STATE
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. This study used secondary data from
the American College Health Association-National College Health Assessment II
Survey (ACHA-NCHA II). A total of 763 Fresno State students completed the
survey with a response rate of 19.2%. A Pearson’s Chi-Square Test with Yates
Correction Factor was used to test significance among the variables of perceived
body weight, actual BMI, gender, weight loss strategies, race/ethnicity, and
exercise weight loss strategies.
The study found statistically significant differences in perceived body
weight and actual BMI. In addition, the study also found statistically significant
differences in the weight loss strategies of dieting, vigorous exercise, and strength
training exercise with respect to gender. However, there were no statistically
significant differences in the use of laxatives, vomiting, or moderate exercise as
weight loss strategies. Moreover, race/ethnicity were not statistically significant
with regard to diet or exercise as weight loss strategies.
The results suggest that college students who are obese perceive themselves
as overweight and that there are gender differences in weight loss strategies. The
analysis of the data was intended to offer valuable information for the
development of an obesity and weight loss program for Fresno State students.
Edward James Boyle IV
August 2015
PERCEIVED OBESITY AND WEIGHT LOSS STRATEGIES
AMONG STUDENTS AT FRESNO STATE
by
Edward James Boyle IV
A thesis
submitted in partial
fulfillment of the requirements for the degree of
Master of Public Health
in the College of Health and Human Services
California State University, Fresno
August 2015
APPROVED
For the Department of Department of Public Health:
We, the undersigned, certify that the thesis of the following student
meets the required standards of scholarship, format, and style of the
university and the student’s graduate degree program for the
awarding of the master’s degree.
Edward James Boyle IV
Thesis Author
Vickie Krenz (Chair)
Public Health
Kara Zografos
Public Health
Eric Krenz
Public Health
For the University Graduate Committee:
Dean, Division of Graduate Studies
AUTHORIZATION FOR REPRODUCTION
OF MASTER’S THESIS
X
I grant permission for the reproduction of this thesis in part or in
its entirety without further authorization from me, on the
condition that the person or agency requesting reproduction
absorbs the cost and provides proper acknowledgment of
authorship.
Permission to reproduce this thesis in part or in its entirety must
be obtained from me.
Signature of thesis author:
ACKNOWLEDGMENTS
This thesis is dedicated to my wife Nereida, my son Edward James Boyle
V, and my daughter Daniela Rachelle Boyle. This journey was made possible
because of their support and unconditional love. A very special thank you to my
committee of Dr. Vickie Krenz, Dr. Kara Zografos, and Dr. Eric Krenz for the
dedication and guidance through this process. I would also like to thank the staff
of the Graduate Writing Studio for all of their assistance, and my parents for their
encouragement.
TABLE OF CONTENTS
Page
LIST OF TABLES ................................................................................................. vii
CHAPTER 1: INTRODUCTION ............................................................................ 1
Introduction ....................................................................................................... 1
Background ....................................................................................................... 3
Statement of the Problem .................................................................................. 6
Hypotheses ........................................................................................................ 9
Limitations ........................................................................................................ 9
Theoretical Framework ................................................................................... 10
Definitions ....................................................................................................... 14
Summary ......................................................................................................... 14
CHAPTER 2: LITERATURE REVIEW ............................................................... 16
Introduction ..................................................................................................... 16
ACHA-NCHA II Survey Overview ................................................................ 16
Perceived Body Weight and BMI ................................................................... 18
Diet Weight Loss Strategies and Gender ........................................................ 22
Diet Weight Loss Strategies and Race / Ethnicity .......................................... 25
Exercise Weight Loss Strategies and Gender ................................................. 27
Exercise Weight Loss Strategies and Race/Ethnicity ..................................... 29
Summary ......................................................................................................... 31
CHAPTER 3: METHODOLGY ............................................................................ 32
Introduction ..................................................................................................... 32
Setting and Participants ................................................................................... 32
Data Collection................................................................................................ 33
vi
Page
Data Analysis .................................................................................................. 34
Protection of Human Subjects......................................................................... 35
Summary ......................................................................................................... 35
CHAPTER 4: RESULTS ....................................................................................... 36
Introduction ..................................................................................................... 36
Demographics ................................................................................................. 36
Analyses of Hypotheses .................................................................................. 39
Summary ......................................................................................................... 46
CHAPTER 5: DISCUSSION AND RECOMMENDATIONS .............................. 47
Introduction ..................................................................................................... 47
Demographics ................................................................................................. 47
Hypotheses Findings ....................................................................................... 53
Implications to Public Health .......................................................................... 61
Conclusion and Recommendations ................................................................. 62
Recommendations ........................................................................................... 66
Summary ......................................................................................................... 67
REFERENCES ....................................................................................................... 69
APPENDIX: TABLES ........................................................................................... 78
LIST OF TABLES
Page
Table 1 Gender, Age, and Race/Ethnicity of Participants .................................... 37
Table 2 How Would You Describe Your Body Weight? ........................................ 38
Table 3 Fresno State Students’ Actual BMIs......................................................... 38
Table 4 Diet Weight Loss Strategies ..................................................................... 39
Table 5 Exercise Weight Loss Strategies .............................................................. 39
Table 6 Fresno State Students Self-Described Weight .......................................... 41
Table 7 Last 30 Days: Diet to Lose Weight........................................................... 42
Table 8 Last 30 days: Vomit or Take Laxatives to Lose Weight ........................... 42
Table 9 Last 30 days: Take Diet Pills to Lose Weight .......................................... 43
Table 10 Past 7 days: Moderate Exercise for at Least 30 Minutes ...................... 44
Table 11 Past 7 Days: Vigorous Exercise for at Least 20 Minutes ...................... 45
Table 12 Past 7 days: Exercise to Strengthen Muscles 8-12 Repetitions ............. 45
Table 13 Gender of all Fresno State Students, Fresno State ACHA-NCHA II
Participants, and National ACHA-NCHA II Participants ....................... 48
Table 14 Age of all Fresno State Students, Fresno State ACHA-NCHA II
Participants, and National ACHA-NCHA II Participants ....................... 50
Table 15 Race/Ethnicity of all Fresno State Students, Fresno State ACHANCHA II Participants, and National ACHA-NCHA II Participants ....... 51
Table 16 Did You Do Any of the Following? Last 30 Days: Diet to Lose
Weight ...................................................................................................... 79
Table 17 Did You Do Any of the Following? Last 30 Days: Vomit or Take
Laxatives to Lose Weight ......................................................................... 79
Table 18 Did You Do Any of the Following? Last 30 Days: Take Diet Pills to
Lose Weight .............................................................................................. 80
Table 19 Did You Do Any of the Following? Last 7 Days: Moderate Exercise
for at Least 30 Minutes ............................................................................ 81
viii
Page
Table 20 Did You Do Any of the Following? Last 7 Days: Vigorous Exercise
for at Least 20 Minutes ............................................................................ 82
Table 21 Did You Do Any of the Following? Past 7 Days: Exercise to
Strengthen Muscles 8-12 Repetitions ....................................................... 83
CHAPTER 1: INTRODUCTION
Introduction
Obesity has become a major health issue in the United States. Data from the
National Center for Health Statistics indicated that 30% of individuals over the age
of 20, or 60 million adults, are obese (Wyatt, Winters, & Dubbert, 2006). Among
U.S. residents, the prevalence of obesity increased over the last 40 years with more
than 100% increase in 2007-2008 from 1976-1980 (Finkelstein et al., 2012).
Obesity is characterized as “an increase in body fat” based on calculations of the
body mass index (BMI) (Wyatt et al., 2006, p. 166). Individuals whose calculated
BMI is between 25.0-29.9 are considered overweight whereas individuals whose
calculated BMI is greater than 30.0 are considered obese (Wyatt et al, 2006). The
purpose of this study was to investigate perceived obesity and weight loss
strategies used by Fresno State students.
The prevalence of obesity has been shown to possibly be leveling off
among some subpopulations, but severe obesity, which was extremely rare in the
1970s, has continued to increase with no evidence of slowing down (Finkelstein et
al., 2012). Individuals who are either overweight or obese are at an increased risk
for many chronic diseases such as type 2 diabetes, cardiovascular disease, and
some cancers (Nelson, Gortmaker, Subramanian, Cheung, & Wechsler, 2007). In
addition, obesity has consistently been found to be associated with increasing
morbidity and mortality of nine body systems (Wyatt et al., 2006). The
cardiovascular, endocrine, respiratory, gastrointestinal, musculoskeletal, and
genitourinary system are some of the systems that obesity has been known to
affect (National Obesity Forum, n.d.).
2
The number of deaths attributed to obesity has increased substantially and
may surpass tobacco as the leading preventable cause of death (Jia & Lubetkin,
2005). The estimated annual deaths attributable to either being overweight or
obese are estimated to be between 110,000 to 400,000 annually (Wyatt et al.,
2006). The Framingham Health Study found a decrease in life expectancy of 6 to 7
years by the age of 40 among participants who are overweight.
The relationship between excess weight and poor health also has an
estimated cost of obesity as high as $147 billion per year, which accounts for
approximately 9% of all annual medical expenditures (Finkelstein et al., economic
impact. 2012). Per capita, the average total health care expenses were $4,333 for
adults who were obese and $2,970 for those who are healthy weights (Wyatt et al.,
2006). The majority of these costs are paid through Medicare and Medicaid public
funds. Indirect cost has also been linked with obesity in the form of absenteeism,
loss in productivity, and premature deaths (Wyatt et al., 2006).
Obesity rates and trends in the United States have become so alarming that
the U.S. Surgeon General has “issued a call to action regarding the obesity
epidemic and offered guidelines and strategies for addressing this public health
challenge” (Wyatt et al., 2006). A challenge in reporting the prevalence of obesity
is the limited amount of data sources used to determine U.S. rates. The two most
common sources of data used in reporting obesity data are the Behavioral Risk
Factor Surveillance Survey (BRFSS) and the National Health and Nutrition
Examination Survey (NHANES). The BRFSS survey collects data on healthrelated risk behaviors, chronic conditions, and the usage of preventive services
among U.S. residents. The Centers for Disease Control and Prevention [CDC]
(2015a) conducts over 400,000 interviews each year and has the largest
continuously conducted survey on health in the world.
3
The NHANES and the National Longitudinal Study of Adolescent Health
found that obese adolescents have a higher probability of remaining obese as they
transition into adulthood (Desai, Miller, Staples, & Bravender, 2008). Between the
years of 1976 and 2002, the percentage of overweight and obese adolescents has
more than tripled from 5% to 17%. The increased percentage is alarming as it
displays similar trends that have occurred among U.S. adults in the last 40 years.
At the college level, the 2005 American College Health Association
National College Health Assessment (ACHA-NCHA) national study found that 3
out of 10 college students were either overweight or obese (Sparling, 2007). The
CDC (2007) found that 6 of 10 college students did fewer than 3 days of moderate
exercise per week. The CDC also found that 9 out of 10 college students do not
consume the recommended five serving of fruits or vegetables per day (CDC,
2007).
The college population is more prone to using inappropriate weight loss
strategies, such as vomiting and taking laxatives. In particular, college-aged
women have been shown to be more susceptible to these inappropriate weight loss
strategies. Much research has been devoted to the study of obesity, although the
majority focuses upon obesity among children, adolescents, and adults in general.
Few studies examine obesity among college students. The college setting provides
an optimal setting in promoting weight management and other healthy lifestyle
practices because many students are transitioning into adult responsibilities and
formulating lifelong habits (Wharton, Adams, & Hampl, 2008).
Background
Obesity can be identified as the highest end of the body mass index (BMI),
which is a ratio of weight to height. Elevated BMI has been found to positively
4
correlate with comorbid conditions (Wyatt et al., 2006). Decreased activity levels
with increased calorie intake are the main causes of obesity. To measure obesity in
a practical way, BMI measurements are used in estimating body fat (Wang &
Beydoun, 2007). BMI is calculated by weight in kilograms divided by a person’s
height in meters squared. This measure is used to assess a person’s body fat and
therefore the risk for developing other chronic illnesses and diseases (The Centers
for Managing Chronic Diseases [CMCD], 2013). The National Heart, Lung, and
Blood Institute and the North American Association for the Study of Obesity
committee classify BMI outputs between 18.9 and 24.9 kg/m2 to be healthy or in
the desirable range, 25.0 to 29.9 kg/m2 is considered unhealthy, and a BMI over
30.0 kg/m2 is classified as obese (Wyatt et al., 2006). BMI tends to be the more
practical and academically agreed upon method for estimating body fat. The
values used to calculate BMI are age independent and may or may not correspond
“to the same degree of fatness in different populations due, in part, to different
body proportions” (World Health Organization [WHO], 2013, p. 1).
The prevalence of obesity was stable from the 1960s to about the 1980s, at
which point the prevalence escalated (Parikh et al., 2007). In 1980, no state in the
U.S. had an obesity rate above 15%, and by 1991, no state had an obesity rate
above 20%. Since 2005, 41 of the 50 states have had obesity rates above 25% and
none had rates below 20% (Trust for America’s Health & Robert Wood Johnson
Foundation, 2013). The obesity rate has doubled among U.S. adults and it has
tripled among children and adolescents (Jaffe, 2011).
The alarming rates of obesity have led to a major focus of concern across
college campuses nationwide. Studies on the college population have “suggested
that unhealthy diets and low physical activity levels are the largest contributors to
the overweight and obesity problem among this group” (Boyle & LaRose, 2008, p.
5
195). In 2009, there were an estimated 18.1 million students working toward their
undergraduate degree at a community college or at a university with
approximately 39% of these individuals being between the ages of 18-24 (Jaffe,
2011).
The recognition of the obesity problem among the college population is of
grave concern. The college years are “highly influential in shaping adult behavior”
(Desai et al., 2008, p. 109). Desai et al. found that interventions to combat
overweight and obesity among the college population would reduce the rate of
obesity from adolescence to adulthood, thereby preventing much long-term
obesity related consequences. They also highlighted that obesity is not easily
reversible and that those who are obese as young adults will most likely continue
to be so as adults.
