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Changes in body weight, composition, and shape: a 4-year study of college students

Publication: Applied Physiology, Nutrition, and Metabolism
17 September 2012

Abstract

The objectives of this study were to examine changes in body weight, body mass index (BMI), body composition, and shape in a group of male and female students over the 4-year college period. Anthropometric assessments including height and weight (via standard techniques), body composition (via bioelectrical impedance analysis), and body shape (via 3-dimensional body scanning) were conducted at the beginning of the freshman year and end of the senior year in 131 college students. Four-year changes included significant (p < 0.0001) gains in weight (3.0 kg), BMI (1.0 kg·m–2), body fat (3.6%), and absolute fat mass (3.2 kg). Males gained significantly (p < 0.0001) greater amounts of weight, BMI, percent and absolute fat mass, and fat-free mass than females. Weight change ranged from 8.7 to +16.8 kg. About 70% of the participants gained weight, which averaged 5.3 kg; significant (p < 0.0001) gains in BMI, fat-free mass, absolute fat mass, and percent body fat and significant (p < 0.0005) increases in neck, chest–bust, waist, hips, seat, and biceps circumferences were also observed in this weight gain group. The percentage of participants classified as overweight–obese increased from 18% to 31%. The number of females and males with ≥30% and 20% body fat, respectively, increased from n = 14 to n = 26 (with n = 4 exhibiting normal weight obesity) over the 4-year period. The waist circumference changes were significantly (p < 0.0001) correlated with both weight and percent body fat changes. In conclusion, the increasing prevalence of obesity and normal weight obesity among this college population suggests the need for additional health promotion strategies on college campuses.

Résumé

Cette étude se propose d’analyser les variations de la masse corporelle, de l’IMC, de la composition corporelle et de la forme corporelle d’un groupe d’étudiants, hommes et femmes, sur une période de quatre années universitaires. Au début et à la fin de ces quatre années, on évalue la taille et la masse corporelles (au moyen des techniques habituelles), la composition corporelle (par l’analyse de l’impédance bioélectrique) et la forme corporelle (numérisation par balayage tridimensionnel) de 131 étudiants universitaires. Sur une période de 4 ans, on observe une augmentation significative (p < 0,0001) de 3,0 kg de la masse corporelle, de 1,0 kg·m–2 de l’IMC, de 3,6 % du pourcentage de gras corporel et de 3,2 kg de la masse adipeuse. Comparativement aux femmes, l’augmentation de poids, de l’IMC, du pourcentage de gras, de la masse adipeuse et de la masse maigre est plus importante chez les hommes (p < 0,0001). La variation de la masse corporelle s’étale de –8,7 à + 16,8 kg. Environ 70 % des participants ont pris en moyenne 5,3 kg; l’augmentation de l’IMC, de la masse maigre, de la masse adipeuse et du pourcentage de gras est significative (p < 0,0001) et l’augmentation de la circonférence du cou, de la poitrine, de la taille, des hanches, du bassin et de la circonférence du bras est aussi significative (p < 0,0005) dans le groupe qui a pris du poids. Le pourcentage de participants appartenant à la catégorie surpoids–obèse est passé de 18 % à 31 %. Le nombre de femmes et d’hommes présentant respectivement ≥30 % et 20 % de gras corporel est passé en quatre ans de 14 à 26 dont 4 obèsesde poids normal. Les variations du tour de taille sont corrélées significativement (p < 0,0001) aux variations du poids et du pourcentage de gras corporel. En conclusion, l’augmentation de la prévalence d’obésité et d’obésité de poids normal dans cette population étudiante est une indication de la nécessité d’instaurer d’autres stratégies de promotion de la santé sur les campus.

