thesis statement about healthy eating habits and lifestyle

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Fiji Year 13 English Certificate Examination Research Project 2022

A study on the changes in the eating habits and lifestyle patterns of the residents of Togalevu village and whether or not these changes affect an individual's health positively or negatively.

Related Papers

Kannan Navaneetham

Background There is scanty information regarding sex or gender differences in health-related habits, NCD risk factors, and prevalence of NCDs in Botswana. The purpose of this study is to assess the influence of gender differences on health-related habits, weight status, common NCD risk factors, and on the prevalence of non-communicable diseases. Methods A cross-sectional, population-based survey called the Botswana STEPS Survey II which was conducted in 2014 based on people aged 15–64 years. The survey used a multi-stage cluster sampling methodology to arrive at nationally representative sample. As such during analysis of data, a complex sample module from SPSS was adopted to account for the multiple stages of sampling. The predicted probabilities of outcome variables were derived by controlling the covariates. A total sample size of 2947 participants aged 25–64 years were used in this study. Results The study results showed that a statistically significant high predicted percentage...

Journal of Advances in Medicine and Medical Research

Stephanie Ukwandu

Background: A healthy lifestyle is a way of living that reduces the risk of being severely ill. In 1967, the World Health Organization (WHO) defined health as “of complete physical, mental and social well-being and not merely the absence of disease or infirmity ». An unhealthy diet and lack of physical activity are in the lead for global health risks. Aim: This study explored the impact modern lifestyle has on the health of medical students Methods: Our study included a literature review, and a questionnaire consisting of 24 questions which were answered by 76 participants which targeted; diet, exercise regimen, sleep cycle, alcohol, substance use, and technology use. Results: From the responses, 63.1% of respondents practice a sedentary lifestyle, 68.4% skip breakfast and 35.5% have an unhealthy diet. Conclusion: There is a need for individuals to pay attention to their daily practices as modern lifestyle can have a negative impact on quality of life.

Public health nutrition

María Rosa Curutchet

The current study aimed to assess Uruguayan consumers' accounts of their own need to change their dietary patterns, their intended changes and the barriers related to doing so, and to compare the intentions and barriers with the recommendations of the national dietary guidelines. An online survey with 2381 Uruguayan employed adults, aged between 18 and 65 years, 65 % females, was conducted. Participants had to answer two open-ended questions related to changes they could make in the foods they eat and/or the way in which they eat to improve the quality of their diet and the reasons why they had not implemented those changes yet. Content analysis using inductive coding by two researchers was used to analyse the responses. Consumers mainly intended to change consumption of types of foods, particularly eating more fruits, vegetables and legumes and consuming less flour, but also intended to alter their eating patterns. Lack of time and the fact that healthy foods are perceived as b...

Journal of Educational and Social Research

tanzuma zaman

The new normal due to COVID-19 has changed the dynamics of every aspect of on life, be it household, professional life, finances, education or the food patterns. There has been lack of a fixed routine in the lives of children because of closure of schools, therefore the routine of wake up, sleep, time food timings have gone haywire. Children are indirectly affected by the pandemic, through poor diet, mental health effects, social isolation, screen addiction, unhealthy and irregular food habits. This paper is aimed at discussing the potential effect of pandemic on nutritional status of children; especially when children are indulged in continue classes for long hours, sitting one place. Data from various research papers have been discussed in this review paper, highlighting the impact of the new normal health of covid-19 on the nutritional health of children this situation requires effective and practical measures which can be adopted at the home setting to enhance the nutritional st...

Marijana Saric

The aim of this cross-sectional study was to determine the associations between health dietary patterns, knowledge, and consumption of dietary fiber (DF) with frequency of food label reading on food products with special reference to DF. The study was conducted in 2536 Croatian adults using an original questionnaire. Multiple linear regression models were used to assess associations between food label reading habits and predictor variables. Our study confirms the association between habits regarding the reading of labels on food products, especially in relation to information about DF with the sociodemographic factors of respondents, dietary food patterns and DF consumption, as well as knowledge and sources of information about DF. Women, individuals with a university-level education, and those living in an urban environment had more frequent labels used. Food habits as well as eating outside of the home were positive predictors while eating fast food was a negative predictor of foo...

Kathy Sanchez

Wheat flour-based foods and rice have replaced native cereals in the diets of many urbanliving Peruvians. Urban areas have also seen increases in overweight, obesity, and type 2 diabetes mellitus prevalence in recent years. The focus of this research is to describe observations regarding consumption of quinoa, amaranth and kañiwa cereals; weight status; and self-described experiences of potential risk factors and warning signs for, and symptoms that may represent complications of, type 2 diabetes mellitus in Peruvian adults living in the city of Arequipa. A survey instrument was developed and administered to 110 subjects (22 diabetics, 88 non-diabetics), middle-aged and over. Participants with normal BMIs consumed quinoa, amaranth, and kaniwa more frequently than overweight or obese participants. Diabetics reported more frequent consumption of Andean cereals, particularly amaranth, and less frequent consumption of white flour than non-diabetics. Most participants reported eating a diet high in carbohydrates and leading a sedentary lifestyle.

Frontiers in Nutrition

Mrinmoyi Kulkarni

Angeles City Science High School

Zylas Timothy Reyes

Students' food choices and eating habits vary due to the pandemic. The researchers wanted to see if the ACSci SHS students follow the food pyramid to make healthy meal choices. Accordingly, the study's aim is to educate students about the necessity of eating the right food groups and getting sufficient nutrition from the foods they eat. The survey found that 288 ACSci SHS students followed the food pyramid to make healthy dietary choices that would keep them in good condition. Consuming the correct food group and recommended amount based on the nutritional guide pyramid is significant to get the recommended daily food intake based on their nutritional needs. The descriptive type of research design was applied wherein a survey was conducted to gather information. The researchers determined the sample size through the Slovins' formula. The researchers calculated the data percentage, mean, and frequency distribution to evaluate the adherence of ACSci students to the food pyramid. The statistics were tallied and organized in the form of tables. Having said that, the study revealed that most students follow the Food Nutrition and Research Institute (FNRI)-developed food pyramid as an eating plan for healthy living and they include three to four food groups in their daily meals. The majority of the students had a healthy BMI throughout the pandemic. Given the information gathered, all respondents check the nutritional label of the foods they buy before eating them, wherein calorie is the most checked nutritional value whereas sodium is the least checked. Meanwhile, most students began taking supplemental vitamins, specifically vitamin C, to strengthen their immune systems during the pandemic. However, there has been an increase in consuming unhealthy foods. As a result, the researchers highly recommend everyone be health-conscious by understanding the value of each food group and eating healthy foods that are appropriate for what they eat. Keywords: food pyramid, food choices, ACSci SHS students, adolescents, nutrition, well-being, lifestyle, diet

Malaysian Journal of Public Health Medicine

hemanath sinnathamby

SARS-CoV-2 virus created a huge health impact due to isolation, quarantine, or lockdown. University students also affected with the closure of institute and switch in teaching methods. The objective of this study is to explore the health-related lifestyle changes among university students during the implementation of movement control order. Secondly, we aimed to convoke suggestions and recommendations to promote healthy living amidst university students. This study implemented qualitative method via using a semi-structured interview. Three focus group discussions were conducted consisting of 12 participants recruited from snowball sampling method. Utilizing verbatim transcription approach, an inductive thematic point was sketch for data analysis. Seven male and five female students with a mean age of 20 ± 1.3 years (range 19-23) were recruited into this study. Four themes identified from the interview. Physical health influence by administrative roles to physically inactive and less...

International Journal of Environmental Research and Public Health

Elisa LANGIANO

The COVID-19 pandemic has forced schools and universities to shift their activities online, influencing the adoption of health-related behaviours such as physical activity and healthy dietary habits. The present study investigates the changes in adherence to a healthy diet and regular physical activity in university students in Italy before and during the COVID-19 pandemic and understands the role of sociodemographic variables in creating the changes above. We conducted a repeated cross-sectional survey performing the same sampling strategy at the first data collection (T0) and second data collection (T1) with a combination of convenience and snowball sampling approaches. The sample is composed of a total of 2001 students, 60.2% women and 39.8% men, with an average age of 22.7 (±5.5 SD). At T1, 39.9% of the students reported regular physical activity. During the pandemic, however, many, especially male students, abandoned or reduced physical activity practice (T1 40%), with an incre...

RELATED PAPERS

Małgorzata Kosicka-Gębska

Humanities and social sciences

farzana syed

Christine Dokun-Mowete

Nepal Journal of Epidemiology

International Journal of Advanced Research (IJAR)

IJAR Indexing

Jimaima Lako

Thandi Puoane

Gachomo Mapis

Dominika Grońska

Texila International Journal

P. Sindhuja

Maitri Panchal

JINAV: Journal of Information and Visualization

Ebenezer Appah Bonney

Raaji Sharma

William M Agai

Child and Adolescent Obesity

Lucy-joy Wachira

Sylvia Byrd

World Nutrition

Regina Keith

Joseph Machira

IJIRT Journal

Asian Journal of Applied Sciences

Meriem El F.

World Journal of Social Science Research

Thiwankee Wickramasinghe

zaynab alourfi

Biniyam Asmare

Saudi Journal of Medicine

Kawthar AlEid

Aspasia Katrina Vaka , Gade Waqa , Tilema Cama

Almu'atasim Khamees

Asian Journal of Social Science Studies

machiko higuchi

brighton makumbe

Małgorzata Drywień

BMC Public Health

Chan Ying Ying

Amjad Jarrar

JHSSR Special Issue on COVID-19

Horizon Journal of Humanities & Social Sciences Research (JHSSR) , kanchan sandhu

Texila International Journal of Academic Research

Texila International Journal , Rabecca Kayumba Piyo

Integrity Research Journals

Preetha Thomas

Asian Journal of Education and Social Studies

siony ubane

Nina Ciuciuc

Anna Paczkowska

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

Healthy Lifestyle and Eating Essay

Healthy eating is the process of keeping the body clean, strong, and healthy at all times (Allen, 1926). Healthy living, on the other hand, means that one should be able to eat the right food, get enough exercise, and maintain cleanliness (James, 1907). Unfortunately, many people do not keep track of these requirements. Thus, they end up with serious health problems, which can be difficult to treat. Prevention of these problems can be accomplished through maintaining a healthy lifestyle. Such a lifestyle is achievable by eating the right food and adhering to all the requirements of healthy living.

