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Running head: OBESITY MANAGEMENT IN COLLEGE STUDENTS 1
DNP Capstone Proposal
Health Coaching Model Focusing on Nutrition and Physical Activity Education for Decreasing
Obese in College Students: A Pilot Study
Mercy Ojumu
Maryville University
Capstone Chair: Dr. Geralyn Frandsen
Capstone Committee Member: Dr. Connie Webster
Date of Submission: December 10, 2018
Table of Contents
Abstract..........................................................................................................................................4
Introduction and Background......................................................................................................5
Problem Statement........................................................................................................................6
Objectives and Aims......................................................................................................................7
Review of Literature......................................................................................................................7
Factors Contributing to Obesity in College Students...................................................................8
Self-Efficacy..............................................................................................................................10
Approaches to Weight and Obesity Management......................................................................11
Students’ Approach to Weight Management.........................................................................11
Interventions for Overweight and Obesity Management in College Students.......................12
Health Coaching Approach....................................................................................................13
Theoretical Model........................................................................................................................17
Project and Study Design............................................................................................................19
Setting and Resources................................................................................................................20
Study Population........................................................................................................................21
Sources of Data..........................................................................................................................21
Data Analysis................................................................................................................................23
Quality........................................................................................................................................23
Results...........................................................................................................................................24
Discussion.....................................................................................................................................25
Limitations.................................................................................................................................26
Implications for Practice............................................................................................................26
Ethics and Human Subjects Protection.....................................................................................27
Timeframes or Timeline..............................................................................................................29
Budget...........................................................................................................................................29
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Strengths and Weaknesses of the Study....................................................................................30
Strengths.....................................................................................................................................30
Weaknesses................................................................................................................................30
Conclusion....................................................................................................................................30
References.....................................................................................................................................32
Appendix A...................................................................................................................................35
Appendix B...................................................................................................................................36
Appendix C...................................................................................................................................38
Appendix D...................................................................................................................................39
Appendix E...................................................................................................................................41
Appendix F...................................................................................................................................42
Appendix G...................................................................................................................................43
Appendix H...................................................................................................................................44
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OBESITY MANAGEMENT IN COLLEGE STUDENTS 4
Abstract
The rate of obesity among college students continues to rise in the United States. There is a need
for an effective method to facilitate weight loss in overweight or obese college students. The
study is to determine the effectiveness of health coaching on weight loss in overweight and obese
college students. The aim is to educate and motivate overweight or obese college student to
facilitate weight loss. The study is a quantitative 4-week descriptive pre- and post-intervention
design. Validated questionnaires were used to collect data from a convenience sample of 15
overweight or obese college students. Data analyses include descriptive statistics and paired t-
test. Results show eighty-seven percent of the participants were females, 60% were African
American, and 33% were freshman college students. Weight loss ranged from 0.2lbs to 8.6 lbs.
A paired t-test shows no statistically significance between both pre- and post-intervention weight
and body mass index (BMI). In conclusion, further study with a larger sample size that includes
more male participants is recommended.
Keywords: Obesity, college students, overweight, weight loss, health coaching
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OBESITY MANAGEMENT IN COLLEGE STUDENTS 5
Introduction and Background
More than 36.5% of adults and 32.3% of young adults ages 20 to 39 are obese in the United
States (Centers for Disease Control and Prevention [CDC], 2017a; Ogden, Carroll, Fryar, &
Flegal, 2015). The prevalence of overweight /obesity among college students aged 19 to 24 was
37.9 % in 2016 (American College Health Association (ACHA), 2017). Obesity is determined by
a body mass index (BMI) of over 30 kg/m2 (CDC, 2016). For adults over age 18, BMI is
calculated by dividing body weight by the height in kilometer squared (CDC, 2016). A BMI of
18.5-24.9 kg/m2 is considered a normal healthy weight, BMI between 25-29.9 kg/m2 is
overweight, and a BMI of over 30 kg/m2 is identified as obese. Obesity is a chronic health
problem and has become an epidemic in the United States (Schwartz & Richardson, 2015).
Obesity is associated with both psychological and physical health consequences that include
depression, low self-esteem, osteoarthritis, cardiovascular diseases, type 2 diabetes, stroke,
cancer, and preventable death (CDC, 2017a).
The rate of obesity continues to increase steadily in the United States despite efforts
being made by many organizations towards reducing the problem. One such organization was the
United States Department of Health and Human Services (DHHS) which created Healthy People
2010 an initiative that focused on reducing obesity and had an objective of reducing obesity in
adults by 15% and 10% in children by 2010 (CDC, 2015). However, the goal of Health People
2010 to reduce obesity was not achieved. Instead, the rates of obesity in both adults and children
increased. Additionally, the medical cost of obesity in 2008 was $147 billion and $149.4 billion
estimated cost in 2014 (CDC, 2017a; Kim & Basu, 2016). Obesity is a complex problem
affecting both male and female, children and adults, and all ethnic groups in the United States
(Marchiondo, 2014).
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College students ages 18 to 20 are transitioning from adolescence to adulthood. The
transition period corresponds with a period when many students are becoming independent of
their parents and are responsible for making decisions that could impact their health and
academic success (Lambert & Donovan, 2016). According to ACHA guideline (2012), healthy
eating and physical activity are recommended for achieving healthy weight which could
contribute to student success in addition to preventing negative consequences associated with
obesity. Health education about healthy eating and physical activity to reduce weight in obese
college students is effective in the short-term, but the change is not sustained (Hamel & Robbins,
2013).
There is a need for an effective individualized weight reduction intervention that is
sustainable. Healthcare providers can bridge the gap by taking action in the practice setting by
implementing the evidence-based approach in educating and motivating obese individuals to lose
weight. The goal of this project is to conduct a pilot project implementing health coaching to
provide health education on nutrition and physical activity and to facilitate behavioral change
that would lead to weight reduction in college students. Health coaching has been used
effectively for managing chronic health problems such as diabetes and hypertension in the
United States (Whyte, 2014).
Problem Statement
The problem statement for the study is What is the effect of a weekly phone call to
provide education on diet and physical activity with health coaching on weight loss in
overweight or obese college students?
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Objectives and Aims
The aim of the project is to engage overweight or obese students as active participants in
their weight reduction and weight management activities by providing them with education and
support needed for a change to occur. The goal is to improve the knowledge and behavior of
overweight or obese college students to facilitate weight reduction and weight management
activities. The objectives of the project are: 1) to educate overweight or obese students to
facilitate lifestyle modifications, and 2) to provide the support and motivation through health
coaching that allows a student to be actively involved in his/her weight loss efforts. Also,
through the implementation of the health coaching, to contribute towards meeting the Healthy
People 2020 objectives of increasing the proportion of adults who are at a healthy weight and
reducing the proportion of adults who are obese.
