Perceived Weight Change and Contributing Factors among College Students

ABSTRACT The purpose of this study was to examine the association between perceived weight change since high school and perceived factors contributing to weight change, or lack thereof, among college students. Students from a large university in the Northeast of the United States self-reported socio-demographic characteristics, and perceived factors contributing weight change (or lack thereof) via an online survey; and, completed an objective health assessment that included the anthropometric measurements. Of all participants (n = 183), most were men (61.2%), juniors/seniors (89.5%), non-Hispanic white (65.9%). Most participants reported gaining weight since high school (n = 113, 62.1%), and these participants had significantly greater abdominal girth, weight, and body fat percentage than those who maintained their weight (p < 0.005). Perceived factors contributing to weight change explained a significant portion of the variance in perceived weight change, and perceived factors contributing to weight change differed significantly between those who perceived that they had lost or gained weight. In summary, perceived weight gain despite awareness of contributing health behaviors among some students reinforces that supporting/facilitating actual health behavior changes, rather than mere awareness of healthy behaviors, should be the focus of health promotion efforts.


Introduction
Body composition, in particular weight, changes during the transition to (Fedewa et al., 2014;Vadeboncoeur et al., 2015) and throughout college (Gropper et al., 2012;Morgan et al., 2012) are well documented.Though findings are inconsistent (Wilson, Galascio, et al., 2021), weight and adiposity changes are likely attributable, at least in part, to changes in behaviors that influence energy balance, such as physical activity and diet.Physical activity tends to decline during the transition to (e.g., Deforche et al., 2015;Wilson et al., 2022) and throughout college (e.g., Small et al., 2013).In fact, just over half of college students meet aerobic physical activity recommendations (≥150 min/week of moderate to vigorous aerobic physical activity), and even less meet musclestrengthening recommendations (≥2 days/week of muscle-strengthening activity; Wilson, Panza, et al., 2021).Similarly, dietary quality also tends to deteriorate over the course of college (Small et al., 2013), while alcohol consumption increases considerably during students' first year at college (Beaudry, 2017;Pullman et al., 2009) including in the United States (US) despite the illegality of most students consuming alcohol due to their age (Butler et al., 2004;Economos & Hyatt, 2008).
Understanding behaviors that influence weight changes has the potential to inform policies and practices to intervene and prevent the unfavorable outcomes such as increased risk of non-communicable diseases (Webber et al., 2012) and mental health disorders (Gariepy et al., 2010;Luppino et al., 2010), poorer quality of life (Kushner & Foster, 2000), and increased risk of mortality (Zimmermann et al., 2011).Moreover, while students may seem to be a relatively healthy population, many emerging adults are already at risk of future health problems associated with cardiovascular disease and obesity (Kamara et al., 2019;Morrell et al., 2012;Wilson et al., 2019).The purpose of this study was to examine the association between perceived weight change since high school and perceived factors contributing to weight change, or lack thereof, among college students.Establishing whether college students are aware of behaviors that contribute to changes in weight will help inform whether efforts need to continue to focus on awareness, or move beyond awareness to help students adopt and maintain habits that are favorable for short and longterm health and wellbeing.

Participants
One hundred eighty-seven college-aged students enrolled at a large Northeastern University in the US completed an objective health assessment as a part of a required general health and wellbeing course assignment and were then invited to complete a survey voluntarily.

Demographics
Participants self-reported their: age, gender identity, race, and current year of enrollment.

Anthropometric measures
Height and weight were measured to calculate body mass index (BMI).Those with a BMI more than 25 kg/m 2 and 30 kg/m 2 were considered to have overweight or obesity, respectively.Abdominal girth was assessed at the narrowest circumference between the umbilicus and the xiphoid process with a Gulick II tension regulated tape measure.Body fat percentage was measured using a Bodystat 1500 bioelectrical impedance system.

Perceived weight change
Participants responded to the question "how has your weight changed since high school" on a 5-point scale, ranging from one (decreased considerably/significantly) to five (increased considerably/significantly).Categories were collapsed into those that reported weight loss, weight maintenance, or weight gain for the purposes of reporting and analyses.

Contributing factors
Participants identified factors contributing to weight change, or lack thereof, since high school.Survey logic was used to frame perceived contributing factors based on the response to the preceding question regarding weight change.For example, a participant who indicated that their weight had decreased would be asked which factors had contributed to this decrease.Contributing factors included: increased aerobic exercise, increased strength training, increased active transport (e.g., walking or biking), increased food consumption, increased alcohol consumption, decreased aerobic exercise, decreased strength training, decreased active transport (e.g., walking or biking), decreased food consumption, a healthier diet, an unhealthier diet, injury or prolonged illness, and "other" contributors (specified) via open-text entry).

