|Year : 2016 | Volume
| Issue : 2 | Page : 172-177
Dietary habits and physical activity among medical students of a teaching hospital in South India: A descriptive analysis
SV Saranya, Chythra R Rao, Sravan C Kumar, Veena Kamath, Asha Kamath
Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||5-Jul-2016|
Chythra R Rao
Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal - 576 104, Karnataka
Context: Among the college population, it is assumed that medical students have better knowledge about healthy lifestyle and dietary practices when compared to other students. However, there is no evidence to indicate that this knowledge translates into practice in terms of maintaining good health. Also, medical students have been known to exhibit early risk factors for chronic diseases. Aim: To assess dietary practices and physical activity among medical students. Materials and Methods: A cross-sectional study was done among 438 medical students from a teaching hospital in South India. A predesigned questionnaire was used to assess diet and current physical activity levels [using the International Physical Activity Questionnaire (IPAQ) short version] among consenting medical students. Statistical Analysis Used: Data were analyzed using statistical package for social sciences (SPSS) version 15.0 from SPSS South Asia Bangalore, India. Chi-square test was used for univariate analysis. Results: Among 438 medical students, 97% were aware of balanced diet, but only 42.9% were following it. Nearly, 9.4% of students consumed junk foods everyday. Compared to the previous year, junk food intake had increased in 40.4% and fruit intake had decreased in 50% of students. Significant association was noted between overweight and obesity and daily consumption of junk foods. Over 95% of students were physically active. In comparison to the previous year, nearly 67% of students had increased their physical activity by walking. Conclusions: Although unhealthy eating habits were prevalent among medical students, practice of physical activity was good. It is, therefore, essential to identify and take corrective actions to promote healthy lifestyle practices.
Keywords: Balanced diet, diet pattern, junk food, physical activity
|How to cite this article:|
Saranya S V, Rao CR, Kumar SC, Kamath V, Kamath A. Dietary habits and physical activity among medical students of a teaching hospital in South India: A descriptive analysis. Trop J Med Res 2016;19:172-7
|How to cite this URL:|
Saranya S V, Rao CR, Kumar SC, Kamath V, Kamath A. Dietary habits and physical activity among medical students of a teaching hospital in South India: A descriptive analysis. Trop J Med Res [serial online] 2016 [cited 2020 Feb 28];19:172-7. Available from: http://www.tjmrjournal.org/text.asp?2016/19/2/172/185450
| Introduction|| |
It is generally assumed that medical students have better knowledge about healthy lifestyle and dietary practices when compared to other college students. However, there is no evidence to indicate that this knowledge translates into practice in terms of maintaining good health. Also, medical students have been shown to exhibit early risk factors for chronic diseases. 
Having healthy dietary habits, undertaking sufficient physical activity, and tackling overweight and obesity are fundamental aspects of the prophylactic ways of ensuring health, which includes the prevention of cardiovascular diseases. Students are more likely to demonstrate several unhealthy lifestyle behaviors, some of which results in inappropriate nutrition that in later life leads to the so-called "diseases of civilization". Monitoring such subjects is vital, because in the future these students will themselves be responsible for ensuring public healthcare and its promotion. 
Declining physical activity levels and nutrition transition like increased consumption of high-fat diet containing saturated fatty acids; sugars; or refined carbohydrates like white rice, maida, white bread etc., and low-fiber diet are found to be responsible as risk factors for noncommunicable diseases worldwide.  The world is facing an epidemic of noncommunicable diseases and lack of physical activity is found to be one of the major risk factors for these diseases. It is estimated that lack of physical activity causes 1.9 million deaths worldwide. The Centers of Disease Control (CDC) recommends at least 30 min of moderate physical activity like brisk walking at least for 5 days in a week for adults (150 min of moderate-intensity physical activity per week).  According to the World Health Organization (WHO) Indian Council of Medical Research, Noncommunicable Diseases Risk Factor (ICMR, NCDRF) surveillance 2003-2004, the rates of job-related physical activity of moderate and vigorous intensity in urban, slum, and rural population were 35.8%, 55.2%, and 61%, respectively, whereas rates of leisure-time, moderate-intensity and vigorous-intensity physical activity were 15.6%, 12.1%, and 14%, respectively.  Doctors are in a position to give physical activity counseling to their patients. Encouraging healthy lifestyle practices among medical students, who are going to be future doctors, would facilitate the cadre of healthy physicians who are more likely to provide proper health counseling.  With this objective in mind, the study was undertaken to understand the knowledge and practice of balanced diet and physical activity among medical students, so that awareness regarding healthy lifestyle practices can be promoted among students who would then become healthy future role models for the society.
