Focus on the Freshman Fifteen

Saturday, 21 July 2018

Rebecca Graves, PhD1
Sharon Fruh, PhD1
Heather R. Hall, PhD1
Katherine Bydalek, PhD1
Bettina H. Riley, PhD, RN2
Debra M. Swanzy, DNP1
Susan G. Williams, PhD3
Theresa F. Wright, DNP1
Christen Carter, BMS-S4
(1)College of Nursing, University of South Alabama, Mobile, AL, USA
(2)College of Nursing, Community Mental Health Nursing, University of South Alabama, Mobille, AL, USA
(3)College of Nursing, University of South Alabama, Fairhope, AL, USA
(4)University of South Alabama, Mobile, AL, USA


Incoming college freshmen are at an elevated risk for weight gain. Between 51% and 72% of college students gain weight during their first college year (Gillen & Lefkowitz, 2011; Smith-Jackson & Reel, 2012). As of 2016, 36.8% of college students in the U.S. were classified as overweight or obese (American College Health Association, 2016). The causes of weight gain during this time include students having more autonomy over their dietary and exercise choices (Gillen & Lefkowitz, 2011).

Most freshman students at a specific university in the Deep South are from the state of Alabama (77-82% freshmen/year over the past five years), the third most obese state in the U.S. (Trust for America’s Health & Robert Wood Johnson Foundation, 2016). Furthermore, 50% of the students from Alabama are from a county that has the highest rates of diabetes in the U.S. (Gallup-Sharecare, 2016). Thus, the probability is high that students at the university enter with higher rates of obesity than at colleges in other areas of the country.

College students have increased exposure to the obesogenic environment often noted on college campuses (Delinsky & Wilson, 2008), including unlimited high-calorie, high-salt, and high-fat foods and snacks; late-night eating; insufficient sleep; stress; lack of time/interest/access regarding meal preparation; higher cost of healthy foods; drinking alcohol and soft drinks; sitting for long periods; and low levels of physical activity. The term “freshman fifteen” is a weight gain of 15 lbs. or more frequently occurring during the college freshman year (Smith-Jackson & Reel, 2012). It is often difficult to lose excess weight gained by a young person, which frequently then carries over into adulthood (Mahlotra, Ostbye, Riley, & Finkelstein, 2013). Adults 25 years and older gain one pound/year on average (or 35 pounds by the age of 60; Mahlotra et al., 2013). Young adults who gain excess weight are at much higher risk for diseases as they age, including diabetes, hypertension, heart disease, and stroke (Dangardt, Chen, Berggren, Osika, & Friberg, 2013). Overweight or obese individuals are also at increased risk for depression, anxiety, and social isolation (Ames & Leadbeater, 2017). Addressing health habits regarding diet and activity in college students may improve their physical and mental health status (Plotnikoff, Collins, Williams, Germoy, & Callister, 2015).

This study is significant because: 1) college freshmen are vulnerable for weight gain (Smith-Jackson & Reel, 2012); 2) the majority of freshmen at the university are from Alabama, which has a very high-risk for obesity (Trust for America’s Health & Robert Wood Johnson Foundation, 2016); 3) lifestyle changes initiated in college will likely last into adulthood (Mahlotra et al., 2013); and 4) it is critical to understand the extent of the problem for freshmen of the university from their perspectives (Weinstock, 2010). Findings from this study can contribute to future interventions preventing excess weight gain in college students since these data identify prevalent areas of concern.


This cross-sectional exploratory study was designed to collect detailed self-reported information from freshman pre-nursing students at the university regarding dietary and activity habits as well as challenges the students experience while functioning in an obesogenic environment. An on-line survey was developed in Qualtrics based on BUCS: Live Well survey created by Michelle Lee, PhD, RD (McKinney, 2013) to offer a convenient, efficient way of collecting data in a college environment, because it allows students anonymity and the ability to answer sensitive questions with decreased pressure for social conformity and/or embarrassment.

Research Design

After institutional review board approval, the research team administered the on-line survey to a convenience sample of pre-nursing students in an Introduction to Nursing course the Fall of their freshman year. Time was allocated to administer the survey during class; however, no class credit or other incentive was provided, completion of the survey was voluntary, and all responses were anonymous.

Statistical Analysis. Data from the surveys were exported into SPSS and evaluated for frequencies and descriptive statistics, including measures of central tendency and variance. Body mass index (BMI) was calculated from self-reported height and weight. Pearson and Spearman’s correlations were analyzed between pertinent variables.



