Empirical Claim Critique

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PERcEPTIONs OF cOLLEGE wEIGHT GAIN: AN ExPLORATORy sTuDy

Retta R Evans University of Alabama at Birmingham

Donna O Burnett Auburn University

Research has demonstrated that a majority of college students gain weight during their college years. However, research has not agreed on the multifaceted causes of weight gain among this population. The purpose of this qualitative study was to examine college students’ per- ceived environmental, personal and behavioral factors influencing col- lege weight gain. A total of 110 students participated in focus groups. Utilizing constant comparative analysis, researchers worked together to code data into themes and sub-themes. The majority of participants reported negative factors in the social, institutional and physical envi- ronment impacting college weight gain. In particular, they perceived four dining hall policies that made eating healthy difficult on campus. Participants also reported a lack of confidence in how to plan, shop and cook healthy meals. Further, participants were unsure how to budget and plan out what to spend their money on related to food. This study elucidated several unique interactions in the environment that may in- fluence college weight gain. Targeted research focusing on these inter- actions is needed.

Introduction According to 2015-2016 data, 35.1% of

U.S. youth aged 2-19 years were overweight or obese (Fryar, Carroll, & Ogden, 2018). The transition from adolescence into young adulthood is an important period for excess weight gain (Nelson, 2008). The period of “emerging adulthood,” typically defined as 18–25 years of age, is marked by important transitions such as leaving home, shifting interpersonal influences and increasing au- tonomy in decision-making (Arnett, 2000). This period may be an important, yet over- looked, age for establishing long-term health behavior patterns.

Given that nearly 5.5 million Americans are currently obese by the time they reach the age of 30 and the prevalence of obesity doubles as individuals progress from their 20s to their 30s (Gordon-Larsen, 2010), there is an urgent need to investigate the causes of weight gain among college stu- dents over time. The purpose of this study was to better understand the social, behav- ioral and environmental factors perceived by college students to be related to college weight gain. These qualitative findings were part of a mixed methods study exploring college student’s perceptions of weight gain using constructs of reciprocal determinism.

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Literature Review Weight gain among first year college

students is so common it has been termed the “freshman 15” (Graham & Jones, 2002). However, most studies debunk the myth that students gain 15 pounds in the first year of college, and suggest that freshman weight gain is closer to 3-5 pounds (Vella-Zarb & Elgar, 2009). The vast majority of research- ers conducting cross-sectional and prospec- tive studies with public and private college students over the past 10 years have found a statistically significant mean weight gain (Gropper, Simmons, Connell, & Ulrich, 2012; Pliner & Saunders, 2008; Vella-Zarb & Elgar, 2010).

Researchers have not agreed on the multi- faceted causes of weight gain among this pop- ulation. Evidence indicates that a reduction in physical activity and sports, poor food choic- es, and academic stress may all play a role in college weight gain (Dusselier et al, 2005; Graham & Greeney et al., 2009; Jones, 2002); however, the evidence is mixed. Nelson, Story, Larson, Neumark-Sztainer, and Little (2008) conducted interviews and focus groups to investigate the perceived determinants of weight-related behaviors among a sample of college students. Major themes that emerged in describing the influences on weight, dietary intake, and physical activity included the abundance of food availability on campus, snacking and late-night eating, alcohol con- sumption and alcohol-related eating, eating because of stress/boredom, and lack of time. Similar to other age groups, participation in physical activity and sports declines dramati- cally among college students after high school (Keating, Guan, Pinero & Bridges, 2005), and in fact, 53.8% of college students reported not meeting physical activity recommenda- tions (American College Health Association, 2018). College students’ diets have been char- acterized as low in fruits and vegetables and high in fat, sugar, and sodium. Many college

students exhibit unhealthy eating behaviors, such as skipping meals and consuming large quantities of carbonated beverages (Abraham, Martinez, Salas, & Smith, 2018), fast food (Driskell, Kim, & Goebel, 2005), and high-fat foods (Roy, Soo, Conroy, Wall, & Swinburn, 2019). According to recent data, only 25.2% of college students reported eating 3-4 fruits and vegetables a day (American College Health Association, 2018). This data concurs with studies reporting a decrease in fruit and vegetable consumption and an increase in unhealthy foods to be associated with college weight gain (Jung, Bray, & Ginis, 2008; Plin- er & Saunders, 2008).