| Materials and Methods|| |
This was a cross-sectional study conducted over a period of 3 months (February-April) in 2014, among medical students of a teaching hospital in South India. A clearance from the Institutional Ethics Committee and written informed consent from the participants were obtained before conducting the study. A meeting was held with the class representatives of all the semesters to brief them about the study. A total of 438 students voluntarily consented to participate in the study. A predesigned questionnaire was administered to collect information pertaining to the dietary habits as well as the current physical activity levels.
Awareness and practices regarding balanced diet was assessed by questions on consumption of different types of foods in the past week, water intake, and pattern of having food on weekdays and weekends.
Sedentary lifestyle practices were assessed by questions on usage of gadgets like mobile phones, laptops, television, video games; nap time during the day and night; and sitting hours in a day. Current physical activity levels in the previous week were assessed using the International Physical Activity Questionnaire (IPAQ) short version.  Metabolic equivalent of task (MET) values were calculated. Physical activities are classified based on the MET values as follows: Light activity (<3 METs), moderate activity (3-6 METs), and vigorous activity (>6 METs). Total MET-minutes per week was calculated and based on this physical activity was classified as low (<600 MET-min/week), moderate (600-1200 MET-min/week), and vigorous (>1500 MET-min/week). 
The height and weight of the students were measured according to the World Health Organization (WHO) guidelines.  Body mass index (BMI) was calculated using the formula weight (kg)/height (m 2 ). Subjects with BMI ≥25 kg/m 2 were considered overweight and those with BMI ≥30 kg/m 2 were considered obese. 
Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 15.0 from SPSS South Asia, Bangalore, India. All the categorical and quantitative variables were summarized as proportions and means with standard deviation, respectively. Chi-square test was employed to determine the association with a P value of <0.05 being considered as statistically significant.
| Results|| |
The study included 438 undergraduate medical students, among whom 187 (42.7%) were males and 251 (57.3%) were females. The students belonged to 2 nd semester (169), 4 th semester (197), and 6 th semester (72).
Regarding their dietary habits, 31.1% were vegetarians. Awareness regarding balanced diet was good (97%), but less than 50% of them were consuming balanced diet. The reasons cited by the students following balanced diet were as follows: For maintaining good health (93.1%) and maintaining good body image (14.9%). Among the students who were not following balanced diet, lack of time (42.2%), poor taste (34.8%), nonavailability of balanced diet (32.4%), and peer pressure (2.5%) were the main cited reasons. Male students consumed full breakfast at least more than three times in a week as compared to female students during weekdays and this association was found to be statistically significant (P < 0.05) as mentioned in [Table 1]. Nearly 75% students consumed full lunch and full dinner almost everyday.
Among the 438 students, consumption of eggs, fish, meat, and chicken was found to be higher among male students as compared to their female counterparts. Consumption of rice/roti, milk and milk products, and vegetables and fruits was not found to be significantly different among the boys and girls. More than half of the boys consumed adequate water unlike girls.
Consumption of carbonated drinks was found to more among the male students whereas the consumption of sweets and pastries was found to be higher among the female medicos. There was no significant gender difference with respect to the consumption of coffee/tea and fruit juices. Compared to the previous year, junk food intake had increased in 40.4%, decreased in 24.9%, and no change was seen in 34.7% students. Fruits intake had increased in 23.3%, decreased in 50%, and no change was seen in 26.7% students. Reasons for change in the diet pattern as compared to the previous year was found to be nonavailability of regular food (48.4%), health reasons (25.6%), to remain fit (18%), cost of food (12.3%), curiosity and experimentation (8.9%), for maintaining body image (5.5%), and peer pressure (3.9%). Correlating junk food intake with BMI, nearly one quarter of the students who consumed junk foods everyday were found to be overweight or obese as mentioned in [Table 2]. This association was found to be statistically significant (P < 0.05). Statistically significant association was found between consumption of sweets, pastries, and carbonated drinks and overweight/obesity (P < 0.05).