College life is a time where lifestyle perceptions and behavior can be
modified and changed especially with regard to diet, exercise, and other lifestyle
habits (Desai et al., 2008). During college life, individuals make the transition
from depending on their sociological upbringing to independently making their
own decisions regarding lifestyle behaviors. Students transitioning into college
often live away from home as an estimated 74% of them live away from their
parent(s)/guardian in campus residence halls, off campus, or other college housing
(American College Health Association [ACHA], 2013a). Students living away
from their families often mean that, for the first time in their lives, they are solely
responsible for what they eat and are no longer required to participate in physical
education activities. Limited physical activity and unhealthy eating habits have
been shown to be risk factors that contribute to obesity. The 2008 American
College Health Association (ACHA) survey revealed that 10% of college students
reported themselves as obese and 21.9% as overweight (Jaffe, 2011).
6
The ACHA conducted the National College Health Assessment (ACHANCHA II) survey that specifically sampled the college population nationwide in
order to obtain precise data on students’ health habits, behaviors, and perceptions
(ACHA-NCHA, 2015). The ACHA-NCHA II survey is a nationally recognized
research survey where campuses self-select to participate. The survey offers the
opportunity to map an array of health issues including sexual health; alcohol,
tobacco, and other drug use; weight, nutrition, and exercise; personal safety and
violence; and mental health (ACHA, 2013a). The median age of respondents for
the fall 2013 survey was 21 with over 60% of participants identifying themselves
as White, 6.6% as African American or Black, 13.9% as Hispanic or Latino/a, and
13.5% as Asian or Pacific Islander. Less than 10% identified themselves as Native
or Native Hawaiian, Biracial/Multi-Racial, or other (ACHA, 2013a).
Fresno State was one of the campuses that elected to participate in the
ACHA-NCHA II survey. The most recent Fresno State ACHA-NCHA II data
were from 2013, where a total of 763 students completed the survey. The median
age for respondents was 22 with 68.5% of student participants being female and
29.6% male. Slightly over 40% of Fresno State students who participated in the
ACHA-NCHA II survey identified themselves as Hispanic or Latino/a, 36% as
White, 19.9% as Asian or Pacific Islander, 5.5% as Biracial or Multi-Racial, and
5% as Black or African American. Only 1.4% identified themselves as American
Indian or Alaskan and 4.6% as other racial/ethnic category (ACHA, 2013b).
Statement of the Problem
Obesity has become a major health issue in the United States. The data
from the NCHS indicated that “30% of people over the age of 20 years, or 60
million adults, are obese” (Wyatt et al., 2006, p. 166). Increased obesity rates
7
reveal that a greater number of people have developed chronic illnesses and
diseases at younger ages, including high blood pressure, type II diabetes, heart
disease, and cancer (LaChausse, 2012). Obesity has been found to increase
mortality rates as those whose BMI is greater than 30 have greater mortality rates
compared to those with BMIs between 25 and 30 (Wyatt et al., 2006). Factors
associated with obesity have included age, gender, socioeconomic status (SES),
ethnicity, and geographic location (Wang & Beydoun, 2007). The contributions
from these factors are complex and closely interrelated, making it difficult to
pinpoint a single culprit for increased obesity (Wang & Beydoun, 2007).
The adolescent age group of 12 to 19 years of age have shown an increase
in overweight and obesity rates as well, increasing from 5% to 17% between 1976
and 2002 (Desai et al., 2008). The 2008 ACHA–NCHA II survey found that
nationally, 28.4% of college females and 39.4% of college males were overweight
or obese (Harring, Montgomery, & Hardin, 2010). Overall, between 2000 and
2009, overweight and obesity rates among college students increased from 29% in
2000 to 32.5% in 2009 (LaChausse, 2012).
Buscemi, Yurasek, Dennhardt, Martens, and Murphy (2012) found that a
large amount of college students fall into the categories of being overweight or
obese. These findings revealed that over 37% of male college students and 29% of
female college students reported being obese or overweight. At Fresno State,
37.3% of students described themselves as being overweight and 9.3% describing
themselves as obese (ACHA, 2013b). The slightly overweight percentages are
higher than the national average of 30.3% by 4.9% (ACHA, 2013b). Similarly,
more Fresno State students reported themselves as being very overweight
compared to the national very overweight average of 4.1%. Additional studies
8
have found that the rate of weight gain is higher among first-year college students
compared to non-student in the same age group (Buscemi et al., 2012).
With the rise of obesity rates among college students, attempts have been
made across college campuses to combat the obesity epidemic. A 2010-11 weight
loss study on college students found that integrating technology into a weight loss
program produced significantly greater weight losses among college students
compared to programs that did not. Participants of the study were between the
ages of 18-29, were college students, had BMIs between 25-50, had a cell phone
with unlimited texting, and were active Facebook users (Napolitano, Hayes,
Bennett, Ives, & Foster, 2013). Participants were randomized into three groups: a
Facebook group, a Facebook and text messaging group, and a control group.
Those in the Facebook and text-messaging group had greater weight loss rates
compared to the other two groups.
Technology is fully integrated into the day-to-day lives of most college
students with approximately 94% having a cell phone, 89% having their cell
phone on them at all times, 93% using text messages, and 94% using text
messaging more than email (Napolitano et al., 2013). Furthermore, college
students frequently use the social networking site Facebook as a means of
communication and is the most commonly used web site among this population.
The integration of technology platforms in weight loss programs for college
students via Facebook and text messaging offer a low-cost method of
disseminating evidence-based content. Fresno State offers one-on-one counseling
with a nutritionist, exercise classes, intermural sport teams, bike lanes and
sidewalks around campus, and a state of the art recreation/gym that is accessible to
Fresno State students (Fresno State, n.d.). However, despite the documented
prevalence of obesity among college students there is very little empirical research
9
that evaluates weight gain interventions among this population (Buscemi et al.,
2012).
The prevalence rate among college students is of concern as obesity has
been linked to a number of chronic illness and diseases. Furthermore, the obesity
rates have been increasing over the decades with an increase of 29% to 32.5%
between 2000 and 2009 (LaChausse, 2012). More students describe themselves as
slightly overweight or very overweight at Fresno State than the national average.
Integrating technology, such as group messaging and Facebook, into a college
weight loss programs has been found to higher success than programs that do not.
Hypotheses
The study investigated the following hypotheses:
1. There was no statistically significant difference in Fresno State students’
perceived body weight and actual body mass index (BMI).
2. There was no statistically significant difference in Fresno State students’
weight loss strategies and gender.
3. There was no statistically significant difference in Fresno State students’
weight loss strategies and race/ethnicity.
4. There was no statistically significant difference in Fresno State students’
exercise weight loss strategies and gender.
5. There was no statistically significant difference in Fresno State students’
exercise weight loss strategies and race/ethnicity.
Limitations
The following limitations must be considered prior to making
generalizations of this study.
1. The data collected were from students enrolled in spring 2013.
10
2. The data collected were limited to self-reports and have potential recall and
selection biases.
3. The researcher did not administer the survey that was provided to the
students at Fresno State.
4. The sample size does not reflect the total population of the student body
and therefore may not be representative of the Fresno State student
population.
Theoretical Framework
It is recommended that overweight or obese individuals try to lose weight
gradually at a rate of one to two pounds per week (CDC, 2015c). Research has
found that individuals who lose weight too quickly have a more difficult time
keeping the weight off. Successful long-term weight loss encompasses lifestyle
changes in eating and exercise habits. In order to lose weight at a rate of one to
two pounds per week a person needs to use more calories than they take in. One
pound of weight equals approximately 3,500 calories and caloric intake needs to
be reduced by 500-1,000 calories per day in order to lose weight at the
recommended rate (CDC, 2015c). Because weight loss relies on an individual’s
behavior, the transtheoretical model provided the framework in unifying both.
The four constructs that make up the transtheoretical model are the stages
of change, decision balance, self-efficacy, and processes of change. The stages of
change represent the heart of the model and describe an individual’s thoughts
regarding shifts in a particular behavior. The transtheoretical model consists of
five stages that identify and incorporate a health behavior modification (Prochaska
& DiClemente, 1984). The five stages are precontemplation, contemplation,
preparation, action, and maintenance. The transtheoretical model was developed
11
by James O. Prochaska in 1977 and defined behavior change as “a process that
unfolds over time and involves progress through a series of stages” (Prochaska,
2008, p. 845). The transtheoretical model allows for individuals to initiate change
prior to recognizing the need to change. The model represents how an individual
decides to make a change, how the individual makes the change, and whether or
not the individual continues to adhere to the change over an extended period of
time (Prochaska & DiClemente, 1984).
The use of the transtheoretical model for weight management programs is
not as extensive as it is for smoking cessation, but has been shown to be
promising. The transtheoretical model has successfully been used in smoking
cessation programs for years. Smoking is a behavior that may go through a series
of stages of change steps before successful terminating. Like diet and exercise
behavior(s), those trying to quit smoking and implement healthier alternatives may
relapse and revert to previous unhealthy habits. The transtheoretical model
recognizes that successful termination is not easy and that relapses are probable.
The successful use of the transtheoretical model in altering smoking habits is
significant because tobacco is the leading preventable cause of death and is
attributed to the deaths of approximately 5 million people in the world each year
(Koyun & Erglu, 2014). Smoking cessation programs noted early on that programs
that did not consider differences in individual’s stage of change were more likely
to develop resistance by its members. The transtheoretical model provides
smoking cessation programs the flexibility to use appropriate interventions based
on the readiness of change by an individual. The implementation of flexible
intervention strategies is vital because time is wasted when individuals are given
the same information. This increases the development of resistance against a
behavioral change. One study (Mallin 2002, as cited in Koyun & Erglu, 2014)
12
found that only 7.9% of smokers are able to quit on their own without help,
whereas the combined use of nicotine replacement, support, and medication
utilizing the constructs of the transtheoretical model increases the quit rate to 35%.
In 2003, a 6-month clinical based treatment study, based on the
transtheoretical model, focused on physical activity nutrition, and behavioral
change. By the end of the treatment, participants demonstrated significant
reductions in fat, caloric intake, and weight. There was also evidence of gradual
weight loss during follow up periods (Johnson et al., 2008). This study recruited
overweight or obese individuals who were then randomly assigned to a treatment
or control group that utilized the transtheoretical model. Individuals assigned to
the control group received no treatment while those who were in the treatment
group received tailored reports on how to eat healthy, exercise, and manage
emotional distress without eating. Individuals who were part of the treatment
group had greater percentages of progressing to the action or maintenance stage of
healthy eating compared to the control group at 6, 12, and 24-month intervals.
Among those in the pre-action stage for exercise, 43%, 37.7%, and 44.9%
progressed to the action or maintenance stage at 6, 12, and 24 months compared to
34.6%, 35.6%, and 38.1% of those in the control group. The management of
emotional distress was also significantly greater for those in the treatment group
(Johnson et al., 2008).
A 2007 Mayo Clinic study found that the primary impediments for weight
management are: lack of knowledge or confidence, lack of motivation, and
pessimism about obesity management (Peterson, 2009). The transtheoretical
model was utilized in a small weight management study of obese patients and
found that the majority of patients met weight loss goals, gained flexibility,
reduced pain, gained personal knowledge, and/or reinforced behavioral change
13
(Peterson, 2009). The study further suggested that assessing readiness for change
is a crucial step in combating unhealthy behaviors such as those that may
contribute to obesity along with identifying motivators and barriers towards
change.
The transtheoretical model has been used to map out alcohol consumption,
tobacco consumption, exercise behaviors, and healthy eating within college
populations. The model was used to gain better “understanding of students’
tendencies and motivations for adopting healthy lifestyle habits” (HornefferGinter, 2008, p. 352). Among college students, it was found that targeting multiple
health habits potentially reveal gateway behavior. Furthermore, targeting a
specific behavior may positively affect other behaviors which can help college
health promotion efforts (Horneffer-Ginter, 2008).
The transtheoretical model is successful in initiating change because it
causes individuals to discern their need to make changes. The transtheoretical
model can be applied to obesity because it allows individuals to weigh the benefits
and consequences of their current actions in relation to their overall health and
well-being. The model can be applied before the need to change is acknowledged
by increasing awareness of the potential harmful effects of one’s current actions.
Mason, Crabtree, Claudill, and Topp (2008) stated that the transtheoretical model
provides the ideal framework in heightening awareness and acceptance when it
comes to obesity and should be employed as an appropriate intervention. Lack of
awareness among those who are obese has been found to be a leading impediment
for weight management.
14
Definitions
Body Mass Index (BMI): A number calculated from a person’s weight and
height (CDC, 2015b). WHO categorizes BMI as follows: underweight <18.5,
normal weight 18.5-24.9, pre-obese 25.0-29.9, class I obese 30.0-34.9, class II
obese 35.0-39.9, and class III obese 40.0 or above (WHO, 2013).
Obesity/overweight: Overweight and obesity are both labels for ranges of
weight that are greater than what is generally considered healthy for a given height
(CDC, 2012).
Socioeconomic Status: A composite measure that typically incorporates
economic, social, and work status. Economic status is measured by income. Social
status is measured by education, and work status is measured by occupation. Each
status is considered an indicator. These three indicators are related but do not
overlap (CDC, 2014b).
Transtheoretical Model: also referred to as the stages of change model, is a
conceptualized behavior change pattern that is used to initiate change in a person’s
behavior. The model defines behavior change as “a process that unfolds over time
and involves progress through a series of stages: pre-contemplation,
contemplation, action, maintenance, and termination” (Prochaska, 2008, p. 845).
Type 2 Diabetes: Formerly called adult-onset diabetes or noninsulindependent diabetes, it is the most common form of diabetes (National Diabetes
Information Clearinghouse, 2014).
Summary
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. The prevalence of obesity has
increased over the last 40 years with over 60 million U.S. adults currently
considered obese. Obesity is characterized as “an increased in body fat” based on
15
calculations of the body mass index (BMI). Individuals whose calculated BMI is
between 25.0-29.9 are considered overweight whereas individuals whose
calculated BMI is greater than 30.0 are considered obese (Wyatt et al, 2006).
Obesity rates among college students have increased in a similar manner to
the rest of the population. From 2000 and 2009, the overweight obesity rates
among college students increased from 29% in 2000 to 32.5% in 2009
(LaChausse, 2012). The 2008 ACHA–NCHA II survey found that nationally,
28.4% of college females and 39.4% of college males were overweight or obese
(Harring et al., 2010). At Fresno State however, 37.3% of students described
themselves as being overweight and 9.3% describing themselves as very
overweight (ACHA, 2013b). These percentages are higher than the national
average with 7.0% more students at Fresno State (37.3%) reporting themselves to
be slightly overweight compared to the national college average 30.3%. Over 9%
of students at Fresno State reported themselves to be very overweight, which is
almost double the national report of 4.9%.
