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Relation between Eating Habits and a High Body Mass Index among Freshman
Students: A Cross-Sectional Study

Article  in  Journal of the American College of Nutrition · June 2012

DOI: 10.1080/07315724.2012.10720024 · Source: PubMed

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Original Research

Relation between Eating Habits and a High Body Mass

Index among Freshman Students: A Cross-Sectional
Study

Fatma Esra Gunes, PhD, Nural Bekiroglu, PhD, Nese Imeryuz, MD, Mehmet Agirbasli, MD
Department of Nutrition and Dietetic, Faculty of Health Science (F.E.G.), Department of Biostatistics (N.B.), Department of
Gastroenterology (N.I.), Department of Cardiology (M.A.), Medical School, Marmara University, Istanbul, TURKEY
Key words: eating habits, body mass index, freshman students, obesity, overweight

Objectives: This study aimed to examine the relation between eating habits and a high body mass index
(BMI) in first-year freshman university students and included 2525 freshman university students 18 to 22 years
old from a Turkish population.
Methods: İn this study, 48% of the students were men. They were asked to complete a questionnaire on their
dietary habits including the frequency of their consumption of individual food items, demographic data, and
smoking habit.
Results: The effects of eating habits on increased BMI (25) were analyzed. Of 2259 subjects included in the
analyses, 322 were overweight or obese and 1937 had normal and thin BMI (,25). Multivariate analyses
identified male gender, recent weight change, and high number of meals as independent predictors of obesity/
overweight. Frequent consumptions of beer, alcoholic drinks other than beer and wine (e.g., spirits including
whisky, gin, raki, vodka), coffee, tea, coke, red meat, variety meat, and eggs were associated with a significantly
higher risk of obesity/overweight, whereas frequent consumption of snacks was associated with a low risk.
Conclusions: Findings of further studies, possibly taking into consideration the absolute quantities of
consumption along with cultural and local issues, would guide the adoption of healthier feeding behaviors in this
particular age group.

INTRODUCTION including smoking and alcohol consumption, and poor food

The prevalence of obesity and overweight is quite high in
the world population. According to a 2008 World Health
Organization report, one billion of the world population is
overweight and an additional 300 million are obese. Changing
eating habits can be responsible for the rapid increase in these
conditions, particularly among the young population.
Several screening studies on the prevalence of obesity have
been performed in Turkey, including TEKHARF and TURDEP
[1]. Another large-scale study has been completed in 2009,
which was conducted by the Turkish Association for the Study
of Obesity (TASO-TOAD). Of 13,878 subjects in that study,
32.5% were overweight and 28.6% were obese [2].
Previous studies have demonstrated that the adoption of an
unhealthy lifestyle after becoming a university student,
preferences may be attributed to moving away from home, poor
cooking skills, low income, and little time availability to
engage in physically active recreation, and so forth [3,4]. Such
lifestyle changes lead to weight gain and an increase in body fat
composition during the first year of the university education
[5,6]. Gow et al. indicated that first-year college students
became overweight and at risk of becoming obese adults;
therefore, they drew attention to this issue to provide
prevention efforts [7]. On the other hand, this period of life
provides a good opportunity to adopt healthy eating habits and
a healthy lifestyle, which is also reflected by the conduction of
many recent studies targeting the students of this age group [8–
10]. Besides type and amount of food consumed, frequency of
eating individual food types may also contribute to weight gain
as a parameter of eating behavior. Thus, identification of the

Address correspondence to: Fatma Esra Gunes, Marmara Universitesi Saglik Bilimleri Fakultesi, Beslenme ve Diyetetik Bolumu, E-5 Uzeri Yanyol, Cevizli Kartal 34000
Istanbul, TURKEY. E-mail: fegunes@marmara.edu.tr

Journal of the American College of Nutrition, Vol. 31, No. 3, 000–000 (2012)
Published by the American College of Nutrition