College students spend a substantial amount of time on campus, causing some to suggest that the environment may play a role in the diet choices of this population. Levitsky, Halbmaier, and Mrdjenovic (2004) reported that college food environments are plagued by energy dense and nutrient poor food choices. Food environments that expose students to energy dense foods, fast foods, and buffet-style dining may be linked to poorer food choices and weight gain (Racette, Deusinger, Strube, Highstein, & Deusinger, 2005).

College students report factors including stress, lack of exercise and discipline, time constraints, and the availability of unhealthy foods as causes of weight gain (Greaney et al., 2009). The impact of stress on college student health behaviors, including weight gain, has also been investigated. Previous research has found that stress is related to changes in phys- ical activity and eating practices, and these changes link stress to weight change (Dusse- lier et al., 2005). Some studies demonstrate weight loss as a result of stress (Kilpatrick, Hebert, & Bartholomew, 2005), while others link stress to weight gain (Adam & Epel, 2007). Behavioral responses to stress may de- pend upon the type of stress. One study found that physical stressors were associated with

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decreased food intake, whereas interpersonal stressors were more likely to trigger increased intake (O’Connor, Jones, Conner, MacMillan, & Ferguson, 2008).

Theoretical Framework When designing health interventions,

important attention should be given to the use of behavioral theory. Literature sug- gests that theoretically-based health behav- ior interventions are more effective than research that does not infuse a theoretical perspective (Glanz & Bishop, 2010; Levy, Finch, Crowell, Talley, & Jeffery, 2007). Social Cognitive Theory (SCT) has been used extensively in the design of nutrition education interventions and explaining di- etary behaviors among this population. So- cial Cognitive Theory, developed by Albert Bandura (1986), provides a framework for understanding how people actively shape and are shaped by their environment. Recip- rocal determinism, a key principle of SCT, postulates that there is a dynamic interaction among a person’s behavior, the environment in which the behavior occurs, and personal characteristics. These relationships can be positive or negative. The behaviors that lead to college weight gain may be highly influ- enced by environmental factors, therefore SCT is an appropriate theory to examine these relationships. For the purposes of this study, the three constructs of reciprocal de- terminism (behavioral, environmental, and personal factors) were used to explore the qualitative data.

Methods

Participants and Recruitment In total, eight focus groups consisting of

a convenience sample of 110 students at a private, mid-sized southwestern university participated in this study. Focus group inter- views were recorded for later transcription

by the principal investigator and checked for accuracy by the co-investigator. Recruitment was completed using four main methods: classroom announcements, recruitment flyer distributed on campus, information about the study printed in the student newspaper, and word of mouth among peers.

Procedures The study protocol was submitted to the

Institutional Review Board (IRB) at the uni- versity and approved prior to start of study. During the focus group sessions, participants were asked a series of open-ended questions. Focus group inquiry items included student perceptions of the following topics: (a) per- ceptions of the “freshman 15” and college weight gain; (b) environmental factors that could impact college weight gain; (c) psy- chological factors that could impact college weight gain; (d) behavioral/lifestyle factors that could impact college weight gain; and (e) how eating and physical activity behaviors have changed since high school.

Data Analysis

Utilizing constant comparative analysis (CCM), two researchers worked together to code, compare and sort data. Initial catego- rization of data were defined using the con- structs of reciprocal determinism and from a comprehensive review of the related litera- ture. Using this method allowed researchers to analyze individual statements and group similar statements into emergent themes. Constant comparative analysis began with initial/open-coding, a process used to deter- mine codes within the data. Next, axial cod- ing was used to reduce data where substantial overlap was identified, and coded data were analyzed for sub-themes. All coding was con- ducted with NVivo qualitative data analysis software (QSR International Pty Ltd. Version 10, 2012).

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Results

Of the 110 students that participated in the focus groups, 33.3% were freshman, 23.8% were sophomores, 20% were juniors, and 22.9% were seniors. The majority of partic- ipants (59%) were White-non-Hispanic, with 86% reporting as female, 11% male. Table 1 provides a summary of demographic charac- teristics of participants.