Introduction

Both obesity (defined as a body mass index (BMI) ≥ 30 kg·m–2) and “normal weight obesity” (i.e., having a BMI in the normal range of 18.5 to 24.9 kg·m–2 but having excessive body fat) are associated with a multitude of health problems. While obesity has been linked with an increased risk of hyperlipidemia, heart disease, hypertension, and stroke, among others, normal weight obesity or greater adiposity has been linked with dyslipidemia, hypertension, and hyperglycemia (Daniels et al. 1999; Dervaux et al. 2008; Gómez-Ambrosi et al. 2011; Romero-Corral et al. 2010; Vizcaíno et al. 2007) as well as with elevated plasma C-reactive protein concentrations, an indicator of inflammation (Musso et al. 2011; Ridker et al. 2003). Moreover, recent studies, which have included adults aged as young as 20 years, have found that gains in body fat are positively associated with heart disease as well as all-cause mortality and cardiovascular mortality (Romero-Corral et al. 2010).
Waist circumference represents an excellent marker of abdominal or central obesity (Huang et al. 2001), and like body adiposity, larger waist circumference measurements have been associated with multiple health conditions. Waist circumference has been shown to be predictive of insulin resistance (Raman et al. 2008) and to be associated with cardiovascular disease risk factors (Freedman et al. 2007; Schwandt et al. 2010; Yan et al. 2007). Additionally, waist circumference was found to be an independent determinant of intima media thickness of the common carotid coronary artery (a marker of subclinical atherosclerosis) in obese children (Fang et al. 2010). Waist circumference and BMI also have been shown to be significantly correlated with plasma C-reactive protein concentrations in adolescents (Jung et al. 2010; Musso et al. 2011). It has been demonstrated that for every centimeter increment in waist circumference, cardiovascular risk increases by 2% (de Koning et al. 2007), and for every 4 kg·m–2 increase in BMI, heart disease risk increases by at least 26% (Nordestgaard et al. 2012).
Weight and BMI gains during the first year of college have been extensively studied in both the United States and Canada (Economos et al. 2008; Edmonds et al. 2008; Gropper et al. 2009; Holm-Denoma et al. 2008; Mifsud et al. 2009; Provencher et al. 2009; Pullman et al. 2009). While the so called “freshman 15”, the belief that students gain 15 pounds the first year of college, has been disproven, few studies have investigated changes in weight and (or) BMI into the sophomore year of college (Gropper et al. 2011; Hull et al. 2007; Lloyd-Richardson et al. 2009; Racette et al. 2005, 2008). Moreover, no studies have examined changes in body composition and (or) waist circumference beyond the first 2 years of college and only 1 study has been conducted to date that followed weight and BMI in students through the senior year of college (Racette et al. 2008). The present study investigated not only changes in body weight and BMI, but also changes in body composition and shape, including waist circumference, over the 4-year college period.

Materials and methods

Subjects

College freshmen were recruited from Auburn University’s incoming freshman class via email, fliers, and class announcements in introductory courses typically taken by first year students at the beginning of fall semester in 2007. Auburn University’s 2007 incoming freshman class consisted of 4191 students (53% female and 47% male). This freshman class was mostly Caucasian (81.7%), followed by African-American (11.3%), Hispanic (2.9%), Asian (1.9%), and Native American (0.8%) with permanent residence in Alabama (57%); however, about 43% of the class had permanent residences elsewhere, including Georgia (18.3%), Florida (6.1%), Tennessee (3.8%), and Texas (2.7%) to name a few (Auburn University 2007).
Freshman volunteers were excluded from participation if they were under 17 years or older than 19 years of age, pregnant, married, had children, reported a diagnosed eating disorder, or enrolled at the university prior to fall semester 2007. Informed consent from participants and from parents for subjects under 19 years was obtained prior to study participation. This study was approved by the university’s Institutional Review Board for the Use of Human Subjects in Research.

