Eating behavior and physical activity leading to gender differences in overweight and obesity among college students in China

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Eating behavior and physical activity leading to gender differences in overweight and obesity among college students in China

https://doi.org/10.21203/rs.3.rs-1882754/v2

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Overweight and obesity are showing an increasing prevalence among college students. But gender differences related to overweight and obesity in Chinese college students have not been adequately characterized. This cross-sectional study aimed to investigate the gender differences in overweight and obesity among college students, then, investigate why these gender differ-ences exist. A total of 622 undergraduate students (females: N = 245, male: N = 377), aged 18–23 years, were recruited from the Hebei Sport University in China. Anthropometric data, physical activity and sedentary behaviors, eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating) and food addiction were collected through anthropometric measurements and questionnaires that included the International Physical Activity Questionnaire short-form (IPAQ-SF), the Modified Food Addiction Scale version 2.0 (mYFAS 2.0), and the Three Factor Eating Questionnaire (TFEQ). Here, we show that female college students had a significantly higher prevalence of overweight and obesity (Female: BFP ≥ 25%; Male: BFP ≥ 20%) than male students. Meanwhile, Female college students had a higher mean body fat percentage (BFP) and a lower waist circumference, waist-to-hip ratio, visceral fat area, fat-free mass, muscle mass, and skeletal muscle mass compared to male college students. Additionally, female college students were more likely to be moderate physical activity than males, while male college students were more likely to be severe physical activity. Female college students had significantly higher mean scores for cognitive restraint, uncontrolled eating, and emotional eating than males. Our findings indicated that the higher prevalence of overweight and obesity rates in female college students than male students may be due to de differences in physical activity and eating behavior.

gender differences

overweight

obesity

college students

International Physical Activity Questionnaire

Yale Food Addiction Scale

Three Factor Eating Questionnaire

Overweight and obesity are defined as abnormal or excessive fat accumulation, which is a major global public health problem and a predisposing factor for many diseases, including type 2 diabetes mellitus [1], cardiovascular disease (CVD) [2], multiple cancers [3], a series of skeletal and muscular diseases [4], chronic kidney disease [5]. Notably, the China Chronic Disease and Nutrition Surveillance 2015–2019 survey indicated that the overall prevalence of overweight and obesity among adults (≥ 18 years) were 34.3% and 16.4%, respectively [6]. On current trends, one out of five adults worldwide will be obese by 2025. Although overweight and obesity have become a global epidemic, there are also significant differences in gender [7], race/ethnicity [8], socioeconomic status [9], geographic region [8], and health insurance status [10]. Previous studies suggest that the prevalence of overweight and obesity tends to be higher in richer countries, but overweight and obesity rates are higher in the rural population compared to both the prefecture and metropolitan populations in America [11]. Additionally, Black men have greater odds of obesity than White men, but Asian men have lower odds of obesity than white men in the South, West, and Midwest of America [8]. Lastly, overweight and obesity are more prevalent in women than men in most countries, but in some countries and population subgroups, this gender gap is more pronounced [12, 13]. According to 2017–2018 data from the National Health and Nutrition Examination Survey (NHANES) of America found that the percentage of adult men who are overweight (34.1%, 25 ≤ BMI ≤ 29.9 kg/m²) is higher than the percentage of adult women who are overweight (27.5%), but the percentage of adult women who have severe obesity (11.5%, BMI ≥ 40 kg/m²) is higher than the percentage of adult men who have severe obesity (6.9%). Some findings from China show that boys (2–10 years old) are more likely to be overweight and obese than girls in Shanghai and Nanchang of China [14, 15]. However, overweight and obesity differences among gender inequalities in Chinese college students have not been sufficiently explored. The present study will examine the different rates of overweight and obesity between female and male college students, then, investigate why these gender differences exist. Understanding the drivers of these gender differences might help to provide guidance for the most promising intervention strategies.

