Journal of the American College of Nutrition, Vol. 23, No. 5, 391-396 (2004)
Published by the American College of Nutrition
Weight Control Measures among University Students in a Developing Country: A Cultural Association or a Risk Behavior
Hala Tamim, PhD,
Nuhad Dumit, MA,
Abdallah Terro, BSc,
Ramzi Al-Hourany, BSc,
Dima Sinno, BSc,
Fadi Seif, BSc,
Souzan Steitieh, BSc and
Umayya Musharrafieh, MD
Department of Epidemiology and Population Health, Faculty of Health Sciences (H.T., D.S., S.S.), American University of Beirut, Beirut, LEBANON
School of Nursing (N.D.), American University of Beirut, Beirut, LEBANON
Medical School (A.T., R.A.-H., F.S., U.M.), American University of Beirut, Beirut, LEBANON
Address reprint requests to: Dr. Hala Tamim, American University of Beirut, Department of Epidemiology and Population Health, Faculty of Health Sciences, P.O. Box 11-0236 Riad El Solh, Beirut 1107 2020, LEBANON. E-mail: ht02{at}aub.edu.lb
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ABSTRACT
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Objective: The purpose of the study was to determine the prevalence of university students, in Lebanon, trying to lose weight and assess the relation of trying to lose weight with demographic, scholastic and health behavioral factors.
Methods: The study was cross-sectional conducted in the academic year 2000–2001. A proportionate random sample of 2,013 students was selected among five public and private universities in Beirut. Participants completed a self-administered anonymous questionnaire that included questions on trying to lose weight, demographic, scholastic, and health behavioral factors including smoking, alcohol, and seat belt use. Bivariate and stepwise logistic regression analyses were performed to examine the association between trying to lose weight and the above-mentioned characteristics.
Results: The overall prevalence of students trying to lose weight was 30%, with 71% of them being under weight or normal weight. Use of medications and inducement of vomiting constituted 12% and 11%, respectively. Stepwise logistic regression analysis showed that the variables significantly associated with trying to lose weight were socio-economical factors rather than risky behaviors. Students who were at increased odds of performing such methods were females OR = (2.08, 95% CI = 1.6–2.5), employed (OR = 1.36, 95% CI = 1.01–1.8), and registered in a private university (OR = 1.69, 95% CI = 1.25–2.0). The major of students was also a significant predictor.
Conclusion: In Lebanon, weight reduction could be re-enforced by socio-economical factors and not necessarily be an adolescent risk behavior.
Key words: weight control, university students, Lebanon
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INTRODUCTION
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It is important to study health behavior of young adults because the rapidly changing conditions in the world are bringing about changes in behavior, and behavior formed in the second decade of life has lasting implications for the individual in particular and the public health in general [1]. Weight reduction is a widespread practice among adolescents and young adults. It is not only restricted to overweight people who suffer clear adverse medical consequences. It also extends to include normal or low weight people who may wish to lose weight for cultural, social, or psychological reasons [2,3]. The methods used for weight reduction are classified as either accepted, such as diets prescribed by specialists and certain types of fitness exercises, or risky, such as diet pills, laxatives and vomiting [4,5].
A multitude of studies have been done addressing the issues of weight reduction and related aspects such as gender, age, socioeconomic status, and living outside one’s country [4,6,7]. Moreover, studies have related weight reduction to other health behaviors such as smoking and drinking alcohol [8].
The war period the Lebanese youth have lived through, on one hand, and rapid globalization, on the other hand, may have prompted changes in behaviors and attitudes. Additionally, the mass media, which raise issues regarding beauty, fitness and ideal body form, present multiple weight reducing methods. The issue of appearance has become a matter of a social necessity [4].
In Lebanon, there is a need to document the prevalence of students trying to lose weight and the methods used. The objectives of the present study were to determine 1) the prevalence of university students trying to lose weight and 2) the association between the attempt to lose weight and demographic, scholastic and health behavioral factors.