Table 1. Frequencies and Percentages for Demographic Characteristics of Participants

Variable n % Gender

Male 11 10.5

Female 86 81.9

No response 8 7.6

Class

First Year 35 33.3

Second Year 25 23.8

Third Year 21 20.0

Fourth Year 24 22.9

No response 0 0.0

Ethnicity

White, non-Hispanic 59 56.2

Black, non-Hispanic 18 17.1

Hispanic or Latino 12 11.4

Asian or Pacific Islander 14 13.3

American Indian, Alaskan native or Native Hawaiian 0 0.0

Biracial or Multi-racial 1 1.0

Other 1 1.0

Residence

Campus housing 56 53.4

With parent or guardian 1 1.0

Off campus housing 47 44.8

No response 1 1.0

The constructs of reciprocal determinism were used as a framework for understanding the interaction of the environment, behavioral and personal factors impacting the percep- tions of college weight gain. Qualitative find- ings are presented according to the constructs of reciprocal determinism.

Behavioral Factors Behavioral factors are characterized by

actions taken as either health-enhancing or health-compromising. Focus group partici- pants identified both health-enhancing and health-compromising behaviors related to the transition from high school to college that may have affected overall weight man- agement in college. However, the majority of participants reported health-compromising behaviors related to either physical activi- ty or food. A total of nine sub-themes were identified focusing on behavioral factors that may affect college weight gain. Table 2 lists selected quotes from the behavioral factors sub-themes, which are elaborated on below.

Transition increased physical activity. Some participants believed they were more active now that they attended college as compared to high school. Some students suggested that they were more motivated to exercise and try and eat healthier, now that they were out on their own. One student stat- ed, “The gym is definitely a big thing. Back at home, I’d never have time to go to the gym because I’d have to go to work and my fam- ily would go to the gym without me. Here, I can go whenever I want. On Tuesdays and Thursdays, I only have one class at 8:00, so after that I go to the gym and work out for about an hour.”

Transition healthier eating. Contrary to other research, several focus group par- ticipants felt that their eating habits had im- proved now that they were in college. One student stated, “For me, looking back, my diet has changed a lot for the better. I don’t

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Table 2. Selected Quotes of Behavioral Factors Sub-Themes

Theme Sub-Theme Selected Quotations Health- Enhancing Behaviors

Transition increased physical activity

I didn’t like really work out in high school besides the activities I was involved in, but now I find myself going to the gym with friends or playing basketball. It’s really social, so I feel like the university really encourages being active.

Transition healthier eating

I really had to learn to control when I was eating or the food groups I was eating. I had to learn on my own to eat healthy.

Health- Compro- mising Behaviors

Transition decreased physical activity

In high school I was very active and everything in sports. But then, when I came to college, I was involved in nothing. All I did was eat junk food and then bam, the weight gain.

Transition unhealthful eating & snacking

It’s easy to take the snacks I know I shouldn’t be eating. It’s just convenient.

Eating out When you’re awake really late and the only things that are open at night are really bad for you.

Food as reward & cele- brations

I know after a test, I’ll be like oh I can have a few cookies or I can have some kind of sweets. It’s like a reward behavior.

Meal management (Reported in Table 3)

Study eating If you’re up late studying and you need something to keep you going, something to snack on, it’s easy to just snack on chips or go to McDon- ald’s and study.

Stress eating I think you need to pay attention to what you’re eating. You have access to different foods all the time in college. You’re stressed so you stress eat.

know if it’s an Asian mom thing, but my mom literally just force feeds me any time I’m home. We’ll go to CostCo and spend an insane amount of money. She’ll cook all these dishes. I went home this last weekend, and I came back with a box full of food. It’s the ‘I want to take care of you and love you’ from my mom and she does it through food. When I was in high school, that’s pretty much what happened. She would just feed me all the time. The fridge was always full. The pantry was always so full. Then, coming to college, it was a complete 180 where I had to take things into my own initiative and my own hands. I didn’t have food readily available, so learning how to cook, learning what foods are good for me and what foods aren’t good for me. This is a transformation that really happened a lot in this past year taking my first nutrition class.

Transition decreased physical activi- ty. Although some focus group participants agreed that their dietary and exercise habits had improved since high school and living at home, the vast majority of participants re- ported health-compromising behaviors. Many students reported that in high school, they had more opportunities to be active as they were involved in sports. With the transition to college, many reported not being motivated to exercise, lack of time, and fewer opportuni- ties to engage in physical activity.