Overweight and obesity are often driven by energy intake that exceeds energy expenditure, which is a state of positive energy balance [16]. A variety of factors such as inactive lifestyle, environment, genes and family history, health problems, medicines, emotional factors, smoking habits, age, pregnancy, and sleep patterns may have an effect in causing people to have an energy imbalance [17]. It has been shown that physical inactivity in adolescence (16–18 years) strongly and independently predicts total abdominal obesity in young adulthood (at the age of 25), while overweight and obesity often impact negatively on an individual’s level of physical activity [18]. Accumulating evidence suggests that physical activity contributes to dampening the development of overweight and obesity, and higher levels of physical activity always accompany lower rates of overweight and obesity [19, 20]. Researchers have speculated that 225–420 minutes per week of physical activity can lead to clinically significant weight loss (≥ 5% weight loss), and 200–300 minutes per week of physical activity can prevention of weight gain after weight loss [21]. Although physical activity contributes to weight loss and maintenance, combining physical activity with a healthy diet is a more effective way to lose weight. A physical training program (275 min/wk) of six months combined with energy-restricted intake (− 1200 to − 1500 kcal/day) resulted in a loss of 10% or more of initial body weight in adult overweight women [22]. Cognitive restraint eating (CR), uncontrolled eating (UE), and emotional eating (EE) are the most commonly studied types of eating-related behavior which refer to a tendency to overeat in response to negative emotions or hunger and a tendency to consciously restrict food intake [23, 24]. Additionally, food addiction is a complex and maladaptive eating behavior that results in the excessive and uncontrolled intake of palatable food [25]. Previous studies have shown that men report more cravings for foods with a high content of fat, whereas women report more cravings for sweets and chocolate [26, 27]. In the present study, we determined whether physical activity, food addiction and eating behaviors influence gender differences in overweight and obesity rates.

2.1 Participants

In this cross-sectional survey study, a total of 647 undergraduate students, aged 18–23 years, were recruited from the Hebei Sport University in China. twenty-one undergraduate students (9 males, 12 females) were excluded because they did not finish all the tests. Participants are divided into two groups according to gender: female college students (N = 245, Mage = 19.9 years old) and male college students (N = 377, Mage = 20.1 years old). Data were collected through anthropometric measurements and questionnaires (International Physical Activity Questionnaire short-form (IPAQ-SF); Modified Food Addiction Scale version 2.0 (mYFAS 2.0); Three Factor Eating Questionnaire (TFEQ)). Participants were informed about the objectives of the study and informed written consent was obtained. All methods were carried out in accordance with the relevant guidelines and regulations. All procedures were approved by the ethics committee of the Guangzhou Sport University and Hebei Sport University.

2.2 Anthropometric measurements

Body height and weight were measured with the standing position without shoes. The data of body height and body weight were recorded to the nearest 0.1 cm and 0.1kg, respectively. Body mass index (BMI) was calculated using this equation: BMI = weight (kg) / Height² (m). Grading of BMI was done according to China grading (underweight: BMI < 18.5 kg/m²; normal weight: 18.5 ≤ BMI ≤ 23.9 kg/m²; overweight: 24 ≤ BMI ≤ 27.9 kg/m²; obesity: BMI ≥ 28 kg/m²) [28]. Additionally, based on WHO and China criteria, overweight and obesity were identified as body fat percentage (BFP) ≥ 25% in females and BFP ≥ 20% in males [29]. Waist circumference (WC) and hip circumference (HC) was measured at the midpoint between the lower rib and top of the iliac crest and at the largest hip circumference, respectively [30]. Dates were recorded to the nearest 0.1 cm. The Waist-Hip-Ratio (WHR) was calculated as WC (cm) divided by HC (cm). Body composition and adipose tissue content (Visceral fat area, VFA (cm²); Body fat percentage, BFP (%); Fat-free mass, FFM (kg); Muscle mass (kg); Skeletal muscle mass (kg)) were detected by multi-frequency bioelectrical impedance analysis (MF-BIA) using the InBody 770.