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Eating Habits and a High BMI in University Students
individual contribution of different food types and food groups
would assist in designing strategies to combat obesity and
overweight observed in the young population.
This cross-sectional study aimed to determine the current
status of freshman students’ eating habits and to examine the
associations between eating habits, including the consumption
frequency of different food/beverage types and overweight/
obesity.
METHODS
Subjects
This cross-sectional study enrolled 2525 freshman univer-
sity students who were 18 to 22 years old. Of the total
participants, 1196 were male (48.8%) and 1254 were female
(51.2%). The subjects were currently attending first-year
classes of 1 of the 2 large universities in Istanbul, Turkey: a
state university (Marmara University, n ¼ 721) and a private
university (Yeditepe University, n ¼ 1804). All freshman
students who were attending the university on the survey day
and accepted the invitation to respond voluntarily to a
questionnaire were included in the study. The response rate
was quite high: among 2525 students, 2259 (89.4%) students
answered the questionnaire. A total of 2259 subjects with self-
reported body mass index (BMI) data were included in the
analyses.
Data Collection
A committee consisting of a cardiologist, a gastroenterol-
ogist, a biostatistician, and a dietitian worked together to
determine the content validity of the questionnaire. Before the
survey, a pilot study was performed. For this purpose, the
questionnaire was given to 15 students with the same age and
gender of the target population to test its feasibility. Necessary
revisions were made to the initial draft, including excluding
foods that were consumed infrequently such as broccoli,
Brussels sprouts, and avocados, as well as excluding questions
about physical activities on the grounds that there was no
consistent perception among students of the meaning of
‘‘heavy’’ and ‘‘moderate’’ physical activity.
All subjects were asked to complete this formed question-
naire, which included demographic characteristics and eating
habits, such as gender, age, recent weight change, change in
place of residence, any medication use, smoking habits, alcohol
consumption, frequency of consumption of individual food
items, and number of meals per day. The questionnaires were
completed in the classroom immediately before a midterm
exam, when almost all of the students were present, so the
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coverage was 95%. The BMI of each student was calculated
from self-reported body weight and height data. During the
administration of the questionnaire, all authors were present in
the classroom to detect instantly overweight and obese
students, in order to check the reliability and validity of their
self-reported weight and height data.
Analysis of Data
The primary outcome measure of the study was the
presence of overweight or obesity (BMI 25). In addition to
the effects of demographic variables and smoking on high
BMI, the effects of consuming each food item and each food
group at a high frequency were tested. Criteria used to define
frequent consumption of each food/beverage item are given in
Table 1.
Statistical Package for Social Sciences (SPSS) version 15.0
and MedCalc version 10.2.0.0 statistical software were used for
the analysis of data. Categorical data are presented as frequency
(percentage), and the single continuous random variable was
presented as mean 6 standard deviation. For the comparison of
categorical data, a chi-square test was performed, and
continuous variables were compared using unpaired t-test. To
identify the independent predictors of a BMI 25, stepwise
logistic regression was used. Odds ratios (ORs) and 95%
confidence intervals (CIs) were calculated. The validity of the
model was tested using classification table percentage,
Omnibus test of model coefficients, and the Hosmer and
Lemeshow test [11]. Overall, ORs of each food group were
calculated using a meta-analysis method (MedCalc). A p value
,0.05 was considered as an indication of statistical signifi-
cance.
RESULTS
Predictors of a High BMI
Of 2259 subjects included in the analyses, 322 had
overweight or obesity and 1937 had normal and thin BMI
(,24.9). Table 2 shows the relation between potential
predictors and BMI status, respectively, BMI .25 and BMI
,24.9. Male gender (78.5% vs 44.1%, p , 0.0001), weight
change during the recent year (82.3% vs 64.8%, p , 0.0001),
smoking (33.9% vs 23.3%, p , 0.0001), and any medication
use for treatment purposes (13.7% vs 9.9%, p ¼ 0.038) were
significantly more frequent among subjects with a high BMI. In
addition, the mean number of meals per day was significantly
lower among these subjects (2.83 6 0.76 vs 2.94 6 0.77, p ¼
0.021). Multivariate analyses identified gender, recent weight
change, and number of meals as independent predictors of
obesity/overweight. Gender (OR, 0.195; 95% CI, 0.145–0.263)
 Eating Habits and a High BMI in University Students

Table 1. Portion Sizes and Frequency Criteria for High Consumption of Food/Beverage Items

Criteria for High

Consumption Food/Beverage Portion Size
.2–3 times a month Other alcoholic beverages A wineglass
Variety meat The size of 3 meatballs, 90 g
Seafood other than fish 1 portion, 6 tablespoons
.Once a week Frozen food 1 portion, 6 tablespoons
.Twice a week Beer A bottle
Wine A wineglass
Coke A bottle
Cooked dried beans 1 portion, 6 tablespoons
Canned food 1 portion, 6 tablespoons
Snacks A package, 100 g
Burger/fried chicken 1 portion
Fried potato 1 medium portion, 150 g
.3–4 times a week Fruit juice A glass
Red meat The size of 3 meatballs, 90 g
Chicken The size of 3 meatballs, 90 g
Fish 4 small fish or 1 medium-sized fish
Cooked rice/pasta 6 tablespoon
.5–6 times a week Nuts A handful
.Once a day Coffee A cup
Egg 1
.Twice a day Cheese The size of a matchbox, 30 g
Milk, yogurt A glass
Raw vegetables 1 portion, except green salad
Cooked vegetables 1 portion, 6 tablespoons
Green salad 1 portion, a plateful
.3 times a day Tea A cup
Fresh fruits 1 portion
.4 times a day Bread 1 slice