Transition unhealthful eating and snacking. Many participants reported snack- ing more and eating on-the-go processed foods and convenience foods more often in college as compared to home. One participant summarized these feelings by stating, “I feel like I don’t sit down and eat as much as I do

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when I was at home. Now, I’m eating lunch in class or always eating something on the way to something else instead of sitting down for a nice home cooked meal. Occasionally, on the weekends more when I have time, but it’s not like every night when your mom makes din- ner or you have a lunch break. I don’t really have a lunch break, but at school we had one. My school provided breakfast, too, so there was always an opportunity to sit down and have a nice warm meal instead of on the go.”

Eating out. Participants also reported eating out more often because of conve- nience, time constraints and low cost of fast foods. One student said, “It’s so much easier to drive to Subway or WhatABurger or you know places that are around right here to get the food because it’s right there. Like the taco place has $1 tacos.”

Food as reward and celebrations. Par- ticipants felt that they used food frequently as a reward after taking tests, and complet- ing homework and projects. One participant stated, “I’ve had a long day. I’m just going to sit in bed and watch a show and eat food. It’s like rewarding in a different sort of way, even just for the day. If you have nothing else to do, you’re like well it sounds fun to

just snack and lay down. Then, all of a sud- den, you’ve eaten so much when you didn’t even mean to.” Others stated they now have more opportunities to celebrate with food and alcohol, since the college setting is a very social experience.

Meal Management

A large majority of focus group partic- ipants perceived the logistics of managing meals to be difficult in college. Data analy- sis revealed 57 comments related to meal management. These comments were further analyzed and broken down into five catego- ries. Table 3 lists selected quotes from each of the meal management categories. Partici- pants felt that the changing demands and time constraints of college life made consistent, healthy eating difficult. Many also felt a lack of confidence in planning meals, shopping and cooking. Also, the expense of healthy eating was mentioned as a barrier. Lastly, participants felt that convenience foods were easier when time was limited.

Study eating. Many participants felt that an important factor related to college weight gain was snacking and eating while studying. Most reported eating high-fat,

Table 3. Selected Quotes of Meal Management Sub-Theme

Categories Selected Quotations Control In high school you had to at least go to bed around a certain time so that way you can be up

in the morning. But here at college you can go to bed any time, get about 2 hours of sleep, go to class, go back to sleep. Therefore, I just eat any time. Sometimes I also skip meals because you have classes all day and you don’t bring a snack with you. You just sit in class hungry. I think with me that’s how it changed.

Grocery shopping and/or cooking

I hear a lot of people saying they don’t know how to shop, and they don’t know how to cook.

Monitoring food intake

I think college weight gain is real if you don’t keep track of what you’re eating because it’s easy to eat junk food.

Planning and bud- geting

When you’re trying to get healthy stuff, you end up spending a lot of money. If you just go get honey buns, it’s just a dollar for a whole box. You just have to make those kind of choic- es and sometimes you just want to get cheaper and sometimes you want to get healthier.

Time and/or conve- nience

There’s also the factor of being busy because sometimes I’m so busy that I will forget to eat at some point. Then, by the time I do eat, I stuff my face with a lot of food.

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high-carbohydrate packaged snacks and fast foods while studying. One participant stated that it is common to go to the library, fill up on snacks and vending machine foods and study late into the night.

Stress eating. Some participants reported eating when they felt stressed about tests, grades or finals. Others reported stress eating when they felt overwhelmed by school re- sponsibilities and relationship troubles. One participant summarized these feelings by stat- ing, “I definitely eat more when I’m stressed. A lot more. I stock up on food when it’s finals time. If I’m upset, it’s a lot more sugar. I’ve noticed that. I’ve got a bag of Reese’s because it’s been a really hard week. I feel like a lot of my emotions kind of dictate what I’m eating which I recognize that it’s not always healthy, so I try to see what my week’s going to look like. If it’s going to be really stressful, I try to buy healthier things if I can. That doesn’t always work out because you’re still going to go get something else if you’re hungry for it.”

