University students who perceive themselves as overweight and obese tend to have higher consumption of processed foods: an observational study

Introduction

The World Health Organization (WHO) declared COVID-19 a pandemic and a global public health emergency on 30 January 2020, due to the rapid spread of the virus and the severe consequences that can occur following infection, ranging from respiratory difficulty to death. Since December 2019, approximately 760 million confirmed cases and 6.9 million deaths have been reported worldwide, although the numbers could be higher.^1,2

In Peru, the first case of COVID-19 was confirmed on March 6, 2020, and it was projected that in the worst-case scenario, there would be approximately 1.4 million infections by 2022.³ In response to this situation, a State of Emergency was declared, implementing a series of containment measures to prevent the spread of the virus.⁴ One of these measures was the suspension of classes to prevent educational institutions from becoming hotspots for transmission among students. As a result, the Ministry of Education (MINEDU) opted for distance learning, which significantly affected the student community,⁵ especially university students.⁶ This population experienced changes in their lifestyle due to social isolation and economic uncertainty, with one of the most notable changes being alterations in their usual eating patterns.^7,8 According to a report by nutritionists from the Ministry of Health of Peru (MINSA), 55.4% of Peruvians over the age of 17 experienced an increase in appetite during confinement. Some mentioned that this variation was influenced by stress, anxiety, lack of physical activity, and insufficient sleep.⁹

In the Americas region, obesity and overweight have tripled over the past 50 years, affecting 62.5% of the adult population.¹⁰ In Peru in 2020, the prevalence of obesity and overweight among individuals aged 15 and older was 37.9% and 24.6%, respectively.¹¹ This is concerning as both conditions represent risk factors for developing noncommunicable diseases such as hypertension, heart failure, coronary artery disease, type 2 diabetes, osteoarthritis, respiratory problems, and certain types of cancer (endometrial, prostate).¹²

Additionally, it is crucial to consider that the increasing globalization of food systems has driven a nutritional transition that has promoted the consumption of processed foods.¹³ These foods have undergone modifications to enhance their taste, durability, or appearance,¹⁴ resulting in increased refined sugar, salt, saturated fats, and trans fats content.¹³ It is important to note that numerous studies have shown that the consumption of processed foods is associated with a higher risk of overweight/obesity, accumulation of abdominal fat, low levels of HDL cholesterol, metabolic syndrome, and other health issues, ultimately increasing mortality.¹⁵

This context becomes relevant during the COVID-19 pandemic, as an increase in the consumption of processed foods¹⁶ and a decrease in physical activity have been observed.¹⁷ Physical activity plays a crucial role in maintaining energy balance and controlling body weight in the face of food consumption. Therefore, controlling diet and engaging in regular physical activity are essential for preserving overall health and well-being, as well as preventing the development of long-term noncommunicable chronic diseases.¹⁸ This phenomenon of confinement and lifestyle changes reflects the challenges faced by the university population, who were affected not only in the educational sphere but also in important aspects of their well-being during the health crisis.

Thus, the objective of this study is to determine the relationship between processed foods and the perception of changes in body image among Peruvian university students during the COVID-19 lockdown. Additionally, the most frequent processed foods, the perception of perceived body image on consumption frequency, and the influence of gender on these variables were described.

Methods

Population, inclusion criteria, and instruments

A snowball sampling was used for simple random sampling. The study population consisted of 100 university students who voluntarily enrolled to participate in the study via social networks and the university’s website. Inclusion criteria were students enrolled at the Lima campus aged between 17 and 28 years of both genders, from all study cycles and semesters, and who had both face-to-face and remote classes. After selection, the study sample comprised 84 students ( Figure 1).

Figure 1. Flowchart of the study.

In this research, two instruments were used (Suppl. 1.). To determine the consumption of processed foods, the Brief Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF) developed by Martínez-Pérez²³ in 2022 was employed as a model (A). Thirteen foods and beverages were included (fatty dairy, sugary dairy, processed meats, alcohol, sugary beverages, snacks, sweets, fats, fast food, refined cereals, sauces, additives, and fried foods), recording the frequency of their consumption by assigning 0 points if never consumed and 1 point if consumed occasionally, frequently, or very frequently. Thus, a higher score indicates greater consumption of these foods. We used the Spanish version of the questionnaire (Suppl. 2.)