The human body needs a balanced diet, which includes enough minerals, fats, vitamins, fiber, and carbohydrates (Albrecht, 1932). These substances are required by the body to facilitate the growth and functioning of body tissues. Low energy foods such as vegetables and fruits have small amounts of calories per unit volume of food. Therefore, it is advisable to eat this combination of foods in large volumes as it contains fewer calories, but has nutrients that are essential for optimal body functionality. Incidentally, one should take food that is free from unhealthy fats, but should ensure that whole grains and proteins go alongside fruits and vegetables.

Apart from choosing the best foods for the body, it is also advisable that people should maintain moderate quantities of food intake. For instance, it is prudent to eat less of unhealthy foods such as refined sugar and saturated fats and more of healthy foods such as vegetables and fruits. This pattern of eating has massive health benefits to its adherents. As such, people should strive to develop good eating habits that can sustain them throughout their lives.

Further, it is recommended that one should eat a heavy breakfast an hour after waking up. The breakfast needs to consist of carbohydrates, healthy fats, and proteins in balanced proportions. It should then be followed by light meals throughout the day. This requirement is important since breakfast helps to initiate the body’s metabolism. The light and healthy meals thereafter help maintain a high body energy level that keeps one active throughout the day (Allen, 1926). People should avoid eating late at night. Early dinners are advisable followed by an average of 15 hours of no food until breakfast time the next morning. Past studies show that this pattern helps regulate body weight (James, 1907).

People who are diagnosed with lifestyle diseases such as anemia, high blood pressure, and diabetes among others are advised to follow diets that are rich in fruits and vegetable content (Allen, 1926). Depending on the stage of illness, such people should strictly watch what they eat. For example, high blood pressure patients should cut down on sodium, which is mainly found in salt. They should also avoid foods that have high cholesterol and saturated fats since diets of this sort prompt a high risk of artery clogging. Consequently, it increases the risk of heart attacks and blood vessel diseases (Albrecht, 1932). Further, they need to control the amount of carbohydrates they take.

Carbohydrates should only account for 50% of their daily calories (Allen, 1926). Finally, they are discouraged from foods with a high phosphorous content since they may lead to bone diseases (Allen, 1926). Overweight people constitute another special needs group. They should reduce weight to be healthy. Consequently, they need at least 30 minutes of rigorous physical exercise everyday and a lean diet.

In conclusion, all these groups of people should increase their water intake. Water is essential in the human body since it facilitates the regulation of all body functions. As such, it enhances body health. In this regard, people should strive to take at least eight glasses per day. Apparently, healthy living calls for discipline and commitment. If people foster these two values in the lifestyles, the world will be full of healthy people.

Albrecht, Arthur E. (1932). About foods and markets : A teachers’ handbook and consumers’ guide . New York City, NY: Columbia University. Web.

Allen, Ida C. (1926). Your foods and you or the role of diet . Garden City, NY: Doubleday Page & Company. Web.

James F. (1907). How we are fed: A geographical reader . New York, NY: Macmillan. Web.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2020, May 22). Healthy Lifestyle and Eating. https://ivypanda.com/essays/healthy-lifestyle-and-eating/

"Healthy Lifestyle and Eating." IvyPanda , 22 May 2020, ivypanda.com/essays/healthy-lifestyle-and-eating/.

IvyPanda . (2020) 'Healthy Lifestyle and Eating'. 22 May.

IvyPanda . 2020. "Healthy Lifestyle and Eating." May 22, 2020. https://ivypanda.com/essays/healthy-lifestyle-and-eating/.

1. IvyPanda . "Healthy Lifestyle and Eating." May 22, 2020. https://ivypanda.com/essays/healthy-lifestyle-and-eating/.

Bibliography

IvyPanda . "Healthy Lifestyle and Eating." May 22, 2020. https://ivypanda.com/essays/healthy-lifestyle-and-eating/.

• School Breakfast Program for Children's Health
• The Concept of Carbohydrates
• Breakfast Effect on Child’s Work in School
• Diet and Nutrition: European Diabetes
• Obesity: the Public Health Challenge of Our Time
• Spoilage Device: Forget Expiration Dates
• "Salt, Sugar and Fat" a Book by Michael Moss
• Iron Deficiency Effects and Management

• Search Menu
• Advance Articles
• Editor's Choice
• Author Guidelines
• Submission Site
• Open Access
• About Health Education Research
• Editorial Board
• Advertising and Corporate Services
• Journals Career Network
• Self-Archiving Policy
• Dispatch Dates
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Introduction.

• < Previous

Young people and healthy eating: a systematic review of research on barriers and facilitators

• Article contents
• Figures & tables
• Supplementary Data

J Shepherd, A Harden, R Rees, G Brunton, J Garcia, S Oliver, A Oakley, Young people and healthy eating: a systematic review of research on barriers and facilitators, Health Education Research , Volume 21, Issue 2, 2006, Pages 239–257, https://doi.org/10.1093/her/cyh060

• Permissions Icon Permissions

A systematic review was conducted to examine the barriers to, and facilitators of, healthy eating among young people (11–16 years). The review focused on the wider determinants of health, examining community- and society-level interventions. Seven outcome evaluations and eight studies of young people's views were included. The effectiveness of the interventions was mixed, with improvements in knowledge and increases in healthy eating but differences according to gender. Barriers to healthy eating included poor school meal provision and ease of access to, relative cheapness of and personal taste preferences for fast food. Facilitators included support from family, wider availability of healthy foods, desire to look after one's appearance and will-power. Friends and teachers were generally not a common source of information. Some of the barriers and facilitators identified by young people had been addressed by soundly evaluated effective interventions, but significant gaps were identified where no evaluated interventions appear to have been published (e.g. better labelling of food products), or where there were no methodologically sound evaluations. Rigorous evaluation is required particularly to assess the effectiveness of increasing the availability of affordable healthy food in the public and private spaces occupied by young people.

Healthy eating contributes to an overall sense of well-being, and is a cornerstone in the prevention of a number of conditions, including heart disease, diabetes, high blood pressure, stroke, cancer, dental caries and asthma. For children and young people, healthy eating is particularly important for healthy growth and cognitive development. Eating behaviours adopted during this period are likely to be maintained into adulthood, underscoring the importance of encouraging healthy eating as early as possible [ 1 ]. Guidelines recommend consumption of at least five portions of fruit and vegetables a day, reduced intakes of saturated fat and salt and increased consumption of complex carbohydrates [ 2, 3 ]. Yet average consumption of fruit and vegetables in the UK is only about three portions a day [ 4 ]. A survey of young people aged 11–16 years found that nearly one in five did not eat breakfast before going to school [ 5 ]. Recent figures also show alarming numbers of obese and overweight children and young people [ 6 ]. Discussion about how to tackle the ‘epidemic’ of obesity is currently high on the health policy agenda [ 7 ], and effective health promotion remains a key strategy [ 8–10 ].

Evidence for the effectiveness of interventions is therefore needed to support policy and practice. The aim of this paper is to report a systematic review of the literature on young people and healthy eating. The objectives were

(i) to undertake a ‘systematic mapping’ of research on the barriers to, and facilitators of, healthy eating among young people, especially those from socially excluded groups (e.g. low-income, ethnic minority—in accordance with government health policy);

(ii) to prioritize a subset of studies to systematically review ‘in-depth’;

(iii) to ‘synthesize’ what is known from these studies about the barriers to, and facilitators of, healthy eating with young people, and how these can be addressed and

(iv) to identify gaps in existing research evidence.

General approach

This study followed standard procedures for a systematic review [ 11, 12 ]. It also sought to develop a novel approach in three key areas.

First, it adopted a conceptual framework of ‘barriers’ to and ‘facilitators’ of health. Research findings about the barriers to, and facilitators of, healthy eating among young people can help in the development of potentially effective intervention strategies. Interventions can aim to modify or remove barriers and use or build upon existing facilitators. This framework has been successfully applied in other related systematic reviews in the area of healthy eating in children [ 13 ], physical activity with children [ 14 ] and young people [ 15 ] and mental health with young people [16; S. Oliver, A. Harden, R. Rees, J. Shepherd, G. Brunton and A. Oakley, manuscript in preparation].

Second, the review was carried out in two stages: a systematic search for, and mapping of, literature on healthy eating with young people, followed by an in-depth systematic review of the quality and findings of a subset of these studies. The rationale for a two-stage review to ensure the review was as relevant as possible to users. By mapping a broad area of evidence, the key characteristics of the extant literature can be identified and discussed with review users, with the aim of prioritizing the most relevant research areas for systematic in-depth analysis [ 17, 18 ].

Third, the review utilized a ‘mixed methods’ triangulatory approach. Data from effectiveness studies (‘outcome evaluations’, primarily quantitative data) were combined with data from studies which described young people's views of factors influencing their healthy eating in negative or positive ways (‘views’ studies, primarily qualitative). We also sought data on young people's perceptions of interventions when these had been collected alongside outcomes data in outcome evaluations. However, the main source of young people's views was surveys or interview-based studies that were conducted independently of intervention evaluation (‘non-intervention’ research). The purpose was to enable us to ascertain not just whether interventions are effective, but whether they address issues important to young people, using their views as a marker of appropriateness. Few systematic reviews have attempted to synthesize evidence from both intervention and non-intervention research: most have been restricted to outcome evaluations. This study therefore represents one of the few attempts that have been made to date to integrate different study designs into systematic reviews of effectiveness [ 19–22 ].