Environmental Factors Environmental factors were broken down

into three categories (social, institutional, and physical), and eight sub-themes. Each environmental component can function to promote or inhibit behavior. The majority of participants reported negative factors in the environment that were associated with the risk of college weight gain.

The social environment includes all of the people in the environment that can influence behavior. Results from this study found three sub-themes: accountability with physical ac- tivity, lack of supervision, and peer influence.

Accountability with physical activity. Students felt that having someone to hold them accountable for physical activity would be helpful. Some reported that in high school, they had coaches and other adults telling them what to do; now, in college, that lack of accountability lessened their likelihood of

engaging in exercise. Others felt that taking college activity courses helped them stay active. For example, one student stated, “I sign up for HPE’s. I signed up for running this semester—not because I needed to but because I knew it was good motivation, and I knew I’d have to go because of the atten- dance policy. I forced myself to work out by signing up for running.”

Lack of supervision. Many participants reported that the lack of parental supervision on what to eat and when, had a negative im- pact on overall eating behaviors at college. One participant summed it up well by saying, “I have a budget for myself, but if I go past that budget, my mom can’t say why are you using the credit card? It’s mine. So I can swipe as much as I want. I’ll pay it later of course. But it’s like I can buy as much junk food as I want. I can go through the candy aisle and just pick everything, you know?”

Peer influence. A majority of participants agreed that peers had both a positive and neg- ative impact on physical activity and eating behaviors. Some reported positive peer in- fluence. For example, one participant stated, “I’m definitely influenced by my roommates. It helps that one of mine is super active. She runs everyday, and she does arm workouts in her room. I feel like I should be doing more. It’s a positive influence when you see others working out or eating healthier. Freshman year, my roommate did not eat healthy at all. She would leave to-go boxes under the bed, and it was so gross.” However, others report- ed that their peers had a negative influence on their health behaviors. One participant stated, “My roommates are both kind of lazy and they don’t have a car. They make me drive them everywhere. We’ll be coming from my car and I’ll say let’s take the stairs guys and they’re like no I’ll take the elevator, so we’ll ride the elevator up a flight of stairs. I’m like guys we could have gotten there faster if we had gone up the stairs. It would have been

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easier, but they’re like, ‘nah this was better.’ Then, if they don’t want to go work out with you, you don’t have anyone to go work out with until you find a new partner.”

The institutional environment can also im- pact health behaviors of college students. This includes the rules (written and unwritten), policies and practices within the institution – in this case, the university. Data revealed two sub-themes of institutional environmental influence: dining hall policies and practices and free food.

Dining hall policies and practices. A large majority of focus group participants perceived that current campus dining pol- icies and practices made it difficult to eat healthy to prevent college weight gain. Data revealed 55 negative comments related to dining hall policies and practices. These data were further analyzed and broken down

into four categories. Table 5 lists selected quotes from each category of the campus dining policies and practices sub-theme. A majority of participants felt that the 24 hour access to campus dining food was a barrier to weight management. Also, many did not like the buffet style system offered in the dining halls, and felt that this poli- cy promoted overeating. Participants also complained about the lack of healthy food options and the plethora of high-fat, pro- cessed foods. Some participants believed that the campus dining meal plan was too expensive. One participant stated, “I feel like I eat a lot more because my mom put me on the 16 meal plan, and I don’t want to waste what she paid for. I’ll go to the dining hall even if I’m like semi-hungry, I’m going to get pasta or something and end up eating all of it. It’s more than I usually eat.”

Table 4. Selected Quotes of Environmental Factors Sub-Themes

Theme Sub-Theme Selected Quotations Social (People)

Accountability with physical activity

I know for me, I did sports in high school, so I had practice everyday and some- one telling me to go work out or watch what I was eating, so coming to college no one was telling me to go to the gym which made me not go to the gym.

Lack of super- vision

I know at home my parents did all the shopping, and they usually don’t buy a lot of food, so I’m not used to having so many options. I’m used to just having to wait all day for dinner.

Peer influence Basically, when you’re in college with your friends 24/7, so every meal is a social event.

Institutional Dining hall policies & practices

(Reported in Table 5)

Free food All of the campus organizations hand out free food. I’m like well it’s free, I might as well eat it.