To measure body image perception, the Thompson and Gray C Scale (1995)²⁴ was used, which presents nine anatomical silhouettes of the body contouring of men and women. Body image is a mental representation of body shape, form, and size, which can be influenced by various sociocultural factors. Therefore, being an abstract representation, they are created with reference to measurable and quantifiable physical characteristics (height, weight, BMI, etc.) of the group being evaluated.^25,26 Each of the silhouettes by Thompson and Gray has a score ranging from 1 to 9 (from left to right); they are grouped and classified as thin (silhouette 1), normal (silhouettes 2–4), overweight (silhouettes 5–7), and obesity (silhouettes 8–9).²⁷ It is noteworthy that due to its easy administration, this instrument has been used to assess body image perception in university populations worldwide.^25,26

Results

Of the total participants, 52 (63.4%) were women, and the average age was 21 ± 2.8 years (95% CI 20.4 to 21.6). The most frequent age group was 17 to 20 years with 40 (48.8%) students, followed by those aged 21 to 25 years with 36 students (43.9%). A significant difference was found between the average age of women and men (20.8 ± 2.7 years and 21.3 ± 3.1 years; p = 0.304). Regarding body image perception, 56 (68.3%) participants perceived themselves as being overweight, and 12 (14.6%) as obese. Only 14 (17.1%) perceived themselves as “normal,” and none perceived themselves as thin in their anatomical model ( Table 1).

Overall, it was observed that most participants frequently consumed processed foods, with sweets (41.5%) and refined cereals (40.2%) being the most consumed, even very frequently by 32.9% of students. To a lesser extent, 37.8% frequently consumed additives, while 35.4% did so very frequently. A correlation was found between body image perception and the consumption of processed meats and fats (both with p = 0.001), fast food (p = 0.018), and sauces (p = 0.017) (Table 2).

The most frequently consumed processed food by overweight students was sweets (50%), followed by additives (41.1%) and refined cereals (39.3%). There is a significant difference in the consumption of sweets in students perceiving themselves as overweight versus those perceiving themselves as normal (p < 0.032). Differences were also reported between these groups in the consumption of fats (p < 0.001), fast food (p = 0.037), and processed meats (p < 0.001); being consumed by overweight students in 55.4%, 55.4%, and 51.8%, respectively. Differences were also found between participants perceiving themselves as normal versus those with obesity in the consumption of processed meats (p = 0.004), fats (p = 0.002), and fast food (p = 0.066). Also, the majority frequently consumed fast food, refined cereals, and fried foods (50%), followed by sugary beverages, snacks, sweets, and sauces (41.7%). Additionally, they showed very frequent consumption of sugary dairy and additives (33.3%) (Table 2).

In addition, 82.9% participants reported a body image with overweight or obesity, and the five most frequently and very frequently consumed foods were refined cereals (76.4%), additives (75%), sweets (69.1%), fried foods (60.3%), and snacks (58.8%). Likewise, there were no differences between both groups regarding the consumption of processed meats (p > 0.05), sweets (p = 0.465), fats (p > 0.05), and fast food (p > 0.987). In those with overweight, 54.3% and 51.4% of women frequently consumed refined cereals and sweets, respectively, while 42.9% very frequently consumed additives ( Figure 2). Additionally, worrying patterns of processed food consumption were observed in individuals with overweight and obesity. In overweight men, 42.9% frequently consumed additives, while 28.1% had a high intake of sweets and refined cereals. On the other hand, 57.1% of obese women preferred snacks and fried foods frequently, and 42.9% very frequently consumed refined cereals. Furthermore, 40% of obese men showed a high consumption of these processed foods, but only differences in the consumption of snacks between men and women were found (p = 0.020).

Figure 2. Consumption of processed foods according to body image perception of university students.