Literature searching

A highly sensitive search strategy was developed to locate potentially relevant studies. A wide range of terms for healthy eating (e.g. nutrition, food preferences, feeding behaviour, diets and health food) were combined with health promotion terms or general or specific terms for determinants of health or ill-health (e.g. health promotion, behaviour modification, at-risk-populations, sociocultural factors and poverty) and with terms for young people (e.g. adolescent, teenager, young adult and youth). A number of electronic bibliographic databases were searched, including Medline, EMBASE, The Cochrane Library, PsycINFO, ERIC, Social Science Citation Index, CINAHL, BiblioMap and HealthPromis. The searches covered the full range of publication years available in each database up to 2001 (when the review was completed).

Full reports of potentially relevant studies identified from the literature search were obtained and classified (e.g. in terms of specific topic area, context, characteristics of young people, research design and methodological attributes).

Inclusion screening

Inclusion criteria were developed and applied to each study. The first round of screening was to identify studies to populate the map. To be included, a study had to (i) focus on healthy eating; (ii) include young people aged 11–16 years; (iii) be about the promotion of healthy eating, and/or the barriers to, or facilitators of, healthy eating; (iv) be a relevant study type: (a) an outcome evaluation or (b) a non-intervention study (e.g. cohort or case control studies, or interview studies) conducted in the UK only (to maximize relevance to UK policy and practice) and (v) be published in the English language.

The results of the map, which are reported in greater detail elsewhere [ 23 ], were used to prioritize a subset of policy relevant studies for the in-depth systematic review.

A second round of inclusion screening was performed. As before, all studies had to have healthy eating as their main focus and include young people aged 11–16 years. In addition, outcome evaluations had toFor a non-intervention study to be included it had to

(i) use a comparison or control group; report pre- and post-intervention data and, if a non-randomized trial, equivalent on sociodemographic characteristics and pre-intervention outcome variables (demonstrating their ‘potential soundness’ in advance of further quality assessment);

(ii) report an intervention that aims to make a change at the community or society level and

(iii) measure behavioural and/or physical health status outcomes.

(i) examine young people's attitudes, opinions, beliefs, feelings, understanding or experiences about healthy eating (rather than solely examine health status, behaviour or factual knowledge);

(ii) access views about one or more of the following: young people's definitions of and/or ideas about healthy eating, factors influencing their own or other young people's healthy eating and whether and how young people think healthy eating can be promoted and

(iii) privilege young people's views—presenting views directly as data that are valuable and interesting in themselves, rather than only as a route to generating variables to be tested in a predictive or causal model.

Non-intervention studies published before 1990 were excluded in order to maximize the relevance of the review findings to current policy issues.

Data extraction and quality assessment

All studies meeting inclusion criteria underwent data extraction and quality assessment, using a standardized framework [ 24 ]. Data for each study were entered independently by two researchers into a specialized computer database [ 25 ] (the full and final data extraction and quality assessment judgement for each study in the in-depth systematic review can be viewed on the Internet by visiting http://eppi.ioe.ac.uk ).

Outcome evaluations were considered methodologically ‘sound’ if they reported:Only studies meeting these criteria were used to draw conclusions about effectiveness. The results of the studies which did not meet these quality criteria were judged unclear.

(i) a control or comparison group equivalent to the intervention group on sociodemographic characteristics and pre-intervention outcome variables.

(ii) pre-intervention data for all individuals or groups recruited into the evaluation;

(iii) post-intervention data for all individuals or groups recruited into the evaluation and

(iv) on all outcomes, as described in the aims of the intervention.

Non-intervention studies were assessed according to a total of seven criteria (common to sets of criteria proposed by four research groups for qualitative research [ 26–29 ]):

(i) an explicit account of theoretical framework and/or the inclusion of a literature review which outlined a rationale for the intervention;

(ii) clearly stated aims and objectives;

(iii) a clear description of context which includes detail on factors important for interpreting the results;

(iv) a clear description of the sample;

(v) a clear description of methodology, including systematic data collection methods;

(vi) analysis of the data by more than one researcher and

(vii) the inclusion of sufficient original data to mediate between data and interpretation.

Data synthesis

Three types of analyses were performed: (i) narrative synthesis of outcome evaluations, (ii) narrative synthesis of non-intervention studies and (iii) synthesis of intervention and non-intervention studies together.

For the last of these a matrix was constructed which laid out the barriers and facilitators identified by young people alongside descriptions of the interventions included in the in-depth systematic review of outcome evaluations. The matrix was stratified by four analytical themes to characterize the levels at which the barriers and facilitators appeared to be operating: the school, family and friends, the self and practical and material resources. This methodology is described further elsewhere [ 20, 22, 30 ].

From the matrix it is possible to see:

(i) where barriers have been modified and/or facilitators built upon by soundly evaluated interventions, and ‘promising’ interventions which need further, more rigorous, evaluation (matches) and

(ii) where barriers have not been modified and facilitators not built upon by any evaluated intervention, necessitating the development and rigorous evaluation of new interventions (gaps).

Figure 1 outlines the number of studies included at various stages of the review. Of the total of 7048 reports identified, 135 reports (describing 116 studies) met the first round of screening and were included in the descriptive map. The results of the map are reported in detail in a separate publication—see Shepherd et al. [ 23 ] (the report can be downloaded free of charge via http://eppi.ioe.ac.uk ). A subset of 22 outcome evaluations and 8 studies of young people's views met the criteria for the in-depth systematic review.

The review process.

Outcome evaluations

Of the 22 outcome evaluations, most were conducted in the United States ( n = 16) [ 31–45 ], two in Finland [ 46, 47 ], and one each in the UK [ 48 ], Norway [ 49 ], Denmark [ 50 ] and Australia [ 51 ]. In addition to the main focus on promoting healthy eating, they also addressed other related issues including cardiovascular disease in general, tobacco use, accidents, obesity, alcohol and illicit drug use. Most were based in primary or secondary school settings and were delivered by teachers. Interventions varied considerably in content. While many involved some form of information provision, over half ( n = 13) involved attempts to make structural changes to young people's physical environments; half ( n = 11) trained parents in or about nutrition, seven developed health-screening resources, five provided feedback to young people on biological measures and their behavioural risk status and three aimed to provide social support systems for young people or others in the community. Social learning theory was the most common theoretical framework used to develop these interventions. Only a minority of studies included young people who could be considered socially excluded ( n = 6), primarily young people from ethnic minorities (e.g. African Americans and Hispanics).

Following detailed data extraction and critical appraisal, only seven of the 22 outcome evaluations were judged to be methodologically sound. For the remainder of this section we only report the results of these seven. Four of the seven were from the United States, with one each from the UK, Norway and Finland. The studies varied in the comprehensiveness of their reporting of the characteristics of the young people (e.g. sociodemographic/economic status). Most were White, living in middle class urban areas. All attended secondary schools. Table I details the interventions in these sound studies. Generally, they were multicomponent interventions in which classroom activities were complemented with school-wide initiatives and activities in the home. All but one of the seven sound evaluations included and an integral evaluation of the intervention processes. Some studies report results according to demographic characteristics such as age and gender.

Soundly evaluated outcome evaluations: study characteristics (n = 7)

RCT = Randomized Controlled Trial; CT = controlled trial (no randomization); PE = process evaluation.

Separate evaluations of the same intervention in two populations in New York (the Bronx and Westchester County).

The UK-based intervention was an award scheme (the ‘Wessex Healthy Schools Award’) that sought to make health-promoting changes in school ethos, organizational functioning and curriculum [ 48 ]. Changes made in schools included the introduction of health education curricula, as well as the setting of targets in key health promotion areas (including healthy eating). Knowledge levels, which were high at baseline, changed little over the course of the intervention. Intervention schools performed better in terms of healthy food choices (on audit scores). The impact on measures of healthy eating such as choosing healthy snacks varied according to age and sex. The intervention only appeared possibly to be effective for young women in Year 11 (aged 15–16 years) on these measures (statistical significance not reported).

The ‘Know Your Body’ intervention, a cardiovascular risk reduction programme, was evaluated in two separate studies in two demographically different areas of New York (the Bronx and Westchester County) [ 45 ]. Lasting for 5 years it comprised teacher-led classroom education, parental involvement activities and risk factor examination in elementary and junior high schools. In the Bronx evaluation, statistically significant increases in knowledge were reported, but favourable changes in cholesterol levels and dietary fat were not significant. In the Westchester County evaluation, we judged the effects to be unclear due to shortcomings in methods reported.

A second US-based study, the 3-year ‘Gimme 5’ programme [ 40 ], focused on increasing consumption of fruits and vegetables through a school-wide media campaign, complemented by classroom activities, parental involvement and changes to nutritional content of school meals. The intervention was effective at increasing knowledge (particularly among young women). Effects were measured in terms of changes in knowledge scores between baseline and two follow-up periods. Differences between the intervention and comparison group were significant at both follow-ups. There was a significant increase in consumption of fruit and vegetables in the intervention group, although this was not sustained.

In the third US study, the ‘Slice of Life’ intervention, peer leaders taught 10 sessions covering the benefits of fitness, healthy diets and issues concerning weight control [ 41 ]. School functioning was also addressed by student recommendations to school administrators. For young women, there were statistically significant differences between intervention and comparison groups on healthy eating scores, salt consumption scores, making healthy food choices, knowledge of healthy food, reading food labels for salt and fat content and awareness of healthy eating. However, among young men differences were only significant for salt and knowledge scores. The process evaluation suggested that having peers deliver training was acceptable to students and the peer-trainers themselves.

A Norwegian study evaluated a similar intervention to the ‘Slice of Life’ programme, employing peer educators to lead classroom activities and small group discussions on nutrition [ 49 ]. Students also analysed the availability of healthy food in their social and home environment and used a computer program to analyse the nutritional status of foods. There were significant intervention effects for reported healthy eating behaviour (but not maintained by young men) and for knowledge (not young women).