and number of meals (OR, 0.800; 95% CI, 0.671–0.953) were
found to be significant variables in favor of female and high
number of meals, respectively. On the other hand, recent
weight change was associated with more than a 3 times higher
likelihood of obesity/overweight (OR, 3.564; 95% CIs, 2.535–
5.012). The validity of the model was high with 85.4% correct
classification table percentage, ,0.0001 omnibus test p value,
and 0.201 Hosmer and Lemeshow test p value.
Consumption Frequency of Individual Food Items
and a High BMI
Univariate analysis containing comparisons of BMI groups
with individual food/beverage items were given in Table 2.
Frequent consumptions of beer (OR, 1.80; 95% CI, 1.32–2.44),
alcoholic drinks other than beer and wine (e.g., spirits including
whisky, gin, raki, vodka; OR, 1.99; 95% CI, 1.49–2.65), coffee
(OR, 3.78; 95% CI, 2.61–5.46), tea (OR, 1.96; 95% CI, 1.46–
2.62), coke (OR, 1.35; 95% CI, 1.02–1.79), red meat (OR,
1.39; 95% CI, 1.04–1.86), variety meat (OR, 1.79; 95% CI,
1.31–2.34), and eggs (OR, 2.11; 95% CI, 1.08–4.11) were
found to be significant for obesity/overweight, especially
coffee, which was found significantly with a high risk of
obesity/overweight, whereas frequent consumption of snacks
appeared to be protective (OR, 0.64; 95% CI, 0.50–0.82).
Overall Effect of Each Food/Beverage Group
Fig. 1 shows the overall effects of each food/beverage group
on obesity/overweight. This analysis indicates that frequent
consumption of alcoholic (OR, 1.81; 95% CI, 1.50–2.19) or
nonalcoholic beverages (OR, 1.30; 95% CI, 1.15–1.47), meat
and related products (OR, 1.32; 95% CI, 1.15–1.52), and
frozen food (OR, 1.28; 95% CI, 1.003–1.63) is associated with
noncritical risk, whereas frequent consumption of snacks and
nuts appears to be associated as a protective factor in this
Turkish population (OR, 0.77; 95% CI, 0.64–0.92).
DISCUSSION
This cross-sectional study with a relatively large sample
size examined the relation between BMI and eating habits of
first-year freshman university students and found associations

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Eating Habits and a High BMI in University Students

