​

Overweight and obesity affect nearly 1/3 of the world and are ranked as the 5th foremost reason for global mortality. The World Health Organization (WHO) defines obesity as an “abnormal or excessive fat accumulation that may impair health.” All systems of the human body are negatively impacted by excess adiposity which, in turn, is directly associated with rising non-communicable disease rates. (Mohajan & Mohajan, 2023). Malnutrition in all its forms – overnutrition, undernutrition, and nutrient imbalances –has economic and human costs. (Killeen et al., 2021). A McKinsey Global Institute analysis estimated the global economic cost of obesity as approximately $2.0 trillion or 2.8% of global gross domestic product (GDP) (Anekwe et al., 2020). That amount of money could buy 100% of the Apple Computer company, all professional sports teams in America, and repay the entire U.S. debt to China. The scale of the problem keeps growing; scientists are concerned that obesity may threaten the existence of humanity (Mohajah & Mohajan, 2023). 

​

U.S. National Health and Nutrition Examination Survey (NHANES) data indicate that American adults are now more at risk of obesity/overweight and its comorbidities than ever in modern history (Woolcott & Seuring, 2022). A study by Fan et al. (2023) explored trends according to decade-wide birth cohorts. Adults born in the 1940s were the last group with recorded weight stability. Starting in the 1950s, an upward trend in obesity prevalence began with rates increasing in each decade (Fan et al., 2022). Industrialization, mechanized transportation, urbanization, technology, and an abundant supply of inexpensive energy-dense food contributed to the development of an obesogenic environment in this country. By the year 2030, it is predicted that 48.9% of U.S. adults will be obese (Anekwe et al., 2020). Complications of being overweight or obese include high blood pressure, heart disease, diabetes, sleep apnea, and some cancers. 

​

Within the U.S. population, young adults aged 18 – 28 years, are seeing the greatest rate of increase in overweight. This puts them at premature risk for chronic diseases previously found in older Americans (McArthur et al., 2018). According to the American College Health Association, 34.1 % of college students are overweight or obese (Odlaug et al., 2015). Behavior-change programs to prevent obesity typically overlook college students as an at-risk population (Martinez et al., 2016), but they are an ideal target for nutrition intervention. The student population is in a time of transition to independence and is receptive to acquiring new knowledge. Making positive changes in lifestyle habits at this age promotes self-confidence (Makiabadi et al., 2019). While most college students are biologically mature adults, their psychosocial development is still incomplete. Unhealthy habits acquired during adolescence may persist and, without intervention, continue into later years (Helvaci et al., 2021). Previous studies have shown that college students consume excessive amounts of sugar-sweetened beverages and foods high in fat and salt. They are sedentary due to class time, study time, and technology use (Banna et al., 2017; Martinez et al, 2016). Two university-based studies determined that interventions to increase nutritional literacy improved nutritional behaviors (Banna et al., 2016; Makiabadi et al., 2019). Researchers at the University of Hawaii (UH) studied the barriers to healthier student behaviors. Students identified a lack of knowledge, time, and facility access as hindrances. They also reported an interest in potential campus programming to improve diet and increase physical activity (Martinez et al., 2017). 

​

College women are of particular interest to public health experts. The World Health Organization (WHO) declared that maternal nutrition is a leading issue for global public health (Killeen, 2021). While a precise preconception period is not known until after a woman conceives, dietary behaviors should be improved years before conception is considered (Stephenson et al., 2018). Healthy People 2030 proclaims a goal of increasing the number of women with a healthy weight before pregnancy (ODPGP, n.d.). The average age of first-time pregnancy in the U.S. is 25.8 years old (Odlaug et al., 2015). While college women may not be considering motherhood, providing education about healthy dietary behaviors benefits their overall health whether a pregnancy is in their future or not. A program of interventions aimed at college-aged women may help reduce overweight and obesity, the associated health risks and serve to establish healthy eating and exercise behaviors (Desai et al., 2008). 

 

The proposed program. “Today Matters: Health is in Your Hands,” will provide evidence-based nutrition education to college women in the greater Boston area. This program intends to:

• Improve the nutritional knowledge of college-aged women.

• Improve the nutritional status of college-aged women.

• Promote increased physical activity among college-aged women.

• Increase the number of college-aged women who achieve and maintain a healthy weight.

​

The proposed program will include in-person classroom instruction, fitness training, cooking demonstrations, and small group discussion support within an academic semester. By providing evidence-based information about nutrition and physical activity and emphasizing its importance to young adult women, "Today Matters" can inspire participants to adopt healthy habits and make positive lifestyle choices for a better future.

​

Offering this program in the Boston metropolitan area will provide access to a large pool of college students from all over the world. The area is home to 360,000 students at 85 institutions of higher learning (McSweeney & Marshall, n.d.). This program has great potential to successfully reduce the incidence of overweight/obesity among women 18-24, their risk for impaired health and chronic disease, and indirectly, complications of future pregnancies. First, this program is theoretically based on the Health Belief Model (HBM), incorporating constructs of perceived susceptibility, perceived barriers, and self-efficacy (McArthur et al., 2018). Second, similar nutrition education programs delivered at Tabiz University in Iran (Saghafi-Asl et al., 2020), the University of Hawaii (Martinez et al., 2016), and the University of Minnesota (Pope et al., 2019) improved college students’ awareness of the value of achieving a healthy weight.