The second ‘North Karelia Youth Study’ in Finland featured classroom educational activities, a community media campaign, health-screening activities, changes to school meals and a health education initiative in the parents' workplace [ 47 ]. It was judged to be effective for healthy eating behaviour, reducing systolic blood pressure and modifying fat content of school meals, but less so for reducing cholesterol levels and diastolic blood pressure.

The evidence from the well-designed evaluations of the effectiveness of healthy eating initiatives is therefore mixed. Interventions tend to be more effective among young women than young men.

Young people's views

Table II describes the key characteristics of the eight studies of young people's views. The most consistently reported characteristics of the young people were age, gender and social class. Socioeconomic status was mixed, and in the two studies reporting ethnicity, the young people participating were predominantly White. Most studies collected data in mainstream schools and may therefore not be applicable to young people who infrequently or never attend school.

Characteristics of young people's views studies (n = 8)

All eight studies asked young people about their perceptions of, or attitudes towards, healthy eating, while none explicitly asked them what prevents them from eating healthily. Only two studies asked them what they think helps them to eat healthy foods, and only one asked for their ideas about what could or should be done to promote nutrition.

Young people tended to talk about food in terms of what they liked and disliked, rather than what was healthy/unhealthy. Healthy foods were predominantly associated with parents/adults and the home, while ‘fast food’ was associated with pleasure, friendship and social environments. Links were also made between food and appearance, with fast food perceived as having negative consequences on weight and facial appearance (and therefore a rationale for eating healthier foods). Attitudes towards healthy eating were generally positive, and the importance of a healthy diet was acknowledged. However, personal preferences for fast foods on grounds of taste tended to dominate food choice. Young people particularly valued the ability to choose what they eat.

Despite not being explicitly asked about barriers, young people discussed factors inhibiting their ability to eat healthily. These included poor availability of healthy meals at school, healthy foods sometimes being expensive and wide availability of, and personal preferences for, fast foods. Things that young people thought should be done to facilitate healthy eating included reducing the price of healthy snacks and better availability of healthy foods at school, at take-aways and in vending machines. Will-power and encouragement from the family were commonly mentioned support mechanisms for healthy eating, while teachers and peers were the least commonly cited sources of information on nutrition. Ideas for promoting healthy eating included the provision of information on nutritional content of school meals (mentioned by young women particularly) and better food labelling in general.

Table III shows the synthesis matrix which juxtaposes barriers and facilitators alongside results of outcome evaluations. There were some matches but also significant gaps between, on the one hand, what young people say are barriers to healthy eating, what helps them and what could or should be done and, on the other, soundly evaluated interventions that address these issues.

Synthesis matrix

Key to young people's views studies: Y1 , Dennison and Shepherd [ 56 ]; Y2 , Harris [ 57 ]; Y3 , McDougall [ 58 ]; Y4 , Miles and Eid [ 59 ]; Y5 , Roberts et al. [ 60 ]; Y6 , Ross [ 61 ]; Y7 , Watt and Sheiham [ 62 ]; Y8 , Watt and Sheiham [ 63 ]. Key to intervention studies: OE1 , Baranowski et al. [ 31 ]; OE2 , Bush et al. [ 32 ]; OE3 , Coates et al. [ 33 ]; OE4 , Ellison et al. [ 34 ]; OE5 , Flores [ 36 ]; OE6 , Fitzgibbon et al. [ 35 ]; OE7 , Hopper et al. [ 64 ]; OE8 , Holund [ 50 ]; OE9 , Kelder et al. [ 38 ]; OE10 , Klepp and Wilhelmsen [ 49 ]; OE11 , Moon et al. [ 48 ]; OE12 , Nader et al. [ 39 ]; OE13 , Nicklas et al. [ 40 ]; OE14 , Perry et al. [ 41 ]; OE15 , Petchers et al. [ 42 ]; OE16 , Schinke et al. [ 43 ]; OE17 , Wagner et al. [ 44 ]; OE18 , Vandongen et al. [ 51 ]; OE19 , Vartiainen et al. [ 46 ]; OE20 , Vartiainen et al. [ 47 ]; OE21 , Walter I [ 45 ]; OE22 , Walter II [ 45 ]. OE10, OE11, OE13, OE14, OE20, OE21 and OE22 denote a sound outcome evaluation. OE21 and OE22 are separate evaluations of the same intervention. Due to methodological limitations, we have judged the effects of OE22 to be unclear. Y1 and Y2 do not appear in the synthesis matrix as they did not explicitly report barriers or facilitators, and it was not possible for us to infer potential barriers or facilitators. However, these two studies did report what young people understood by healthy eating, their perceptions, and their views and opinions on the importance of eating a healthy diet. OE2, OE12, OE16 and OE17 do not appear in the synthesis matrix as they did not address any of the barriers or facilitators.

In terms of the school environment, most of the barriers identified by young people appear to have been addressed. At least two sound outcome evaluations demonstrated the effectiveness of increasing the availability of healthy foods in the school canteen [ 40, 47 ]. Furthermore, despite the low status of teachers and peers as sources of nutritional information, several soundly evaluated studies showed that they can be employed effectively to deliver nutrition interventions.

Young people associated parents and the home environment with healthy eating, and half of the sound outcome evaluations involved parents in the education of young people about nutrition. However, problems were sometimes experienced in securing parental attendance at intervention activities (e.g. seminar evenings). Why friends were not a common source of information about good nutrition is not clear. However, if peer pressure to eat unhealthy foods is a likely explanation, then it has been addressed by the peer-led interventions in three sound outcome evaluations (generally effectively) [ 41, 47, 49 ] and two outcome evaluations which did not meet the quality criteria (effectiveness unclear) [ 33, 50 ].

The fact that young people choose fast foods on grounds of taste has generally not been addressed by interventions, apart from one soundly evaluated effective intervention which included taste testings of fruit and vegetables [ 40 ]. Young people's concern over their appearance (which could be interpreted as both a barrier and a facilitator) has only been addressed in one of the sound outcome evaluations (which revealed an effective intervention) [ 41 ]. Will-power to eat healthy foods has only been examined in one outcome evaluation in the in-depth systematic review (judged to be sound and effective) (Walter I—Bronx evaluation) [ 45 ]. The need for information on nutrition was addressed by the majority of interventions in the in-depth systematic review. However, no studies were found which evaluated attempts to increase the nutritional content of school meals.

Barriers and facilitators relating to young people's practical and material resources were generally not addressed by interventions, soundly evaluated or otherwise. No studies were found which examined the effectiveness of interventions to lower the price of healthy foods. However, one soundly evaluated intervention was partially effective in increasing the availability of healthy snacks in community youth groups (Walter I—Bronx evaluation) [ 45 ]. At best, interventions have attempted to raise young people's awareness of environmental constraints on eating healthily, or encouraged them to lobby for increased availability of nutritious foods (in the case of the latter without reporting whether any changes have been effected as a result).

This review has systematically identified some of the barriers to, and facilitators of, healthy eating with young people, and illustrated to what extent they have been addressed by soundly evaluated effective interventions.

The evidence for effectiveness is mixed. Increases in knowledge of nutrition (measured in all but one study) were not consistent across studies, and changes in clinical risk factors (measured in two studies) varied, with one study detecting reductions in cholesterol and another detecting no change. Increases in reported healthy eating behaviour were observed, but mostly among young women revealing a distinct gender pattern in the findings. This was the case in four of the seven outcome evaluations (in which analysis was stratified by gender). The authors of one of the studies suggest that emphasis of the intervention on healthy weight management was more likely to appeal to young women. It was proposed that interventions directed at young men should stress the benefits of nutrition on strength, physical endurance and physical activity, particularly to appeal to those who exercise and play sports. Furthermore, age was a significant factor in determining effectiveness in one study [ 48 ]. Impact was greatest on young people in the 15- to 16-year age range (particularly for young women) in comparison with those aged 12–13 years, suggesting that dietary influences may vary with age. Tailoring the intervention to take account of age and gender is therefore crucial to ensure that interventions are as relevant and meaningful as possible.

Other systematic reviews of interventions to promote healthy eating (which included some of the studies with young people fitting the age range of this review) also show mixed results [ 52–55 ]. The findings of these reviews, while not being directly comparable in terms of conceptual framework, methods and age group, seem to offer some support for the findings of this review. The main message is that while there is some evidence to suggest effectiveness, the evidence base is limited. We have identified no comparable systematic reviews in this area.

Unlike other reviews, however, this study adopted a wider perspective through inclusion of studies of young people's views as well as effectiveness studies. A number of barriers to healthy eating were identified, including poor availability of healthy foods at school and in young people's social spaces, teachers and friends not always being a source of information/support for healthy eating, personal preferences for fast foods and healthy foods generally being expensive. Facilitating factors included information about nutritional content of foods/better labelling, parents and family members being supportive; healthy eating to improve or maintain one's personal appearance, will-power and better availability/lower pricing of healthy snacks.

Juxtaposing barriers and facilitators alongside effectiveness studies allowed us to examine the extent to which the needs of young people had been adequately addressed by evaluated interventions. To some extent they had. Most of the barriers and facilitators that related to the school and relationships with family and friends appear to have been taken into account by soundly evaluated interventions, although, as mentioned, their effectiveness varied. Many of the gaps tended to be in relation to young people as individuals (although our prioritization of interventions at the level of the community and society may have resulted in the exclusion of some of these interventions) and the wider determinants of health (‘practical and material resources’). Despite a wide search, we found few evaluations of strategies to improve nutritional labelling on foods particularly in schools or to increase the availability of affordable healthy foods particularly in settings where young people socialize. A number of initiatives are currently in place which may fill these gaps, but their effectiveness does not appear to have been reported yet. It is therefore crucial for any such schemes to be thoroughly evaluated and disseminated, at which point an updated systematic review would be timely.

This review is also constrained by the fact that its conclusions can only be supported by a relatively small proportion of the extant literature. Only seven of the 22 outcome evaluations identified were considered to be methodologically sound. As illustrated in Table III , a number of the remaining 15 interventions appear to modify barriers/build on facilitators but their results can only be judged unclear until more rigorous evaluation of these ‘promising’ interventions has been reported.