Review of Literature
A search of the literature was conducted using Maryville online library. The Cumulative
Index to Nursing and Allied Health Literature (CINAHL) and ProQuest databases were searched
for relevant articles. Key terms used to identify articles were obesity, college students, obesity in
college students, health coaching, nutrition, physical activity, and weight management. The
articles were reviewed using the following inclusion criteria: articles published in English,
published within the past ten years (2007-2017), and have abstracts. Exclusion criteria include
articles that were not published in English, articles published more than ten years ago, and
articles without abstracts. A total of 225 articles were retrieved using the terms indicated out of
which 45 were reviewed. Of the 45 articles, 22 were selected as meeting the inclusion criteria
and were chosen for this review.
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The literature reviewed revealed three overarching themes. The themes were factors
contributing to obesity in college students, issue related to a lack of self-efficacy regarding
overweight and obese; and educational modalities and interventions used to facilitate weight loss
in obese college students.
Factors Contributing to Obesity in College Students
Obesity has been associated with inadequate physical activity and poor nutritional
practices (Mackey et al., 2015). The American College Health Association (2015) indicated that
less than five percent of college students consume the recommended amount of servings of fruits
and vegetables per day. About 81.6% of adults do not engage in the recommended amount of
physical activities per day (Downes, 2015). The United States DHHS, Healthy People 2020’s
recommendations for physical activity for adults ages 18 to 64 include engaging in a moderate-
intensity activity for at least 150 minutes per week (CDC, 2015). Downes (2015) conducted a
cross-sectional descriptive correlational survey of 106 college students with the purpose of
exploring the relationship between physical activity, dietary habits, and weight status. The author
studied the motivating factors and barriers to a healthy lifestyle in college students. The
motivating factors examined include personal and environmental factors such as living longer
and social support (Downes, 2015). The personal factors were the desire to live longer, be
healthier, increase energy and for spiritual beliefs. The environmental factors were the
availability of role models, social support, provider counseling, and health information (Downes,
2015).
Additionally, the barriers to a healthy lifestyle that were assessed include lack of
motivation, lack of time, health concern, lack of perceived benefit, safety concerns and lack of
resources (Downes, 2015). The result of the study shows that there is a significant correlation
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between physical activity and motivating factors for weight loss (p < .01) and poor dietary health
practices correlated with the barriers which were the inhibiting factors (p < .05). The study
further shows that participants that score high on the motivation scale are more likely to exercise
more and eat more fruits than those that score high on the barrier scale (Downes, 2015).
A qualitative study was conducted by Smith-Jackson and Reel (2012) examined weight
gain in 30 freshmen college women aged 18 and 19. The purpose of the study was to understand
the impacts and explanations for the "Freshman 15" (Smith-Jackson & Reel, 2012). “Freshman
15” is associated with the belief that an average of 15-pounds weight gain was experienced
during the freshman’s year of college (Smith-Jackson & Reel, 2012). In addition, it was noted
that college students gain between 9.6 to 27 pounds by graduation (Smith-Jackson & Reel,
2012). Reasons for the weight gain were influenced by students’ having to make independent
choices regarding food, and social environmental factors such as peer influence. Smith-Jackson
& Reel (2012) also found that some freshmen women associated their weight gain to poor eating
habit and perceived weight gain as inevitable. The possibility of students gaining weight at the
level indicated in this study could increase the risk of developing obesity-related health problems
in the future.
Furthermore, Vadeboncoeur, Townsend, and Foster (2015) conducted a meta-analysis of
22 studies involving 5,549 students. The study aimed to update the literature on the 15 pounds
average weight gain by first-year college students referred to as “Freshman-15” (Smith-Jackson
& Reel, 2012). The study indicated that 60.9% of the students gained weight during the freshman
year with an average weight gain of 7.5lbs (95 % CI: 2.85 - 3.92) (Vadeboncoeur, Townsend, &
Foster, 2015). Results of this study support findings from a previous study by Smith-Jackson &
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Reel (2012) that indicates the need for interventions to facilitate weight reduction and prevent
overweight and obesity in college students.
In addition, abnormal eating patterns such as binge eating and preoccupation with food
have been observed in overweight and obese college students. Desai, Miller, Staples, and
Bravender (2008) conducted a cross-sectional survey of 4,201 participants with the aim of
assessing abnormal eating perceptions and behaviors of college students. The result of the study
shows a relationship between body mass index (BMI) and abnormal eating such as binge eating,
noting that students that engage in binge eating have higher BMI. Also, the authors identified a
relationship between preoccupation with food and obesity with students who were preoccupied
with food being obese. Similarly, students that were not engaged in physical activity were also
more obese.
Self-Efficacy
Studies indicate that many college students lack self-efficacy for healthy eating and
exercise (Smith-Jackson & Reel, 2012; Stephens, Althouse, Tan, & Melnyk, 2017). Self-efficacy
for healthy eating is the belief that one possesses the ability to make better food choices in a
given situation. Also, self-efficacy for physical activity is the belief in one’s ability to perform
recommended physical activity in a given situation (Stephens et al., 2017). Low self-efficacy in
nutrition and physical activity could impact eating habits and physical activity behaviors.
Stephens, Althouse, Tan, and Melnyk (2017) conducted a descriptive study with 62 college
students to examine gender and race as they relate to nutrition, exercise habits, and self-efficacy.
The authors assessed nutritional knowledge to identify participants’ knowledge of various foods
regarding sodium, saturated fat, vegetable and fruit servings per day; physical activity was also
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assessed. The results of the study showed that high self-efficacy score for healthy eating was
associated with low consumption of sodium, and saturated fat and higher consumption of fruits.
The study showed male students scored lower in self-efficacy for healthy eating. The study
indicates the need for intervention that focuses on increasing self-efficacy for healthy eating to
see a change in eating habits.
Approaches to Weight and Obesity Management
Students’ Approach to Weight Management.
