Objectives

To examine the effectiveness of a 24-month weight gain prevention intervention to positively affect body mass index (BMI) in 2-year college students.

Background

Obesity is a major public health priority. Approximately 5.5 million Americans are obese by the age of 30. Recent research shows that once individuals gain weight, losing weight and maintaining that weight loss is difficult. The young adult years, ages 18-35, are an influential period for excess weight gain and unhealthy weight-related behaviors. At-risk young adult populations are at a particularly high risk for a range of adverse weight-related outcomes. A study found that students enrolled in 2-year colleges, particularly women, had a higher prevalence of overweight and obesity, lower levels of physical activity, more TV viewing, and higher intakes of soda and fast food compared with students attending 4-year colleges. The use of technology to successfully engage participants in weight-related interventions has been identified as a priority area for future research with the young adult age group. The Choosing Healthy Options in College Environments and Settings (CHOICES) study was one of seven trials funded through the EARLY consortium, and tested the effectiveness of a 24-month intervention to reduce unhealthy weight gain in 2-year community college students.

Participants

A total of 962 students from three (3) 2-year colleges in Twin Cities, Minnesota expressed interest in the study. Of these, 441 students participated in baseline measurement and were randomized; 224 students were randomized to the intervention group and 217 student were randomized to the control group. Of these, 187 students and 179 students, respectively, are included in the primary analysis.

The main eligibility requirements included: (1) being aged 18–35 years; (2) having a BMI between 20 and 34.9 kg/m2; and (3) planning to live in the geographic area for at least 2 years. Participants were excluded for: past or planned weight loss surgery, current participation in commercial weight loss program, current treatment for eating disorder or malignancy, regular use of systemic steroids, use of weight loss drugs and/or diabetes medication, pregnancy, lactation, cardiovascular events within the last 6 months, and systolic BP at screening ≥ 160 mmHg or diastolic BP ≥ 100 mmHg.

Design

Two cohorts of students were recruited to participate in the study with a cohort beginning at both the fall and spring semesters. Students randomized to the intervention condition were required to enroll in a 1-credit, semester-long academic course at their college, designed and taught by CHOICES study staff. The course was based on the Sleep, Eat, and Exercise course from the Rothenberger Institute at the University of Minnesota. A social network website designed for the CHOICES study was introduced in the course and encouraged self-monitoring, goal setting, and interaction around the same health behaviors taught in the course. Incentives in the form of points for participation were provided and could be redeemed for a variety of wellness-related products such as yoga mats and cooking utensils. These incentives and periodic encouragement via e-mail from intervention staff were used to encourage students to participate in the website during the 24-month intervention period.

Students randomized to the control condition received health assessments with their measurement visits as well as basic health promotion information on a quarterly basis. Assessments included a measurement visit at the participant’s college where height, weight, waist circumference, blood pressure, and body fat were assessed by trained study staff. In addition, participants completed a paper/pencil survey to report their demographic characteristics, behavioral patterns, and other psychosocial and affective characteristics. Students were also asked to complete two dietary recalls online using the Automated Self-Administered 24-hour dietary recall system. Data for the study were collected at baseline (2011/2012), 4 months (2012), 12 months (2013), and 24 months (2014) post-randomization.

Conclusions

There was not a statistically significant difference in BMI between conditions at the end of the trial. However, participants randomized to the intervention who were overweight or obese at baseline were more than three times as likely to transition to a healthy weight by the end of the trial as compared with control students.

Lytle LA, Laska MN, Linde JA, et al. Weight-Gain Reduction Among 2-Year College Students: The CHOICES RCT. Am J Prev Med. 2016;52(2):183-191.

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