Finally, it is important to acknowledge that the majority of the outcome evaluations were conducted in the United States, and by virtue of the inclusion criteria, all the young people's views studies were UK based. The literature therefore might not be generalizable to other countries, where sociocultural values and socioeconomic circumstances may be quite different. Further evidence synthesis is needed on barriers to, and facilitators of, healthy eating and nutrition worldwide, particularly in developing countries.

The aim of this study was to survey what is known about the barriers to, and facilitators of, healthy eating among young people with a view to drawing out the implications for policy and practice. The review has mapped and quality screened the extant research in this area, and brought together the findings from evaluations of interventions aiming to promote healthy eating and studies which have elicited young people's views.

There has been much research activity in this area, yet it is disappointing that so few evaluation studies were methodologically strong enough to enable us to draw conclusions about effectiveness. There is some evidence to suggest that multicomponent school-based interventions can be effective, although effects tended to vary according to age and gender. Tailoring intervention messages accordingly is a promising approach which should therefore be evaluated. A key theme was the value young people place on choice and autonomy in relation to food. Increasing the provision and range of healthy, affordable snacks and meals in schools and social spaces will enable them to exercise their choice of healthier, tasty options.

We have identified that several barriers to, and facilitators of, healthy eating in young people have received little attention in evaluation research. Further work is needed to develop and evaluate interventions which modify or remove these barriers, and build on these facilitators. Further qualitative studies are also needed so that we can continue to listen to the views of young people. This is crucial if we are to develop and test meaningful, appropriate and effective health promotion strategies.

We would like to thank Chris Bonell and Dina Kiwan for undertaking data extraction. We would also like to acknowledge the invaluable help of Amanda Nicholas, James Thomas, Elaine Hogan, Sue Bowdler and Salma Master for support and helpful advice. The Department of Health, England, funds a specific programme of health promotion work at the EPPI-Centre. The views expressed in the report are those of the authors and not necessarily those of the Department of Health.

Google Scholar

Google Preview

• healthy diet

Email alerts

Citing articles via.

• Recommend to your Library

Affiliations

• Online ISSN 1465-3648
• Print ISSN 0268-1153
• Copyright © 2024 Oxford University Press
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

College Students and Eating Habits: A Study Using An Ecological Model for Healthy Behavior

Giovanni sogari.

1 Department of Food and Drug, University of Parma, 43124 Parma, Italy; [email protected]

2 Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY 14850, USA; ude.llenroc@7gim

Catalina Velez-Argumedo

3 Tecnológico de Monterrey, EGADE Business School, San Pedro Garza García 66269, Mexico; [email protected]

Miguel I. Gómez

Cristina mora.

Overweightness and obesity rates have increased dramatically over the past few decades and they represent a health epidemic in the United States (US). Unhealthy dietary habits are among the factors that can have adverse effects on weight status in young adulthood. The purpose of this explorative study was to use a qualitative research design to analyze the factors (barriers and enablers) that US college students perceived as influencing healthy eating behaviors. A group of Cornell University students ( n = 35) participated in six semi-structured focus groups. A qualitative software, CAQDAS Nvivo11 Plus, was used to create codes that categorized the group discussions while using an Ecological Model. Common barriers to healthy eating were time constraints, unhealthy snacking, convenience high-calorie food, stress, high prices of healthy food, and easy access to junk food. Conversely, enablers to healthy behavior were improved food knowledge and education, meal planning, involvement in food preparation, and being physically active. Parental food behavior and friends’ social pressure were considered to have both positive and negative influences on individual eating habits. The study highlighted the importance of consulting college students when developing healthy eating interventions across the campus (e.g., labeling healthy food options and information campaigns) and considering individual-level factors and socio-ecological aspects in the analysis.

1. Introduction

Overweightness and obesity rates have dramatically increased over the past few decades and they represent a health epidemic in the United States, as well as in many other areas of the world [ 1 , 2 , 3 ]. According to a scoping review of risk behavior interventions in young men, Ashton, Hutchesson, Rollo, Morgan & Collins [ 4 ] identified obesity as a serious health risk with an incidence rate of obesity reaching 29% of the population aged 20–39 years old [ 5 , 6 ]. Physical inactivity and unhealthy dietary habits are among the main behaviors that potentially have adverse effects on weight status in young adulthood, and consequently, the future health of adults [ 3 , 7 ].

As reported by the World Health Organization (WHO) [ 8 ], the adult disease burden is due to health risk behaviors that start during adolescence (e.g., unhealthy eating practices). For example, most of the United States (US) population does not consume the recommended daily amount of fruit and vegetables, nuts, and seeds. On the other hand, the consumption of added sugars, processed meats, and trans fats is higher than the recommended daily intake [ 9 ]. It has been shown that after the transition from adolescence to young adulthood, when independency increases, young adults are continuously challenged to make healthful food choices [ 2 , 10 ]. Along with unhealthy eating behaviors, a new series of weight-related behavioral patterns begins throughout this period, such as excessive alcohol consumption and a low level of physical activity.

Substantial life-changing transitions happened when young adults finish high school to start college or a working life [ 10 ]. According to the literature [ 11 , 12 , 13 ], university is a critical period for young adults regarding food choices and their relationship with weight gain. Some studies have even shown that college students tend to gain more weight than those who do not attend university [ 14 ]. In order to design and support healthy nutrition campaigns (e.g., less meat options) across campuses, it is critical to improve knowledge of dietary behaviors in the university-age population [ 15 ].

In the last decades, there has been growing interest in the development and implementation of health promotion interventions in the workplace [ 16 ]. Studies exploring eating behavior in children [ 17 ], adolescents [ 18 , 19 ], and young adults [ 20 ] have been done in recent years; however, theories to explain such behaviors are still moving from the nascent to the mature stage [ 21 ].

Recently, the so-called Ecological Model has been considered as an acceptable framework to link individual and social behaviors with environmental determinants, to reduce serious and prevalent health problems [ 22 ].

The aim of this study is to explore the barriers and enablers of healthy eating behaviors among US college students, using focus groups that foster open discussion between a small number of participants. This study is the first stage of a larger research project called “CONSUMEHealth. Using consumer science to improve healthy eating habits”, funded bythe European Union’s Horizon 2020 research and Innovation programme (Marie Sklodowska-Curie grant agreement No 749514).

2. Materials and Methods

2.1. focus groups.

We selected focus group interviewing as a key methodology for the study, the elements of which include participant observation, formal and informal interviewing, filming, and recording, among others [ 23 ]. Focus groups are used to obtain insights and in-depth information on why and how people think (perceptions, attitude, opinions, experience) about a topic of interest [ 24 ] used to unlock the complexity of the decision-making process [ 25 ] and unencumbered by what we expect to find [ 26 ]. In our study, a focus group was suitable, since we were aiming to obtain cultural insights from a group of individuals, and to explore their beliefs and behaviors [ 27 ], allowing for us to examine the context of healthy eating behaviors [ 16 , 28 ]. Various studies have demonstrated that focus groups are an appropriate research method to study eating habits, particularly among students [ 2 , 29 ]. Since the definition of this population was not just a matter of age, but of lifestyle and identity, a focus group could help us to better understand the meanings of healthy eating behaviors and its contexts.

2.2. Participants

Eligible participants were college students aged 18 to 25 years, who were transitioning from adolescence to young adulthood, who lived in the USA, and who were enrolled at Cornell University in the town of Ithaca (New York, NY, USA). Similar to previous studies [ 29 ], no first-year university students were included in the study, due to their limited college experience. In addition, we excluded students from nutrition classes or any other disciplines that might transmit a greater overall knowledge or awareness of healthy eating. The final group consisted of students from different disciplines (humanistic and scientific). These young adults were recruited via flyers that were distributed across the University facilities, and via email using a college student database. In the advertisement sheet, a link to an online survey was provided to facilitate recruitment, and to give subjects the essential statement outline of the study (aim, benefits, and risks that are associated with time, incentives, other). One advantage of our approach was that it allowed us to recruit participants from different disciplines and years of study. In addition, we chose to have mixed-gender groups, which could produce a greater variety of responses and better discussion [ 29 ]. The interview guideline was designed to take participants on a journey, starting from a broader concept of health, to more specific questions on past, present, and future diet behavior practices.

2.3. Procedure

The recruitment of participants was carried out using an online system at Cornell University. A recruitment rate of between six and eight participants per focus group session was planned, in order to have at least four people in each focus group session, therefore, an over-recruitment of two students was planned in the case of ‘no-shows’.

Following the literature [ 29 ], a semi-structured question guide was developed to identify the key questions for the research problem (eating habits, physical activity levels, and weight change). Enough flexibility and side-questions allowed for open discussions within the group, to obtain more in-depth information from participants.

Projective techniques were used both at the beginning of the sessions for “ice-breaking”, and later on to understand better emotional connections and cognitions towards the topic of interest [ 30 ]. Specifically, the photograph response test technique was used, which consists of showing a series of photographs that are related to the topic under investigation. A stimulus (images of obese/overweight individuals) was presented to the group, and the participants were asked to answer with the first words that came to their mind.

As reported by Guerrero and Xicola [ 24 ], the integration of different qualitative techniques (e.g., projective stimuli as in this study) within the same focus group was considered to be a mixed approach. The study was approved by the Institutional Review Board (IRB) of the Office of Research Integrity and Assurance of Cornell University (Protocol ID: 1709007406).

2.4. Data Collection Outline

During the online prescreening registration, all of the participants completed a short questionnaire, providing self-reported socio-demographic information, physical activity, height, weight status, and perceived body image.

Before beginning the focus group, an information sheet about the study and a consent form for anonymity and confidentiality were signed by each participant. Drinks and a few snacks were provided in order to make the environment as much comfortable as possible. In addition, the room that was used to carry out the discussions was modified to look like a living room of a house.