College students are responsible for planning their meals and making appropriate food
choices. However, many students consume an unhealthy diet that is high in fat, sugar, and
sodium (Harring, Montgomery, & Hardin, 2010; Stephens et al., 2017). Poor eating habits and
decrease physical activity contribute to overweight and obesity in college students. Harring,
Montgomery, and Hardin (2010) conducted a study of 97,357 students to determine if inaccurate
body weight perception predicts unhealthy weight management strategies. The authors also
investigated the degree of body weight perception associated with depressive symptoms among
college students in the United States. The study found that some college students engage in
unhealthy weight management practices that include the use of diet pills, laxatives, self-induced
vomiting, and excessive exercise to lose weight. The study found inaccurate perception of weight
by students in that 38.8% of female participants, and 30.8% male participants, described
themselves as overweight or obese while based on their calculated BMI, 28.8% female and
39.4% male were overweight or obese respectively (Harring, Montgomery, & Hardin, 2010).
The study showed that college students demonstrate inaccurate weight perception and engage in
unhealthy weight management strategies. The study indicated that college students need
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education regarding appropriate strategies for achieving a healthy weight and appropriate
methods for preventing and managing obesity.
Interventions for Overweight and Obesity Management in College Students
Various approaches have been used to assist patients to lose weight and reduce the risks
of developing chronic diseases with the majority including providing education on healthful
eating and improving physical activity. Appel et al. (2011) conducted a randomized controlled
trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients.
Participants in the study were obese patients with at least one cardiovascular risk factor such as
hypertension, diabetes or hyperlipidemia. There were two intervention groups in the study and
one control group. Participants in one of the intervention groups received weight-loss support
through remote access involving the use of the telephone, email, and website study. The second
intervention group received face-to-face support in addition to remote interventions using the
telephone, email and website similar to the first group. The control group did not receive any
intervention. The mean weight changes at the end of the 24-months study were compared with
mean baseline weight. The result shows mean change in weight in the control group of -0.8 kg, -
4.6 kg in the group that received remote support only (p < 0.001), and -5.1 kg in the group that
received face-to-face support and remote support (p < 0.00.1). The changes in weight were not
significantly different between the two intervention groups. The study shows a significant weight
loss was achieved by providing patients with weight loss support using the remote method and
providing face-to-face intervention with remote support (Appel et al., 2011).
The use of computers, websites and emails have been found effective for providing
healthy eating and physical activity interventions (Hamel & Robbins, 2013; Mackey et al., 2015;
Schwartz & Richardson, 2015). Mackey et al. (2015) conducted a 24-week randomized
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controlled trial with 47 participants to evaluate the acceptability of an e-mail–delivered
intervention program to promote nutrition and physical activity in African American college
students. Forty-six percent of the participants were overweight or obese with poor nutrition
behavior. The intervention group received an email-based intervention to improve diet and
physical activity while the control group received general health information. At baseline, 80.9%
of the participants showed the desire to improve their diet while 76.0% wanted to improve their
physical activity. At 24-week, 70% of the control and 86% of the intervention group showed
satisfaction with the program. The study shows the feasibility and acceptability of an e-mail
delivered program promote positive health behaviors in African American college students.
Also, Gow, Trace, & Mazzeo (2010) conducted a four-arm pre- post-test control group
study with 170 freshmen with the goal of identifying the feasibility of internet intervention for
obesity prevention in college students. The study participants were randomly assigned to one of
the four study groups that consist of internet intervention, feedback intervention, combined
intervention and control group. This study showed a significant change in the BMI of the
intervention group (Gow, Trace, & Mazzeo, 2010). The authors noted the effectiveness and
feasibility of providing intervention through online medium.
Health Coaching Approach
Health coaching is a patient-centered approach that has been effective for the
management of chronic diseases such as obesity, hypertension, fibromyalgia, diabetes, and
obesity (Crittenden, Seibenhener, & Hamilton, 2017; Hackshaw et al., 2016; Munoz Obino,
Aguiar Pereira, & Caron-Lienert, 2016; Olsen & Nesbitt, 2010; Sherman, Crocker, Dill, &
Judge, 2013). Health coaching is an approach that increases patients’ awareness of their health
problems and enables patients to become responsible for changing their health behavior
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(Crittenden et al., 2017; Munoz Obino et al., 2016). In addition, coaching facilitates patient’s
self-management of health problem by engaging and guiding the patient through behavioral
changes (Sherman, Crocker, Dill, & Judge, 2013). The patient is allowed to identify the
objectives and actions needed to accomplish his/her goals. The coach collaborates with the
patient, providing health education, and challenging the patient through motivational
interviewing, questioning and monitoring patient’s actions. This coaching process improves the
patient’s confidence and encourages patient to change. (Munoz Obino et al., 2016). Health
coaching also involves the use of the motivational interviewing technique which allows patients
to resolve perceived barriers.
The use of health coaching and telephone intervention were found to be effective for
weight reduction in obese adults (Sherman, Crocker, Dill, & Judge, 2013). The authors reported
a case study involving the provision of health coaching for obesity management that resulted in a
weight reduction from 216lbs to 165lbs for a total of 51lbs weight loss within 18 months. The
participant received ten health coaching sessions, seven of which were by using the telephone
and three sessions were provided face-to-face. Health coaching technique encourages
participant’s involvement in setting and achieving their goals (Sherman, Crocker, Dill, & Judge,
2013).
Olsen and Nesbitt (2010) conducted an integrative review to examine the effectiveness of
health coaching in helping patient adopt healthy lifestyle behaviors needed to prevent and control
chronic diseases. The result of the study showed significant improvements in participants’
behaviors including nutrition, physical activity, and weight management.
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Munoz Obino, Aguiar Pereira, and Caron-Lienert (2016) conducted a literature review
with the goal of identifying how coaching could assist in weight loss and improve health.
Thirteen articles were reviewed for the study. The study found that combining in-person sessions
with telecoaching was the commonly used approach in majority of the studies. The study showed
that providing telecoaching was effective for reducing anthropometric measurements. In
addition, the study showed that coaching increased motivations and personal satisfaction
compared with traditional health education alone.
Similarly, other research studies have been conducted that showed the effectiveness of
health coaching in the management of chronic health conditions. Crittenden, Seibenhener, and
Hamilton (2017) conducted a pilot study using the health coaching model for the management of
hypertension. The goal of the study was to examine the impact of health coaching on lifestyle
modification in patients with hypertension. There were 21 participants in the study. At baseline,
57.1% of the participants were unaware of their blood pressure goals, 66.7% were non-adhering
to any lifestyle recommendations, and 81% were low in adhering to their antihypertensive
medications. After the health coaching intervention, the result showed significant changes. The
percentage of participants that were aware of their blood pressure goals increased to 90%, and
the percentage of those adhering to lifestyle modifications and antihypertensive medications
increased to 81%. The conclusion of the study was that health coaching was effective for
sustaining patients’ engagement in lifestyle modification and enhancing adherence to
medication. The study demonstrated the impact that coaching could have in empowering patients
to change lifestyles to achieve their health goals.