 

Finally, the “Today Matters” program will be tailored to the needs of female college students and supported by the infrastructure of college partners. College administration, faculty, and staff are stakeholders who will find this program an asset to existing wellness initiatives. Creating a healthier campus community and improving the well-being of students aligns with each college’s mission and supports a thriving psychosocial and academic environment. Students will benefit directly from participating in the program, and their parents, lifelong influencers of their children’s health, will be advocates. The Boston area and even the global community will benefit from the creation of a more health-focused culture which can ultimately lead to a reduction in healthcare costs. Investing in the “Today Matters” program is an investment in the health of young women and potentially, future generations. 

​

​

References

​

Anekwe, C. V., Jarrell, A. R., Townsend, M. J., Gaudier, G. I., Hiserodt, J. M., & Stanford, F. C. (2020). Socioeconomics of obesity. Current obesity reports, 9, 272-279. 

https://doi.org/10.1007/s13679-020-00398-7

​

Banna, J., Richards, R., & Brown, L. B. (2017). College students' perceived differences between the terms real meal, meal, and snack. Journal of nutrition education and behavior, 49(3), 228-235. https://doi.org/10.1016/j.jneb.2016.11.001

​

Desai, M. N., Miller, W. C., Staples, B., & Bravender, T. (2008). Risk factors associated with overweight and obesity in college students. Journal of American College Health, 57(1),109-114. https://doi.org/10.3200/JACH.57.1.109-114

​

Fan, K., Lv, F., Li, H., Meng, F., Wang, T., & Zhou, Y. (2023). Trends in obesity and severe 

obesity prevalence in the United States from 1999 to 2018. American Journal of Human Biology, 35(5), e23855. https://doi.org/10.1002/ajhb.23855

​

Helvacı, G., Kartal, F. T., & Ayhan, N. Y. (2021). Healthy Eating Index (HEI-2015) of female college students according to obesity and exercise participation. Journal of Obesity & Metabolic Syndrome, 30(3), 296. https://doi.org/10.7570/jomes21018

​

Killeen, S. L., Geraghty, A. A., O'Brien, E. C., O'Reilly, S. L., Yelverton, C. A., & McAuliffe, F. M. (2022). Addressing the gaps in nutritional care before and during pregnancy. Proceedings of the Nutrition Society, 81(1), 87-98.  https://doi.org/10.1017/S0029665121003724

​

Pope, Z. C., Barr-Anderson, D. J., Lewis, B. A., Pereira, M. A., & Gao, Z. (2019). Use of 

wearable technology and social media to improve physical activity and dietary behaviors among college students: a 12-week randomized pilot study. International journal of environmental research and public health, 16(19), 3579. 

https://doi.org/10.3390/ijerph16193579

​

Makiabadi, E., Kaveh, M. H., Mahmoodi, M. R., Asadollahi, A., & Salehi, M. (2019). Enhancing nutrition-related literacy, knowledge and behavior among university students: a randomized controlled trial. International Journal of Nutrition Sciences, 4(3), 122-129. https://doi.org/10.30476/IJNS.2019.82709.1027

​

Martinez, Y. T. S., Harmon, B. E., Nigg, C. R., Bantum, E. O., & Strayhorn, S. (2016). Diet and physical activity intervention strategies for college students. Health behavior and policy review, 3(4), 336-347. https://doi.org/10.14485/HBPR.3.4.5

​

McArthur, L. H., Riggs, A., Uribe, F., & Spaulding, T. J. (2018). Health belief model offers opportunities for designing weight management interventions for college 

students. Journal of nutrition education and behavior, 50(5), 485-493. 

https://doi.org/10.1016/j.jneb.2017.09.010

​

McSweeney, D. M., & Marshall, W. J. (n.d.). The prominence of Boston area colleges and Universities. United States Bureau of Labor Statistics. 

https://www.bls.gov/opub/mlr/2009/06/regrep.pdf

 

Mohajan, D., & Mohajan, H. K. (2023). Obesity and its related diseases: a new escalating alarming in global health. Journal of Innovations in Medical Research, 2(3), 12-23. https://doi.org/10.56397/JIMR/2023.03.04

​

Odlaug, B. L., Lust, K., Wimmelmann, C. L., Chamberlain, S. R., Mortensen, E. L., Derbyshire, K., ... & Grant, J. E. (2015). Prevalence and correlates of being overweight or obese in college. Psychiatry Research, 227(1), 58-64.

https://doi.org/10.1016/j.psychres.2015.01.029

​

Office of Disease Prevention and Health Promotion (ODPHP) (n.d.) Pregnancy and childbirth. Healthy People 2030. U. S. Department of Health and Human Services. 

https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-proportion-women-who-had-healthy-weight-pregnancy-mich-13

​

Saghafi-Asl, M., Aliasgharzadeh, S., & Asghari-Jafarabadi, M. (2020). Factors influencing weight management behavior among college students: An application of the Health Belief Model. PloSone, 15(2), https://doi.org/10.1371/journal.pone.0228058

​

Stephenson, J., Heslehurst, N., Hall, J., Schoenaker, D. A., Hutchinson, J., Cade, J. E., Poston, L. Barrett, G., Crozier, S. R., Barker, M., Kumaran, K., Yajnik, C. S., Baird, J., & 

Mishra, G. D. (2018). Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet, 391(10132), 1830-1841. https://doi.org/10.1016/S0140-6736(18)30311-8

​

Woolcott, O. O., & Seuring, T. (2023). Temporal trends in obesity defined by the relative fat mass (RFM) index among adults in the United States from 1999 to 2020: a population-based study. BMJ open, 13(8), e071295. https://doi.org/10.1136/bmjopen-2022-071295

​