Physical Environmental Cues

I feel like at football games a lot. I’m not a huge soda drinker, but I’ll drink Dr. Pepper at football games because that’s just a thing. You have to have the nachos and all the other unhealthy food at sporting events. I find it encourages unhealthy eating.

Built Environ- ment

I live in a dorm, so if I want to make something healthy it’s difficult. There are kitchens, but they’re not always up to date. They’re usually really old.

Stressful Sur- roundings

High school was a really stressful environment, but coming here, my stress skyrocketed, so I’m just too tired to do anything else after having long days everyday.

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Table 5. Selected Quotes of Dining Hall Policies & Practices Sub-Theme

Categories Selected Quotations Access I think the dining halls affect college weight gain. Here at college, you have to have a meal

plan. A lot of the dorms have a dining hall in them. It’s very easy to go and get food whenev- er–it’s just accessible. I think that plays a huge role.

Unlimited In high school, it was a set meal and everything was timed. You were also charged again and again every time you went back. Here its buffet style and you can go up and get as much stuff as you want and get it to go.

Unhealthy A lot of the foods offered at the dining halls are all comfort foods or fried foods, and that doesn’t help.

Get Monies Worth Meal plans are really expensive. They’re really expensive so just the impact of making your money go as far as it can.

Free food. Lastly, some participants reported that it is a regular practice for cam- pus organizations to use free food to attract participation. Typically the foods offered at these events are high in fat, greasy, and highly processed. For this reason, focus group partic- ipants felt this could have a negative impact on eating behavior.

The physical environment also emerged as a factor noted by participants as contributing to college weight gain. The physical environ- ment discussed in the focus groups included environmental cues, the built environment, and stressful elements in their surroundings.

Environmental cues. Many participants reported that there are events and places in the college environment that may promote unhealthy eating and contribute to college weight gain. Attending sporting events, avail- ability of foods in living quarters, and having unlimited access to food on campus were cit- ed as environmental cues.

Built environment. Participants noted both positive and negative aspects of the built environment that might affect college weight gain. Several positive comments focused on good access to exercise facilities on campus and access to sidewalks for walking to and from classes and work. Students living off campus, however, complained about the distance to on campus exercise facilities. A number of participants stated that the cooking

equipment and facilities in the dormitories was poor, which made cooking meals diffi- cult. One participant stated, “I know at [the dormitory] all you have is a stove top and an oven and everybody can use it. It’s like that’s your only option if you want to actually cook your food versus a microwave.”

Stressful surroundings. A number of participants described the environment at college as being stressful. This included the stress of studying for tests and keeping grades high enough to stay in college, com- petition among peers to maintain grades, and the difficulty of juggling school, work and personal relationships. Some participants commented that stress increases during the junior and senior year.

Personal Factors Personal factors include characteristics

previously learned, beliefs, thoughts, expecta- tions, and emotions. Surprisingly, there were only 44 comments related to personal factors. Data found five sub-themes related to person- al factors contributing to college weight gain. Some participants did report feelings of de- pression, feeling homesick, and lonely or sad. Also there were a few comments on having a poor body image and disordered eating dis- turbance. Participants also reported that their personal food preferences didn’t always align with the food options that were available, and

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that there was a lot of repetition in what was offered. Lastly, some participants reported that their expectation was that college weight gain was normal, and an inevitable result of college life. See Table 6 for selected quotes for sub-themes of personal factors.

Discussion of Main Findings This study used the constructs of recipro-

cal determinism to explore student percep- tions of college weight gain. The results from focus groups shed new light on the behavioral, environmental and personal factors that may affect healthy eating and weight gain among this population. Overall, a majority of partic- ipants reported health-compromising behav- iors, with many of these behaviors focused on food. For example, participants reported eating out at fast food restaurants more often. Previous research suggests that fast food is typically high in calories, saturated fat, sug- ar, and sodium (Abraham, Martinez, Salas, & Smith, 2018). Dingman, Shulz, Wyrick, Bibeau, & Gupta (2014) found that 23% of the student meals came from fast food, and 50% of students reported eating at least three fast food meals per week.