As suggested in the literature [ 28 ], each focus group lasted around 90 min, and it was held in a comfortable and quiet place. The sessions were video-audio recorded with the permission of the participants, and were facilitated by a well-trained and experienced moderator (female moderator with five years of experience in focus groups in the field of food, both in the public and private context). The principal investigator was an observer, and stayed in another room that was connected with audio and video recording systems during the focus group discussion. The moderator directed the flow of the discussion, and ensured that all of the important issues were covered. We opted for small groups (4–6 people), which was considered to be more appropriate when the topic of investigation is seen as complex and personal [ 31 ]. Both the principal investigator and the moderator did not have any type of relationship with the participants; we strongly believe that no bias or conflict of interest exist between the research team, the subjects, and the focus of the study.

The semi-structured questions guide ( Table 1 ), as developed following Krueger and Casey [ 27 ], aimed to investigate the main factors influencing eating behaviors among college students. First, a projective technique was first used for “ice breaking”, and to facilitate the group discussion. At the beginning, all of the participants were asked to list “five healthy eating habits” and “five unhealthy eating habits”, and afterwards to read the list out and share it with group. In this way, the whole group was actively involved in the discussion, and participants became acquainted with, and felt connected with each other. The main questions focused on factors influencing students’ health and weight-related behaviors. Before ending each of the focus group sessions, the moderator and principal investigator decided whether further questions were needed. At the very end of the focus group, all of the subjects chose to either receive a monetary payment ($ 15) or university course credit (1.5) for their participation.

Short version of the Focus Group questions guide.

2.5. Data Analysis

In the field of health studies, the use of focus groups for research is a relatively recent phenomena [ 28 ]. The information resulting from focus groups is usually analyzed throughout a process of categorizing and coding the data in a systematic manner.

At the end of the six focus group sessions, the audio tapes were transcribed verbatim in Microsoft Word by an independent transcription agency, and they were double-reviewed by two researchers. Second, the data collected were analyzed by the principal investigator and two research assistants who were trained in qualitative analysis. All quotes were encoded using the computer-assisted qualitative data analysis software Nvivo11 Plus Version 11 (QSR International Pty Ltd., Melbourne, Australia) [ 32 ]. This software helped the researchers at the stage of data analysis, marking, and coding the transcription, and helped them to identify the relations between categories (concepts, themes, and ideas) and individuals [ 28 ].

An inductive thematic approach, which is useful for identifying core meanings that were relevant to the research objects, was used for data analysis, in which quotes were coded and categorized into themes and subthemes [ 25 , 33 ]. These themes were organized into individual, social, and environmental categories using an Ecological Model framework [ 16 , 22 ], and were successively described. A Microsoft Excel package was used to analyze the characteristics of the sample using responses from the questionnaire (descriptive statistics).

3.1. Descriptive Results

In our study, six focus group discussions were conducted until saturation of new information was reached. The final sample consisted of 35 students (23 females), with a mean age of 20.4 ± 1.5 years and a mean body mass index (BMI) of 23.2 (SD ± 4.52), which was calculated as weight (kg) divided by height squared (m 2 ). Most participants considered themselves to have a healthy weight status, and few of them indicated current or past eating disorders. The characteristics of the sample are summarized in Table 2 . Participants were also from a variety of study disciplines and different college years (from junior to senior). This variety in participant characteristics enormously contributed to gather more insights (e.g., diverse experiences and opinions) into the relationship between behaviors and healthy eating.

Characteristics of focus group participants ( n = 35).

3.2. Qualitative Results

Following the literature [ 31 ], the researchers reviewed the transcript line-by-line encoding and classified the text. As a first step, the questions that were enclosed in the script were used as initial categories, then during a rigorous and systematic reading of the transcript, the main categories started to emerge [ 33 ]. The researchers used an inductive coding method to find meaningful messages to categorize into main themes and sub-themes.

The information was then analyzed in conjunction with the Ecological Model conceptual framework. The importance of the Ecological Model in the social sciences is the consideration of interactions between the people’s behavior and the environment (sociocultural, policy, and physical) [ 16 , 29 ].

With the results from this model, we developed a list of factors influencing healthy eating behaviors among college students, based on content analysis of the focus groups ( Figure 1 ). We adapted a model by Deliens, Clarys, Bourdeaudhuij & Deforche [ 29 ], and then developed the following main levels for the analysis: individual (intrapersonal), social (interpersonal relationship), and university environment (community settings), and some main attributes of the students (e.g., gender). The most significant quotes by respondents were reported to illustrate each (sub)theme. We also decided to incorporate some basic information of the participants by using an ID for the quotes: e.g., FG1_F21 (Focus Group 1, Female, age 21 years old).

Factors influencing healthy eating behaviors of college students.

3.2.1. Individual Level (Intrapersonal)

Intrapersonal factors are represented mainly by attitude, behavior, self-concepts, and skills [ 16 ].

Healthy Eating: Meaning, Perception, and Consequences

Research shows that individuals’ beliefs about a healthy diet is shaped by their psychology. Understanding what healthy eating means is crucial to making healthy food choices across and within product categories. Participants seemed to be aware of healthy eating habits: “ For me, healthy eating is eating clean. So, lots of fresh veggies and fruits and some sort of protein ” (FG1_F20); however, they were also aware that they did not necessarily follow this suggestion: “ Things (healthy food) that help fulfil your daily nutrition requirement, even though I obviously don’t do that ” (FG1_F20).

There was a gap between having knowledge and actually practicing it: “ … now I feel like I’m more aware of it (healthy eating), I just don’t pay attention to it ” (FG5_F21). In addition, they highlighted how the meaning of healthy eating had changed over the past decades: “ when I was a kid, I definitely thought it was more ... just eating less, ... now I understand that it’s more eating the right things, and not necessarily eating less, but just eating different stuff ”(FG1_F21).

During the focus groups, the term “healthy” itself proved to be quite elastic: “ I think about getting a lot of balance ” (FG3_M23) and it was perceived to have changed overtime: “ before, it was all about portion control, eating smaller things, but now, it’s focused more on eating healthy things ” (FG1_F20). Most participants considered their generation to be more health-aware and more health-conscious than the previous ones. However, others believed that today, it is harder for people to eat healthy because there is so much fast food available. For someone whose parents taught them during childhood, healthy eating remained an important factor for the future: “ my mom told me when I was a kid, healthy eating is if your plate is colourful, so sometimes when I went through that little phase where I was trying to eat really well at the dining halls I’d be like, carrots, orange, tomatoes, red, I’d get a bowl of blueberries, blue. You’d try to get every colour on your plate and that’s healthy ” (FG5_F19).

Participants were aware of the long-run consequences of not maintaining a healthy diet: “ It’s risk for diseases, increasing your risk of dying earlier ” (FG4_F19); “ you have less health problems, for the most part, that are related to your diet. You probably have more energy, honestly, because processed stuff sort of slows you down ” (FG1_F20). In particular, a male participant reported: “ I think that America has this epidemic, which is obesity. And I know that leads to a whole bunch of complications, especially the demographic that I am. I understand that our life expectancy isn’t as high as other demographics, and that’s due to obesity, diabetes, heart disease and stuff like that ” (FG2_M20).

They also considered “eating healthy” as something that was related to a lifestyle with positive consequences to the general mindset of the individual: “ I think healthy is feeling good about yourself, having energy, and not being exhausted all day ” (FG2_F18); “ I think healthy goes beyond just food, you have to be mentally healthy and physically healthy ” (FG2_F19); “ I tend to like healthy food, it makes me feel better ” (FG6_M22). More generally, people related the concept of being healthy to both physical and psychological status: “ I think being healthy is both your physical appearance and your mindset… exercised and eating food, as well as balancing it out with your mental state ” (F2_M20).

We used a projective technique to create more interaction and interest on the topic. Images of overweight/obese people were shown, and participants were then asked what thoughts came into their mind. Most participants felt uncomfortable with describing these images. Some of them thought that being heavily overweight or obese could be attributed to not having control over their own lifestyle: “ I feel bad for them, because I know the probably inside, they are not happy with themselves, but it’s all your personal choice ” (FG3_M19). At the same time, there was a feeling both of sadness for them, but also a willingness to not judge other people’s weight status. Only one person mentioned that body image was a motivator in maintaining healthy eating: “ I want to be in a good shape, and I think that’s what motivates me ” (FG4_M21).

Eating Habits (Healthy and Unhealthy)

Every participant was asked to list five healthy and five unhealthy eating habits on post-it notes and then share it among the groups ( Table 3 ). First, snacking was associated most of the time with unhealthy eating, as mentioned by several participants: “ I’m trying to eat a heavier breakfast so that I snack less throughout the day ” (FG1_F21); “ I have snacks late night, mostly, if I’m going to snack at all, it’s generally junk food ” (FG4_M19). Only a few of them tried snacking with an healthy option: “ I don’t mindlessly snack, but when I do snack, it’s always something healthy like nuts or fruit ” (FG4_F19). Some participants did not seem conscious of having three meals a day, but preferred to have smaller snacks consistently throughout the day and being portion-aware: “ I try to eat like four to five times a day like smaller meals as opposed to just like breakfast, lunch and dinner ” (FG3_M23). Regarding drinking habits, surprisingly, alcohol consumption was not mentioned as an unhealthy drinking habit; but more attention was focused on the most common daily drinks (i.e., water, coffee, and soda). One female participant said: “ I like carbonated drinks, like sugary drinks that I should probably stay away from ” (FG1_F21). Many people were aware that a high sugar-sweetened beverage intake was associated with greater weight gain.

Top 12 self-reported healthy and unhealthy eating habits of the participants.

Notes: “Other”: eating habits that have been mentioned only one or two times. The researchers decided not to report them.

The participants were asked about why American consumers do not follow the dietary guidelines given by the United States Department of Agriculture (USDA). Most of them mentioned that nowadays there is a greater availability of unhealthy foods: “ I think there’s a lot more junk food now than there was then, and it’s also way cheaper than getting healthy food ” (FG1_F20); “ I think junk food is way more accessible than going out to get healthy food ” (FG1_F21); “ sometimes people just don’t have access to food in their neighbourhood ” (FG6_M22).