Procedures

Participants were assessed at the beginning (about the first 4 weeks) of fall semester of their freshman year (in late August and early September 2007) and at the end of spring semester of their senior year (in late April and early May 2011). At the initial assessment, participants completed a demographic questionnaire to obtain self-reported information regarding sex, race–ethnicity, birth date, state of permanent residence, and residence location at college. At both assessments, height and body weight, composition, and shape were measured. This study was part of a larger study, which included additional anthropometric assessments along with questionnaires investigating environmental, behavioral, and lifestyle habits; body image and satisfaction; eating behavior regulation; stress; and depression over the 4-year period.
Body weight and height were measured with a digital scale and an attached height rod (Healthometer, Pelstar, LLC, Model 500KL, Bridgeview, Ill., USA). Participants were required to remove items from their pockets as well as to remove outer garments, such as coats, shoes, belts, and hats, before being weighed and measured. Scale accuracy was verified with external weights prior to all assessments. BMI was calculated for each participant by the standard formula, dividing weight by height squared (kg/m2). Participants were classified based on BMI as underweight, normal weight, overweight, or obese using the Centers for Disease Control and Prevention (CDC) definitions for adults because of the longitudinal study design.
Body composition was measured using bioelectrical impedance analysis (BodyStat, BioVant Systems, Detroit, Mich., USA) which has been validated for accuracy against other body composition assessment methods (Kyle et al. 2004). Measurements varied by less than 0.5% with repeated measurements of the same subject. For body composition assessments, participants reclined on their back for 5 min and were positioned with arms and legs separated laterally from the medial axis and with electrodes attached to the right hand and foot. Participants were instructed not to eat 2–4 h prior to assessments as well as not to drink alcohol or caffeine or participate in moderate to vigorous physical activity for 12 h prior to assessments.
Body shape was assessed using the NX16 3-dimensional body scanner (TC2, Cary, N.C., USA). Body scans, using white light technology, obtained body circumference measurements with a circumference accuracy of <3 mm, a higher level than achieved by traditional measurements (TC2 Technology Corporation 2012).

Statistical analyses

Statistical analyses were performed using Instat 3.0 (GraphPad Software, San Diego, Calif., USA), and SPSS Statistics 17.0 (SPSS Inc., Chicago, Ill., USA). Differences in ethnicity–race between the university freshman population and the study population were examined using the χ2 test. Repeated measures analysis of variance was used to examine differences in outcome measures between the beginning of the freshman year and the end of the senior year. A Student’s t test was used to compare the weight and BMI of those who returned versus those who did not return for re-assessments as well as to compare differences in outcome measures between males and females. A p value of <0.05 was considered statistically significant. Data are reported as means ± standard deviation unless noted differently.

