College Students' Barriers and Enablers for Healthful Weight Management: A Qualitative Study

Abstract

Objective

To identify barriers and enablers for healthful weight management among college students.

Design

Sixteen on-line focus groups, homogeneous by sex and university.

Setting

Eight universities in 8 states.

Participants

College students (N = 115; 55% female; mean age 19.7 ± 1.6).

Analysis

Qualitative software, Nvivo version 2 (QSR International, Victoria, Australia, 2002), was used; similar codes were grouped together and categorized using an ecological model.

Results

Males and females cited the same barriers to weight management: intrapersonal (eg, temptation and lack of discipline); interpersonal (social situations); and environmental (eg, time constraints, ready access to unhealthful food). Similar enablers were identified by sex: intrapersonal (eg, regulating food intake, being physically active); interpersonal (social support); and environmental (eg, university's environment supports physical activity). More barriers than enablers were given, indicating that these college students were more sensitive to barriers than the enablers for weight management. Factors viewed by some students as barriers to weight management were viewed as enablers by others.

Conclusions and Implications

When designing weight management interventions for college students, sex specificity may not be as important as considering that a barrier for one student may be an enabler for another. From an ecological perspective, individually focused interventions must be implemented in conjunction with environmental-level interventions to facilitate behavior change.

Introduction

Entering college is a key transitional period for young adults.¹ They face challenges adjusting to new surroundings and workloads, and many will have greater lifestyle freedom than ever before. Often these changes are associated with excessive weight gain.² Low intake of fruits and vegetables, excess caloric intake, and lack of physical activity are frequently cited as reasons for weight problems in adults.³ Many college students have low intakes of fruits and vegetables and high intakes of food with excess calories, saturated fats, alcohol, and added sugars.4, 5 Based on national surveys of college students, only 5.7% report eating 5 or more daily servings of fruits and vegetables,⁶ 62% report only 1-2 daily servings of fruits and vegetables,⁶ and 21.8% report eating 3 or more high-fat food items a day.⁷ Furthermore, college students as a population are physically inactive,8, 9 with only 20% reporting participation in moderate physical activity and 30% in vigorous physical activity on a regular basis.6, 10

The most rapid weight gain for adults is during their twenties,¹¹ which may result in gains in weight and body fat above normal maturation.2, 12, 13 According to results of the 2006 American College Health Assessment, 4.5% of college students are underweight, 64.1% are a healthful weight, 21.9% are overweight, and 9.5% are obese, with rates of overweight and obesity higher among males than females.¹⁴ Excess weight gain during early adulthood may lead to increases in overweight and obesity later in life, with associated health consequences.15, 16 To prevent obesity, consuming a healthful diet and being physically active are important.¹⁷ Educators in nutrition and exercise science are key in developing effective interventions to prevent obesity.

To address topics such as body weight that may be considered sensitive, on-line focus groups provide a forum for preserving anonymity and increasing frank discussions.¹⁸ On-line focus groups may be especially suited to college students because of their familiarity with computers. Although paralinguistic cues and body language are not apparent during on-line focus groups, respondents easily communicate attitudes and personality through writing.19, 20

A series of on-line focus groups was conducted as part of a collaboration of 8 universities from 8 states (Michigan State University, Pennsylvania State University, South Dakota State University, Syracuse University, Tuskegee University, University of Maine, University of Rhode Island, and University of Wisconsin–Madison) to identify factors college students consider to be barriers and enablers to healthful weight management. Findings will be used to develop a Web-based weight management curriculum for college students using the Health at Every Size (HAES), nondiet approach that encourages internally regulated eating, enjoyment of eating and physical activity, and size acceptance.²¹