Moreover, Hackshaw et al. (2016) conducted a pilot study with the purpose of showing
that health and wellness coaching intervention for the treatment of fibromyalgia would result in
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sustained improvements in health and quality of life of patients and reduce patients’ health care
utilization. There were nine participants in the study. The study finds that the addition of health
and wellness coach to pharmacologic management of patients with fibromyalgia produced
clinically significant improvements. The patients’ quality of life was measured using the Revised
Fibromyalgia Impact Questionnaire (FIQR), patients experienced pain reduction as measured by
the Brief Pain Inventory Short Form (BPI), and there was a decrease in health care utilization.
Kivela, Elo, Kyngas, and Kaariainen (2014) conducted a systematic review of 13 studies
with the purpose of describing the effectiveness of health coaching provided by health care
professionals on adults with chronic diseases. The authors reviewed randomized controlled trials
and quasi-experimental designed articles. The result of the study showed that health coaching
improves patient’s physical and mental health conditions and motivated changes in patient’s
lifestyle behaviors and social life (Kivela, Elo, Kyngas, & Kaariainen, 2014). The study
concluded that health coaching improved the management of chronic diseases.
Gaps identified by many authors in their studies indicate areas where further studies are
needed. Desai et al. (2008) recognized the need for longitudinal studies to evaluate BMI and the
determinants of obesity. To further evaluate the sustainability of weight loss post interventions, a
longitudinal study will allow the evaluation of the effectiveness of the interventions provided.
The effectiveness of weight reduction interventions for preventing chronic diseases could also be
evaluated. A gap identified by Mackey et al. (2015) in their study is the need for research studies
to assess the physical activity level of college students using a validated instrument. The
effectiveness of health coaching for weight reduction in overweight or obese college students
needs to be studied.
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Many students lack knowledge associated with effective weight management. Some
overweight/obese students use unsafe methods such as using diet pills, laxatives, self-induced
vomiting, starvation, and excessive exercise to lose weight (Harring, Montgomery, & Hardin,
2010). The stakeholders at the proposed project site, including the Director of Student
Development and Student Success, the insurance company, and faculty members strongly
support efforts to improve students’ knowledge about weight management, disease prevention,
and health promotion. The Advanced Practice Nurse (APRN) is in an ideal position for educating
and motivating students in efforts to achieve a healthy weight (Downes, 2010). This project
proposes to provide students with the education about diet and physical activity needed to
facilitate weight reduction and provide health coaching for motivating overweight/obese students
to actively participate in their weight loss efforts, thereby increasing self-efficacy.
Theoretical Model
Pender’s Health Promotion Model (HPM) provides the framework for this project (Figure
1) (See Appendix A). The HPM was proposed by Nola Pender in 1982 and revised in 1996
based on changing theoretical perspective and empirical findings (Pender, Murdaugh, & Parsons,
2011). The theoretical background of the theory includes Expectancy-Value Theory and Social
Cognitive Theory (Pender et al., 2011). The expectancy-value theory posits that individuals will
engage in actions that they perceive to be possible and will result in a valued outcome. Similarly,
social cognitive theory indicates that thoughts, behaviors, and environment interact, therefore for
an individual to alter their behavior, they must alter their thought. The HPM is a model that is
based on human behaviors. The purpose of the model is to assist nurses in understanding health
behavior determinants as the basis of behavioral counseling to promote health (Pender et al.,
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2011) There are three components to the theory that include individual characteristics and
experiences; behavior-specific cognition and affect; and behavioral outcome-health promotion
behaviors (Appendix A). Individual characteristics and experiences component of the model
include prior related behaviors and personal factors. The second component is personal related
behaviors and personal factors. This component consists of constructs that are frequently studied
in research works. They include perceived benefits of action, perceived barriers to action, self-
efficacy, activity related affect, interpersonal influences, social support, situational influences.
The third component is behavioral outcome-health promotion behaviors. This third component
could be influenced by some immediate competing demands and commitment to action.
This model fits the obesity management and prevention project as a health promotion
model. The project seeks to effect behavioral changes and actively engage overweight and obese
students in weight reduction efforts. Perceived benefits and self-efficacy constructs play major
roles in influencing behavioral change (Pender et al., 2011). Perceived benefits are the benefits
an individual believes they will achieve by performing the action; this belief reinforces the action
while self-efficacy is the belief that one can perform the action or perform the health behavior
successfully. Self-efficacy involves having confidence in one’s ability to achieve a goal.
One of the assumptions of the HPM is that the health professionals is a part of a patient’s
interpersonal environment that could influence the patient throughout their life span. Nurses and
advanced practice nurses could assess patient’s knowledge need as they perceive the benefits of
an action that could impact their health and provide the education needed to increase patients’
knowledge. Additionally, nurses could provide positive motivation to enable patients to
participate in managing their chronic health management. Advanced practice nurses can also
educate patients to enable a change in their perceptions of barriers and develop ways of
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overcoming obstacles to lifestyle changes. Patients’ self-efficacy could be enhanced by
empowering them by collaborating with them in making lifestyle changes.
Project and Study Design
The study was a quantitative 4-week descriptive pre- and post-intervention pilot study
design. Institutional Review Board approvals were obtained prior to the start of the study from
Maryville University and the University where the study was conducted. The University is
located on the eastern part of the United States. Participants were selected from the target
population at the University. Participants were recruited by flyers to be placed in students’
common areas and by inviting overweight or obese students to participate in the study after their
clinic visits. Participation in the study was voluntary. The link to the Youtube PowerPoint
presentation was emailed to volunteers for the study. The PowerPoint presentation discussed the
roles of study participants and the researcher, inclusion and exclusion criteria, and the informed
consent. The researcher’s contact information was included in the presentation for potential
participants to schedule an appointment with the researcher. During the appointment, any further
questions about the study was answered. Volunteer’s height was measured by the researcher
using Accustat Genentech Stadiometer, and weight was measured using Tanita Composition
Analyzer BF-350. Body mass index (BMI) was calculated using height and weight
measurements; the BMI result was used to determine eligibility. A signed informed consent was
obtained from participants. Participants thereafter completed the demographic questionnaire
(Figure 2) (See Appendix B), the Youth Risk Behaviors Survey (YRBS) (Figure 3) (See
Appendix C) and the Motivators and Barriers Survey of Healthy Lifestyle Survey (MABS)
(Downes, 2015) (Figure 4) (See Appendix D). Appointments for the weekly phone calls were
scheduled.