2.3 Physical activity and sedentary behaviors

Physical activity and sedentary behaviors were measured using the International Physical Activity Questionnaire short-form (IPAQ-SF) which contain seven questions that require participants to recall the number of days per week and average minutes spent per day participating in walking, moderate-intensity activities, vigorous-intensity activities, and sitting time [31, 32]. We classified physical activity below 600 MET•min/week, 600–3000 MET•min/week, and greater than 3000 MET•min/week as mild, moderate, and severe activity respectively [33]. The formula for the computation of Met-minutes is: MET values (walking − 3.3 METs; moderate activity − 4.0 METs, and vigorous activity − 8.0 METs.) × minutes of activity/day × days per week. The sum of Walking, Moderate, Vigorous physical activity was considered as total physical activity. The time spent in sedentary behavior was also evaluated. This variable was dichotomized based on a threshold of 6 h or less of daily sedentary behavior [32]. The IPAQ-SF has already shown good reliability and validity in Chinese college students [34].

2.4 Food addiction

The modified Yale Food Addiction Scale version 2.0 (mYFAS 2.0) was used for the analysis of the presence of positive food addiction and addictive-like eating behavior during the past 12 months in university students [35]. The mYFAS 2.0 questionnaire consists of 11 items assessing symptoms of food addiction, and two items assessing diet-related impairment and distress. Each item scored on an eight-level Likert scale ranging from 0 (never) to 7 (every day). Then, the question was scored as “threshold not met” or “threshold is met” based on a different threshold. Two scoring options are available: symptom count score (11 items) and the clinical significance criterion (2 items). For diagnosis with mYFAS 2.0, the symptom count score (threshold is met) must be ≥ 2 out of 11 food addiction criteria and show the clinical significance criterion. The severity level of food addiction is calculated as: mild food addiction (2–3 symptoms and clinical significance), moderate food addiction (4–5 symptoms and clinical significance), and severe food addiction (6 or more symptoms and clinical significance). Higher mYFAS 2.0 scores indicate an increased risk of food addiction [36]. The mYFAS 2.0 could be considered reliable (Cronbach's α = 0.88) for a sample of college students [37].

2.5 Eating behaviors

Eating behaviors were measured using the 21-item Three Factor Eating Questionnaire (TFEQ-R21, Chronbach’s α = 0.82) [38, 39]. The scale included 21 questions that measure three domains of eating behavior: cognitive restraint (CR, 6 questions; the conscious restriction of food intake aimed to control body weight and/or to promote weight loss), uncontrolled eating (UE, 9 questions; the tendency to eat more than usual due to a loss of control over intake with a subjective feeling of hunger), and emotional eating (EE, 6 questions; an inability to resist emotional cues, eating as a response to different negative emotions). Items 1–20 were scored on a four-point response scale (1: none or a little of the time, 2: some of the time, 3: good part of the time, 4: most or all of the time). But item 21 had an eight-point response scale, where 1 means ‘I never restrain from eating’ and 8 means ‘I always restrain from eating’ and was scored as follows: 1 or 2 (1 points), 3 or 4 (2 points), 5 or 6 (3 points), and 7 or 8 (4 points). The scores for the three dimensions of the scale were calculated separately. A high score from any sub-dimension of the scale indicates that the eating behavior related to that sub-dimension is high [40].

2.6 Statistics

Data are presented as the mean ± SD. Demographic data including overweight and obesity rates, physical activity, sedentary behavior, and food addiction were compared using chi-square tests among female and male participants. Other data sets (age, height, weight, body mass index, waist circumference, waist-to-hip ratio, visceral fat area, body fat percentage, fat-free mass, muscle mass, skeletal muscle mass, sedentary time, mYFAS 2.0 scores, cognitive restraint, uncontrolled eating, emotional eating) were compared using independent t-tests. Results were considered to be significant at p < 0.05.