Results

Of the 240 initial participants (65% females and 35% males), over half, 131 participants (68% females and 32% males), returned at the end of the senior year for reassessment. Of the non-returners, 48 participants (44% of the non-returners) were no longer enrolled at the university, and 3 females (about 3%) were not invited back to participate because of reported eating disorders. The initial weight and BMI of the non-returners (64.6 ± 12.4 kg / 142.2 ± 27.2 lbs and 22.5 ± 4.9 kg·m–2, respectively) did not significantly differ from those of the returners (66.2 ± 16.2 kg / 145.7 ± 35.7 lbs and 22.5 ± 3.3 kg·m–2, respectively). The demographics of the participants returning at the end of the senior year, who were 80.2% Caucasian, 13.7% African-American, 0.8% Hispanic, 2.3% Asian, and 2.3% other, did not significantly differ from the sample population that was 81.7% Caucasian, 12.1% African-American, 2.9% Hispanic, 1.7% Asian, and 1.7% other. The sample population also did not significantly differ from the university’s 2007 incoming freshman class.
Four-year changes for the 131 participants included significant (p < 0.0001) gains in height 0.6 ± 0.5 cm (0.25 ± 0.20 inches), weight 3.0 ± 5.0 kg (6.7 ± 11.1 lbs), BMI 1.0 ± 1.7 kg·m–2, percent body fat 3.6% ± 3.5%, and absolute fat mass 3.2 ± 3.4 kg (7.0 ± 7.5 lbs). Males gained significantly (p < 0.0005) greater amounts of weight, BMI, percent body fat, absolute fat mass, and fat-free mass than females. These gains are shown in Table 1. Weight change ranged from 8.7 to +16.8 kg (19.2 to +37 lbs).
Table 1.
Table 1. Selected demographic and anthropometric characteristics of the initial and end of study sample population.
a
Change is calculated based on the 131 participants who completed both assessments.
b
Data are presented as mean (SD) except for gender, which is express as n (%).
c
p < 0.0001.
d
p < 0.006.
About 70% (38 males, 54 females) of the participants gained weight (p < 0.0001), averaging 5.3 ± 4.7 kg (11.7 ± 9.1 lbs) in this weight gain group. Additionally in this group, there were significant (p < 0.0001) gains in BMI, fat-free mass, absolute fat mass, and percent body fat (Fig. 1). Males gained significantly more weight (6.8 ± 4.3 kg, 15.0 ± 9.5 lbs) (p = 0.002), BMI (2.1 ± 1.4 kg·m–2) (p = 0.049), and fat-free mass (p = 0.002) (1.8 ± 2.5 kg, 3.9 ± 5.5 lbs) than females (4.2 ± 3.6 kg, 9.3 ± 8.1 lbs; 1.5 ± 1.3 kg·m–2; and 0.3 ± 1.6 kg, 0.7 ± 3.6 lbs, respectively) as shown in Fig. 1. In this weight gain group, 18% of participants gained ≥9.1 kg (20 lbs); 28 participants (30%) gained 4.5 to 9.0 kg (10 to 19.9 lbs); 19 participants (21%) gained 2.3 to 4.4 kg (5.0 to 9.9 lbs), and 28 participants (30%) gained less than 2.3 kg (5 lbs).
Fig. 1.
Fig. 1. Changes in body weight, body mass index (BMI), fat-free mass, fat mass, and % body fat among students who gained weight over the 4-year college period.
Changes in selected circumference measurements for this weight gain group are shown in Fig. 2. Over the 4-year period, significant increases were observed in the neck (p < 0.005), chest–bust (p < 0.002), waist (p < 0.0001), hips (p < 0.0001), seat (p < 0.0002), and biceps (p < 0.0001) for both the males and females in this weight gain group. A significant (p < 0.0003) increase in thigh circumference was also documented in the males but not in the females. The changes in waist circumference were significantly correlated with changes in weight (p < 0.0001, r = 0.75, r2 = 0.557) and with changes in percent body fat (p < 0.0001, r = 0.42, r2 = 0.177). Initially, 4 females and 2 males exhibited waist circumference measurements in excess of 88 and 102 cm (35 inches and 40 inches), respectively, and by the end of the study period, 9 females and 3 males exceeded the respective values.
Fig. 2.
Fig. 2. Changes in circumference measurements among students who gained weight over the 4-year college period.
The initial BMI of the participants was 23.2 ± 4.9 kg·m–2, with a range from 15.2 to 50.7 kg·m–2, and by the end of the senior year, BMI had significantly increased, averaging 24.1 ± 4.9 kg·m–2, with a range of 16.7 to 53.4 kg·m–2. At the beginning of the freshman year, the percentages of participants classified as under–normal weight and overweight–obese were 82% and 18%, respectively, whereas by the end of the senior year these percentages were 69% and 31%, respectively. Initially, 13 females had ≥30% body fat, yet by the end of the senior year 18 females had ≥30% body fat; similarly, 1 male initially had ≥20% body fat, and by the end of the senior year, 8 males had ≥20% body fat. In terms of normal weight obesity, initially none of the males or females with BMIs in the normal range had percent body fat values ≥20% and 30%, respectively; however, 4 years later, 1 male and 3 females had BMIs in the normal range and ≥20% and 30% body fat, respectively.