A total of 158 pre-nursing freshmen responded to the survey; 91% were female. The mean age was 18.38 (SD=1.3). Most respondents were white (69%), 26% black/African American, 3% Asian, 1% Hispanic, and 0.6% biracial. Most students (67%) lived on campus and had a university meal plan (70%).


Mean BMI was 25.02 (SD=5.2) with a range of 16.44 to 39.53; however, 15 respondents did not provide both measurements necessary to calculate BMI. When asked to describe their weight, 34% selected “slightly overweight” and 5% “very overweight”; 58% indicated they were trying to lose weight at the time of the study. Most students selected it was somewhat important (56%) or extremely important (20%) to eat healthy each day. Additionally, most reported it was somewhat important (53%) or extremely important (25%) to be physically active each day. Two students were taking medication to control high blood pressure, two for type 2 diabetes, and three for depression.


Most students reported eating less than 2 servings of fruit daily (51%) and less than three servings of vegetables daily (70%). Most students do not avoid foods high in salt (64%) or in total fat (57%). Unhealthy daily consumption habits included regular sodas (17%), sweet tea (9%), energy drinks/flavored water (10%), alcoholic drinks (0.6%), fries (9%), potato chips (6%), baked crackers/chips (8%), white bread (5%), white pasta (3%), and sweets (9%). Positive daily consumption habits included fruit (13%), green salad (9%), vegetables (10%), whole grain bread (4%), and whole grain pasta (2%); however, the low percentages of students consuming these healthy foods daily is alarming.

Dietary Challenges. When asked how difficult decreasing food consumption would be, 27% selected “somewhat difficult”, and 8% selected “very difficult”. The biggest challenge to healthy eating was the cost of healthy foods (53%) followed by the time healthy eating takes (20%) and being too busy to eat healthy foods (13%).


Almost half (49%) of the students selected that they were “a bit” physically active but “not a lot”, and 34% percent reported they did not exercise regularly. However, 39% agreed and 29% strongly agreed that they enjoy getting regular exercise.

Activity Challenges. The biggest barriers to exercise for those who did not exercise regularly were lacking the time (47%), lacking self-discipline (29%), and being self-conscious (16%). Forty-two percent were too busy to exercise, and 8% did not enjoy exercising.


More than once a year, almost half (49%) of the respondents stated they are treated with less respect than others, 63% feel other people act as if they are better than the respondent, 38% are called names or insulted. Twenty-nine percent are teased about their weight.


Students’ levels of satisfaction with various aspects of daily life with a Likert-type scale ranged from “very dissatisfied” (=1) to “very satisfied” (=5). Respondent BMI was negatively correlated with six of these seven constructs including personal appearance (r= -.31, p=.000), energy and feeling healthy (r= -.25, p=.002), overall quality of life (r= -.25, p=.003), self-esteem (r= -.21, p=.012), confidence/self-assurance (r= -.21, p=.013), and physical mobility and activity (r= -.18, p=.034).

Respondent BMI was also associated with a) activity level (r= -.24, p=.005) with frequency and duration increasing as the score increased, b) if respondent currently exercises (r=.22, p=.008) with “yes”=1 and “no”=2, c) if respondent enjoys getting regular exercise (r=.24, p=.004) with “strongly agree”=1 and “strongly disagree”=5, and frequency of respondent being called names or insulted (r=.2, p=.02) with frequency increasing as score increased. Other significant correlations confirmed associations between healthy dietary and activity habits.


As with any survey, there will be respondents who do not answer every question and those who do not answer questions truthfully or appropriately. Responses identified as incomplete were removed from the data before analysis.

This study was conducted in the Deep South; therefore, findings may not be generalizable to other areas of the U.S. due to the significant weight problems and weight-related health problems in this area of the country. However, the optimal location to address a problem is where occurrence is the highest.


This study identifies that incoming freshman pre-nursing students have a BMI in the overweight range. These students also indicated that they have unhealthy diets with limited fruit and vegetable intake and do not avoid foods high in salt and fat. This population is at very high risk for obesity and related diseases.

Results also indicate that increased BMI is associated with low levels of life satisfaction and activity. All findings are especially concerning since Melnyk et al. (2017) found that higher rates of depression and obesity in nurses is associated with poor health indices and that nurses in poor mental and/or physical health have reported making more medical errors than have those who are healthy. It is critical that health habits of pre-nursing students are evaluated and that interventions are designed to promote physical and emotional health in this high-risk population.