Participants in this study also reported us- ing food as a reward and eating during times of stress and when studying. Errisuriz, Pasch,

and Perry (2016) found that students with greater perceived stress reported higher consumption of caffeinated beverages such as energy drinks and coffee, as well as pro- cessed salty snacks, frozen meals, and fast food. Also, many participants reported that the transition from high school to college had resulted in decreases in physical activ- ity, and more unhealthy eating and snack- ing. This finding is consistent with other research (Keating et al., 2005; Nelson et al., 2008). Further, another interesting finding was related to low self-efficacy related to meal management. Participants reported a lack of confidence and knowledge in how to properly plan out, shop for groceries and cook healthy meals. Also, participants were unsure how to budget and plan out what to spend their money on related to food. This is consistent with previous research, suggest- ing that young adults lack the knowledge, skills, time and motivation to prepare home cooked meals (Larson et al., 2006; Laska, Graham, Moe, Lytle & Fulkerson, 2011). Lichtenstein & Ludwig (2010) suggest bringing back home economics in second- ary education to better prepare emerging adults to cook healthy meals.

There were a number of environmental factors reported by participants that should

Table 6. Selected Quotes of Personal Factors Sub-Themes

Sub-Theme Selected Quotations Depression When you’re depressed, a lot of times you eat more.

Disordered eating & body image

I started having self-esteem issues. I felt really bad, and I didn’t have a lot of energy, so I was just like I have to do something about this. That was me wanting to lose weight, so I wouldn’t feel bad anymore.

Food preference I think that it’s hard to find something you want to eat that’s not overly repetitive that’s also healthy.

Homesick, lonely or sad I noticed that sometimes I’ll be around friends and then I’ll get back to my dorm and just feel really lonely. I kind of go to food for that comfort. It can be a comfort thing.

Outcome expectations A lot of people hear in high school and they’re kind of scared about gaining 15 pounds because everyone says once you come to college you’re going to gain 15 pounds as soon as you step on campus. It’s like kind of a crazy thing. It kind of psychs people out and they really think they’re going to gain weight as soon as they get to college.

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be discussed. Many participants felt a lack of confidence in the ability to make good decisions and control eating behavior in the college environment. In particular, they cited the difficulty with transitioning from a highly structured environment with daily adult guidance, to the college environment, whereby students have greater control of food and physical activity decisions, coupled with a lack of structure and accountability. Further, making healthy decisions seemed to be particularly difficult when there is 24- hour access to high-fat, nutrient poor foods in all-you-can-eat dining environments. Many participants commented that healthy foods were expensive and limited in supply as compared to unhealthy options. Recent research supports these findings (Hebden, Chan, Louie, Rangan, & Allman-Farinelli, 2015; Roy, Soo, Conroy, Wall & Swinburn, 2019; Tam, Yassa, Parker, O’Connor, & Allman-Farinelli, 2017). Tam and col- leagues (2017) found that the main factors affecting college student food-purchasing choices were taste, value, convenience, and cost. Other recent research (Roy, Soo, Conroy, Wall & Swinburn, 2019) suggest that college campuses typically have a high proportion of energy-dense nutrient-poor foods. Increasing the availability and ac- cessibility of lower cost healthy options on campus could be effective in improving the food environment.

For the purpose of this study, personal factors were defined as beliefs, thoughts, previously learned characteristics, expecta- tions, and emotions. Surprisingly, very few participants described being diagnosed with depression or disordered eating. However, eleven participants did describe feeling homesick, lonely and/or sad, which may affect their motivation to eat healthy or ex- ercise. This finding was not reported in the literature.

Strengths and Limitations

The study was successful in recruiting a large number of participants (n = 110) for focus groups. Further, this research utilized behavioral theory as a framework to guide data analysis. However, there are some limitations of selection bias, including gen- der (women overrepresented) and ethnicity (White, non-Hispanic overrepresented). Also, since this study used convenience sam- pling the results may not be generalizable to the wider population.

Summary

This study elucidated several unique fac- tors in the environment that may determine college weight gain. It appears that there are interactions between the social/institutional/ physical environments, behaviors, and person- al characteristics of college students related to this phenomena. Targeted research focus- ing on these interactions are needed. Health promotion strategies addressing college food environments should focus on ensuring foods that are readily available, nutritious, and that are in line with students’ taste preferences. Further, educational interventions focused on increasing student self-efficacy on meal man- agement strategies would enable students to make healthier food decisions.

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