|Table 2: Correlation of fast foods and beverages consumption with BMI among medical students (N=438) |
Click here to view
Hours of gadget usage and sedentary habits
Average time spent on mobile phone usage among students was 3 h (interquartile range [IQR]: 2-6 h). Median hours of laptops usage were 1 h 45 min (IQR: 1-3 h). Median nap time during the day was 1 h (IQR: 30-90 min) while median sleep time during the night was 6 h (IQR: 5-7 h). The average time spent sitting was 8 h (IQR: 6-10 h). With regard to physical activity among students, in comparison to the previous year, walking had increased in 66.7% of students, decreased in 12.6%, while there was no change in 18.7%, 1.4% did not engage in any physical activity, and 0.7% had just started. A quarter of the students had decreased playing outdoor games while 32% reported an increase, there was no change in 18%, and 23.5% did not play outdoor games. Reasons for change in the physical activity (both increase and decrease) were as follows: Need to remain fit (32.4%), lack of time (31.3%), being busy with studies (27.6%), building body image (8.2%), curiosity (7.1%), peer pressure (3.9%), and expensive nature of the activities (1.6%).
Among 438 students, 17 students could not quantify the physical activity, hence the analysis of physical activity have been done for the remaining 421 students (using the short version of IPAQ). Among them, 10.5% were involved in light activity, 20.7% in moderate activity, and 68.9% in vigorous activity. The light and moderate activity were significantly higher in girls as compared to boys; while vigorous activity was higher among boys (75.3%) in comparison to girls (64%) (P < 0.05).
The correlation between BMI and the type of physical activity showed no significant association as depicted in [Table 3]. But the students who had BMI ≥25, were more physically active. We hypothesize that overweight status could have motivated the students to initiate vigorous physical activity. However, this cannot be substantiated because of the cross-sectional nature of the study.
|Table 3: Correlation of physical activity with BMI among medical students (N=421) |
Click here to view
| Discussion|| |
A number of studies conducted to evaluate the physical activity, diet, and fitness status of university students , have revealed that the physical condition and nutritional habits of students is very much associated with their own attitudes toward health promotion and illness prevention. , Positive attitudes in this regard are vital for the future health professionals. In the present study, healthy lifestyle practices like awareness and practice of physical activity was good among future doctors but in contrast unhealthy eating habits were also found to be prevalent. Among the medicos, nearly half of the students did not have regular breakfast and 11-15% were irregular with their lunch and dinner during weekends. This is comparable to studies done by Ganasegeran et al. and Chhaya et al. , The students may skip breakfast to control weight, but it is a known fact that people who do not eat breakfast are more likely to eat unhealthy foods, which in turn induces weight gain. 
The present study findings of daily consumption of vegetables (60.5%), fruits (21%), and junk foods (9.4%) were in contrast to the study done among urban adolescents in India.  Compared to the previous year, increase in junk food consumption (40.4%) and decrease in fruits intake (50%) were comparable to the study conducted among school adolescents in Chandigarh.  Low consumption of fruits and high junk food intake indicated personal preferences among students that are risk factors for weight gain. During the transition from school to college, majority of students experience significant amount of weight gain. This was congruent with findings from the USA. 
The association of overweight and obesity among medical students with the consumption of junk foods, carbonated drinks, and sweets/pastries is comparable to the study conducted among the students of a private medical university in Karachi. 
The sedentary habits in terms of median hours of gadget usage was similar to studies from Iran and India. , With growing affluence and a dramatic increase in TV watching and laptop usage documented in India, it is more likely to observe more sedentary habits among adolescents.
In comparison to the previous year, physical activity had increased in 66.7% of students by walking, which is a good sign. Decrease in playing outdoor games was observed among 25.6% of students. In the present study, 10.5% students involved in light activity, 20.7% in moderate activity, and 68.9% in vigorous activity. Practice of vigorous activity was found to be higher in comparison to the other reported literature. ,, There was no significant correlation between physical activity levels and BMI among medical students, similar to the study by Rao et al. 