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The health coaching intervention consisted of three weekly calls to participants. Coaching
involves using the motivational interviewing technique to strengthen a person’s commitment to
change. The motivational technique involves asking open-ended questions, validating
information, attentive listening, and encouraging self-efficacy and confidence. Participants were
guided towards identifying positive behaviors and making healthy choices. Weekly calls focused
on dietary and physical activity education. Participants were encouraged to focus on their goals
towards changing any unhealthy habits related to nutrition and physical activity. Eating
recommended five servings of fruits and vegetables daily, limiting sugary drinks, drinking more
water, and portion control were encouraged. In addition, participants were encouraged to get 30
minutes or more of physical activity daily.
Validated instruments were used to collect data from the participants. The Youth Risk
Behavior Survey (YRBS) is a 12-item self-reported instrument that measures dietary habits and
physical activity behaviors. The Motivators and Barriers Survey of Healthy Lifestyle Survey
Scales (MABS) is an 18-item tool that is divided into two subscales, with eight items measuring
motivating factors while ten items measure barriers that were inhibiting healthy lifestyle
behaviors. The scoring of the MABS is on a Likert scale. The MABS questionnaire has a
Cronbach’s alpha internal consistency of .81 for the Motivators and .88 for the barriers (Downes,
2015). Permission to use the MABS was obtained from the author; no permission was needed for
the use of YRBS. Participants’ height and weight were measured at the beginning and the end of
the fourth week and participants also completed the YRBS and MABS. Collected data was
categorized and entered an Excel spreadsheet for statistical analysis.
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Setting and Resources
The setting for the study was a University located on the eastern part of the United States.
Resources needed for the study were a telephone, a laptop computer, copies of questionnaires,
measurement tools for height and weight, pens and pencils. The researcher used a personal
telephone and laptop that were password protected and only accessible to the researcher. The
clinic provided photocopies of the questionnaires. A private office available at the Health Center
was used for completing the questionnaires. Limited financial resource was needed. The
researcher purchased pencils and pens at a minimum cost.
Study Population
Participants in the project included adults, overweight or obese college students at the
University. Participants for the study were recruited using flyers placed in students’ common
areas on campus. All overweight or obese students were asked to participate in the project after
their scheduled clinic appointment. Participation in the study was voluntary and did not impact
the care provided. Inclusion criteria are 1) College students ages 18 to 29, 2) Current enrollment
in the institution, 3) Male and female students, 4) Body mass index (BMI) of 25 kilograms per
meter squared (kg/m2) or greater, and 5 All ethnic groups. Eligibility was determined by
performing actual measurements of height and weight and calculating BMI. The currency of
student’s University status was validated. Exclusion criteria were: 1) Students currently
undergoing weight reduction treatments or pregnant, 2) BMI less than 18 kilograms per meter
squared (kg/m2), 3) Contraindications to exercise, 4) Special diets prescribed by a healthcare
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provider, and 5) Not currently enrolled at the institution. A convenient sample of 20 participants
was selected.
Sources of Data
Research instruments for data collection include the demographic questionnaire, the
Youth Risk Behavior Survey (YRBS), the Motivators and Barriers to Healthy Lifestyle Survey
(MABS) and performing biophysical measurements of height and weight and calculating body
mass index (BMI). The Youth Risk Behavior Survey (YRBS) is a 12-item self-reported
instrument that measures dietary habits and physical activity behaviors (CDC, 2017b; Downes,
2015). The Motivators and Barriers Survey of Healthy Lifestyle Survey Scales (MABS) is an 18-
item tool that is divided into two subscales, with eight items measuring motivating factors while
ten items measure barriers inhibiting healthy lifestyle behaviors (Downes, 2015). The scoring of
the MABS is on a Likert scale. The MABS questionnaire has a Cronbach’s alpha internal
consistency of .81 for the Motivators and .88 for the barriers (Downes, 2010). Participants’
heights were measured by the researcher using Accustat Genentech Stadiometer and weight
measured using Tanita Composition Analyzer BF-350. BMI was calculated using their height
and weight. Permission to use the MABS was obtained from the author; no permission was
needed for the use of YRBS.
The principal investigator collected all data, performed all measurements, and provided
weekly phone calls. Key research variables for the study are weight, height, body mass index,
exercise habits, dietary habits, motivators, and barrier factors. Operational definitions of the
variables are:
Weight: Participant’s body weight in pounds and ounces measured without shoes.
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Height: Participant’s height in feet and inches measured without shoes.
Body mass index: Body weight in kilograms divided by the square of height in meters to assess
overweight and obesity (Centers for Disease Control and Prevention [CDC], 2016)
Exercise habits: Participant’s 7-day exercise habit recall (CDC, 2017b)
Dietary habits: Participant’s 7-day dietary habit recall (CDC, 2017b)
Motivators factors: Personal and environmental factors affecting the participant’s healthy
lifestyle behaviors (Downes, 2015).
Barrier factors: Factors contributing barriers to participant’s healthy lifestyle behaviors
(Downes, 2015).
Data Analysis
Collected data were categorized and entered into an Excel spreadsheet and submitted to
the statistician for data analysis. Descriptive Statistics and paired t-test were calculated (Table 1)
(See Appendix E). Frequencies and percentages were obtained for categorical data such as age,
gender, race/ethnicity, class status, and housing. Means and standard deviations were calculated
for continuous data such as weight and BMI. Paired t-test was calculated to determine the
difference between pre- and post-intervention measurements.
Quality
Data were collected at the intended University in a timely manner; all participants
completed the questionnaires at the beginning and at the end of the study. The research
administered all questionnaires in the same manner in a private environment free of distraction
by the researcher. All biophysical measurements were performed by the researcher using
specialized instruments for consistency. The data collection instruments used were pretested for
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reliability and validity by the creator of the tools. The YRBS has a test-retest reliability of 75%,
and the MABS has Cronbach’s alpha of .81 for the motivator subscale and .88 for the barrier
subscale (Downes, 2015). Principal investigator administered the questionnaires to eliminate
bias and to maintain the validity and reliability of measurement tools. In addition, no changes
were made to the questionnaires by the researcher. The YRBS and the MABS are valid and
reliable measurement tools; both have face and content validity. The questionnaires were specific
and sensitive to the construct of the study. The YRBS measures the dietary habits and exercise
behaviors of participants. This instrument has face validity; sample questions are: In the past
seven days, how many times did you exercise or participate in physical activity for at least 20
minutes that made you sweat? and In the past seven days, how many times did you eat
vegetables?