CHAPTER 2: LITERATURE REVIEW
Introduction
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. Over 60 million Americans are obese
with the obesity rate showing no evidence of slowing down (Finkelstein et al.,
2012). Obese individuals are at an increased risk for many chronic diseases with
obesity being associated with increasing morbidity and mortality of nine body
systems (Wyatt et al., 2006). It is estimated that being overweight or obese is
attributed to 110,000 to 400,000 premature deaths each year (Wyatt et al., 2006).
The economic impact that obesity has on society is estimated to be $147 billion
per year, which accounts for approximately 9% of all annual medical expenditures
(Finkelstein et al., 2012). The indirect cost associated with obesity is absenteeism,
loss in productivity, and premature deaths. This chapter includes a comprehensive
review of literature on: ACHA-NCHA survey overview; perceived body weight
and actual BMI; gender and weight loss strategies; race and weight loss strategies;
gender and exercise weight loss strategies; and race and exercise weight loss
strategies.
ACHA-NCHA II Survey Overview
The ACHA-NCHA contains approximately 300 questions which are
designed to assess students’ health status, health problems, risks, protective
behaviors, as well as impediments to academic performance (ACHA, 2009). The
original ACHA-NCHA survey was developed by ACHA and was first conducted
in 2000. In 2008, the survey was revised and the ACHA-NCHA II was developed.
The survey was completely confidential, as neither students’ names nor email
addresses were attached to their responses with schools self-selecting to participate
17
(ACHA, 2009). The majority of participating campuses were public institutions
with 127 of the 172 participating campuses being 4-year institutions (ACHA,
2013a).
The focus of the American College Health Association (ACHA) is to assess
current behaviors and health needs of students across colleges and universities
nationwide. It is also the leading source in the field of college health (ACHA,
2009). The results of the survey can be used to identify the most common health or
behaviors risks affecting students, help guide the design of evidence based
programs, compare students’ behavior to their peers, aid the development of grant
proposals, and provide needs assessment data (ACHA, 2009). The ACHA has ties
to the creation of Healthy Campus 2010 and 2020 which set national health goals
and objectives for college and universities. The Healthy Campus has identified
overweight and obesity as one of their ten major public health issues across
campuses (ACHA, 2009). Over the years, the percentage of college students that
have been classified as overweight or obese has increased from 29% in 2000 to
32.5% in 2009 (Lachausse, 2012).
Research on the health of college students is limited and the ACHA-NCHA
II is distinguishable because it is one of the few that focuses on college health. The
college population “is very understudied” and is considered “hard to reach”
(Janeway & Mistry, n.d., p. 1). This population is considered hard to reach
because large phone based surveys typically do not reach college students or cell
phones.
One of the few studies on college students set out to study the freshman 15.
The freshman 15 is the phenomenon of the 15 pounds gained, sometimes more
sometimes less, by college students during their freshman year. A study of
students at Cornell University assessed weight gain of freshman first semester
18
students. Participants of the study were weighed at the beginning of the semester
and then again 12 weeks later. In addition, the students completed a questionnaire
regarding their eating, exercise, and sleeping habits. The study found that, on
average, students consumed approximately 174 more calories per day than they
expended. In addition, the freshman 15 is actually closer to the freshman 5 or 7,
but it is often followed by the sophomore 2 or 3. Such weight gains are
noteworthy as they may be attributable to students’ transition from their
sociological upbringing to independently making their own decisions.
In addition to ACHA-NCHA II and the Cornell University study, the CDC
has prioritized six topics, based on their prevalence on campuses, for college
student’s health and safety. Those six focuses are healthy lifestyle, sexual assault,
sexually transmitted infections (STI), binge drinking, smoking, and managing
stress. STI’s and sexual assaults are of grave concern among the colleges
population as half of all new sexually transmitted diseases occur in people
between the ages of 15-24 as well as one in five college women are victims of
sexual assault. Furthermore, 17.3% of college age adults between the ages of 1824 smoke (CDC, 2014a); however, the CDC stated that over 20% of young adults
between the ages of 18 and 24 were obese. This percentage accounts for only
those who are obese and not those who are considered overweight.
Perceived Body Weight and BMI
The concept of body image was first established in 1935 by psychiatrist
Paul F. Schilder who believed that the mental image an individual has of their own
bodies helps explain the way their bodies get introduced to them (Schilder, 1950).
In 1938, Schilder also stated that individuals “build up the image of our own body
only in relation to others” (Schilder, 1938, p.5). This representation is built and
19
rebuilt with the notion of body weight self-perception varying from the “public
health and normative cultural standards” (Chang & Christakis, 2003, p. 332). The
perception of an individual’s body is often accompanied by an emotional and
behavior response to the perception. These perceptions are often driven by sociocultural factors, with differences in the perception of body weight having been
well documented. One study on healthy and unhealthy weight loss practices found
that non-white ethnic groups have lower prevalence of dieting and weight
concerns (Mercado, 2008). Another study found that both social and cultural
norms influence acceptance of larger body sizes. This same study revealed that
“African American and ‘other’ race women preferred larger silhouettes than the
referent White group even after controlling for BMI” (Kronenfeld, RebaHarrelson, Von Holle, Reyes, & Bulik, 2009, p. 134).
In 2009, a study on women focused on whether differences existed across
racial/ethnic groups and perceived body size. The study found that “African
American women selected smaller silhouette than White women to reflect their
current size” (Kronenfeld et al., 2009, p. 134). Findings were consistent with
women of equivalent BMI’s and corroborate with previous research that stipulate
that the “self-identification in a specific ethnic group and the internalization of the
dominant culture contribute to the complexity of the manifestation of body
satisfaction” (Kronenfeld et al., 2009, p. 134). The disparities for higher
preference of a larger body size among women of different racial/ethnic groups
have been extensively researched. However, less is known about the cultural
differences in body perceptions among men. Males in general are much less likely,
compared to women, to have concerns about their body weight and to lose weight
(Paeratakur, White, Williamson, Ryan, & Bray, 2002)
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Cultural differences are not the only factors that may play a role in body
weight perceptions. Parent and peer, the media, individual factors such as dieting
and negative mood, biological factors, and protective factors may all play a role in
an individual’s perception of themselves (Presnell, Bearman, & Madeley, 2007.
Dissatisfaction with one’s body is one component of body image and is comprised
an individual’s internal perception, thought, and the negative evaluation of
physical appearance. Body dissatisfaction has been associated with distress,
altering appearance methods, an unhealthy weight control behaviors. Pressure to
conform to beauty standards influence how individuals perceive themselves and
evaluate their bodies (Presnell et al., 2007).
A 3,466 participant multi-city longitudinal study between 1985 and 2006
was conducted on body weight perceptions and actual body weight. The study
found that women who perceived their weight as overweight or obese were more
likely to lose weight, whereas women who perceived their weight as normal, were
more likely to gain weight. This same study went to find that males “often
perceive themselves as smaller than they are, due to a desire for a larger or more
muscular body” (Ratanasiripong & Burkey, 2011, p. 19).
Studies have found that the perception of being overweight or obese,
among those who are, has decreased over the years. Despite the decrease of body
dissatisfaction over the years, the biggest disparity of body dissatisfaction occurs
during the college years (Presnell et al., 2007). This perception is higher among
women in comparison to men (Lemon, Rosal, Zapka, Borg, & Andersen, 2009).
Ratanasiripong and Burkey (2011) assessed the differences in body image and
BMI among diverse college students in the western United States. With the
exception of Asian Americans, the researchers found statistically significant
differences for gender and all ethnic variables. Male participants of the study
21
significantly underreported overweightness and obesity compared to the female
participants. Significant differences in underreporting obesity by ethnicity were
found in African American, Latino/Hispanic, and White college students, but not
for Asian American college students (Ratanasiripong & Burkey, 2011). As a
result, inadequate perceptions and acknowledgment of body weight may
consequently influence lifestyle choices and diminish behavioral change (Chock,
2011). Inadequate body perceptions may also be influenced by the comparison to
others.
The perception college students have of their close friends and peers often
shapes their behaviors. One indicator of healthful lifestyle is BMI. A Syracuse
University study of first year college students found that respondents’ BMI
categorization was consistent with other college students’ BMI studies. The study
also found that college students perceived themselves as healthier than their best
friends and substantially healthier than average college students. Among genders,
the study found that males gave higher self-rating of their own lifestyle compared
to females. However, respondents in the obese BMI category were found to give
themselves significantly lower rating compared to those in other BMI categories
(Chock, 2011). This suggested that the role of close friends and peers should be
addressed when working on weight related issues among college students.
BMI has been used as a general indicator of “nutrition and exercise related
health behaviors” (Chock, 2011, p 336). However, the use of BMI as an indicator
of healthfulness is not without criticism. One study assessed the diagnostic
accuracy of the BMI test and obesity. The study revealed that a BMI ≥ 30 had high
specificity (95% in men and 99% in women) and a poor sensitivity (36% in men
and 49% in women) in detecting body fat percentage obesity (Romero-Corral et
al., 2008). These specificity findings reveal that the BMI test is highly accurate in
22
diagnosing individuals who are not obese, however, the sensitivity finding show
that the test has high false negative rates. In addition, individuals whose BMI fall
within the normal range may still participate in unhealthy activities. In regard to
individuals’ self-reported weight and height, it is not unusual for people to
overestimate height and underestimate weight which results in a less than optimal
BMI score (Chock, 2011).
Diet Weight Loss Strategies and Gender
It is recommended that overweight or obese individuals try to lose weight
gradually at a rate of one to two pounds per week (CDC, 2015c). Research has
found that individuals who lose weight too quickly have a more difficult time
keeping the weight off. Successful long-term weight loss encompasses lifestyle
changes in eating and exercise habits. In order to lose weight at a rate of one to
two pounds per week, a person needs to use more calories than they take in. One
pound of weight equals approximately 3,500 calories and caloric intake needs to
be reduced by 500-1000 calories per day in order to lose weight at the
recommended rate (CDC, 2015c).
In the United States, the use of unhealthy weight loss practices as a means
of rapid weight loss is not uncommon. Unhealthy weight loss practices include,
but are not limited to, taking diet pills, fasting, vomiting, laxatives, and smoking
cigarettes as a food substitute. For example, those suffering from eating disorders
often abuse laxatives believing that they are getting rid of unwanted calories to
lose weight (National Eating Disorders Association [NEDA], 2015). Abusing
laxatives is dangerous because it disrupts electrolyte and mineral balance, can
create colon laxative dependency to produce bowel movements, can lead to organ
damage, and lead to severe dehydration. Severe dehydration can cause weakness,
23
tremors, blurred vision, kidney damage, fainting, and in extreme cases, death.
Laxative abuse can also increase the risk for colon cancer. The abuse of laxatives
for the purpose of losing weight is considered a form of an eating disorder. More
than half of adolescent girls and nearly one third of adolescent boys have
participated in unhealthy weight loss behaviors such as fasting, skipping meals,
vomiting and taking laxatives (NEDA, 2015).
About 20 million women and 10 million men will suffer from an eating
disorder such as anorexia or bulimia nervosa at some point in their lives (NEDA,
2015). Compensatory behaviors are usually tied into disordered eating.
Compensatory behaviors consist of laxative abuse, self-induced vomiting, and
exercise with the “intent to influence one’s body shape or weight” (Reilly,
Anderson, Anderson, & Schaumberg, 2014, p. 526). Females are more often
dissatisfied with their bodies and are five times “more likely to see themselves as
overweight” (Hancock, Jung, & Petrella, 2012, p. 72). Among college students
unhealthy weight loss practices are common, particularly among college women
(Davila et al., 2014). The Spring 2013 ACHA-NCHA II Reference Group Data
Report found that in the last 30 days, among college students, 1% of male and 4%
of female students had vomited or taken laxatives to lose weight. The report also
noted the gender differences in other weight lose strategies as 2% of male and 4%
of female college students reported having taken diet pills in the last 30 days in an
effort to try to lose weight (ACHA, 2013).
Gender plays a significant role in the prevalence of obesity. According to
one study, male students are more likely to be overweight than female college
students (Nelson et al., 2007). In 2013, 28% of male and 32% of female college
students identified themselves as being slightly overweight while 4% of male and
5% of female college students saw themselves as very overweight (ACHA, 2013).
24
In regard to what college students are trying to do about their current weight, 37%
of males and 60% of females stated that they are trying to lose weight (ACHA,
2013). A study of differences of dieting practices among female college students
found the five most common weight loss behaviors to be exercising, choosing low
fat or fat free foods and drinks, eating less, consuming sugar free products, and
counting calories. Less frequent behaviors were the use of laxatives and vomiting
after eating. Among female college students who used laxatives, 2% were of
normal weight, 6% were overweight, and 5% were obese. Similar results were
found for those who vomited after eating as 4% were normal weight, 6% were
overweight, and 5% were obese. Overall, among female college students 5% had
used vomiting and 3% had used laxatives as a weight loss strategy
(Malinauskas, Raedeke, Aeby, Smith, & Dallas, 2005).
Differences in obesity rates between male and female college students may
be related to the perceptions of body image for each gender. It has been suggested
that females tend to have lower obesity rates due to the stigmas associated with
being obese (Crosnoe, 2007). The stigmas help to deter females from gaining
weight in an effort to maintain a certain body image and maintain norms for body
weight. Public perception and belief of what a female’s body should look like
keeps females from gaining as much weight by being more health conscious
(Crosnoe, 2007). Another study found that women tend to not consume as many
calories as men, especially when in the company of others (Cottingham,
O’Donnell, Nowark, & Snyder, 2011). The same study indicated that men
consumed the same number of calories whether in the company of other males or
females. This suggests that gender does play a role in the development of obesity
by identifying that gender roles and images contribute to decisions about food
choices.