3.1. Gender differences in overweight and obesity rates, body composition among participants

Participants' characteristics are shown in Table 1. The total number of participants who participated in this study was 622 college students, 39.4% of them were females (n = 245, Mage = 19.9 years old), and 60.6% were males (n = 377, Mage = 20.1 years old). There was no significant difference between female and male college students in mean age (p > 0.05). The mean reported height of female and male participants was 163.3 cm (SD = 5.6) and 176.8 cm (SD = 6.0), respectively. The average weight of female and male college students was 56.3 kg (SD = 7.7) and 71.9 kg (SD = 11.0), respectively. Our results showed that male college students were significantly taller and heavier than female college students (p < 0.001). The BMI of female and male college students were 23.6 kg.m² (SD = 5.1) and 23.0 kg.m² (SD = 3.2), respectively, but the gender differences were not statistically significant (p = 0.073). When the overweight and obesity rate was examined according to BMI (BMI ≥ 24 kg/m²), we found that the prevalence of overweight and obesity was 10.61% for female college students and 26.79% for male college students. Additionally, the mean BFP was significantly higher (p < 0.001) in female (23.9 ± 5.3 kg/m²) than in male (16.0 ± 5.8 kg/m²) college students. Based on BFP (Female: BFP ≥ 25%; Male: BFP ≥ 20%) classification, the prevalence rates of overweight and obesity among female and male college students were 37.34% and 20.46%, respectively. There were significant gender differences in the overweight and obesity rate (p < 0.001). Regarding body composition differences between gender, female participants had lower mean values of waist circumference, waist-to-hip ratio, visceral fat area, fat-free mass, muscle mass, and skeletal muscle mass compared with males (p < 0.001).

3.2. Gender differences in the level of physical activity and sedentary behavior

As shown in Table 2, more than half of female college students (52.65%) had mild physical activity levels, 31.43% had moderate physical activity levels and 15.92% had severe physical activity levels. Additionally, there were 55.70% of male college students reported mild physical activity, and 20.42% and 23.87% reporting moderate and severe physical activity, respectively. The chi-square test revealed a significant difference in moderate (p = 0.002) and severe (p = 0.020) physical activity levels between females and males. The proportion of females engaging in moderate levels of physical activity was notably lower than males. However, males were more likely than females to participate in severe physical activity.

Sedentary behavior (SB) has been defined as a mean of > 6 hours of sitting or reclining posture [32]. In this study, we found 15.10% of female college students and 17.24% of male college students reported sitting for > 6 hours per day (sedentary behavior). The mean sedentary time was 4.2 hours per day for female college students and 4.4 hours per day for male college students. The results showed that there was no significant difference between female and male college students in the sedentary behavior and mean sedentary time (p > 0.05).

3.3. Gender differences in the food addiction

In the current study, we found that 6.94% of female college students and 7.96% of male college students met the criteria for food addiction measured by using the mYFAS 2.0. The mean mYFAS 2.0 scores were 24.8 for female college students and 24.0 for male college students. There were no statistically significant gender differences in the food addiction and mYFAS 2.0 scores (p > 0.05).

Table 1

Characteristics of the study participants by gender
Parameters	Female	Male	p值
Number of participants (N)	245	377
Age (years)	19.9 ± 1.2	20.1 ± 1.2	p = 0.051
Height (cm)	163.3 ± 5.6	176.8 ± 6.0	p < 0.001
Weight (kg)	56.3 ± 7.7	71.9 ± 11.0	p < 0.001
Body mass index (kg/m²)	23.6 ± 5.1	23.0 ± 3.2	p = 0.073
BMI ≤ 23.9 kg/m² (N, %)	219, 89.39	276, 73.21	p < 0.001
BMI ≥ 24 kg/m² (N, %)	26, 10.61	101, 26.79	p < 0.001
Waist circumference (cm)	67.9 ± 7.1	76.6 ± 8.7	p < 0.001
Waist-to-hip ratio	0.75 ± 0.05	0.80 ± 0.05	p < 0.001
Visceral fat area (cm²)	34.9 ± 20.0	52.2 ± 21.6	p < 0.001
Body fat percentage (%)	23.9 ± 5.3	16.0 ± 5.8	p < 0.001
Female: BFP ≥ 25 (N, %)	90, 37.34		p < 0.001
Male: BFP ≥ 20 (N, %)		76, 20.46	p < 0.001
Fat-free mass (kg)	42.7 ± 3.9	59.9 ± 8.1	p < 0.001
Muscle mass (kg)	39.2 ± 3.6	55.8 ± 7.0	p < 0.001
Skeletal muscle mass (kg)	18.7 ± 4.0	29.2 ± 5.7	p < 0.001

