Associations Between Modifiable Health Behaviors and Obesity Among U.S. College Students: An Analysis of the ACHA-NCHA Data

PurposeTo examine the individual and combined effects of modifiable health behaviors-physical activity, healthy diet, smoking, and alcohol consumption-on obesity among U.S. college students.DesignCross-sectional.SettingData from the 2018 American College Health Association-National College Health Assessment surveys.SampleData included 91,535 undergraduate students.MeasuresModifiable health behaviors included self-reported physical activity, diet, smoking, and alcohol use. Weight-related measures included perceived weight status, weight control intentions, weight loss behaviors, and BMI (obesity defined as BMI ≥30).AnalysisWeighted and adjusted logistic regression models estimated associations between individual behaviors, the number of guidelines met, and obesity.ResultsNon-adherence to guidelines for moderate-intensity physical activity, vigorous-intensity physical activity, muscle-strengthening activities, and healthy diet significantly increased obesity odds (OR = 1.14, 1.53, 1.45, and 1.46, respectively). Non-adherence to alcohol guidelines was associated with lower obesity odds (OR = 0.78). Cigarette smoking was not significantly associated with obesity after covariate adjustments. Meeting more guidelines was linked to healthier BMI and weight perceptions. Males were more likely to meet physical activity and alcohol guidelines, whereas females adhered more to dietary and smoking guidelines.ConclusionsInterventions targeting multiple health behaviors are needed to reduce obesity among college students.