On the other hand, we found no differences in the perception of weight variation according to perceived body image (p = 0.440). However, significant differences were found between the perception of weight variation and the consumption frequency of processed foods. Participants perceiving weight variation consumed fatty dairy (50% vs. 43.8%, p = 0.048), processed meats (42.4% vs. 25%, p < 0.001), sweets (65.2% vs. 50%, p = 0.024), fats (37.9% vs. 31.5%, p < 0.001), fast food (42.4% vs. 37.5%, p = 0.027), and sauces (43.9% vs. 6.3%, p = 0.046) more frequently or very frequently compared to those who did not perceive weight variation. No differences were found between physical exercise and body image perception (p = 0.267), but there were with dairy consumption (p = 0.018) during the pandemic. A higher percentage of participants who exercised consumed dairy very frequently compared to those who did not (fatty: 22% vs. 18.2%; sugary: 20.4% vs. 15.2%).

In overweight men, 42.9% frequently consumed additives, and 28.1% frequently consumed sweets and refined cereals. Among women with obesity, 57.1% frequently preferred snacks and fried foods, while 42.9% consumed refined cereals very often. Additionally, 40% of obese men consumed these processed foods very frequently. Significant differences were observed in the consumption of snacks between men and women (p = 0.020), but no differences were found in the perception of weight variation according to perceived body image (p = 0.440). However, significant differences were found between the perception of weight variation and the frequency of consumption of certain processed foods such as dairy (p = 0.048), processed meats (p < 0.001), sweets (p = 0.024), fats (p < 0.001), fast food (p = 0.027), and sauces (p = 0.046). Regarding physical exercise, no differences were found between its performance during the pandemic and body image perception (p = 0.267), but there were with dairy consumption (p = 0.018). A higher percentage of participants who exercised consumed dairy very frequently compared to those who did not.

Discussion

This study has evaluated a cohort of young university students finding a correlation between the consumption of processed foods (processed meats, sweets, fats, fast food) and overweight/obesity during the pandemic. The five most consumed foods by those perceiving themselves as overweight or obese were sweets, additives, refined cereals, fried foods, and snacks. It was observed that females were most affected by overweight and obesity, and it was also the group that consumed the most processed foods.

Conclusions

We observed that the majority of participants frequently consumed processed foods, especially those who perceived themselves as overweight or obese, with a notable consumption of sweets and refined cereals. We found significant associations between perceived weight variation and the frequency of processed food consumption, and significant differences in the consumption of certain foods between men and women with overweight or obesity.

Broader and longitudinal research is needed to better understand the relationship between processed food consumption, body image perception, and other factors such as the level of physical activity and psychological well-being. Additionally, it would be valuable to explore educational and health promotion interventions aimed at improving eating habits and body image perception in the university population, especially during periods of stress and change such as those caused by the pandemic or crisis situations.

Author contributions

Conceptualization, J.M-S., and V.R-Z.; methodology, J.M-S. and C.V.S-R.; software, J.M-S. and C.V.S-R.; validation, J.M-S. and B.M-S.; formal analysis, J.M-S., E.A.G-P., and B.M-S.; investigation, B.M-S.; resources, C.V.S-R., and N.A.B.C.; data curation, J.M-S., E.A.G-P., and N.A.B.C.; writing—original draft preparation, J.M-S., E.A.G-P., B.M-S., and M.E.M-M.; writing—review and editing, J.M-S., E.A.G-P., C.V.S-R., N.A.B.C., and V.R-Z.; visualization, J.M-S., and E.A.G-P.; supervision, J.M-S.; project administration, J.M-S. All authors have read and agreed to the published version of the manuscript.

Ethical considerations

This study was approved by the Ethics Committee of Universidad Tecnológica del Perú (Registration 115–2021-1, March 17th, 2021) and has complied with the bioethical principles and guidelines of the Helsinki Declaration.²⁹ Written informed consent was obtained from all adults subjects involved in the study. In the case of minors, their parents were consulted to obtain their informed consent, and the student was consulted to obtain their written assent. This work was carried out by university administrators according to a previously established plan.

For students under 18, printed informed assent and written consent forms were provided for parents. Students aged 18 and over used printed informed consent forms. The first author was responsible for the management and safeguarding of the data obtained in accordance with Peruvian Law 29733 on data protection.