Table 2. Distribution of Demographical Data and Eating Patterns in the 2 Groupsa

BMI 25 (n ¼ 322)* BMI ,25 (n ¼ 1937)* P for Difference

General variables
Male gender 249/317 (78.5%) 827/1877 (44.1%) 0.0001
Recent weight change  263/312 (82.3%) 1225/1889 (64.8%) 0.0001
Smoking 108/319 (33.9%) 449/1926 (23.3%) 0.0001
Change in place of residence  195/322 (60.6%) 1111/1933 (57.5%) 0.299
Any medication use 43/313 (13.7%) 182/1846 (9.9%) 0.038
No. of meals per day (mean 6 SD) 2.83 6 0.76 2.94 6 0.77 0.021
High consumption of individual food/beverage items
Cereals and beans
Bread 64/317 (20.2%) 374/1892 (19.8%) 0.862
Rice, pasta 137/316 (43.4%) 832/1885 (44.1%) 0.795
Dried beans 137/311 (44.1%) 771/1865 (41.3%) 0.369
Fruits and vegetables
Cooked vegetables 4/310 (1.2%) 26/1872 (1.4%) 0.871
Raw vegetables (excepted green salad) 9/306 (2.9%) 97/1732 (5.6%) 0.078
Green salad 10/311 (3.2%) 66/1863 (3.5%) 0.771
Fresh fruits 13/313 (4.2%) 71/1869 (3.8%) 0.763
Fast-food
Burger, fried chicken, etc. 126/311 (40.5%) 781/1863 (41.9%) 0.641
Fried potato 114/312 (36.5%) 755/1866 (40.5%) 0.190
Snacks and nuts
Snacks 162/311 (52.1%) 1170/1860 (62.9%) 0.001
Nuts (dried) 45/311 (14.5%) 296/1864 (15.9%) 0.527
Alcoholic beverages
Beer 65/316 (20.6%) 233/1849 (12.6%) 0.001
Wine 21/307 (6.8%) 84/1818 (4.6%) 0.097
Other alcoholic beverages 80/310 (25.8%) 264/1772 (14.9%) 0.001
Nonalcoholic beverages
Coffee 50/312 (16.0%) 90/1871 (4.8%) 0.001
Tea 74/317 (23.3%) 257/1908 (13.5%) 0.001
Coke and other fizzy drinks 243/315 (77.1%) 1346/1885 (71.4%) 0.035
Fruit juice 119/317 (37.5%) 763/1883 (40.5%) 0.323
Meat and related products
Red meat (cow, sheep) 71/316 (22.5%) 325/1886 (17.2%) 0.031
Variety meat (e.g., liver, brain) 75/302 (24.8%) 278/1751 (15.9%) 0.001
Chicken 51/314 (16.2%) 303/1867 (16.2%) 0.995
Fish 15/314 (4.8%) 99/1877 (5.3%) 0.713
Other sea products 73/232 (31.5%) 406/1793 (22.6%) 0.620
Eggs 12/312 (3.8%) 35/1879 (1.9%) 0.025
Dairy products
Cheese 28/314 (8.9%) 113/1886 (6.0%) 0.051
Milk, yogurt 33/314 (10.5%) 181/1887 (9.6%) 0.611
Frozen and canned food
Frozen food 65/308 (21.2%) 340/1832 (18.6%) 0.291
Canned food 28/274 (10.2%) 133/1818 (7.3%) 0.235
BMI ¼ body mass index.
a
Unless otherwise stated, data are presented as n/n of subjects with available data (percentage).
  During the past year.

between certain patterns and high BMI. Overall, the over-
weight/obesity rate was 14%, with a higher rate than among
male subjects. This distribution pattern is similar to the findings
of previous reports [12–18]. In Turkey, the frequency of
overweight/obesity is gradually increasing among freshman
students [2]. However, female subjects included in this study
had lower BMI than male subjects based on their self-reported
body weight and height data. This relatively low rate of
increased BMI among female students may be explained by
low food consumption, possibly in an attempt to maintain an