3.4. Gender differences in the mean scores of eating behavior (cognitive restraint, uncontrolled eating, emotional eating)

We next examined gender differences in the parameters of cognitive restraint, uncontrolled eating, and emotional eating. The means of cognitive restraint of female and male college students were 14.5 (SD = 2.4) and 13.0 (SD = 2.7), respectively. The means of uncontrolled eating of female and male college students were 22.3 (SD = 3.6) and 19.9 (SD = 4.3), respectively. The means of emotional eating of female and male college students were 12.0 (SD = 3.7) and 9.8 (SD = 4.0), respectively. Overall, female college students had significantly higher mean scores for cognitive restraint, uncontrolled eating, and emotional eating than males (p < 0.001).

Table 2

Physical activity, sedentary behavior, food addiction and eating behavior
Parameters	Female	Male	p值
Number of participants (N)	245	377
Mild PA (N, %)	129, 52.65	210, 55.70	p = 0.460
Moderate PA (N, %)	77, 31.43	77, 20.42	p = 0.002
Severe PA (N, %)	39, 15.92	90, 23.87	p = 0.020
Sedentary behavior (N, %)	37, 15.10	65, 17.24	p = 0.508
Sedentary time (hours)	4.2 ± 1.7	4.4 ± 1.7	p = 0.246
Food addiction (N, %)	17, 6.94	30, 7.96	p = 0.757
mYFAS 2.0 scores	24.8 ± 13.2	24.0 ± 14.3	p = 0.490
Cognitive restraint	14.5 ± 2.4	13.0 ± 2.7	p < 0.001
Uncontrolled eating	22.3 ± 3.6	19.9 ± 4.3	p < 0.001
Emotional eating	12.0 ± 3.7	9.8 ± 4.0	p < 0.001

The current study aimed to investigate the overweight and obesity differences in gender inequalities among Chinese college students, then, examine why these gender differences exist. Here, we have demonstrated that female college students had a higher prevalence of overweight and obesity than male college students (Female: BFP ≥ 25%; Male: BFP ≥ 20%). Additionally, the proportion of females engaging in moderate physical activity was notably higher than males. However, males were more likely than females to participate in severe physical activity. Female college students had significantly higher mean scores for cognitive restraint, uncontrolled eating, and emotional eating than males. Our findings suggest that gender differences in overweight and obesity may be partly due to differences in physical activity and eating behavior.

We found that the overweight and obesity rate of females when the body fat percentage (PBF) was used was 37.34%, which was higher than that when BMI was used (10.61%). However, the overweight and obesity rate of males when PBF was used was 20.46%, which was lower than that when BMI was used (26.79%). BMI is widely used to classify overweight and obesity. However, BMI presents as an inaccurate obesity classification method that overestimates overweight and obesity among muscular individuals and underestimates overweight and obesity among those with low muscle mass due to its reliance on height and weight rather directly assessing body composition [41]. This study showed that female college students had lower muscle mass and skeletal muscle mass compared with males. Thus, BMI may underestimate the overweight and obesity among female college students and overestimate the overweight and obesity among male college students. Recently, the body fat percentage (BFP) has been considered as a more accurate standard to determine being overweight or obese because it measures body fat directly [42]. Overall, female college students are more susceptible to overweight and obesity than male college students in China. This trend is consistent with previous studies among college students [43]. Additionally, according to the China Chronic Disease and Nutrition Surveillance 2015–2019 survey published in 2020, 50.7% of adult residents (≥ 18 years old) are classified as overweight and obese (BMI ≥ 24 kg/m2), of whom 16·4% are obese (BMI ≥ 28 kg/m2) [6]. Therefore, the prevalence of overweight and obesity among college students was lower than among adult residents in China. This difference may be due to the participants in this study being mainly college students pursuing a degree in physical education who probably have more time for physical activity. Another reason could be the age of the groups studied; the age of college students was 18–23 years, whereas the age of the adult residents was ≥ 18 years old. We should also be mentioned that female participants had lower mean values of waist circumference, waist-to-hip ratio, visceral fat area, and fat-free mass compared with males.