25
Diet Weight Loss Strategies and Race / Ethnicity
The role race and ethnicity play on weight related issues among the college
population is garnering recent attention, specifically in regard to BMI, eating
disorder behavior, and the acquisition of health information (Rich & Thomas,
2008). Ethnic differences have been observed in disordered eating behavior and
attitudes with female European Americans exhibiting higher percentages of eating
disorders compared to female African Americans. In regard to BMI, female
African Americans tend to have higher BMI rates compared to their European or
Latin American counterparts. Higher weight gains at the beginning of college have
also been reported among African American women as well as being less
physically active and having poorer dietary intake (Rich & Thomas, 2008).
The lower prevalence of eating disorders among ethnic minorities may be
attributed to differences in ideals of thinness (Mann & Arriaza, 2001). A 2010
two-sample study of women from private and public universities examined the
racial/ethnic differences in desired BMI and dieting practices among college
women. The study consisted of 407 participants from a private university and 164
participants from a public university and revealed that white women placed the
highest level of importance of achieving a lower body weight which coincides
with a greater probability of attempting to lose weight and in partaking in
behaviors in order to try to achieve this (Schembre, Nigg, & Albright, 2011).
Another study examined eating disorders, body dissatisfaction, and
attractiveness among male college students (Mayo & George, 2014). The study
consisted of 780 college students enrolled in a large urban university. Female
students were only included in the study to reference their preference for ideal
male bodies. The ethnic/racial breakdown of participants was 64% Hispanic, 14%
non-Hispanic, 9% African American, 5% Caribbean/West Indian, and 8% other
26
and non-Hispanic. The study revealed a positive correlation between male body
dissatisfaction and the risk for an eating disorder.
Among adult Americans, the racial/ethnic breakdown of obesity rates
highlights disparities. In 2011-2012 the obesity rates among women in the U.S.
was 56.6% for African American/Black, 44.4% for Hispanic/Latina, and 32.8%
for White. The racial/ethnic obesity rate disparities were much narrower for males
with 37.1% of Black males, 40.1% Latino (Hispanic) males, and 32.4% White
males being classified as obese (The State of Obesity Organization, 2014). The
higher tolerance of a larger body size, among African American women, results in
less pressure and a smaller likelihood of them dieting (Young-Hyman, Herman,
Scott, & Schlundt, 2000).
Studies suggest that differing behavioral practices, such as diet, physical
activity, and television viewing, may attribute to obesity disparities among genders
(Nelson, et al., 2007). Moreover, another study found that what college students
choose to eat plays an influencing role in the development of overweight and
obesity (Bianoco, Simeral, Boek, Chan, & Goto, 2012).
A study of female college students in New York City found that
psychosocial and health behavior is a correlating factor of dieting and purging
(Mercado, 2008). Among the female college students who vomit as a weight loss
strategy, 25% identified themselves as Hispanic and 22.3% as American Indian
(Mercado, 2008). In regard to males, there is a dearth of research, but surveillance
research reveals that Hispanic and African American males have higher
prevalence of obesity compared to Whites. In addition, a college male study
revealed that positive correlation exists between body satisfaction and the risk for
eating disorders (Mayo & George, 2014).
27
Exercise Weight Loss Strategies and Gender
Physical activity, along with a healthy diet, has long been established as
one of the two proximal factors in maintaining a healthy weight. Weight is gained
when the energy intake, via calories that are consumed, exceeds the energy
expenditure through everyday activities and exercise (Wyatt et al., 2006). Exercise
has also been shown to have other health benefits as moderate levels of exercise
being correlated with lower death rates and reduced high blood pressures.
Moderate physical activity is defined as performing 30 min of exercise on most
days of a week whereas high intensity physical exercise is traditionally aerobic
exercise (Magoc, Tomaka, & Thompson, 2012).
According to the BRFSS survey, the majority of adults in the U.S. do not
exercise regularly with many living sedentary lifestyles (Magoc et al., 2012).
Sedentary lifestyles has led to only 20% of adults meeting the physical activity
guidelines (Wyatt et al., 2006). There are many factors that have been attributed to
the decrease of Americans meeting the physical activity guidelines. Increased
wealth, prosperity, and convenience have allowed people to reduce their energy
expenditures. The convenience of driving and taking the elevator instead of
walking up the stairs as well as lack of safety in high crime areas has promoted
inactivity. Research has found that most Americans fail to engage in the combined
behaviors of diet and exercise and tend to adopt only dietary measures when it
comes to weight management (Wharton et al., 2008).
Whereas college women are more prone to restrict calories, take diet pills,
use diuretics, use laxatives, or engage in self-induced vomiting to lose weight,
males are more likely to use dietary supplements, use anabolic steroids, and
engage in exercise to control their weight (Clemens, Thombs, Olds, & Gordon,
2008). Among college women, weight concerns are more closely associated with
28
desire to be thin while among their male counterparts weight concerns are more
closely associated with the body shape and the gaining of muscle mass (Watkins,
Christie, & Chally, 2008). In addition to self-objectification, males who suffer
from negative body image have a higher chance of partaking in exercise abuse and
disordered eating. One study of 188 randomly selected male students from one
college found that among underweight college males, 23% feared losing muscle
mass (Watkins et al., 2008).
Analysis of the 2008 national ACHA-NCHA II survey found gender
difference in exercise as a weight loss behavior. This is most likely attributed to
male’s higher preoccupation in gaining muscle and losing fat. The analysis of the
survey revealed that college males are more concerned with having larger arms or
a V-shaped body compared to female sentiment of “I don’t want to be fat” (Barry,
Whitman, Piazza-Gardner, & Jensen, 2013, p. 411). A study on young college
males found that 8% scored high enough to raise concern of a clinical exercise
disorder. These concerns stem from the fixation of having to exercise five or more
times per week, even when injured or ill. Furthermore, anger, agitation, or
annoyance were words that these college males used to describe the feelings they
felt when their exercise regimen was interrupted or changed (O’dea & Abraham,
2002).
Gender differences were also observed in 2010 published study on physical
activity among diverse college students and found that female students engage in
less physical activities than males. The study found that among its participants
55% of women and 40.3% of men did not “engage in vigorous physical activity
during the preceding month” (Suminski, Petros, Utter, & Zhang, 2002, p. 77). The
same study found that 22% of women and 11.3% of men had not engage in any
form of physical activity in previous 30 days (Suminski et al., 2002).
29
Exercise as a weight loss strategies among college students can be
challenging because individuals in this age group are navigating their way through
college many of whom are taking on adult responsibilities for the first time.
Exercise can play a critical role in an individual’s weight loss strategy and the
adoption or continuance of these behaviors is important because it can lead to the
development of an individual’s lifelong habits. College students who are inactive
or who report living sedentary lifestyles are more likely to be overweight or obese
compared to their peers. It is believed that sedentary lifestyle increases with age
with 20-60% of college students not meeting the minimum physical activity
recommendations (Desai et al., 2008). There are limited studies that focus upon
exercise as a weight loss strategy, and even less that do so within the college
population.
Exercise Weight Loss Strategies and Race/Ethnicity
The Surgeon General’s report recommends that people do moderately
intense activities every day and that inactive individuals can improve their health
and well-being by becoming at least moderately active (Magoc et al., 2012). The
American College of Sports Medicine (ACSM) suggested that individuals do
higher intensity aerobic exercise 3 to 5 times a week. The ACSM considers high
intensity workouts to be 55-65% of maximum heart rate with a duration of 20-60
min (Magoc et al., 2012). Over 60% of those who are overweight or obese have
reported using physical activities to lose weight, yet only 20% of them are meeting
the recommended guidelines (Wyatt et al., 2006). Among ethnic and racial groups
rates of inactivity were high for Mexican-American men and women at 33% and
46% and for African American women at 40% (Suminski et al., 2002).
30
Disproportionate ethnic percentages of inactivity have also been observed among
the college population.
An ethnically diverse sample of American college students also found
ethnic disparities in physical activity rates. The study of over 2800 students found
that the rates of no physical activity were “28.1%, 23.5%, 17.4%, and 20.3% for
Asian, African American, White, and Hispanic women, respectively” (Suminski et
al., 2002, p. 77). Among males the rates of no physical activity were “11.7%,
7.7%, 12.0%, and 13.8% for Asian, African American, White, and Hispanics”
(Suminski et al., 2002, p. 77).
Across all ethnic and racial groups, males reported higher percentages of
physical activity. The comparison of self-reported amount of hours spent per week
weight lifting varied among ethnicity by gender in college students. African
American males spent the most time weight lifting at 2.71 hour per week followed
by 2.54 by both Hispanic and Asian males and 2.44 by White males. Among
female college students, White females devoted the most time per week weight
lifting at an average of 1.93, followed by Black, Hispanic, and Asian females at
rates of 1.88, 1.87, and 1.81 respectively (Suminski et al., 2002). A study of a
predominantly Hispanic college institution found that 12.2% of participants were
completely sedentary, but also found that most students believed that exercise
benefits health (Magoc et al., 2012). The Healthy People initiative has placed low
physical activity and obesity as top priorities and has placed high importance on
maintaining physical health and extending life. Because dietary and physical
activity habits are often learned from a young age and carried into adulthood there
is a consensus within the health community to create and promote a more active
community. Despite the prioritization of physical activity and obesity, there is a
31
dearth research in this area. The dearth of research on exercise as weight loss
strategies is especially limited in regard to college students.
Summary
This chapter included a review of the literature on ACHA-NCHA survey;
perceived body weight and actual BMI; gender and weight loss strategies; race and
diet weight loss strategies; gender and exercise weight loss strategies; and race and
exercise weight loss strategies. Lifestyle choices such as unhealthy eating and low
physical activity have also been long associated with obesity. The review of the
literature illustrated that cultural differences in perceived body size, particularly
among women, as well as gender differences in eating and compensating
disorders. In addition, female diet and exercise behaviors are typically tied into
losing weight, whereas males are more preoccupied with gaining muscle mass.
The literature suggests that racial/ethnic differences exist in body perceptions, diet
practices, and physical inactivity. There is a dearth of research concentrated on
obesity among the college population with the majority of research focused on
obesity in children, adults, and ethnic groups.
CHAPTER 3: METHODOLGY
Introduction
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. This study used data collected from
Fresno State students from the 2013 ACHA-NCHA II survey. This chapter
provides detailed information regarding the setting and participants, data
collection, instrumentation, data analysis, and protection of human subjects.
Setting and Participants
Founded in 1911, Fresno State University is one of 23 state universities in
California. Among its 23,060 enrolled 2013 students, 88% were pursing an
undergraduate degree (Fresno State Office of Institutional Effectiveness [OIE],
2015c). The racial/ethnic breakdown of all Fresno State students in 2013 was
40.6% Hispanic, 26.1% White, 14.9% Asian, 4.1% African American, 0.4%
American Indian, and 02% Pacific Islander. The remaining 9.7% of the population
did not indicate a racial/ethnic category or identified themselves other in the
selection categories (Fresno State OIE, 2015d). The age breakdown of all Fresno
State students was as follows: 3% under 17, 23.9% were 18-19, 51.1% were 2024, 12.5% were 25-29, 4.4% were 30-34, and 5.1% were 35 years of age or older
(Fresno State OIE, 2015a). Fifty-eight percent of the population were female and
42% were male (Fresno State OIE, 2015b). The diversity of the Fresno State
campus is noteworthy in its Title V, Hispanic Serving Institution (HIS), and
designation by the U.S. Department of Education.
The participant demographics of the spring 2013 Fresno State ACHANCHA II survey were similar to the entire Fresno State population as 86.6% were
pursuing an undergraduate degree and a gender enrollment of 42% male and 58%
33
female. The age distribution of participants was 18-19 (22.5%), 20-24 (52.7%),
25-29 (10.7%), 30-34 (4.4%), and 35 years or older (5.1%). The most frequently
selected ethnic/racial categories of participants were Hispanic (37.5%), White
(28.4%), Asian or Pacific Islander (18.3%). Participants of all other racial/ethnic
categories were small at less than 5%.
Data Collection
This study used secondary data from the spring 2013 Fresno State ACHANCHA II survey. The survey consisted of approximately 300 questions that were
designed to assess college students’ health status, health problems, risks,
protective behaviors, as well as impediments to academic performance (American
College Health Association, 2013). Fresno State and other campuses throughout
the U.S. elected to participate in this nationally recognized research survey. A
random sample of Fresno State students were selected to participate with a total of
763 students completing the survey.
Data were collected by the Health Center at Fresno State through the
participation of the ACHA-NCHA II survey. The survey was completed by a
portion of students who attended Fresno State and agreed to complete the survey.
The results of the ACHA-NCHA II survey were quantified in the Institutional
Data Report of Spring 2013 from Fresno State. Only students who completed the
ACHA-NCHA II survey were included in the Institutional Data Report. A total of
763 Fresno State students completed the survey. The age distribution of the
respondents was from 18 to 35+ years and included undergraduates, graduate
students, and transfer students.
34
Instrument
The ACHA-NCHA II survey was designed to assess students’ health status,
health problems, risks, protective behaviors, as well as impediments to academic
performance (ACHA, 2009). Participating institutions were given the option of
disseminating the survey as a paper survey, electronically, or through a
combination of both. Fresno State elected to disseminate the survey electronically
via email.
The survey was comprised mostly of closed-ended questions. Categorical
data questions on the survey pertaining to demographic variables included age,
gender, race/ethnicity, marital status, sexual orientation, year in school,
employment status, hours worked per week, type of residence, and disability
status. Among the open-ended questions were interval measurements, such as
participant’s self-reported heights and weights.
The survey asked participants to describe their general health (excellent,
very good, good, fair, and poor) as well as how they describe their weight
(very/slightly underweight, about the right weight, slightly overweight, and very
overweight. Many of the questions required that participants to recall behavior of
the past 7 days, 30 days, and 12 months. Among such questions were inquires
about participants engagement to dieting and exercise regimes.
Data Analysis
Data analysis was performed utilizing the Statistical Package for the Social
Sciences (SPSS), a software package used for statistical analysis. In order to
determine participant’s actual BMI, calculations were ran using participants’ selfreported height and weight data. The statistical procedure used for this study is a
Pearson Chi-square Test with Yates Correction Factor for significance in SPSS
(Triola & Triola, 2007). The Pearson Chi-square Test with Yates Correlation
35
Factor was selected because it analyzes categorical data and it test for differences.
The demographic variables for age and race/ethnicity were recoded for grouping
purposes. A probability level, or ρ-value, of 0.05 were utilized for analysis of all
tests. Consequently, all null hypotheses were rejected if their ρ-values were less
than or equal to 0.05.