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Fig. 1. Overall effect of each food/beverage group on obesity/overweight. Lines indicate 95% confidence intervals, and circles indicate odds ratios.
attractive body image resembling that of movie stars and
fashion models appearing in media [19].
Becoming a university student has a strong impact on the
lifestyle of individuals and may often result in unhealthy eating
habits [4]. University students are often unable to maintain
their previous healthy eating habits and adopt a diet low in
fruits/vegetables and high in fat content [20]. Generally,
Turkish university students are usually prone to weight and
fat gain, particularly during their first year [5]. New living
arrangements, costs, and economic constraints may all account
for new food choices and activity patterns [3,6]. The transition
from high school to the university is usually problematic, and
efforts to adapt the new social, academic, sports, and
psychosocial environment results in contributing to weight
gain [21].
According to previous studies, smoking behavior is
associated with an increase in fast-food and alcohol consump-
tion, reduced intake of healthy food components, and adoption
of a sedentary lifestyle, all contributing to weight gain.
Similarly, this study found a significant association with
smoking and increased risk for obesity/overweight [22,23].
In this study, more than half of the students were eating 3
meals per day (57.8%), and less than a quarter were eating only
2 meals (23.7%). An increased number of meals was associated
with a lower risk for obesity/overweight. However, the
mechanisms of the relationship between number and/or
regularity of meals and weight status are not clear since most
studies assessing the relationship between meals and weight
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Eating Habits and a High BMI in University Students
status are cross-sectional [24]. Eating regular meals may
prevent snacking of energy-rich unhealthy foods between
meals. On the other hand, the reduced thermic effect of food
after irregular meal frequencies may lead to weight gain in the
long term [25]. Conversely, frequent snacking might improve
appetite control and increase dietary-induced thermogenesis
[26].
Although some controversy and uncertainty remain per-
taining to the role of meat consumption on the risk for weight
gain, meat consumption has already been linked to obesity and
central obesity owing to the associated higher intake of total
fat, saturated fat, and total calories. Increased intake of total fat
and saturated fat seems to be the main cause of increased risk
for central obesity [27].
Baric et al. found higher amounts of meat consumption
among overweight and obese individuals, with an especially
high incidence in males [28]. Our study also found a significant
association with frequent consumption of red meat and
increased BMI.
Frequent consumption of fast-food has been associated with
increased BMI and body fatness in children and adults [29]. In
a cohort study, older children who consumed fried foods away
from home more frequently over a 1-year period were heavier
and had greater total energy intake when compared with
children with a low frequency of fried food consumption away
from home [30]. In another study, males who consumed fast-
food .2 times per week had significantly lower BMI compared
with the males consuming fast-food less frequently; however,
0
Eating Habits and a High BMI in University Students
such an association was not evident for females [31]. Similarly,
our cross-sectional study was also not able to find a significant
relation between fast-food consumption and high BMI.
This study found a significant association between frequent
consumption of alcohol and high BMI, with frequent
consumption of beer and alcoholic beverages other than wine
being significant predictors of overweight and obesity.
However, frequency of wine consumption was relatively less
frequent in this student population and was not significantly
associated with high BMI. Similarly, a previous study found
that students who drank beer were significantly more likely to
be categorized as overweight [32]. Alcohol is the second most
energy-dense macronutrient, following closely behind fat; thus,
research on the role alcohol plays in the obesity epidemic,
especially within the 18- to 25-year age range, is warranted
[33]. Educational programs aimed at limiting alcohol con-
sumption in young populations may be potentially effective for
the risk of high BMI.
In this study, a significant relation was found between
obesity/overweight and frequent consumption of fizzy drinks,
tea, and coffee [34]. Individuals consuming high amounts of
these sugared drinks may cause an increase in their body
weight even if they decrease the consumption of other food
items [34–36]. An association between obesity and sugar-
sweetened hot drinks has been shown previously [37]. In
addition, frequent consumption of these drinks results in
decreased intake of milk and related products. Although
consumption of calcium-rich milk and dairy products has been
shown to control the increase in adipose tissue in another study
[38], this study did not find a significant protective role for
dairy products.
The term snack refers to all foods and drinks taken outside
the context of the 3 main meals [39]. Although increased
consumption of snacks is often imputed to increased
prevalence of obesity, a definite relation between snacking
and BMI has not yet been demonstrated. Habitual meal and
snacking patterns of university students in 2 countries have
been examined, and no correlation could be found between
BMI and snacking [6]. Dietary intake and body mass patterns
among U.S. adults were studied, and stratification by the type
of snacking pattern was carried out. Unexpectedly, the findings
of that study indicated that snacking might affect nutrient
intake but not BMI [40]. In this study, frequent snacking seems
to be protective against obesity/overweight. Cultural factors are
known to influence snacking habits. For example, Scottish
students were found to have more unhealthy snacking behavior
than did Greek students as a result of their higher consumption
of crisps, chocolate bars, and fizzy drinks [6]. Likewise, food
items that are considered snacks in Turkish culture are
unsweetened biscuits, breadsticks, and crisps, which may
partly explain the observed inverse relation between snacking
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frequency and BMI. Several other studies also revealed an
inverse relationship between habitual frequency of eating and
BMI, suggesting that increased frequency of both meals and
snacks helps in avoidance of obesity [41–44]. Frequent snacks
or meals with little caloric content may decrease appetite due to
continuous feeling of satiety and thus may result in skipping
almost main courses with high caloric content. Nevertheless,
further research is needed to examine the relatively complex
relation between meal/snack frequency and BMI. On the other
hand, this study did not find any significant relation between
the consumption frequency of fruits/vegetables and high BMI.
The study of Cho et al. supports our findings partially [45],
because they examined the effects of breakfast type on BMI
and reported that no significant difference was found between
fruits vegetables and BMI when fruits and vegetables were
taken in breakfast.
Having a relatively large sample size including healthy
subjects from a wide range of socioeconomic groups is the
strength of this epidemiologic study. This large sample
belonging to Turkish universities indicates that the study
subjects highly represent the target population. Following are
the potential limitations: food quantity was not measured, self-
reported BMI was used, body fat content was not measured,
and physical activity was not questioned.
Findings demonstrated significant relations between certain
eating habits and obesity/overweight in first-year freshman
university students. Identifying unhealthy habits would guide
in the adoption of healthier feeding behaviors in this particular
age group. However, health benefits of different patterns
should be evaluated in further studies, taking into consideration
not only the frequencies of certain food items but also the
absolute amounts of consumption and body fat content.
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Received April 1, 2011; revision accepted June 6, 2012.

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