Discussion

This is the first study to date to report changes in body weight, composition, and shape among college students over a 4-year period. The gains in weight of 3.0 kg (6.7 lbs) and BMI (1.0 kg·m–2) in this study were greater than those reported by Racette and co-workers (2008), who documented 4-year weight and BMI gains of 2.5 kg (5.5 lbs) and 0.7 kg·m–2, respectively, in a group of 204 college students (68% female, 32% male). When gender specific comparisons are made between the 2 studies, it was the males in the present study that exhibited greater weight (5.9 kg / 13.0 lbs) and BMI gains (1.8 kg·m–2) than those found by Racette and co-workers (2008), who showed weight and BMI gains in males of 4.2 kg (9.26 lbs) and 1.1 kg·m–2, respectively. Weight change in the present study was highly variable ranging from 8.7 to +16.8 kg (19.2 to +37 lbs); a range of 13.2 to +20.9 kg (29.1 to +46.08 lbs) was reported by Racette and co-workers (2008).
Expected gains in weight and height from ages 18 to 20 years based on the 50th percentile using CDC growth curves for males are about 3.6 kg and 1 cm, respectively, and for females are about 2.3 kg and 0.25 cm, respectively. Gains in height for both males and females were similar to those expected based on the growth curves, while 4-year gains in weight by the males (5.9 kg) were not. The extent to which the gain in weight after age 20 years is associated with healthy maturation versus being detrimental to health is not clear, but likely depends upon the total amount of weight that is gained and the accompanying changes in body composition.
A unique contribution of this study is its evaluation of body composition and shape changes over the 4-year college period. Among both the females and males, the observed weight gain consisted of primarily gains in fat mass and smaller changes in fat-free mass. No direct studies or national surveys providing body composition reference data are available for comparison; however, findings from cross-sectional studies examining fat mass and fat-free mass in large population samples from Switzerland reported that fat-free mass in women aged 15 to 24 years was not significantly increased when compared with older women (Kyle et al. 2001; Pichard et al. 2000). Results from these same population samples showed that fat-free mass in men was significantly greater in males aged 25 to 34 years versus those aged 15 to 24 years, and fat mass was lowest in men and in women aged 15 to 24 years versus other age ranges (Kyle et al. 2001; Pichard et al. 2000). Such information is consistent with the results of the present study.
Further significant findings from this study are the notable increases in the percentage of participants classified as overweight–obese (which increased 13%, from 18% to 31%) and in the prevalence of those with excessive body fat. The number of females with ≥30% body fat and males with ≥20% body fat increased from n = 14 initially to n = 26 over the 4-year period. While the healthiest body fat percentages associated with the lowest mortality and mobidity have not been established, ranges of 12% to 20% for men and 20% to 30% for women have been suggested (Abernathy and Black 1996). Normal weight obesity has been linked with dyslipidemia, hypertension, hyperglycemia, heart disease, and all-cause and cardiovascular mortality (Daniels et al. 1999; Dervaux et al. 2008; Gómez-Ambrosi et al. 2011; Musso et al. 2011; Ridker et al. 2003; Romero-Corral et al. 2010; Vizcaíno et al. 2007). While initially no participants had BMIs in the normal range coupled with “excessive” percent body fat, by the end of the study, 1 male and 3 females (3% of the study group) had BMIs in the normal range but ≥20% and 30% body fat, respectively.
The distribution of weight, especially as fat, on the body also has been shown to influence health. Increased waist circumference has been associated with increased risk of insulin resistance, type 2 diabetes, and heart disease (de Koning et al. 2007; Fang et al. 2010; Freedman et al. 2007; Raman et al. 2008; Schwandt et al. 2010; Yan et al. 2007). The number of females with unhealthy waist circumference measurements (greater than 88 cm or 35 inches) in the present study about doubled between the beginning of the freshman year (in which 4 females exceeded recommendations) and the end of the senior year of college (in which 9 females exceeded recommendations). While few males had waist circumference measurements in excess of 102 cm, the finding that about 26% of the gains in circumference measurements were at the waist in the males versus about 11% in the females was particularly interesting. Whether these circumference changes are typical physiological growth and development patterns in young adults and (or) are associated with insufficient physical activity and (or) poor dietary habits requires further investigation.
Upward trends in the proportion of adolescents becoming obese in young adulthood have been reported and are thought to continue (Gordon-Larsen et al. 2004). The findings from this study confirm this trend and suggest that an additional concern may be the increasing prevalence of those with normal BMI but perhaps excessive adiposity. Additional health promotion strategies on college campuses are clearly needed.

Acknowledgements

This research was supported by Alabama Agricultural Experiment Station projects 013-020 and 07-020, and an AAES Initiative Grant. A special thanks to M.J. Gropper for his statistical assistance.

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Published In

cover image Applied Physiology, Nutrition, and Metabolism
Applied Physiology, Nutrition, and Metabolism
Volume 37Number 6December 2012
Pages: 1118 - 1123

History

Received: 18 July 2012
Accepted: 22 August 2012
Version of record online: 17 September 2012

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Key Words

  1. college students
  2. weight gain
  3. body fat gain
  4. circumference changes

Mots-clés

  1. étudiants universitaires
  2. gain de poids
  3. gain de masse adipeuse
  4. variations des circonférences

Authors

Affiliations

Sareen S. Gropper
Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, 101 Poultry Science Bldg, AL 36849, USA.
Karla P. Simmons
Department of Consumer Affairs, Auburn University, 308 Spidle Hall, AL 36849, USA.
Lenda Jo Connell
Department of Consumer Affairs, Auburn University, 308 Spidle Hall, AL 36849, USA.
Pamela V. Ulrich
Department of Consumer Affairs, Auburn University, 308 Spidle Hall, AL 36849, USA.

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