Protection of Human Subjects
The Institutional Review Board (IRB) Committee at the Fresno State
Department of Public Health reviewed and approved the proposal. Personal
identifiers, such as students’ name, email address, or I.D. number were removed
and not used in this study. No primary data were collected with this study and the
IRB Committee at Fresno State Department of Public Health found the research to
be exempt.
Summary
This study utilized secondary data from the ACHA-NCHA –II Institutional
Data Report – Spring 2013 from Fresno State. The ACHA-NCHA II survey
assesses students’ health statuses as well as impediments to academic
performance. Data were run for determine whether differences were observed in
perceived body weight and actual BMI; gender and diet weight loss strategies;
race/ethnicity and diet weight loss strategies; gender and exercise weight loss
strategies; and race/ethnicity and exercise weight loss strategies. All data were
analyzed using the Pearson Chi-Square Test with Yates Correction Factor.
CHAPTER 4: RESULTS
Introduction
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. The Fresno State ACHA-NCHA II
student survey was utilized for this descriptive study. The data for the Fresno State
ACHA-NCHA II survey were collected in the spring 2013 semester. The survey
asked several health related questions that are prevalent on college campuses.
Responses pertaining to questions regarding perceived body weight, diet weight
loss strategies, exercise weight loss strategies were analyzed in relation to actual
BMI, gender, and race/ethnicity.
Demographics
A random sample of Fresno State students were selected for participation in
this study. The ACHA-NCHA II survey was sent out randomly to Fresno State
students by email during the spring 2013 semester. A total of 763 participants out
of 3,973 completed the survey. Among the participants 226 (29.6%) were male
and 523 (68.5%) were female. Table 1 provides demographic data of the
participants. The demographic variables of age and race/ethnicity were recorded.
Over 50% of participants were between the ages of 20-24, and approximately
68.5% of the participants identified themselves as female. Only 56 or 7.3% of
participants were 35 years of age or older. Hispanic or Latino/a was the most
commonly selected race/ethnicity category at 37.5%, followed by white at 28.4%,
and Asian /Pacific Islander at 18.3%. Black or African American, American
Indian or Alaskan, and Biracial or Multi-Racial comprised 3.5%, 1.0%, and 4.5%
of the participants. Slightly over 4% identified themselves as other with
racial/ethnic demographics missing for 2.1% of the participants.
37
Table 1
Gender, Age, and Race/Ethnicity of Participants
Demographics
n
%
Male
226
29.6
Female
523
68.5
Missing
14
1.8
763
100.0
18-19
172
22.5
20-24
402
52.7
25-29
82
10.7
30-34
38
5.0
35+
56
7.3
Missing
13
1.7
763
100.0
217
28.4
27
3.5
Hispanic or Latino/a
286
37.5
Asian or Pacific Islander
140
18.3
8
1.0
Biracial or Multi Racial
34
4.5
Other
35
4.6
Missing
16
2.1
763
100.0
Gender
Total
Age
Total
Race/ethnicity
White
Black or African American
American Indian or Alaskan
Total
38
Table 2 displays Fresno State students’ perceived body weight. The survey
asked participants to describe their body weight. A little over half of the
participants described their weight as very/slightly about the right weight,
overweight, or obese. Of the 763 who completed the survey, 319 (46.5%)
described their body weight as overweight or obese.
Table 2
How Would You Describe Your Body Weight?
Perceived weight
Very/slightly underweight
About the right weight
Overweight
Obese
Missing
Total
n
49
357
284
71
2
763
%
6.5
46.8
37.2
9.3
.30
100.0
As displayed in Table 3, 406 (53.3%) of the participants had BMI’s that
were underweight or at a desirable weight while 348 (45.3%) had BMI’s in the
overweight or obese range. No distinctions were made according to WHO’s BMI
categorization of obesity class type I, II, or III.
Table 3
Fresno State Students’ Actual BMIs
Actual BMI
Underweight
Desired weight
Overweight
Obese*
Missing
Total
n
32
358
185
163
25
763
Note *indicates all obese class types
%
4.2
46.9
24.2
21.4
3.3
100.0
39
Tables 4 and 5 represent frequency data on diet and exercise weight loss
strategies reported by the participants. Among those who participated in the
survey, 756 (99.1%) answered the weight loss question relating to dieting in the
last 30 days. In addition, 753 (98.7%) and 754 (98.8%) of participants answered
the questions pertaining to vomit/laxative behaviors and the used diet pills to lose
weight in the last 30 days. Similarly, 754 (98.8%), 753 (98.7%) and 749 (98.2%)
of the participants answered the questions concerning moderate, vigorous, and
muscle strengthening exercise behavior of the last seven days.
Table 4
Diet Weight Loss Strategies
Variable
Last 30 Days: Diet to lose weight
Last 30 Days: Vomit/laxatives to
lose weight
Last 30 Days: Diet pills to lose
weight
Valid
n
%
756
99.1
Missing
n
%
7
0.92
Total
n
%
763 100.0
753
98.7
10
1.31
763
100.0
754
98.8
9
1.18
763
100.0
Table 5
Exercise Weight Loss Strategies
Valid
Variable
Past 7 days: Moderate exercise for
at least 30 minutes
Past 7 days: Vigorous exercise for
at least 20 minutes
Past 7 days: Exercise to strengthen
muscles 8-12 repetitions
Missing
n
%
n
%
754
98.8
9
753
98.7
749
98.2
Total
n
%
1.18
763
100.0
10
1.31
763
100.0
14
1.83
763
100.0
Analyses of Hypotheses
The five hypothesis examined in this study were analyzed using a Pearson’s
Chi-square test with a Yates Correlation factor and a .05 level of significance.
40
Hypothesis 1
Hypothesis 1 stated: There was no statistically significant difference in
Fresno State students’ perceived body weight and actual body mass index (BMI).
Data on students’ perceived body weight and actual BMI are shown in Table 6.
A Pearson’s Chi-square test with Yates Correction Factor revealed a
statistically significant difference in perceived body weight and actual with BMI
with a χ2 = 699.992, df =20, and a p-value of 0.0001. Because the p –value were
less than 0.05 the null hypothesis was rejected.
Hypothesis 2
Hypothesis 2 stated: There was no statistically significant difference in
Fresno State students’ diet weight loss strategies and gender. A Pearson’s Chisquare test with Yates Correction Factor revealed a statistically significant
difference between gender and students who said they had gone on a diet to lose
weight in the last 30 days with a χ2 = .24.750a, df =1, and a p-value of 0.0001.
Since the p –value was less than 0.05 the null hypothesis was rejected. However,
analysis of the data revealed that there was no statistically significant difference
between gender and vomiting/taking laxatives in the last 30 days to lose weight
with a χ2 = .3.553a, df =1, and a p –value of 0.059. Furthermore, there was no
statistically significant difference in gender and students who had taken diet pills
in the last 30 days to lose weight with a χ2 = .051a, df =1, and a p-value of 0.822.
Because the p –values for vomiting/taking laxatives and diet pill were greater than
0.05 the null hypotheses were not rejected. Data are shown in Tables 7, 8, and 9.
Table 6
Fresno State Students Self-Described Weight
Underweight
Desired
weight
Overweight
Class I
Obesity
Class II
Obesity
Class III
Obesity
Total
BMI classifications
Count
% within BMI Classifications
% within self-described weight
% of Total
Count
% within BMI Classifications
% within self-described weight
% of Total
Count
% within BMI Classifications
% within self-described weight
% of Total
Count
% within BMI Classifications
% within self-described weight
% of Total
Count
% within BMI Classifications
% within self-described weight
% of Total
Count
% within BMI Classifications
% within self-described weight
% of Total
Count
% within BMI Classifications
% within self-described weight
% of Total
Very underweight
2
6.3%
100.0%
0.3%
0
0.0%
0.0%
0.0%
0
0.0%
0.0%
0.0%
0
0.0%
0.0%
0.0%
0
0.0%
0.0%
0.0%
0
0.0%
0.0%
0.0%
2
0.3%
100.0%
0.3%
Slightly underweight
19
59.4%
42.2%
2.6%
22
6.2%
48.9%
3.0%
3
1.6%
6.7%
0.4%
1
1.0%
2.2%
0.1%
0
0.0%
0.0%
0.0%
1
0.0%
0.0%
0.0%
45
6.1%
100.0%
6.1%
About the right
weight
10
31.3%
2.9%
1.4%
278
77.9%
80.8%
37.7%
49
26.5%
14.2%
6.6%
7
7.1%
2.0%
0.9%
0
0.0%
0.0%
0.0%
0
0.0%
0.0%
0.0%
344
46.7%
100.0%
46.7.7%
Slightly overweight
1
3.1%
0.4%
0.1%
55
15.4%
19.8%
7.5%
127
68.6%
45.7%
17.2%
66
66.7%
23.7%
9.0%
21
46.7%
7.6%
2.8%
8
42.1%
2.9%
1.1%
278
37.7%
100.0%
37.7%
Very overweight
0
0.0%
0.0%
0.0%
2
0.6%
2.9%
0.3%
6
3.2%
8.8%
0.8%
25
25.3%
36.8%
3.4%
24
53.3%
35.3%
3.3%
11
57.9%
16.2%
1.5%
68
9.2%
100.0%
9.2%
Total
32
100.0%
4.3%
4.3%
357
100.0%
48.4%
48.4%
185
100.0%
25.1%
25.1%
99
100.0%
13.4%
13.4%
45
100.0%
6.1%
6.1%
19
100.0%
2.6%
2.6%
737
100.0%
100.0%
100.0%
41
42
Table 7
Last 30 Days: Diet to Lose Weight
Male
Variable
Female
Unknown
Total
n
%
n
%
n
%
n
%
No
155
69.0
256
49
8
73.0
419
55.6
Yes
69
31.0
262
51
3
27
334
44.4
Valid responses
224
30.0
518
69.0
11
1.0
753
98.7
-
-
-
-
10
1.3
10
1.3
224
29.4
518
57.9
21
2.8
763
100.0
Missing
Total
Table 8
Last 30 days: Vomit or Take Laxatives to Lose Weight
Male
Variable
Female
Unknown
Total
n
%
n
%
n
%
n
%
No
222
100.0
507
98
10
91.0
739
98.0
Yes
1
0.0
13
3
1
9
15
2.0
223
30.0
520
69.0
11
1.4
754
98.8
-
-
-
-
9
1.2
9
1.2
223
29.2
520
68.2
20
2.6
763
100.0
Valid responses
Missing
Total
43
Table 9
Last 30 days: Take Diet Pills to Lose Weight
Male
Variable
Female
Unknown
Total
n
%
n
%
n
%
n
%
No
215
96.0
504
97.0
11
100
730
96.7
Yes
8
4.0
17
3.0
0
0.0
25
3.3
223
30
521
69
11
1
755
99.0
-
-
-
-
8
1.0
8
1.0
223
29.2
521
68.3
19
2.5
763
100.0
Valid responses
Missing
Total
Hypothesis 3
Hypothesis 3 stated: There was no statistically significant difference in
Fresno State students’ diet weight loss strategies and race/ethnicity. A Pearson’s
Chi-square test with Yates Correlation Factor revealed no statistically significant
differences in diet weight loss strategies and race/ethnicity with a the following
results: diet to lose weight (χ2 = 6.566, df = 6, and a p-value of 0.363),
vomit/laxatives to lose weight (χ2 = 1.106, df = 6, and a p-value of 0.981 ), and diet
pills to lose weight (χ2 = 5.720, df = 6, and a p-value of 0.455). Since the p –values
were greater than 0.05 the null hypotheses were not rejected. Data are shown in
Tables 16-18 (see Appendix).
Hypothesis 4
Hypothesis 4 stated: There was no statistically significant difference in
Fresno State students’ exercise weight loss strategies and gender. A Pearson’s Chisquare test with Yates Correlation Factor found no statistically significant
difference in gender and moderately intense cardio/aerobic exercise in the 7 days
with a χ2 = 12.431, df = 7, and a p-value of 0.087, because the p –value is greater
44
than 0.05 the null hypothesis cannot be rejected. However, analysis of the data did
reveal a statistically significant difference in gender and vigorously intense
cardio/aerobic exercise in the last 7 days with a χ2 = 26.336, df = 7, and a p-value
of 0.0001 and with strength training exercise in the last 7 days with a χ2 = 51.502,
df = 7, and p-value of 0.0001. Since the p –values were less than 0.05 for both
vigorously intense cardio/aerobic exercise and exercise to strengthen muscles the
null hypotheses were rejected. Data are shown in Tables 10-12.