Collected data were secured in a locked box in the researcher’s private office that only
the researcher has access to. The principal investigator administered all questionnaires to
eliminate bias and maintain the consistency of measurement tools
Results
Of the 15 participants that completed the study, 13% were male, 87% were female; 60%
were African American. The median age of the study participants was between 21-22 years.
Participants’ academic class levels were: 33% freshman, 27% sophomore, 7% junior, 13%
senior, and 20% graduate, the majority were freshman students. The University is a non-
residential institution, 53% of the participants live independently in the community, 20% live in
off-campus university housing, 27% live with family. The mean average pre- and post-
intervention weight was 197.1 and 195.6lbs respectively (Table 1) (See Appendix E), and the
amount of weight loss by participants are shown in Table 2 (Appendix F). Sixty percent (10) of
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the participants lost weight ranging from 0.2 to 8.6 lbs. The pre- and post-intervention body mass
index (BMI) shows a slight difference. Four participants gained weight including the two male
participants in the study.
The difference between mean pre-intervention and post-intervention weight was 1.5 lbs.
and the mean pre-intervention and post-intervention BMI was 0.26 respectively (Figure 5) (See
Appendix G). The paired t-test result shows no significant difference in the scores for pre- and
post-intervention weight (t(14) = 1.37, p = .19) and BMI (t(14) = 1.57, p = .14) ( Table 1), (See
Appendix E).
The pre-intervention results of the YRBS questionnaire show that none of the participants
ate the recommended amount of fruits and vegetables. Sixty percent of the participants drank
fruit juice or ate fruit 1-3 times per day. Similarly, 60% ate 1-3 vegetables per day, and 47% ate
snacks 1-3 times per day. Additionally, the YRBS shows that 40% of the participants performed
20 minutes of vigorous physical activity 1-3 days per week, 33% reported exercising for 30
minutes 1-3 days per week. The three top barriers to healthy lifestyle were: having too many
things to do, stress, and lack of motivation (Figure 6) (See Appendix H), while motivators for
practicing a healthy lifestyle include wanting to be healthy, energetic, and lose weight. All 15
participants received three weekly telephone calls to provide health coaching using structured
scripts for consistency. Participants discussed challenges about their diet and physical activity.
Some participants reported a lack of accessibility to healthy food choices due to limited funds.
Participants were offered support and motivation and encouraged to identify ways to eat healthy
and exercise with their limited resources.
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Discussion
Majority of the study participants were females which is similar findings in research
studies (Moe, Lytle, Nanney, Linde, & Laska, 2016). The low male participation in obesity
reduction study was noted attributed to possible perception of their weight as some male showed
no dissatisfaction with the weight (Moe, Lytle, Nanney, Linde, & Laska, 2016). The weight loss
among participants ranged between 0.2 to 8.6lbs although the overall difference in pre- and post-
intervention BMI was not significant. The range of weight loss suggests that some participants
were more motivated than others. Pre-intervention YRBS data shows none of the participants ate
the recommended amount of fruits and vegetables nor performed the recommended amount of
physical activity. This is consistent with research findings that many college students consume
less than the daily recommended amount of fruits and vegetables and do not perform the
recommended amount of physical activity per week (Nanney et al., 2015). Poor eating habits and
the inadequate amount of physical activity are factors contributing to overweight/obesity.
Barriers to a healthy lifestyle results are consistent with research findings that stress is one of the
factors contributing to weight gain in college students (Nanney et al., 2015). Majority of the
participants were African American, and the rate of obesity is higher in African Americans than
the other ethnic groups. This finding is consistent with findings in other studies that African
American has a higher rate of overweight and obesity than other ethnic groups (Sa, Heimdal,
Sbrocco, Seo, & Nelson, 2016).
Limitations
The sample size for the study was small, and there were few male participants in the
study which limits the generalizability of study findings. Also, a convenience sample was used
that may not be representative of the target population. The duration of the health coaching of
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four weeks may not be long enough to measure a significant change in weight and BMI. Other
studies that used health coaching for weight loss provided the coaching longer periods. The use
of self-report is appropriate for obtaining information about dietary and physical activity recall
but could subject the data to bias. Causality cannot be inferred from the study. Another limitation
is that participants were recruited from one setting which is a non-residential Historically Black
University. The study has only two male participants which further limits the result from being
generalized. The racial diversity in the study is limited with the majority being African America.
Implications for Practice
The inadequate dietary and physical activity behavior among some college students
remains a challenge to health care providers. The implications of the study include the clinical
significance at the individual level as evidenced by ten out the 15 participants losing some
weight. Participants who experienced weight reduction might feel a sense of accomplishment
and improved self-confidence in their ability with the appropriate education and support.
Coaching method can be included in practice to motivate, educate and support overweight or
obese students. Results of the study could increase nurses’ knowledge of the barriers and
motivators for healthy lifestyles in college students. The study shows that 33% of the sample
population were in their freshman year. There is a need to educate and motivate overweight and
obese freshman college students to lose weight to prevent weight gain in subsequent years in
college. Nurses need to assist with finding food resources due to many students lacking adequate
resources to provide appropriate food. Weight loss intervention for male college students
requires further study.
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Ethics and Human Subjects Protection
Institutional Review Board (IRB) approvals from Maryville University and at the
University used for the study were obtained before starting data collection for the study to ensure
human subject protection is maintained. One risk for conducting this study is the potential for
breach of confidentiality, which is minimal. Another risk is that participants may feel coerced to
participate in the study as this researcher is one of the healthcare providers at the Student Health
Center. There is a potential risk for injury due to physical activity as participants were advised to
exercise. Also, there is the potential risk of being identified as overweight or obese based on
BMI calculation.
The potential risk of breach of confidentiality was managed by the use of de-identified
data and limited access to the data by only the researcher performing the study. This risk was
minimized by identifying participants by numeric codes instead of using names on all data
collection sheets. The list linking subjects’ names and numeric codes, as well as the signed
informed consents, were kept separate from the data collection sheets and locked in a file cabinet
in the researcher’s locked private office with access limited to the researcher. The data collection
sheets will be kept in a locked file cabinet, separate from the subjects’ names and numeric codes,
as well as the signed informed consents, in the researcher’s locked private office with access
limited to the researcher. The numeric codes and data collection sheets will be shredded upon
conclusion of the study. Informed consents will be shredded after three years.