The gender difference may be mainly influenced by different behavioral styles (physical activity, sedentary behaviors, eating behavior, food addiction) between female and male college students. Physical activity (PA) is a significant factor in the treatment and prevention of overweight and obesity. It has been recommended by the WHO that adult (18–64 years) should participate in moderate-intensity aerobic physical activity for at least 150 minutes per week or vigorous-intensity aerobic physical activity for at least 75 minutes per week to ensure health benefit. Researchers have speculated that 225–420 minutes per week of physical activity can lead to clinically significant weight loss (≥ 5% weight loss), and 200–300 minutes per week of physical activity can prevention of weight gain after weight loss [21]. In this study, the level of physical activity was classified into three categories, which are mild (< 600 MET•min/week), moderate (600–3000 MET•min/week), and severe (≥ 3000 MET•minutes/week) [33]. We found that female college students were more likely to engage in moderate physical activity than female college students but were less likely to engage in severe physical activity. In the present study, we found no significant difference between female and male college students in the sedentary behavior and mean sedentary time. These results indicated that gender differences in overweight and obesity may be partly due to differences in physical activity rather than sedentary behavior and sedentary time.

Food addiction is a food-related behavioral addiction that is characterized by the compulsive or uncontrollable consumption of foods high in fat, salt, and sugars [44]. It has been shown that food addiction was associated with a higher risk of overweight and obesity [32]. In this study, there were no statistically significant gender differences in the food addiction and mYFAS 2.0 scores. This suggests that gender differences in overweight and obesity may not be associated with food addiction. But males and females may tend to crave different kinds of foods. Several studies have shown that men report more cravings for foods with a high content of fat, whereas women report more cravings for sweets and chocolate [26, 27]. Additionally, traditional dietary pattern (high intake of rice, pork and vegetables) was inversely associated with abdominal obesity; modern dietary pattern (high intake of fruit, fast food, and processed meat) was positively associated with abdominal obesity in Chinese elderly people [45]. Meanwhile, there are gender differences in the association between dietary patterns and obesity in middle-aged and elderly populations in Shanghai, China [46].

The present study also sought to examine the variation in eating behavior between genders. Eating behaviors are described as behaviors related to food intake which influence the frequency of eating, meal size, meal content, and attitude to meals. Cognitive restraint eating (CR), uncontrolled eating (UE), and emotional eating (EE) refer to the three most commonly studied psychological types of eating-related behavior [47]. In this study, we utilized the Three Factor Eating Questionnaire (TFEQ) to assess cognitive restraint, uncontrolled eating, and emotional eating among university students [38, 39]. Cognitive restraint refers to the conscious restriction of food intake to control weight and/or promote weight loss, rather than using physiological cues (hunger and satiety) as regulators of intake. Uncontrolled eating refers to a tendency to eat more than usual due to a loss of control over intake with a subjective feeling of hunger and is a defining characteristic of binge eating disorder. Emotional eating reflects an inability to resist emotional cues, eating as a response to different negative emotions (i.e., when feeling stressed, lonely, anxious or depressed). The present study uncovered that female college students had significantly higher mean scores for cognitive restraint, uncontrolled eating, and emotional eating than males. The results suggest that female college students can be more prone to limit food consumption to control their weight, but they are also more vulnerable to eating in response to hunger and negative emotions.

In conclusion, our findings suggested that physical activity and eating behavior may contribute to gender differences in the prevalence rates of overweight and obesity.

Data availability

Data are available upon reasonable request from the corresponding author.

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No competing interests reported.

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Eating behavior and physical activity leading to gender differences in overweight and obesity among college students in China

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Abstract

1. Introduction

2. Materials And Methods

2.1 Participants

2.2 Anthropometric measurements

2.3 Physical activity and sedentary behaviors

2.4 Food addiction

2.5 Eating behaviors

2.6 Statistics

3. Results

3.1. Gender differences in overweight and obesity rates, body composition among participants

3.2. Gender differences in the level of physical activity and sedentary behavior

3.3. Gender differences in the food addiction

3.4. Gender differences in the mean scores of eating behavior (cognitive restraint, uncontrolled eating, emotional eating)

4. Discussion

5. Conclusions

Declarations

References

Additional Declarations

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