Table 10
Past 7 days: Moderate Exercise for at Least 30 Minutes
Female
Variable
Male
Unknown
n
%
n
%
n
%
0 Days
115
22.3
44
19.5
-
1 Day
69
13.4
24
10.7
2 Days
101
19.6
41
3 Days
90
17.4
4 Days
63
5 Days
Total
n
%
-
159
21.4
-
-
93
12.5
18.2
-
-
142
19.1
38
16.9
-
-
128
17.3
12.2
22
9.8
-
-
85
11.5
47
9.1
29
12.9
-
-
76
10.3
6 Days
12
2.3
13
5.8
-
-
25
3.4
7 Days
19
3.7
14
6.2
-
-
33
4.5
Valid responses
516
69.6
225
30.4
-
-
741
97.1
-
-
-
-
22
2.9
22
2.9
516
67.6
225
29.5
22
2.9
763
100.0
Missing
Total
45
Table 11
Past 7 Days: Vigorous Exercise for at Least 20 Minutes
Variable
0 Days
Female
n
%
209
40.4
n
63
%
28.2
Unknown
n
%
-
n
272
%
36.8
1 Day
82
15.9
45
20.2
-
-
127
17.1
2 Days
96
18.6
33
14.8
-
-
129
17.4
3 Days
50
9.7
33
14.8
-
-
83
11.2
4 Days
38
7.3
13
5.8
-
-
51
6.9
5 Days
30
5.8
20
9.0
-
-
50
6.8
6 Days
4
0.8
8
3.6
-
-
12
1.6
7 Days
8
1.5
8
3.6
-
-
16
2.2
517
69.9
223
30.1
-
-
740
97.0
-
-
-
-
23
3.0
23
3.051
517
67.8
223
29.2
23
3.0
763
100.0
Valid responses
Missing
Total
Male
Total
Table 12
Past 7 days: Exercise to Strengthen Muscles 8-12 Repetitions
1 Day
Female
n
%
290
56.2
60
11.6
n
91
19
%
41.4
8.6
Unknown
n
%
-
n
381
79
%
51.8
10.7
2 Days
73
14.1
24
10.9
-
-
97
13.2
3 Days
46
8.9
22
10.0
-
-
68
9.2
4 Days
16
3.1
17
7.7
-
-
33
4.5
5 Days
20
3.9
30
13.6
-
-
50
6.8
6 Days
5
1.0
10
4.6
-
-
15
2.0
7 Days
6
1.2
7
3.2
-
-
13
1.8
516
70.1
220
29.9
-
-
736
96.5
-
-
-
-
27
3.5
27
3.5
516
67.6
220
28.9
27
3.5
763
100.0
Variable
0 Days
Valid responses
Missing
Total
Male
Total
46
Hypothesis 5
Hypothesis 5 stated: There was no statistically significant difference in
Fresno State students’ exercise weight loss strategies and race/ethnicity. Data used
to test differences pertained to questions on moderate exercise for at least 30 min
vigorous exercise for at least 20 min, and 8-12 exercise repetitions to strengthen
muscles in the last 7 days. A Pearson’s Chi-square test with Yates Correction
Factor revealed no statistically significant differences in race/ethnicity and
exercise weight loss strategies. Moderately intense cardio/aerobic exercise had a
χ2 = 49.163, df = 42, and a p-value of 0.208, vigorously intense cardio/aerobic
exercise had a χ2 = 52.252, df = 42, and a p-value of 0.133, and strength training
exercise had a χ2 = 51.353, df = 42, and a p-value of 0.153. Since p –values were
greater than 0.05 all null hypotheses could not be rejected. Data are shown in
Tables 19-21 (see Appendix).
Summary
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. This study tested five different
hypotheses using Pearson’s Chi-square with Yates Correction Factor. Statistically
significant differences were observed in perceived body weight and actual BMI;
dieting in the last 30 days to lose weight and gender; vigorous cardio/aerobic
exercise for at least 20 min and gender; and muscle strengthening exercises and
gender. No statistically significant differences were observed in vomiting/taking
laxatives in the last 30 days to lose weight and gender; diet weight loss strategies
and race/ethnicity; moderate cardio/aerobic exercise for at least 30 min and
gender; or exercise weight loss strategies and race/ethnicity.
CHAPTER 5: DISCUSSION AND RECOMMENDATIONS
Introduction
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. The Fresno State ACHA-NCHA II
spring 2013 survey data were analyzed utilizing the statistical Pearson Chi-square
Test with Yates correction factor with a 0.05 level of significance. The variables
that were tested included perceived BMI, actual BMI, weight loss strategies,
exercise weight loss strategies, gender, and race/ethnicity. The literature review
highlighted that women are more likely to perceive themselves as overweight or
obese compared to males and are also more likely to partake in unhealthy weight
loss strategies. In addition, women are more likely to diet and exercise to lose
weight whereas males are more likely to exercise and lift weights to gain muscle.
The literature accentuated that individuals who live sedentary lifestyles are more
likely to be obese with some racial/ethnic groups having higher levels of
inactivity. The following chapter presents a discussion on the limitations, findings,
and recommendations for future research.
Demographics
The 2013 demographic data of all Fresno State students were obtained from
the OIE and compared with the demographic data from the spring 2013 national
ACHA-NCHA II survey and the spring 2013 Fresno State ACHA-NCHA II
survey. The demographic variables of age, gender, and race/ethnicity were used to
determine if the Fresno State data, Fresno State ACHA-NCHA II data, and the
national ACHA-NCHA II data were comparable. Demographic data from all three
data sets are displayed in the following tables. The tables allow for the display of
the study’s limitations due to differences in comparable data from all three data
48
sets. Comparisons were made on how similar the Fresno States ACHA-NCHA II
demographics were to national ACHA-NCHA II demographics and the overall
Fresno State student population demographics
Gender
Table 13 displays the gender data from Fresno State, the national ACHANCHA II survey, and Fresno State’s ACHA-NCHA II survey. The gender data of
all students at Fresno State were 9,682 (42%) for males and 13,378 (58%). In
regard to the ACHA-NCHA II surveys, the gender data for males were 226
(29.6%) and 523 (68.5%) for female Fresno State participants. The national
ACHA-NCHA II data were 41,313 (33.6%) males and 78,535 (63.8%) female. As
shown in Table 13, the participant male and female ratios for the ACHA-NCHA II
data sets were similar making them comparable. However, the Fresno State gender
data were not comparable to either ACHA-NCHA II data sets as they were not
similar.
Table 13
Gender of all Fresno State Students, Fresno State ACHA-NCHA II Participants,
and National ACHA-NCHA II Participants
Fresno State
Fresno State
ACHA-NCHA II
Gender
n
%
n
%
Males
9,682
42.0
226
29.6
Females
13,378
58.0
523
68.5
Transgender
Missing
14
1.8
Total
23,060
100.0
763
100.0
Note *value was rounded to the nearest hundredth place.
National
ACHA-NCHA II
n
%
41,313
33.6
78,535
63.8
299
0.2
2,931
2.4
123,078
100.0
Table 14 demonstrates age data from Fresno State students and data from
ACHA-NCHA II surveys both as Fresno State and nationally. There were 681
49
students under the age of 18 enrolled at Fresno State in 2013. Students under the
age of 18 were excluded from the ACHA-NCHA II surveys, therefore no
comparisons can be made for this age group. The percentage of students among
the 18-19 age group at Fresno State 22.9% were comparable to that of Fresno
State ACHA-NCHA II participants at 22.5%, but the national ACHA-NCHA II
percentages were not comparable at 28.35%. In the 20-24 age group, the
percentages that represented each data set were similar, and therefore comparable,
at 51.1% for Fresno State students, 52.7% for Fresno State ACHA-NCHA II
participants, and 48.11% for participants of the national ACHA-NCHA II survey.
Similarities also occurred in the 25-29 age group as 12.5% of Fresno State
students, 10.7% of Fresno States’ ACHA-NCHA II participants, and 11.59% of
the national ACHA-NCHA II participants were of this age group. In the 30-34 age
group, 4.4% of Fresno State students and 5% of Fresno State ACHA-NCHA II
participants were of this age group making them similar. More similarities
occurred in the 35 years of age or older age group as 5.1% of the Fresno State
population and 7.3% of the Fresno State ACHA-NCHA II participants were of this
age group. Data for the national ACHA-NCHA II survey for those in the 30 year
of age or older age groups were incomplete and thus no comparisons could be
made.
Race/Ethnicity
Table 15 summarizes data of the race/ethnicity groups for Fresno State
students, Fresno State ACHA-NCHA II participants, and the national ACHANCHA II participants. Data were comparable among the White race/ethnicity
group at Fresno State (26.1%) and with Fresno State ACHA-NCHA II participants
(28.4%). The national data was considerably different as 65.3% of participants
50
Table 14
Age of all Fresno State Students, Fresno State ACHA-NCHA II Participants, and
National ACHA-NCHA II Participants
Age
17 or
under
18-19
20-24
25-29
30-34
35 and
Older
Missing
Total
Fresno State
n
%
681
3.0
Fresno State
ACHA-NCHA II
n
%
-
National
ACHA-NCHA II
n
%
-
5,508
11,794
2,884
1,013
1180
23.9
51.1
12.5
4.4
5.1
172
402
82
38
56
22.5
52.7
10.7
5.0
7.3
34,896
59,213
14,264
-
28.35
48.11
11.59
-
23,060
100.0
13
763
1.7
100.0
14,706
123,078
11.95
100.0
were White. Data were comparable in all three data sets among the Black or
African American race/ethnicity group as 4.1% of Fresno State students, 3.5% of
Fresno State ACHA-NCHA II participants, and 6.6% of all national ACHANCHA II participants identified themselves this way. In regard to the Hispanic or
Latino/a race/ethnic group, 40.6% of Fresno State students, 37.5% of Fresno State
ACHA-NCHA II participants, and 13.9% of the national ACHA-NCHA II
participants identified themselves in this manner. These percentages were
comparable among the Fresno State student population and the Fresno State
ACHA-NCHA II participants, but were drastically different from the national data.
Data was found to be comparable across all three data sets for those in the Asian
or Pacific Islander, American-Indian or Alaska Native, and other race/ethnic
groups. Data were comparable for the Fresno State (4.5%) and national (4.1%)
ACHA-NCHA II Biracial and Multi-racial race/ethnic group. Data were
incomplete for the Biracial and Multi-racial race/ethnic group population at Fresno
State and thus no comparison could be made.
51
Table 15
Race/Ethnicity of all Fresno State Students, Fresno State ACHA-NCHA II
Participants, and National ACHA-NCHA II Participants
Race/Ethnicity
White
Black or African American
Hispanic or Latino/a
Asian or Pacific Islander
American Indian or
Alaskan
Biracial or Multi-racial
Other
Missing
Total
Fresno State
n
%
6,027
26.1
940
4.1
9,367
40.6
3,504
15.2
93
2,234
895
23,060
0.2
9.7
3.9
100.0
Fresno State
ACHA-NCHA II
n
%
217
28.4
27
3.5
286
37.5
140
18.3
8
34
35
16
763
1.0
4.5
4.6
2.1
100.0
National
ACHA-NCHA II
n
%
80,364
65.3
8,087
6.6
17,064
13.9
16,632
13.5
2,034
5,031
4,189
133,401*
1.7
4.1
3.4
108.5*
Note *response included multiple responses.
The gender data for the both the Fresno State and the national ACHANCHA II surveys were comparable as the percentage of male and female
participants were similar. However, the gender data of all Fresno State students
were not comparable as there were considerable differences in the percentage of
those who participated in the survey and Fresno State population. Therefore, the
Fresno State ACHA-NCHA II participants are not reflective of entire Fresno State
population according to gender. In regard to age comparability, the age groups of
20-24 and 25-29 were comparable across all three data sets, but not in the 18-19
age groups. Furthermore, incomplete national ACHA-NCHA II data for the 30-34
and 35 and older age groups made it impossible to compare across all three data
sets. Because the national age data were incomplete it was not comparable to the
Fresno State population or the participants of the Fresno State ACHA-NCHA II
survey. However, the data for Fresno State students and Fresno State’s ACHANCHA II participants were comparable across all age groups.
52
The race/ethnic groups, comparability occurred across all groups for the
Fresno State and the Fresno State ACHA-NCHA II data set. Therefore, the
race/ethnic composition of the Fresno State ACHA-NCHA II participants is
reflective of the entire Fresno State population. Similar compositions occurred in
the Black or African American, Asian or Pacific Islander, American-Indian or
Alaskan race/ethnic groups for all three data sets. The major differences occurred
in the White and Hispanic or Latino/a race/ethnic compositions. Nationally, 65.3%
of the ACHA-NCHA II participants were White compared to 28% of the
participants at Fresno State. The Hispanic Latino/a compositions were also
drastically different as only 13.9% of the national ACHA-NCHA II participants
identified themselves as such compared to 37.5% of Fresno State participants. Due
to substantial race/ethnic group differences, the national ACHA-NCHA II data is
not comparable to Fresno the ACHA-NCHA II data or the Fresno State population
according to gender.
The Fresno State ACHA-NCHA II survey was administered in the spring of
2013. A reason that differences existed between the Fresno State and the national
ACHA-NCHA II data may be attributed to the methods chosen to administer the
survey. At Fresno State, the survey was administered electronically via email to a
random sample of students. The overall response rate at Fresno State was 19.2%.
Nationally, the response rate for the ACHA-NCHA II survey was 34%. Among
the 153 institutions who participated in the survey 32 administered the survey as a
paper survey and 122 as an electronic survey. The response rate for those who
administer the survey electronically were 93% and 18% for paper surveys. Despite
the Fresno State and national response rate differences, the Fresno State response
rate is comparable to the response rate for institutions who administered the survey
electronically (ACHA, 2013a).
53
In addition to demographic and survey administration differences,
limitations due to recall bias and sensitivity of the questions being asked must also
be considered. Participants may or may not have had trouble recalling behavior of
the last 7 days, last 30 days, last several months, or in the past 12 months. In
contrast, sensitivity to questions being asked takes into consideration that
individuals may not feel comfortable answering questions that they deem as
sensitive matter. Questions pertaining to ingestion of diet pills or laxatives as well
as vomiting in an effort to lose weight may be considered sensitive by those who
have partaken in such behaviors and they may or may not answer honestly.
Hypotheses Findings
Hypothesis 1
The first hypothesis stated that there was no statistically significant
difference in Fresno State students’ perceived body weight and actual body mass
index (BMI). The findings of this study revealed that there was a statistically
significant difference in individual’s perceived weight and actual BMI. This was
particularly true among those who are obese, but perceive themselves as
overweight. The data demonstrate that 284 (37.2%) of the participants described
their body weight as overweight and 71 (9.3%) as obese, however when BMI data
was ran for these same individuals it was revealed that 185 (24.2%) were
overweight and 163 (21.4%) as obese. The observed differences show that a
significant number of participants underestimate their weight as overweight when
in actuality they are obese. In comparison, the spring 2013 ACHA-NCHA II
summary reveals that less college students, on a national level, describe
themselves as slightly overweight 30.3% or very overweight at 4.9% (ACHA,
2013). It is possible that, on a national level, students may also be underestimating
54
themselves as overweight when in fact they are obese according to BMI
calculations. However, because the raw national data that allows for the
comparison of perceived body weight and actual BMI could not be attained those
deductions could not be made. In addition, data were not assessed to determine if
there were differences in perceived body weight and actual BMI according to
gender or race/ethnicity.
The reviewed literature revealed that the perception of being overweight or
obese, among those who are, has decreased over the years with the biggest
disparity of body dissatisfaction occurring during the college years (Presnell et al.,
2007). Research on college students found that males more often underreported
overweightness compared to their female counterparts (Ratanasiripong & Burkey,
2011). The perception college students have of their close friends and peers often
shapes their behaviors as a study found that students perceived themselves as
healthier than their best friends and substantially healthier than the average college
student (Chock, 2011).