The present study was designed to assess dietary habits and physical activity among medical students. Although the study intended to include all medical students across semesters, finding an appropriate time for data collection in between their classes was difficult. As the participation was voluntary, it is possible that only healthy students would have participated in the study. The ones who were aware of their faulty practices or their overweight/obese status refrained from being part of the study. The Food Frequency Questionnaire would have been more appropriate for dietary assessment, but was difficult to administer due to time constraints. Details about tobacco usage and alcohol consumption would have been ideal, but accuracy of the information would be questionable. So these details were not included. The positive unintended benefit of the questionnaire on physical activity was that when students filled out the IPAQ, they became aware about their practice of physical activity and the need to improve the same. Repeat measurements across semesters for subsequent years would be beneficial to obtain trends of these risk factors of noncommunicable diseases, so that primary prevention can be implemented and reinforced among future doctors.  Health promotion activities during medical school is the need of the hour as this will go a long way in creating healthy role models for tomorrow.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rao CR, Darshan BB, Das N, Rajan V, Bhogun M, Gupta A. Practice of physical activity among future doctors: A cross sectional analysis. Int J Prev Med 2012;3:365-9.
Likus W, Milka D, Bajor G, Jachacz-£opata M, Dorzak B. Dietary habits and physical activity in students from the Medical University of Silesia in Poland. Rocz Panstw Zakl Hig 2013;64:317-24.
Kelishadi R, Ardalan G, Gheiratmand R, Gouya MM, Razaghi EM, Delavari A, et al
. CASPIAN Study Group. Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study. Bull World Health Organ 2007;85:19-26.
Anand T, Tanwar S, Kumar R, Meena GS, Ingle GK. Knowledge, attitude, and level of physical activity among medical undergraduate students in Delhi. Indian J Med Sci 2011;65:133-42.
Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ)-Short and Long Forms. Available from: http://www.ipaq.ki.se/scoring.pdf
. [Last accessed on 2014 Apr 1].
STEP wise approach to surveillance (STEPS)-Guide to physical measurements. World Health Organization. Available from: http://www.who.int/chp/steps/Part3_Section3.pdf.[Last accessed on 2014 Jan 15].
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.
Greenlee P, Castle CH, Wooley FR. Successful modification of medical students′ cardiovascular risk factors. Am J Prev Med 1992;8:43-52.
Liang MT, Dombrowski HT, Allen TW, Chang CO, Andriulli J, Bastianelli M, et al
. Do medical students′ knowledge and attitudes about health and exercise affect their physical fitness? J Am Osteopath Assoc 1993;93:1020-4, 1028-32.
Ganasegeran K, Al-Dubai SA, Qureshi AM, Al-abed AA, Am R, Aljunid SM. Social and psychological factors affecting eating habits among university students in a Malaysian medical school: A cross-sectional study. Nutr J 2012;11:48.
Chhaya S, Jadav P. Dietary and lifestyle pattern in relation to overweight and obesity among the medical and nursing students. IJRRMS 2012;2:9-12.
Utter J, Scragg R, Mhurchu CN, Schaaf D. At-home breakfast consumption among New Zealand children: Associations with body mass index and related nutrition behaviors. J Am Diet Assoc 2007;107:570-6.
Rani AM, Sathiyasekaran BW. Behavioural determinants for obesity: A cross-sectional study among urban adolescents in India. J Prev Med Public Health 2013;46:192-200.
Galhotra A, Abrol A, Agarwal N, Goel NK, Gupta S. Life style related risk factors for cardiovascular diseases in Indian adolescents. Internet J Health 2009;9. Available from: http://ispub.com/IJH/9/2/4263
[Last accessed on 2014 Apr 9].
Wengreen HJ, Moncur C. Change in diet, physical activity, and body weight among young-adults during the transition from high school to college. Nutr J 2009;8:32.
Nisar N, Qadri MH, Fatima K, Perveen S. Dietary habits and life style among the students of a private Medical University Karachi. J Pak Med Asso Dec 2008;58:687-90.
Anjana RM, Pradeepa R, Das AK, Deepa M, Bhansali A, Joshi SR, et al
. ICMR-INDIAB Collaborative Study Group. Physical activity and inactivity patterns in India-results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5]. Int J Behav Nutr Phys Act 2014;11:26.
Deshpande K, Patel S, Bhujade R, Deepak P. Lifestyle and obesity among college students in Ujjain, India. Natl J Community Med 2013;4:291-3.
Srivastava A, Sharma M, Gupta S, Saxena S. Epidemiological investigation of lifestyle associated modifiable risk factors among medical students. Natl J Med Res 2013;3:210-5.
[Table 1], [Table 2], [Table 3]