Food Preferences

Food preferences are highly complex, personal, and influenced by a broad variety of factors, especially physiological. Even if health seemed to be important for everyone, when choosing food, students did not take health into consideration as the most important factor, but usually pleasure and taste. As one participant said: “ I think unhealthy food just tastes better. I don’t know, if a food tastes good to me, I have thoughts of, "Is this unhealthy?" Because I feel like healthy food just doesn’t taste as good ” (FG2_F19). Likeability as a first factor for choosing food was confirmed by another student: “ I think unhealthier food just tastes better to everybody ” (FG2_M20). Another participant highlighted the importance of the pleasure of eating: “ I really like pasta, like a lot, it’s pretty much what I eat every day. I put hot sauce on everything ” (FG5_F19).

Healthy Activities

Almost all of the participants mentioned that they had been very busy since they started tertiary education, and that this was a barrier to maintaining a healthy lifestyle. They remembered that exercising was as a big part of family time: “… me and my two brothers and my dad, we started going to the gym. So we’d go to the gym like every weekend ” (FG2_M20); “ I play a lot of soccer with my dad ” (FG3_M19). It is clear the role of parents in incentiving activities to stay healthy: “ my parents were also very encouraging of me and my other siblings with doing sports ” (FG6_M21). Nowadays, due to time constraints associated with being a college student, it was more difficult to stay active. The statement “ not keeping junk food in the house ” was repeated by several students as a way to avoid the temptation of eating unhealthy foods, as was having small snacks throughout the day rather than designated meals. They were also aware about overeating, and few of them believed themselves to be good at controlling portion sizes: “ I try to get individual packages, so I have portion control ” (FG2_F18).

Food Preparation and Knowledge

In order to eat healthy, consumers must have some knowledge about food, healthful products, and the composition of a meal, among others. During the focus groups, participants were asked about changes that they had made in their cooking habits since they had moved from home. Some of them realized how negative the changes were in terms of eating healthy: “ the first time I lived outside of home wasn’t good. I ate out twice a day, every day, which is really unhealthy and really expensive. So now I’m trying to cook more, which is good. I feel like I’m healthier when I’m cooking it myself ” (FG1_F21). Others confirmed how expensive it is to eat out frequently: “ Well I didn’t cook at all when I was at home. So just off campus, it’s cheaper to cook than eating out every night, so I’m just trying to cook more ” (FG1_F21).

Students were asked their involvement in preparing food when living with their parents, the majority declared to have never helped in the kitchen or only during holiday meals. One participant shared a personal experience: “ Only for Thanksgiving or Christmas I would usually make a dessert or something like that. Cake or cookies ” (FG6_M21).

When asked to elaborate more on a healthy diet and give examples, few students had a vague idea of what the Mediterranean diet was about: “ I’ve definitely heard of it before, but I don’t ... is it like, only eating certain Greek, Mediterranean ingredients? ” (FG2_F19), and most of them had not even heard of the term before.

Time, Price and State of Mind

The transition from living at home to the college experience was considered to be stressful. Most of the participants mentioned a problem with stress eating, especially when studying; as one participant said: “ … I definitely snack too much when I’m stressed ” (FG4_F19). Another one: “ I work too much. I don’t take the down time to exercise. I like to snack a lot. I use food to regulate my mood ” (FG6_M22). Almost all participants believed that they did not have enough time to prepare healthy meals. The “lack of time” appeared to be an important barrier: “ I don’t have time to be going to the grocery store to just get fruit and healthy things ” (FG1_F20). Time constraints also made students skip meals: “ …then sometimes I will eat at random hours during the day, including sometimes I’ll have to skip lunch if I just don’t have enough time, which I can see the effects, it just makes me really tired, it’s not good for working out ” (FG4_F19).

Also, the relative perception of the high costs of buying healthy food (i.e., fruits and vegetables) was one of the main barriers to a varied diet [ 2 , 34 ]. For many students: “ junk food is way cheaper than getting healthy food ”; as one female participant specified: “ it can be hard to afford healthy food, because no matter what healthy eaters say about how easy is to find cheap, healthy food, it’s always probably gonna be cheaper to find heavily processed junk food ” (FG1_F20). Another female participant with Asian origin confirmed with her personal experience that: “ it’s very abnormal in America that the fruit and the vegetables are much expensive than the meat, because back in China the vegetables and fruits are very cheap, so everyone can have access to that ” (FG5_F24).

3.2.2. Social Level (Interpersonal Relationships)

Social relationships in early adulthood are predominantly formed with roommates and friends at college, as well as with family members, even if with a lower frequency with the latter. The perception of social pressure was a strong determinant in supporting and maintaining a healthy diet [ 35 ]. As one participant said in relation to healthy eating: “ What you eat and who you’re around is really influential ” (FG2_F20). Another one confirmed this point: “ Seeing if someone’s eating really unhealthy, you can be like: "I’m going to be the one to eat healthy tonight", or if everyone’s eating healthy, you feel more inclined to eat healthy ” (FG2_F20). Sometimes, it was also the influence of the partner that could make a person change their dietary habits.

Parental Feeding Behavior

Respondents were asked about how parents can negatively and positively impact a child’s eating behavior. They agreed that it was difficult for kids and adolescents to learn about eating healthy if their parents did not influence and teach them: “ I think as a child, you look up to your parents a lot, so instead of verbally saying, "Eat healthy, blah blah blah…" you actually have to show it ” (FG2_F19).

One student explained that sometimes there was a risk that the parents were too busy to take care of their children’s diet: “ If parents are too busy or they don’t have the income and also the time, if they’re working too many jobs, you know, they’ll just get packaged food or processed foods and that could definitely have a very negative effect ” (FG6_M21). As a result, the parents prefer to give them money to buy food away from home and most of them choose junk food or fast food: “ if I’m with my friends, I can kind of get away with my mom not knowing what I’m eating. So I tend to eat what I can’t eat at home, so always unhealthy ” (FG1_F21).

These young adults believed that parents should give a good example (i.e., not going to a fast food place). Most of the students mentioned the role of the mother as a relevant figure for giving good recommendations: “ my mom has always ingrained the healthy eating thing in me ” (FG1_F20); “ when I was younger ... even now, my mom only has healthy food available for me. And if I ever shop with her, she doesn’t let me buy snacks or sweets ” (FG1_F21). The participants who mentioned that their parents were good at cooking, and liked preparing foods from different cultures, also realized that they should not be really picky in their food choices. Others reported that their parents used some tricks to make their children to eat healthy food: “ I think my parents just seasoned my vegetables so it would taste better. And that way I wouldn’t really have to think about me eating vegetables ” (FG4_M20). Other students experienced a more ambiguous and controversial approach with food: “ We weren’t allowed to leave the table until I finished my food ” (FG4_F21); in this case, sometimes their mothers were part of the "Clean Plate Club”, a club where parents are used to asking their children to finish everything on their plates.

Dietary Aspects of Home, School, and Eating Out

Respondents were asked what different eating behaviors they had between eating out and at home. Even if young adults ate in a variety of different settings, especially after living with their parents, the number of times eating out strongly increased. For instance, eating at home was usually correlated with higher fruit and vegetable intakes. However, many participants said that eating out was a kind of relief where all food desires could be satisfied: “ I tend to eat what I can’t eat at home, so always unhealthy ” (FG1_F21); “ when I’m eating out "I might as well treat myself" and treat myself for nothing ” (FG4_F21); “ when I lived at home, I would always eat really healthy, so whenever I go out, I tend to eat a lot of junk food ” (FG1_F21). One participant’s personal experience confirmed that: “ usually when I go out with my friends or family, I eat just such trash food. And restaurant food to begin with is already so caloric, and then you just add on top of it, let’s get appetizers and desserts ” (FG4_F19).

High school had also a strong determinant on eating habits; most of the time, eating in secondary school was related with a negative experience: “ a lot of times in high school I just ate chips, because I just hated my school lunch, it was pretty bad. But I think if the school lunch is the only thing that’s available to you, it’s definitely going to affect what you’re eating and how you’re eating ” (FG4_F21). Several students reported that they did not feel that the school meal was healthy, due to limited choices. One remembered: “ we always used to joke about saying that pizza counted as a vegetable, we had to get a vegetable but pizza counted, so we’d always get pizza ” (FG4_M19). However, almost all of the participants agreed that nowadays, schools are getting more involved in providing healthy options than in the past: “ I think our school definitely they had healthier options ” (FG5_F19).

Friends and Media Pressure

Young adults are often influenced by their peers for many habits, and also when eating behaviors are involved [ 29 ]; as one male participant, who had a high frequency in activity level and played in a team, said: “ there is just so much social pressure to eat healthy around other people ” (FG3_M23). As one female student reported: “ I think every girl has this kind of thing and you have some pressure from your friends and if you will see them wearing beautiful dresses you want to lose weight or something ” (FG5_F24). Another explained: “ I think general rule of thumb, if you see people [friends] that look healthy, that we tend to ask someone, what do you eat? How do you do that? ” (FG5_M21). Usually, meals with friends tended to be not healthy: “ when I’m with my friends in the evening we do tend to eat heavier meals, which make me feel pretty sick the next morning ”. However, for someone else, the experience was the opposite: “ I think the big thing that changed for me was when I came here at Cornell, I saw other people and their eating habits, and some of them were eating lean or eating healthier, and I tried to pick up on some of those too ” (FG4_M21).

Many participants raised concerns about the role of television and other mass media on how an adolescent or young adult should look: “ I just feel like in the media, you see all these images of celebrities and their body type is glorified, so you just want to eat healthier to look like that ” (FG4_F19). In addition, they also considered advertisement on TVs for candies and other sweet foods to be negative communication on what to eat, as one participant said: “…there’s all these ads on TVs for candies and stuff like that… kids would rather have the bright colors, the fun candies and stuff that aren’t necessarily healthy” (FG1_F21).