Protocol
The Pennsylvania State University Institutional Review Board approved this study.Upon health assessment completion, participants completed an electronic survey (Qualtrics, Provo, UT) that was linked with their health outcomes using an identification number.All students provided their informed consent, and trained technicians administered tests.

Statistical analyses
Descriptive statistics were computed to characterize the sample.One-way ANOVA were used to examine whether anthropometric measures differed between perceived weight change categories.Chi-square tests for independence were used to examine differences in contributing factors based on perceived weight change.A binary logistic regression analysis examined the association between contributing factors and perceived weight change.All analyses were run using SPSS 26.0 (IBM, Armonk, NY), with significance levels set at p < 0.05.Effect sizes, or Eta-squared (η 2 ) were calculated using the formula (t 2 /(t 2 +(N-1)).

Perceived weight and current anthropometric measures
Those who reported gaining weight had significantly greater abdominal girth, weight, and body fat percentage than those who maintained their weight.BMI did not differ between groups (Table 1).

Gender differences in contributing factors
The only significant difference in perceived factors contributing to weight change between men and women was that more men and less women indicated that increased strength training had influenced their weight change since high school respectively (Table 2).

Association between contributing factors and perceived weight change
Weight change contributors were statistically significant predictors of perceived weight change, indicating the model could distinguish between those who had reported their weight decreased or increased.The model explained between 57 and 87% of the variance in perceived weight change, and correctly classified 97.3% of cases.Increased aerobic exercise, healthier diet, eating less, and increased active transport were each associated with a reported decrease in weight.By contrast, decreased aerobic exercise, unhealthier diet, eating more, increased alcohol consumption, and decreased active transport were each associated increased weight (Table 3).

Discussion
The purpose of this study was to examine the association between perceived weight change since high school and perceived factors contributing to weight change, or lack thereof, among college students.Consistent with the literature, most participants reported gaining weight since high school (Vadeboncoeur et al., 2015).Indicators of unfavorable body composition were greater among those who reported having gained weight, which is consistent with the significant increase in adiposity often observed following the transition to college (Beaudry, 2017;Morgan et al., 2012;Rosenbaum et al., 2017).Findings regarding perceived factors contributing weight change contributors offer insight into why some students may have experienced weight change.For example, the only gender difference was in relation to strength training, which was associated with weight change by men more compared to women.This aligns with fewer women tending to participate in muscle-strengthening activity compared to men (Wilson et al., 2023).Findings suggest that students are aware of the behaviors that contribute to weight loss, maintenance, and/or gain.Thus, rather than improving awareness efforts should be focused on supporting and facilitating students to adopt and maintain healthy behaviors.A more comprehensive and coordinated approach to health promotion focusing on the skills and knowledge to adopt and maintain healthy behaviors, beyond just awareness, beginning with freshmen seminars and continuing throughout students' time pursuing a higher education is necessary.For example, though implementation challenges need to be overcome (Wilson et al., 2018) application of the physical activity vital sign is one way in which physical activity could be promoted (Bowen et al., 2019).Some dietary focused interventions, e.g., improving attitudes and efficacy to prepare food, have also demonstrated some promise among college students (Brace et al., 2018).

Limitations
This study is not without limitations, in particular the cross-sectional design, which prevented quantification of actual changes in body composition, as well as the use of selfreported measures.There are also shortcomings with each of the methods used to measure participant anthropometric characteristics, particularly with respect to determining whether individuals have obesity (Okorodudu et al., 2010;Provencher et al., 2018;Wilson et al., 2019).In addition, it is possible that students are unaware of factors contributing to the change, or lack thereof, in their weight.Regardless, findings indicate that those who reported weight gain were in fact in poorer physical condition compared to others and attributed perceived weight change to unfavorable health behaviors.It is worth noting the link between unfavorable health behaviors and weight gain stems from a perspective that has the benefit of hindsight, so it remains unclear whether individuals consciously or unconsciously decided to adopt such behaviors.In future researchers may want to consider longitudinal study designs, as well as other health related outcomes associated with weight such as mental wellbeing and body image.

Conclusion
In summary, findings indicate that students are aware of perceived changes in weight and the contributing health behaviors.Thus, future efforts should focus on health behavior change, beyond merely awareness, and the development of skills and knowledge, as well a supportive environments and policies, to maintain healthy behaviors throughout life.Examples include programmes, environments, and policies that support students to participate regular physical activity (leisure time and active transportation), access and prepare healthy and nutritious meals, and moderate their consumption of alcohol.

Table 1 .
Anthropometric differences based on perceived weight change.

Table 2 .
Gender differences in perceived weight change contributors.

Table 3 .
Differences in perceived weight change contributors based on perceived weight change.