BMI calculations are commonly used to determine obesity but research on
BMI have revealed that the BMI calculations have high specificity and a poor
sensitivity (Romero-Corral et al., 2008). Poor sensitivity indicates that the BMI
calculations have false negative rates for obesity. The review of the literature
aligns with the finding of hypothesis 1. However, the findings were limited as data
were not run to determine if there were differences in perceived body weight and
actual BMI according to gender or race/ethnicity.
Hypothesis 2
The second hypothesis stated that there was no statistically significant
difference in Fresno State students’ diet weight loss strategies and gender. Results
55
of this study revealed that there were statistically significant differences in gender
and dieting in the last 30 days to lose weight. There were, however, no statistically
significant differences in gender and vomiting/taking laxative or taking diet pills
in the last 30 day to lose weight. The statistically significant findings are
consistent with the review of literature that found that found females are more
often dissatisfied with their bodies than males and are therefore more likely to diet
(Hancock et al., 2012).
A study of differences in dieting practices found that choosing low fat or fat
free foods and drinks, eating less, consuming sugar free products, and counting
calories were among the most common diet weight loss strategies used by college
women (Malinauskas et al., 2005). Despite females having lower obesity rates,
female’s diet more often than males. These differences may be related to the
perceptions of body image for each gender with research suggesting that females
tend to have lower obesity rates due to the stigmas associated with being obese
(Crosnoe, 2007).
At Fresno State, more women participated in the unhealthy weight loss
strategies of vomiting/taking laxative or taking diet pills to try to lose weight.
However, these differences were not statistically significant which is inconstant
with the literature that has found significantly more women participate in
compensatory eating behavior disorders. Compensatory behaviors may consist of
laxative abuse and self-induced vomiting intended “to influence one’s body shape
or weight” (Reilly et al., 2014, p. 526). In addition, more women, 20 million
versus 10 million, suffer from an eating disorder compared to men (NEDA, 2015).
The statistically significant differences in dieting according to gender were
consistent with the review of the national ACHA-NCHA II literature that found
that 30% of males and 46% of females students had gone on a diet in the last 30
56
days to ty to lose weight (ACHA, 2013). At Fresno State the percentages were
similar with 31% of male and 51% of female students had done so. Added to that
were that nationally 37% of male and 60% of female ACHA-NCHA II participants
stated that they were trying to lose weight. At Fresno State, when asked about
they were trying to do about their current weight, 37% of male and 66% of female
participants stated that they were trying to lose weight (ACHA, 2013b).
The analysis of the Fresno State ACHA-NCHA II data showed 69 (31%) of
the male participants and 252 (51%) of the female participants had dieted in the
last 30 days to lose weight. These findings are consistent with the national ACHANCHA II data that found that 30% of males and 46% of females had gone on a
diet in the last 30 days in an effort to try to lose weight (ACHA, 2013). In regard
to vomiting, taking laxatives, or taking diet pills as a weight loss strategy, more
female participants indicated that they had done so. One male and 13 (3%) of the
female participants had indicated that they had vomited or taken laxatives in the
last 30 days in an effort to lose weight. Despite the fact that these numbers were
found to not be statistically significant the numbers are consistent with the national
ACHA-NCHA II data that found that 0% and 3% of college had done the same
(ACHA, 2013).
In reference to taking diet pills in the last 30 days in an effort to try to lose
weight 8 of the male participants (4%) and 17 of the female participants (3%)
female Fresno State students had done so. These frequency differences are
consistent with the literature that stipulates that a higher percentage of females
partake in these unhealthy weight loss behaviors, however the differences in
frequencies are not significant as both may be attributed to chance as they had pvalues greater than 0.05. Compared to national ACHA-NCHA II data, the
57
differences in percentage is very minimal as 2% of male participants and 4% of
female participants college students had engage in such behaviors (ACHA, 2013).
Hypothesis 3
The third hypothesis stated that there was no statistically significant
difference in Fresno State students’ diet weight loss strategies and race/ethnicity.
Results revealed that there were no statistically significant race/ethnic differences
in dieting, vomiting/taking laxatives, or taking diet pill in the last 30 day to lose
weight. Among those who had indicated they had dieted in the last 30 days 31.1%
were White, 37.0% were Hispanic or Latino/a, 3.1% were Black or African
American, and 17.7% were Asian or Pacific Islander. In addition, 26.6% of those
who stated they that they had vomited or taken laxatives in the last 30 days were
White, 40% were Hispanic or Latino/a, 6.7% were Black or African American,
and 13.3% were Asian or Pacific Islander. As for those who had taken diet pills in
the last 30 days, 20% of those who indicated they had were White, 40% were
Hispanic or Latino/a, 4% were Black or African American, and 24% Asian or
Pacific Islander.
The review of the literature revealed White females are more likely to
suffer from an eating disorder despite the fact that Black females tend to have
higher BMI’s. The lower prevalence of eating disorders among ethnic minorities
may be attributed to differences in ideals of thinness research has revealed that
white women placed the highest level of importance of achieving a lower body
weight. This coincides with a greater probability of attempting to lose weight and
in partaking in behaviors in order to try to achieve this (Schembre et al., 2011).
The higher tolerance of a larger body size, among African American women,
58
results in less pressure and a smaller likelihood of them dieting (Young-Hyman et
al., 2000).
Analysis of this study showed that race/ethnic differences in weight loss
strategies are not statistically significant. These finding are not consistent with the
literature that found ethnic differences in disordered eating behavior and attitudes.
Female European Americans were found to exhibit higher percentages of eating
disorders compared to female African Americans (Rich & Thomas, 2008). The
lower prevalence of eating disorders among ethnic minorities may be attributed to
differences in ideals of thinness (Mann & Arriaza, 2001). Aside from surveillance
research there is a dearth of research in the race/ethnic differences in weight loss
strategies.
Raw national ACHA-NCHA II data to determine whether differences exist
between race/ethnicity and weight loss strategies could not be obtained. Due to
this the study was limited in comparing weight loss strategies according to
race/ethnic groups to the national ACHA-NCHA II data. The race/ethnic ACHANCHA II composition of White and Hispanic or Latino participants were
drastically different at Fresno State compared to the nation. Due to this selection
bias and random variation may be attributable and may have resulted in under
reporting in national data.
Hypothesis 4
The fourth hypothesis stated that there was no statistically significant
difference in Fresno State students’ exercise weight loss strategies and gender.
This study found no gender statistically significant difference in moderate exercise
for at least 30 min in the last 7 days. There were however, statistically significant
59
gender differences in vigorous exercise for at least 20 min and in repetitions to
strengthen muscles in the last 7 days.
The review of the literature indicated the majority of adults in the U.S. do
not exercise regularly with many living sedentary lifestyles (Magoc et al., 2012).
This was consistent with 0 days of exercise as the most commonly selected option
in all three exercise strategies for both genders. Research on college students
found that males were more likely to exercise to control their weight instead of
restricting calories, using laxatives, or taking diet pills (Clemens et al., 2008). This
analysis of the data that found gender differences in vigorous and strength training
exercise. This is most likely attributed to male’s higher preoccupation in gaining
muscle and losing fat.
Studies on the college population have found that women weight concerns
are more closely associated with desire to be thin while among their male
counterparts weight concerns are more closely associated with the body shape and
the gaining of muscle mass (Watkins et al., 2008). Gender differences were also
observed in 2010 published study on physical activity among diverse college
students and found that that 55% of women and 40.3% of men did not “engage in
vigorous physical activity during the preceding month” (Suminski et al., 2002, p.
77). These numbers are drastically different than those at Fresno State that found
that 28.2% of males and 56.2% of did zero days of at least 20 min of vigorous
physical activity in the last 7 days.
The Fresno State ACHA-NCHA II findings were similar to those of college
students nationwide with differences in percentages nationwide being between 0
and 4% (ACHA, 2013). The analysis of the data of Fresno State students revealed
that there were differences in vigorous and strength training exercise according to
gender. The study results revealed that 40% of female participants did not engage
60
in any vigorous exercise in the last 7 days compared to 28.2% of males. This
analysis is consistent with recent literature that has found that 20-60% of college
students are not meeting the minimum physical activity recommendations (Desai
et al., 2008). The comparison of college students vigorous and strength training
exercise behavior according to gender was similar as percentages were once again
almost identical with the largest difference among Fresno State students and the
national data being 5% (ACHA, 2013).
Hypothesis 5
The fifth hypothesis stated that there was no statistically significant
difference in Fresno State students’ exercise weight loss strategies and
race/ethnicity. The findings of this study revealed that there were no statistically
significant differences among race/ethnic groups and moderate, vigorous, and
strength training exercise. Obesity prevalence data reveal that there is obesity
race/ethnic disparities rate. In addition disproportionate ethnic percentages of
inactivity have also been observed among the college population. One study on
college students found the race/ethnic inactivity rates were “28.1%, 23.5%, 17.4%,
and 20.3% for Asian, African American, White, and Hispanic women,
respectively” (Suminski et al., 2002, p.77). Among males the rates the inactivity
rates were “11.7%, 7.7%, 12.0%, and 13.8% for Asian, African American, White,
and Hispanics” (Suminski et al., 2002, p. 77).
In regard to weight lifting, one study found that African American college
males spent the most time weight lifting at 2.71 hour per week followed by 2.54
by both Hispanic and Asian males and 2.44 by White males. Among female
college students, White females devoted the most time per week weight lifting at
61
an average of 1.93, followed by Black, Hispanic, and Asian females at rates of
1.88, 1.87, and 1.81 respectively (Suminski et al., 2002).
There is a dearth of data on race/ethnicity and exercise and no statistically
significant differences were observed among exercise weight loss strategies and
race/ethnicity at Fresno State. The differences observed in this study may be
attributed to chance, selection bias, or recall bias. Raw national ACHA-NCHA II
data to determine whether differences exist between race/ethnicity and exercise
loss strategies could not be obtained. Due to this, the study was limited in
comparing weight loss strategies according to race/ethnic groups to the national
ACHA-NCHA II data. The race/ethnic ACHA-NCHA II composition of White
and Hispanic or Latino participants were drastically different at Fresno State
compared to the nation. Due to this selection bias and random variation may be
attributable and may have resulted in under reporting in national data.
Implications to Public Health
The results of this study have public health implications as obesity rates in
the U.S. have reached astonishing rates. Obesity has been linked to a number of
chronic disease with the number of deaths attributed to it possibly surpassing
tobacco as the leading preventable cause of death (Jia & Lubetkin, 2005). The
economic toll obesity has on this nation is crippling as it estimated to cost us $147
billion per year, (Finkelstein et al., 2012). There are limited studies about obesity
and college students and the results of this study were not necessarily consistent
with the conclusions of previous studies. The results of this study found that there
were differences in perceived body weight and actual BMI. This was particularly
true for those who perceived themselves as overweight, but are actually obese
according to BMI calculations. This study determined that race/ethnicity were not
62
impacts on diet and exercise weight loss strategies. Gender did indeed have an
impact on diet and exercise strategies.
The results of this study have implications for public health because it is the
first to investigate diet and weight loss strategy differences in respect to gender
and race/ethnicity in college students. The study also investigated differences in
perceived body weight and actual BMI in college students. The results revealed
differences in perceived body weight as gender differences in diet and weight loss
strategies. Because overweight and obesity are mostly preventable, results of this
study can be used by Fresno State to design interventions in an effort to try to
combat obesity. Fresno State can track changes in obesity rates over the years
using the measures used in this study as well as the effectiveness of its
intervention measures. In addition, the data analysis methods used for this study
can be replicated by other universities with the results of those investigations
compared to this study.
Conclusion and Recommendations
Obesity rates in the U.S. have reached alarming proportions with over 60
million American being classified as obese. Obesity increases the risk for many
chronic diseases, is attributed to premature deaths, is an economic health burden,
and is the second leading cause of preventable deaths. A wealth of research has
been devoted to the study of childhood and adult obesity, but there are limited
studies that have focused on obesity among the college population. Research on
the college population is critical because “the college years highly influential in
shaping adult behavior” (Desai et al., 2008, p. 109). Individuals who are obese as
young adults are more likely to continue to be so later in life. Desai et al. found
that interventions to combat overweight and obesity among the college population
63
would reduce the rate of obesity from adolescence to adulthood, thereby
preventing much long-term obesity related consequences.
Overall, results of this study highlighted body weight perceptions, diet
weight loss strategies, and exercise weight loss strategies among students at
Fresno State. The analysis of the data revealed that there were statistically
significant differences in perceived body weight and actual BMI, particularly
among those who viewed themselves as overweight but are actually obese.
Individuals who wrongfully underestimate their weight are putting their health in
danger because they are unaware or are in denial. These individuals would fall
under the precontemplation or contemplation stage of the transtheoretical model
because they are unaware of the need to change or keep putting it off. A weight
loss program for individuals who underestimate their weight should focus on
increasing awareness through conscious raising. In accordance to the other
constructs of the model, a program focused on individuals in the precontemplation
or contemplation phase must also increase the an individual’s decision balance,
self-efficacy, and educate them on the process of change (Prochaska &
DiClemente, 1984).
The analysis of this study also found that significantly more female
students had gone on a diet in the last 30 days in an effort to try to lose weight
compared to male students. Individuals who have made an effort through dieting
to try to lose weight would fall under the preparation or action phase of the
transtheoretical model as they have already begun to take small steps towards
change or have made modifications to their behaviors. A weight loss program of
individuals in the preparation or action phase benefit from conscious raising, but
the focus for these individuals is maintenance strategies, reinforcements, and
stimulus control through healthy reminders (Prochaska & DiClemente, 1984). The
64
analysis of the data did not provide details on what going on a diet in the last 30
days entails nor does it stipulate how many days they were on a diet
Statistically significant gender differences were not found in the use of
laxatives, vomiting, or diet pills. More women did however participate in such
behaviors in the last 30 days in an effort to try to lose weight. The review of the
literature has found that more women participate in disordered eating behaviors
such as the use of laxatives, vomiting, and diet pills. Such behaviors are
considered unhealthy and a weight loss program should not exclude education and
conscious raising. The analysis of the data could not reveal whether these
individuals were underweight, normal weight, overweight, or obese. Because of
this limitation, it is difficult to ascertain what stage those who partook in these
unhealthy behaviors are at.