3.2.3. University Environment and Student Life

Besides human physiology, the physical environment is also another element that can strongly shape our food choices [ 36 ]. In general the surroundings where you are living can strongly determine your diet: “ I also think like your environment that you’re in and that like you’re constantly in really affects how you eat ” (FG3_M19).

The university environment could have both a positive and negative influence on eating habits, as one participant explained: “ I think if the community is driven to be healthier, then I think once you’re in that environment, it tries to influence you to be healthier. And seeing other people around you eat healthy and want to be healthier is a big influencer on changing your habits. And vice versa ” (FG2_F20). For example, most of the students thought that the dining halls strongly influenced their eating habits. Some students started to eat irregularly when starting college: “ I eat irregularly, like sometimes for dinner I just don’t want anything in the dining halls and I’ll just eat cookies or the ice cream ” (FG5_F19); “ I probably eat more meat at college, I don’t know, just a lot of food ” (FG5_F19). When asked what events could make a person gain or lose lots of weight, someone said that going to college made people gain weight: “ having that sort of unrestricted freedom of being able to choose whatever you want to eat, and also having a meal plan where it’s like an “all-you-can eat” buffet ” (FG1_F20). One participant shared a personal experience and said: “ I need to go eat every meal at the dining hall. And once you’re at the dining hall, you have unlimited food, so I feel like I overate a lot in the dining halls. And now living off campus, I’m able to just buy what I want to cook, and sometimes I cook all my food at once. So I can plan, this is for lunch, this is for dinner. So I can do better with portion control ” (FG1_F21).

For some other students, especially athletes, having the dining hall always available and close to the dormitory or workplace was instead an advantage: “ it was good to have the dining halls right there so you could kind of eat whenever you wanted to. So it helped me stay healthy and had a good eating pattern for that kind of lifestyle. And then, I think once when I got off campus, it’s like harder to keep up with good eating patterns ” (FG6_M21). Student life could be a critical period regarding unhealthy changes in lifestyle behaviors: “ I also sometimes skip lunch when I have class or studying to do, and a lot of times when I’m studying I also eat junk food, try to keep myself awake ” (FG4_M21).

Table 4 summarizes the main barriers and enablers that are associated with health decisions during college life.

Summary of the main barriers and enablers to a healthy diet among college students ( n = 35).

Source: own elaboration.

4. Discussion

Using an adapted version of an Ecological Model used by Deliens et al. [ 29 ], we developed a framework that included individual (intrapersonal), social (interpersonal), university environment (community settings), and students’ life factors as influences affecting eating habits. This model integrated individual healthy and unhealthy eating patterns, in combination with the main barriers and enablers that are associated with health decisions during college life. Many researchers [ 4 , 15 , 37 , 38 , 39 ] identified a great number of factors that may contribute to the malnutrition epidemic, and related health problems (e.g., weight gain and other dietary disorders) in emerging adulthood: unhealthy eating habits increased when young adults leave their home circumstances, such as lower consumption of healthy options (i.e., fruit and vegetables), irregular meals (e.g., breakfast skipping), and increasing intakes of unhealthy snacks and other “junk food” (e.g., fried food). For college students, the transition phase from living at home to living alone/with roommates during the period of postsecondary education, is one of the most important life changes, and many food choices are deeply involved in this change.

As indicated by other authors [ 2 , 3 , 4 , 35 ], the most common factors that are reported as barriers to a healthy diet are time constraints, the high price of food items, and their availability, followed by the lack of motivation in food preparation, which is strongly related to intention. Regarding the latter barrier, as reported by Menozzi, Sogari & Mora [ 35 ], intention is the main factor in predicting behavior regarding the consumption of healthy foods, such as fruits and vegetables. Therefore, we believe that nutrition professionals within the university community should design programs and tools that can help students to be more motivated in choosing healthy food. During the focus groups, students realized the strong role of college facilities in influencing their eating habits. In fact, when students start college, they will face a new (food) environment (e.g., all-you-can-eat formula dining), which can have strong impact on their eating habits and intention to perform a healthy behavior. Interventions across campus dining facilities should decrease the potential barriers to healthy food, and increase self-efficacy and behavioral controls, to encourage students to embrace a better diet [ 40 ].

Among the social enablers, students found that having the support of friends to be active in healthy eating was an important stimulus. We also observed that students who have a higher frequency of physical activity believe that social pressure helps them to stay healthy. Parents also have a crucial role, both positive and negative, in shaping the concept of healthy eating and in encouraging children in healthy activities, both related to eating (e.g., food preparation) or more physical (e.g., sport, outdoor activities). We noticed how perceived benefits of healthy eating also influence the intention to consume healthier food [ 41 ], which seems to be more easily achieved if students start planning their meals (self-control technique). Moreover, university characteristics, such as living arrangements (i.e., dormitory, off-campus, with parents) or academic schedules (e.g., classes, exams, etc.), also influence the relationships between individuals and their eating behaviors [ 18 , 29 , 42 ], and they should be taken into account when designing effective and tailored multilevel intervention programs.

Finally, it should be noted that some barriers for certain individuals, might be perceived as potential drivers by others. For instance, and not surprisingly, some students stated that “all-you-can-eat” formulas have a negative impact on the amount and quality of food consumed, whereas others believed that these types of dining halls facilitated their ability to have a healthy diet.

The focus groups confirmed that both lifestyle and behavioral factors are strongly associated with dietary patterns among college students: participants were aware that “being a healthy person” was not just exercising and eating healthy foods, but also taking time for yourself and being an overall happy individual.

One of the methodological limitations to the current study is that these results cannot be automatically generalized to the whole population of university students, when considering the specific and limited sample of participants (i.e., US college environment, healthy BMI status, other). Another limitation is related to the presence of students who might have been more interested in this topic, and decided to participate at the focus group, leading to “selection bias”.

5. Implications

More precision in the relationship between food and health is a topic of growing importance on the public agenda [ 43 ]. Nevertheless, even with wide recognition that the food that we consume has a strong impact on our health, consumers’ food preferences do not always lead to the best nutritional choices. A better understanding of the link between diet and health among college students is important for developing programs and behavioral change strategies to improve their lifestyle in general, and to reduce diet-related diseases in particular [ 9 ].

This study highlights the importance of consulting college students when developing healthy eating interventions across the campus for dining services or programs. As suggested by Stok et al., [ 10 ], researchers in the food and nutrition field should not only focus on individual-level factors, but they should also integrate socio-ecological aspects into the analysis. Dining halls and other University facilities should ensure the availability of healthy food choices, as well as promoting physical activity practices regularly. They should also provide food education and food preparation classes, to make students more knowledgeable on how to cook and better plan meals.

Giving college students the necessary skills to be more aware of what a healthy diet style means would empower them to make better food choices throughout their life. As suggested by many authors [ 4 , 44 ], interventions should be specific for the targeted population (i.e., young adults) in order to help individuals to behave accordingly with their healthy intentions. For instance, social media facilitates the interaction between individuals and organizations (e.g., university administrators and food researchers), in order to provide tailor-made information [ 29 , 45 ]. This aspect can be helpful in promoting healthy diets without creating eating disorders. In addition, price reductions for high-cost foods in campus facilities, such as dining halls and cafeterias, should also facilitate the purchase of more healthy options (e.g., fruits and vegetables). Environmental modifications can include changing and/or labeling healthy food options to make them more appealing, while creating a point of nutrition information where students can see healthy food options.

6. Conclusions

The aim of this study was to identify factors driving healthy lifestyle behaviors among US college students. Opinions and recommendations for effective and tailored-made intervention programs or environmental modifications that support healthy eating were presented, using an ecological framework that combined psychological, social, and environmental strategies.

Consumer behavior scientists typically do not contribute to the scientific debate about what is best to eat from a nutritional point of view or give recommendations about dietary components for the specific amounts and limits for food groups. In this study, we instead tried to understand the individual, social, and environmental factors that influenced students’ healthy eating choices. Our results suggest that participants were influenced by individual, social, and university environmental factors.

The Ecological Model can help university communities to gain more insights into how and why students make certain food choices, and support them in staying healthy.

Colleges and dining halls on campuses should acknowledge their crucial role in guiding healthy eating behaviors, and be the first subjects to be interested in creating a healthy environment for the students. Unless they start understanding the reasons behind unhealthy eating behaviors of young adults, effective policies and managerial strategies to fight malnutrition (obesity, anorexia, micro-deficiency) cannot be developed.

The next step of this research will include the collection of a larger and more representative sample size, especially when taking into consideration the socio-cultural differences of college students between the US and other Western countries. Considering that the same negative trend of overweightness and unhealthy eating behavior among children, adolescents, and young adults is emerging in Europe, and also in Mediterranean countries [ 46 ], discussions on potential and future studies addressing this problem in a national context are advised. In addition, further research should evaluate whether specific tailor-made interventions are effective in changing behaviors towards a healthy lifestyle.

Acknowledgments

This study, which is part of a wider project called “CONSUMEHealth. Using consumer science to improve healthy eating habits”, has received funding from the European Union’s Horizon 2020 research and Innovation programme under the Marie Sklodowska-Curie grant agreement No 749514. We appreciate the assistance of Liam Wickes-Do and Zekun Ma, two research assistants, for the contribution in data collection, cleaning and transcription of the focus groups. The authors also thank all students participating in this study and the staff members of the Cornell Institute for Social and Economic Research (CISER). We also sincerely appreciate the feedbacks and insightful comments of the anonymous reviewers who helped improve and clarify this manuscript.

Author Contributions

G.S. took lead in writing the manuscript and was overall responsible for the study design, data collection and analysis. C.V.-A. has contributed in the study design and in the data collection (Focus Group moderator). C.M. and M.I.G. contributed in the result interpretation and made suggestions and comments of the final version of the manuscript. All authors read and approved the final manuscript.

Conflicts of Interest

None of the authors or affiliated institutions associated with this manuscript submission has any financial or personal relationship or affiliation that could influence the present work.