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MATERIALS AND METHODS
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In Lebanon, the number of students enrolled in higher education for the year 1998–1999 was 113,022 with a male to female ratio of 56,144 to 56,878 [9]. These students are distributed equally between the Lebanese University (the only public university in the country) and private universities, with Beirut containing more than 50% of university students in the country (under the Lebanese central administration). Students who pursue their educations at these universities are believed to represent the religious and socio-economic diversity of university students in the country. The present study, conducted in the spring semester of the academic year 2000–2001, included the four private universities, located in Beirut, that accommodated more than 500 enrolled students. Also, six faculties were selected randomly out of the nine faculties of the Lebanese University located in Beirut. It is worth noting that each of the private universities considered with its various faculties is located within a single campus whereas each of the faculties of the public university has its unique campus. Therefore, for the present study, a proportionate random sample was selected among the public and private universities. Based on the number of students enrolled in each private university, a proportionate random sample of students was considered. Similarly was the case within the faculties of the Lebanese University.
The present study was cross sectional in nature. Participants completed self-administered anonymous questionnaires that included questions on whether the student had tried to reduce his/her weight within the previous three months (since the interview). Students who had tried to lose weight were further asked about the reasons for trying to lose weight and the various methods used. Also included were questions on demographics, scholastic characteristics, and health behavioral aspects. Socio-demographic characteristics included the variables age, weight, height, gender, marital status, nationality, place of residence (living with family), employment status (whether the student had a part time/full time job besides studying), whether the student had lived for more than one year outside the country, and parent’s level of education. Scholastic characteristics included university (public versus private), degree pursued (graduate versus under-graduate), and field of study. Health behaviors considered were smoking and type of product used (cigarettes versus narghile), drinking considerable amounts of alcohol (more than four pints of beer per week) [10], and not wearing seat belts.
Odds Ratios and 95% Confidence Intervals were calculated to test the relation between weight reduction and the different demographic, scholastic and health behavioral characteristics. Moreover, a stepwise logistic regression analysis was performed to examine the association between weight reduction and the above-mentioned students’ characteristics.
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RESULTS
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The overall response rate for the present study was above 90%. The total sample selected was 2,013 distributed equally among public (50.5%) and private (49.5%) universities. The average age was 21.0 years (Standard Deviation (SD) = 2.37), and 60% of the students were females. Based on the Body Mass Index (BMI) categorization [11], the proportion of students who were underweight (BMI less than or equal to 18.5), normal (BMI between 18.5 and 24.9), overweight (BMI between 25 and 29.9), and obese (BMI equal to or greater than 30) were 12%, 69%, 15% and 3%, respectively. The overall prevalence of students trying to lose weight in the sample was 30% (603 students). Table 1 shows the characteristics of students trying to lose weight. Of the students who were trying to lose weight, 71% were underweight or had normal weight. A total of 505 students were trying to lose weight to improve their body shape (84%), while 99 students were trying to lose weight for health reasons (16.4%). The most prevalent method for reducing weight was sports (66%), followed by diet (56%), use of medications (12.4%) (including laxatives, diet pills, and others), and inducement of vomiting (10.8%). Of the students dieting as a method to reduce weight, only 21.5% were following a diet as prescribed by a health professional.
Table 2 presents the distribution of students trying to lose weight by socio-demographic characteristics. Trying to lose weight was significantly higher among females and students who had lived outside the country for a period of at least one year. None of the demographic characteristics marital status, nationality, residency, employment status of the student, mother or father’s education was significantly associated with trying to reduce weight.
In Table 3, the distribution by scholastic characteristics of students trying to reduce weight is presented. The proportion of students trying to reduce their weight was significantly lower for those registered in public universities, and varied significantly across the various fields of studies (p < 0.001), with a low of 18.9% among engineering students to a high of 35.4% among students registered in the sciences disciplines.
Table 4 examines the relation between trying to lose weight and different health behaviors among study participants. Whereas none of the considered health behaviors, smoking narghile, considerable alcohol drinking, or not using a seatbelt showed significant association, smoking cigarettes was significantly associated with trying to lose weight (alpha of 0.05); however, the OR was only 1.2.
Table 5 shows the results of the stepwise logistic regression analysis with the dependent variable being trying to lose weight, and the independent variables all of the socio-demographic, scholastic and health behavioral factors. The variables that were statistically significantly associated with the outcome and thus selected for the model were gender, where females were at higher odds of trying to lose weight; being employed, and being registered in a private university. Also, the field of study of the students was significantly associated with the outcome; students in the fields arts and sciences were at higher odds trying to reduce weight when compared to students registered in the health discipline.