The second risk of coercion was mitigated by requesting participation in the study after
the office visit is completed. In addition, the researcher informed participants that choosing not
to participate will not adversely affect the participants’ relationship with the researcher as their
healthcare provider. The participants have the freedom to ask questions and withdraw from the
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study at any time without penalty. The researcher emphasized that the treatment of the
participants was equitable before, during, and after the research study. It was emphasized that
whether the patients who meet the inclusion criteria agreed to participate in the study or not will
in no way affect the care they receive from their provider.
Any type of physical activity can come with a risk of physical injury. To minimize the
potential risk of physical injury, only participants who have no contraindications to exercise were
recruited for the study. The researcher will verify any contraindication to physical activity by
requesting participants to self-report any healthcare provider’s restrictions on physical activity at
the beginning of the project and during the weekly telephone calls. Participants with
contraindications such as advised not to exercise were excluded from the project to prevent
injury. In addition, the researcher could remove individuals from the study if in the researcher’s
judgment mental or physical health could be compromised if they continue to participate.
Participants will be encouraged to increase their activity and refrain from a sedentary lifestyle.
Participants were not coerced to perform any activity that they felt could compromise their health
or is not within their capacity.
The potential negative impact related to being identified as overweight or obese based on
BMI calculation was minimized by not using negative terms to address participants. Instead,
participants were addressed by their names and terms such as elevated BMI will be used in place
of overweight or obese to avoid any stigma.
Timeframes or Timeline
Institutional Review Board (IRB) approvals were obtained from the University used for
the study in December 2017 and from Maryville University in April 2018. The recruitment of
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participants for the study and data collection was started from April 2018 till September 2018.
Data analysis was performed in October 2018, the interpretation of results was conducted in
November 2018. Oral presentation of capstone project and submission of the write-up were done
in December 2018.
Budget
The researcher contributed to the use of personal telephone for making weekly calls and
the use of a personal password laptop computer that was only accessible to the researcher. The
researcher also measured participants’ heights and weights and calculated BMI. A private room
was available at the Health Center at no extra cost for participants to complete the
questionnaires. Other resources available for use for the study include the Stadiometer scale for
measuring height and the Tanita scale for measuring participants’ weight. The researcher
purchased pencils and pens for at a minimum amount. The statistician who analyzed the data is
an instructor at Maryville University who provided the service at no cost to students.
Strengths and Weaknesses of the Study
Strengths
The data for the study was collected in a timely and consistent manner as planned for the
project. The principal investigator used the same measuring tools to measure the height and
weight of participants; and administered the demographic questionnaire, the YRBS and the
MABS to participants in a private environment free of distraction. Nutrition and physical activity
education were provided to each participant via weekly telephone calls in a consistent manner to
increase the rigor of the study. Valid and reliable tools were used for data collection. The study
could be replicated in similar University settings that are non-residential. The intervention could
work in other health conditions due to the use of valid and reliable tools for data collection.
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There was an organizational support for the project by the University used for the study.
The support includes the approval of the project by the Chief of Student Success and Student
Development and granting the IRB approval.
Weaknesses
Findings from the study could not be generalized due to the small sample size. A large
sample size is needed to achieve a statistically significant result. There was limited diversity in
the ethnic composition of study participants which limits the generalizability of results. The use
of convenience sampling and self-report questionnaires limit the generalizability of results. In
addition, having few male participants in the study is a limitation that could impact the results of
the study.
Conclusion
The study shows adherence to recommended diet and physical activities could result in
weight reduction. Though no statistical significance was determined for the intervention, some
participants lost some weight. The study shows some overweight and obese college students
want to lose weight and need education and support and should be provided with such. Further
studies are needed with larger sample size and the study conducted for a longer period to allow
for recruitment of participants and be able to evaluate the significance of the intervention.
Challenges of overweight and obesity in college students warrant comprehensive intervention
with a multi-disciplinary approach. By involving the athletic department, counseling department,
nutrition and dietetic department, and health services in developing health promotion activities,
an effective weight loss, and weight management goal could be achieved.
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References
American College Health Association (2017). American College Health Association National
College Health Assessment II: Reference Group Executive Summary Fall 2016. Hanover,
MD: American College Health Association
Appel, L. J., Clark, J. M., Yeh, H.-C., Wang, N.-Y., Coughlin, J. W., Daumit, G., & Brancati, F.
L. (2011). Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice.
New England Journal of Medicine, 365(21), 1959–1968
Centers for Disease Control and Prevention. (2015). Healthy People 2020
Retrieved from https://www.cdc.gov/nchs/healthy_people/hp2020.htm
Centers for Disease Control and Prevention. (2016). Defining adult overweight and obesity
Retrieved from https://www.cdc.gov/obesity/adult/defining.html
Centers for Disease Control and Prevention. (2017a). Adult Obesity Facts. Retrieved from
https://www.cdc.gov/obesity/data/adult.html
Centers for Disease Control and Prevention. (2017b). Youth Risk Behavior Surveillance System
(YRBSS). Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/index.htm
Crittenden, D., Seibenhener, S., & Hamilton, B. (2017). Brief Report: Health Coaching and the
Management of Hypertension. The Journal for Nurse Practitioners, 13 e237-e239
Desai, M. N., Miller, W. C., Staples, B., & Bravender, T. (2008). Risks factors with overweight
and obesity in college students. Journal of American College Health, 57(1), 109-114
Downes, L. (2015). Original Research: Physical Activity and Dietary Habits of College Students.
Journal for Nurse Practitioners, 11, 192-198.e2
Gow, R. W., Trace, S. E., & Mazzeo, S. E. (2010). Preventing weight gain in first year college
Page 32 of 46
OBESITY MANAGEMENT IN COLLEGE STUDENTS 33
students: An online intervention to prevent the “freshman fifteen.” Eating Behaviors,
11(1), 33–39
Hackshaw, K. V., Plans-Pujolras, M., Rodriguez-Saona, L. E., Moore, M. A., Jackson, E. K.,
Sforzo, G. A., & Buffington, C. T. (2016). A pilot study of health and wellness coaching
for fibromyalgia. BMC Musculoskeletal Disorders, 17(1), 457
Hamel, L. & Robbins, B. (2013). Computer- and web-based interventions to promote healthy
eating among children and adolescents: A systematic review. Journal of Advance
Nursing, 69(1), 16-30
Harring, H., Montgomery, K., & Hardin, J. (2010). Perceptions of body weight, weight
management strategies, and depressive symptoms among US college students. Journal of
American College Health, 59(1), 43-50. doi:10.1080/07448481.2010.483705
Kim, D. D., & Basu, A. (2016). Systematic Review: Estimating the Medical Care Costs of
Obesity in the United States: Systematic Review, Meta-Analysis, and Empirical Analysis.