Race/ethnicity were also found to not be statistically significant in regard to
differences in diet, laxatives/vomiting, and diet pills as weight loss strategies.
These finding were not consistent with the literature that found ethnic differences
in disordered eating behavior and attitudes. At Fresno State, Hispanics/ Latino
(a)’s, followed by White and Asian/Pacific Islanders, were the race/ethnic groups
with the highest percentage within their group for these behaviors. Because no
statistically significant differences were found among race/ethnic groups, a weight
loss program should not make race/ethnicity a focus of their program. However,
race/ethnic influences should considered on a case by case basis. The advantage
of the transtheoretical model is that it allows for individual tailoring for those who
express that their racial/ethnic identification is an influencing factor in their
behavior.
The analysis of the data showed gender statistically significant differences
in vigorous and strength training exercise, but not moderate exercise. No exercise
65
in the last 7 days was however the most commonly selected answer by either
gender for all types of exercise. The lack of exercise suggested that majority of
individuals, of either gender, are in the precontemplation or contemplation phase
of the transtheoretical model. A weight loss program should target these
individuals through conscious raising of the benefits, types, and frequency of
exercise; increasing confidence in changing their sedentary lifestyles; and
educating them about the process of change. No statistically significant
differences were observed in regard to race/ethnicity and exercise weight loss
strategies and therefore a weight loss program should not be considered in the
development of a program.
College life is a time where lifestyle perceptions and behavior can be
modified and changed “particularly with regard to diet, physical activity, and other
lifestyle habits” (Desai et al., 2008, p. 109). During college life individuals make
the transition from depending on their sociological upbringing to independently
making their own decisions regarding lifestyle behaviors. Limited physical
activity and unhealthy eating habits have been shown to be risk factors that
contribute to obesity .
The sample used in this study was limited to Fresno State students who
completed the ACHA-NCHA II survey in the spring of 2013 and therefore the
findings and generalizations are limited to the study sample. The racial/ethnic
demographics of the participants of the Fresno State ACHA-NCHA II differed
from the national ACHA-NCHA II demographics. At Fresno State, 36% and
40.6% of participants described themselves as White and Hispanic or Latino/a. In
comparison, the national composition of ACHA-NCHA II participants was 75.1%
White and 8.1% Hispanic or Latino/a. The gender compositions were more
comparable however. At the national level 33.6% and 63.7% of participants
66
identified themselves as male and female. At Fresno State the male and female
participant composition was 29.6% and 68.5%.
Recommendations
According to the 2013 Fresno State ACHA-NCHA II summary, 24.2% of
student are overweight and 21.4% are obese. The obesity rate at Fresno State is
particularly alarming as it is nearly 10% higher than the national college average.
This researcher recommends the creation of weight loss and management program
at Fresno State that incorporates technology/Social media and is theory driven.
The transtheoretical model provides the framework for a promising weight loss
program. The model is recommended as it represents how an individual decides to
make a change, how the individual makes the change, and whether or not the
individual continues to adhere to the change over an extended period of time
(Prochaska & DiClemente, 1984).
Based on the finding of this study, a weight loss program should have
education and intervention components and be multifaceted as the needs of the
Fresno State population vary. Perceived body weight as well as gender and diet,
vigorous exercise, and strength training exercise were all found to be statistically
significant and therefore should be tied into development and implementation of
the program. The finding suggested that a substantial amount of students are in
the precontemplation, contemplation, or preparation phase. A major focus of the
program should be in conscious raising as a significant amount of individuals
underestimate their weight and are most likely in the precontemplation or
contemplation stage.
The program should increase awareness and knowledge through a campus
wide campaign as well as open up enrollment to the program for all students. The
67
campus wide campaign should provide information about the dangers and
susceptibility for obesity, specifically targeting those with misperceptions, as well
as diet and exercise tips. Gender should be considered in the development of such
messages as differences were observed. The program must have coordinators
leading the efforts as well as have dieticians, counselors, and trainers on hand to
provide assistance.
The transtheoretical model has successfully been used in smoking cessation
programs and because the model provides flexibility and individual customization
it is compelling in meeting the needs of Fresno State students. In order for the
program to flourish it must incorporate technology and social media as Facebook
is the most commonly used social networking website used by college students. In
addition, 94% of college students have cell phones, 89% have their cell phone on
them at all times, 93% use text messages, and 94% using text messaging more
than email (Napolitano et al., 2013). The integration of these technology
platforms offer a low-cost method of disseminating messages. In addition to a
weight loss program, this researcher recommends surveillance of overweight and
obesity rates, more research on college males health behaviors, and the use of
better methods of disseminating the ACHA-NCHA II survey.
Summary
The purpose of this study was to investigate perceived obesity and weight
loss strategies used by Fresno State students. Data collected through the spring
2013 Fresno State ACHA-NCHA II survey were analyzed using the Pearson ChiSquare Test with Yates Correction Factor. A 0.05 level of significant was used to
determine statistically significant differences. The results of this study revealed a
statistically significant differences in perceived body weight and actual BMI;
68
dieting and gender; vigorous exercise and gender; and exercise to strengthen
muscles and gender. Statistically significant differences were not observed in
vomiting/taking laxatives in the last 30 days and gender or moderate
cardio/aerobic exercise for at 30 min and gender. Furthermore, no statistically
significant differences were observed in any diet weight loss strategies and
race/ethnicity or exercise weight loss strategies and race/ethnicity. The obesity rate
at Fresno State is of concern as it is nearly 10% higher than the national college
average. In addition, Fresno State lacks a theoretically driven model weight loss
program. Despite the obesity concerns on college campuses there are limited
studied that focus on obesity among the college population. Focus on the college
population is of importance because those years help formulate adult behaviors.
More studies on college male behavior, obesity on college campuses, and college
obesity surveillance need to be conducted.
REFERENCES
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American College Health Association. (2013a). American College Health
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APPENDIX: TABLES
79
Table 16
Did You Do Any of the Following? Last 30 Days: Diet to Lose Weight
Yes
Race/Ethnicity
White
Black or
African
American
Hispanic or
Latino/a
Asian or Pacific
Islander
American
Indian or
Alaskan
Biracial or
Multi-Racial
Other
Valid responses
Missing
Total
n
102
%
31.2
n
111
No
%
26.9
Unknown
n
%
_
_
n
213
Total
%
27.9
10
3.1
17
4.1
_
_
27
3.5
121
37.0
165
40.0
_
_
286
37.5
58
17.7
80
19.4
_
_
138
18.1
4
1.2
4
0.9
_
_
8
1.0
20
12
327
327
6.1
3.7
44.2
42.9
14
22
413
413
3.4
5.3
55.8
54.1
_
_
_
23
23
_
_
_
3.0
3.0
34
34
740
23
763
4.5
4.5
97.0
3.0
100.0
Table 17
Did You Do Any of the Following? Last 30 Days: Vomit or Take Laxatives to Lose
Weight
Yes
Race/Ethnicity
White
Black or African
American
Hispanic or Latino/a
Asian or Pacific
Islander
American Indian or
Alaskan
Biracial or MultiRacial
Other
Valid responses
Missing
Total
n
4
%
26.6
n
211
No
%
29.1
Unknown
n
%
_
_
n
215
Total
%
29.0
1
6
6.7
40.0
26
279
3.6
38.5
_
_
_
_
27
285
3.6
38.5
2
13.3
136
18.7
_
_
138
18.6
0
0.0
8
1.1
_
_
8
1.1
1
1
15
_
15
6.7
6.7
20.0
_
2.0
33
33
726
_
726
4.5
4.5
98.0
_
95.1
_
_
_
22
22
_
_
_
2.9
2.9
34
34
741
22
763
4.6
4.6
97.1
2.9
100.0
80
Table 18
Did You Do Any of the Following? Last 30 Days: Take Diet Pills to Lose Weight
Yes
Race/Ethnicity
White
Black or African
American
Hispanic or
Latino/a
Asian or Pacific
Islander
American Indian or
Alaskan
Biracial or MultiRacial
Other
Valid responses
Missing
Total
No
n
5
%
20.0
n
210
%
29.3
Unknown
n
%
-
Total
1
4.0
26
3.6
-
-
27
3.6
10
40.0
276
38.5
-
-
286
38.5
6
24.0
132
18.4
-
-
138
18.6
0
0
8
1.1
-
-
8
1.1
3
0
25
25
12.0
0
3.4
3.2
31
34
717
717
4.3
4.8
96.6
94.0
21
21
2.8
2.8
34
34
742
21
763
4.6
4.6
97.2
2.8
100.0
n
215
%
29.0
Table 19
Did You Do Any of the Following? Last 7 Days: Moderate Exercise for at Least 30 Minutes
White
n
%
Black or
African
American
n
%
Hispanic or
Latino/a
n
%
Asian or
Pacific
Islander
n
%
American
Indian or
Alaskan
n
%
0 Days
43
19.9
1
4.0
61
21.5
38
27.6
2
25.0
7
20.6
8
23.5
-
-
160
21.6
1 Day
23
10.6
2
8.0
38
13.4
17
12.3
0
0.0
7
20.6
6
17.7
-
-
93
12.6
2 Days
46
21.3
7
28.0
48
16.9
33
23.9
1
12.5
4
11.7
3
8.8
-
-
142
19.2
3 Days
42
19.4
4
16.0
51
17.9
20
14.5
0
0.0
5
14.7
5
14.7
-
-
127
17.2
4 Days
27
12.5
4
16.0
32
11.3
12
8.7
3
37.5
2
5.9
3
8.8
-
-
83
11.2
5 Days
20
9.3
4
16.0
30
10.6
9
6.5
1
12.5
6
17.7
6
17.7
-
-
76
10.3
6 Days
10
4.7
0
0.0
8
2.8
5
3.6
1
12.5
0
0.0
1
2.9
-
-
25
3.4
7 Days
5
2.3
3
12.0
16
5.6
4
2.9
0
0.1
3
8.8
2
5.9
-
-
33
4.5
216 29.2
25
3.4
284
38.4
138
18.7
8
1.1
34
4.6
34
4.6
-
-
739
96.9
-
-
-
-
-
-
-
-
-
-
-
-
24
3.1
25
3.3
284
37.2
138
18.1
8
1.0
34
4.5
34
4.5
Duration
Valid
Biracial or
Multi-Racial
n
%
Other
n
%
Missing
n %
n
Total
%
responses
Missing
Total
-
-
216 28.3
24 3.1
24 3.1 763 100.0
81
Table 20
Did You Do Any of the Following? Last 7 Days: Vigorous Exercise for at Least 20 Minutes
Black or
African
American
n
%
Hispanic or
Latino/a
n
%
Asian or
Pacific
Islander
n
%
American
Indian or
Alaskan
n
%
Biracial or
multi-racial
n
%
White
n
%
78
36.4
5
18.5
98
34.5
66
47.8
2
25.0
13
1 Day
39
18.2
5
18.5
51
18.0
23
16.7
0
0.0
2 Days
39
18.2
7
26.0
51
18.0
18
13.0
4
3 Days
29
13.6
2
7.4
31
10.9
13
9.4
4 Days
15
7.1
2
7.4
17
5.9
7
5 Days
9
4.2
4
14.8
25
8.8
6 Days
3
1.4
0
0.0
3
7 Days
2
0.9
2
7.4
214
28.9
27
-
-
214
28.1
Duration
0 Days
Other
n
%
Missing
n
%
Total
n
%
38.2
11
32.3
-
-
273
36.9
5
14.7
4
11.8
-
-
127
17.2
50.0
4
11.8
5
14.7
-
-
128
17.3
1
12.5
3
8.8
4
11.8
-
-
83
11.2
5.1
1
12.5
4
11.8
4
11.8
-
-
50
6.8
4
2.9
0
0.0
3
8.8
5
14.7
-
-
50
6.8
1.1
5
3.6
0
0.0
0
0.0
1
2.9
-
-
12
1.6
8
2.8
2
1.5
0
0.0
2
5.9
0
0.0
-
-
16
2.2
3.7
284
38.4
138
18.7
8
1.1
34
4.6
34
4.6
-
-
739
96.9
-
-
-
-
-
-
-
-
-
-
-
-
24
3.1
24
3.1
27
3.5
284
37.2
138
18.1
8
1.0
34
4.5
34
4.5
24
3.1
763
100.0
Valid
responses
Missing
Total
82
Table 21
Did You Do Any of the Following? Past 7 Days: Exercise to Strengthen Muscles 8-12 Repetitions
White
Duration
Black or
African
American
Hispanic or
Latino/a
Asian or
Pacific
Islander
American
Indian or
Alaskan
Biracial or
multi-racial
Other
Missing
n
%
n
%
n
%
n
%
n
%
n
%
n
%
n
%
0 Days
102
47.9
11
42.3
150
53.0
80
58.4
5
62.5
19
55.9
15
42.9
-
1 Day
24
11.2
5
19.3
29
10.2
11
8.0
0
0.0
5
14.7
4
11.4
2 Days
31
14.6
2
7.7
41
14.5
12
8.8
1
12.5
5
14.7
5
3 Days
24
11.3
3
11.5
22
7.8
15
10.9
0
0.0
1
2.9
4 Days
17
8.0
0
0.0
9
3.2
4
2.9
0
0.0
1
5 Days
10
4.7
3
11.5
19
6.7
8
5.9
2
25.0
6 Days
3
1.4
0
0.0
6
2.1
6
4.4
0
7 Days
2
0.9
2
7.7
7
2.5
1
0.7
213
28.9
26
3.5
283
38.5
137
-
-
-
-
-
-
213
27.9
26
3.4
283
37.1
Total
n
%
-
382
51.9
-
-
78
10.6
14.3
-
-
97
13.2
3
8.6
-
-
68
9.2
2.9
2
5.7
-
-
33
4.5
2
6.0
6
17.1
-
-
50
6.8
0.0
0
0.0
0
0.0
-
-
15
2.0
0
0.0
1
2.9
0
0.0
-
-
13
1.8
18.6
8
1.1
34
4.6
35
4.8
-
-
736
96.5
-
-
-
-
-
-
-
-
27
3.5
27
3.5
137
18.0
8
1.0
34
4.5
35
4.6
27
3.5
763
100.0
Valid
responses
Missing
Total
83
Fresno State
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Edward Boyle
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August 17, 2015
Date