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DISCUSSION
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The results of this study showed that the prevalence of Lebanese university students trying to lose weight was 30% with 20% of those using methods of weight control that are potentially harmful (inducement of vomiting or use of medications). Of significance was that 71% of the students trying to lose weight were under weight or normal weight. Results of the study showed that weight reduction was not associated with health behaviors but with socio-demographic and scholastic characteristics of students. Furthermore, the proportion of students trying to lose weight was significantly higher among female students, registered in private universities, majoring in arts and sciences, and employed while studying.
The proportion of university students trying to lose weight in this study was higher than that in Finland (20.8%), and comparable to that in the United States (28% among males and 38% among females) [12,13,]. The main reason for applying methods of weight control in the present study was to improve appearance (84%), a fact that reflects how easily this group is influenced by social factors.
Of the 340 students who were following a diet as a method to reduce weight only 21.5% followed what health professionals recommend. This raises a concern because, even if the diet included change in its composition, unless properly advised, young adults often use unhealthy dieting practices [14]. The use of unhealthy weight-reduction practices was not uncommon in this study. Of those trying to lose weight, 11% vomited and 12.4% used medications. These figures are comparable to those in the USA, where it was reported that 13% of the subjects resorted to vomiting and 12.7% used pills [15]. A major concern was that such methods put the young adults at increased risk of inadequate nutritional intake and higher levels of fatigue, electrolyte disturbances, cardiac dysrhythmias, psychiatric morbidity and even sudden cardiac death [16–18].
Similar to previous reports, female students were significantly more pre-occupied with trying to lose weight than their male counterparts (36.3% vs. 21.5%, p < 0.01). Although some studies suggested that weight reduction practices are spread across all social groups [18], the current results did not show this. Coming from a private university was significantly associated with trying to lose weight. This may be explained on the basis of socioeconomic differences, whereby students attending private universities are generally better well off financially than those in public ones. Similar results were reported in a study on dieting and social class where higher class students reported higher levels of restrained eating and greater body dissatisfaction than their lower class counterparts [19]. While private students had better financial accessibility to fashion and magazines and thus more exposure to beauty issues [19], public students possibly tend to meet their more pressing necessities such as books and study materials. However, this has to be further investigated in the population under study.
Moreover, it was found in the present study that students majoring in engineering were the least likely to follow weight reduction methods as compared to those majoring in other fields. We speculate that the reason behind this is the time constraints that render engineering students preoccupied with their studies rather than body image.
One interesting finding was the significant relation between having a job and following weight-reduction. Barsky [20] had noted that a perfect body symbolizes control. It is believed that in a society that values self-control and hard work, a desirable body signifies that the individual is healthy and in control. The converse is that people who are overweight or inactive may be looked on as lazy, indulgent and as lacking self-control. However, this is a speculation and requires further investigation.
Of importance in this study was that, based on the regression analysis, none of the considered behavioral factors, smoking, not using seat belt, and drinking considerable amounts of alcohol, was significantly associated with trying to lose weight. Further studies are important to explain the reason for the finding. However, the results of the study suggest that weight reduction could be re-enforced by socio-demographic factors and not necessarily a health behavior.
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CONCLUSION
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Similar to developed countries, attempts to lose weight are also a female phenomenon in developing countries like Lebanon. If dieting is to become a normal way of eating and a common practice among young adults, as is the trend now, it need to be directed towards healthier and realistic goals. Encouraging exercise and educating people about healthier strategies remain of paramount importance in this area. Moreover, socio-cultural factors should be addressed in young adults’ health campaigns in order to redirect the motives of reducing weight among the Lebanese youth.
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ACKNOWLEDGMENTS
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The authors would like to thank Ms. Hania Kassem, Ms. Adline Ghazi, Mr. Tarek Abou Khamis, and Mr. Maher M. Abdul Hay for their help in the collection and management of data.
Received October 14, 2002.
Revised July 10, 2003.
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ABSTRACT
INTRODUCTION