Value in Health, 19602-613. doi:10.1016/j.jval.2016.02.008
Kivela, K., Elo, S., Kyngas, H., & Kaariainen, M. (2014). Review: The effects of health
coaching on adult patients with chronic diseases: A systematic review. Patient Education
and Counseling, 97147-157
Lambert, C. A. & Donovan, J. (2016). College health care providers’ student-centered
care. The Qualitative Report, 21(10), 1979-1998
Marchiondo, K. (2014). Stemming the obesity epidemic: Are nurses credible coaches?
MEDSURG Nursing, 23(3), 155-158.
Mackey, E., Schweitzer, A., Hurtado, M. E., Hathway, J., Dipietro, L., Lei, K. Y., & Klein, C.J.
Page 33 of 46
OBESITY MANAGEMENT IN COLLEGE STUDENTS 34
(2015). The feasibility of an e-mail-delivered intervention to improve nutrition and
physical activity behaviors in African American College Students. Journal of American
College Health, 63(2), 109–117
Moe, S., Lytle, L., Nanney, M., Linde, J., & Laska, M. (2016). Recruiting and retaining young
adults in a weight gain prevention trial: Lessons learned from the CHOICES study.
Clinical Trials (London, England), 13(2), 205–213
Munoz Obino, K., Aguiar Pereira, C. & Caron-Lienert, R. (2016). Coaching and barriers to
weight loss: An integrative review. Diabetes, Metabolic syndrome and obesity: Targets
and Therapy 10, 1 – 11
Nanney, M., Lytle, L., Farbakhsh, K., Moe, S., Linde, J., Gardner, J., & Laska, M. (2015).
Weight and weight-related behaviors among 2-year college students. Journal of
American College Health, 63(4), 221–229
Olsen, J., & Nesbitt, B. (2010). Health Coaching to improve healthy lifestyle behaviors: An
integrative review. American Journal of Health Promotion, 25(1), e1 – e 12
Pender, N. J., Murdaugh, C. L., & Parsons, L. (2011). Health promotion in nursing practice. (6th
ed.). Upper Saddle River, NJ: Pearson
Ogden, C. L., Carroll, M. D., Fryar, C. D., & Flegal, K. M. (2015). Prevalence of obesity among
adults and youth: United States, 2011-2014. NCHS Data Brief, (219), 1-8
Sa, J., Heimdal, J., Sbrocco, T., Seo, D., & Nelson, B. (2016). Overweight and physical
inactivity among African American students at a historically black university. Journal of
the National Medical Association, 108(1), 77-85
Schwartz, J., & Richardson, C. G. (2015). Exploring the potential for internet-based
Page 34 of 46
OBESITY MANAGEMENT IN COLLEGE STUDENTS 35
interventions for treatment of overweight and obesity in college students. Global Health
Promotion, 22(4), 20-28, 59-60, 69-70
Sherman, R., Crocker, B., Dill, D., & Judge, D. (2013). Health coaching integration into primary
care for the treatment of obesity. Global advances in health and medicine, 2(4), 58-60.
Smith-Jackson, T., & Reel, J. J. (2012). Freshmen women and the “freshman 15”: Perspectives
on prevalence and causes of college weight gain. Journal of American College Health.
https://doi.org/10.1080/07448481.2011.555931
Stephens, J. D., Althouse, A., Tan, A., & Melnyk, B. M. (2017). The Role of Race and Gender in
Nutrition Habits and Self-Efficacy: Results from the Young Adult Weight Loss Study.
Journal of Obesity, 1-6. doi:10.1155/2017/5980698
Vadeboncoeur, C., Townsend, N., & Foster, C. (2015). A meta-analysis of weight gain in first
year university students: is freshman 15 a myth? BMC Obesity, 2(1), 22
Whyte, L. (2014). Coaching for life. Nursing Management - UK, 21(1), 15.
doi:10.7748/nm2014.03.21.1.15.s13
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Appendix A
Figure 1. Pender’s Health Promotion Model
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Appendix B
Figure 2. Demographic Questionnaire
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Demographic Questionnaire: Administered by Researcher
(Answer the following questions)
Code #:________________
Age:
___ Under 18
___ 18-19
___ 20-21
___ 22-24
___ 25 and above
Sex/Gender:
___ Male
___ Female
Race/Ethnicity:
___ African American
___ Asian/Pacific Islander
___ Hispanic/Latino
___ Multiracial
___ Native American/American Indian
___ White
___ Not listed
___ Prefer not to respond
Class Status:
___ Freshman
___ Sophomore
___ Junior
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___ Senior
Housing:
A. Which of the following is/are applicable to your living situation? (Check all that apply)
___ I live alone
___ I live with other students
___ I live with parent (s), relative (s) or guardian (s)
___ I live with a husband/wife/significant other
___ I live with my child/children
B. Which best describes where you currently live?
___ Off-campus university housing
___ Living at home with family
___ Living independently
Appendix C
Figure 3. Youth Risk Behavior Survey
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Appendix D
Figure 4. Motivators and Barriers of Healthy Lifestyle Survey Scales (MABS)
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Appendix E
Table 1. Descriptive Statistics and Paired t-Test
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Appendix F
Table 2. Pre- and Post-Intervention Weight Differences
POSTWEIGHT
PREWEIGHT Weight Difference
217 225.6 -8.6226 221.4 4.6
183.4 182.4 1.0209 209.8 -0.8
169.6 172.4 -2.8257.6 249.8 7.8180 185 -5.0212 210 2.0
175.6 175.6 0.0154 154.2 -0.2179 183 -4.0177 181.6 -4.6
205.8 210.2 -4.4172.8 176.2 -3.4215 218.8 -3.8
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Appendix G
Figure 5. Pre- and Post-Intervention BMI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 150
5
10
15
20
25
30
35
40
45
Pre- and Post-Intervention BMI Dif -ferences
PRE-BMI POSTBMI
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Appendix H
Figure 6. Barriers to Healthy Lifestyles
9. Am not motivated
10. Do not have
11. Live in an unsafe
12. Have too many
13. Have health
14. Do not know what
15. Am unable to
16. Am not able to
17. Have not been
18. Feel stressed.
0
1
2
3
4
5
6
7
8
9
10
Barriers to Healthy Lifestyles
Strongly Disagree Disagree Agree Strongly Agree
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