Perceived Stress, Perceived Social Support, Depression and Food Consumption Frequency in College Students

People in the United States are gaining weight at a rate higher than in the past. Because the eating habits people develop in college are similar to the eating habits people will have for the rest of their lives it is imperative that researchers understand more about why people gain weight in college. The purpose of the proposed survey-based study was to explore the relationship between perceived stress, perceived social support, and depression as it connects to weight changes and food choices in college students who are nonnal and abnonnal eaters. We hypothesized that those who are stressed, depressed, and lacking in social support would eat differently and have higher body mass indexes than people who do not suffer from these symptoms. Results from this study indicated that there was a relationship between perceived stress, perceived social support, and depression and this was correlated with restrained eating patterns. There was also a positive correlation found between perceived stress and soda consumption. A correlation was not shown between abnonnal eating patterns and overall weight. Implications from this study are that college food service providers should provide healthy, easy to eat food. Psychosocial Factors and Food Consumption 3 Perceived stress, perceived social support, depression and food consumption frequency in college students More than one third of U.S. adults and 16% of U.S. children are considered. Obese, obesity rates for adults have doubled and obesity rates for children have tripled. Obesity rates among all groups in society have increased markedly and, in 2000, obesity-related health care costs totaled an estimated $117 billion (CDC, 2009). Lack of exercise and poor eating baits have been blamed for the rising obesity rates. People's eating habits and food choices are not only the result of class, culture, media, or gender but also individual intention and personal agency. Perhaps more alarming is the fact that people in college are gaining significantly more weight during their first year of college, infamously termed the "Freshman 15", than the average American gains at any given time. During freshman year alone, the average weight gain for freshman males is four pounds and the average weight gain for freshman women is three and a half pounds (Holm-Denoma, Joiner, Vohls, & Heatherton, 2008). Proposed reasons for this weight gain center around many of the lifestyle changes one makes when he or she goes to college including eating (and often overeating) in buffet style cafeterias, using free time to participate in activities other than exercise, increased alcohol consumption, eating with other people, and making poor food choices regarding what to eat, when to eat, and how much to eat (Hoffman, Policastro, Quick, & Lee, 2006; Castro & Brewer, 1994; Chaiken. & Pliner, 1990; Wansink, 2004). Previous research has shown that there is a connection between what people eat and how people feel (Oliver, Wardle, & Gibson, 2000). Moreover, associations have been shown between unhealthy food consumption, depressive symptoms and perceived stress amongst female students (Mikolajczyk, Ansari, & Maxwell, In Press). People use food to cope with problems unrelated to Psychosocial Factors and Food Consumption 4 hunger or nourishment including stress and life tension (Wardlea, Steptoeb, Olivera, & Lipsey, 2000). In some people stress can induce overeating and in others, overeating can induce stress (Oliver & Wardle, 1999). The results of studies on stress and eating are mixed (Stone & Brownell, 1994; Bellisle, Louis-Sylvestre, Linet, Rocaboy, DaIle, Cheneau, et al., 1990). For example, in one experimental situation, women who were in a high-stress condition preferred sweet and fattening foods whereas women in the low stress condition ate more low fat food than high fat food (Habhad, Sheldon, & Loeb, 2008). Research, nevertheless is lacking in detennining the connection between the different types of eating patterns people follow and perceived stress, perceived social support, and depression. This study was designed to fulfill this current void in the current food psychology literature. Some people use food as a coping mechanism. Weight-related studies have found that obese individuals increase their food intake as a response to negative emotions, including depression (Arnow, Kenardy, & Ab,rras, 1992; Libennan, Wurtman, & Chew, 1986), perceived social support, (Provencher, Polivy, Wintre, Pratt, et al., 2009), and stress (Gibson, 2006; Greeno & Wing, 1994; Macht, 2008; Torres & Nowson, 2007). Results of this finding are mixed, as exemplified in a study of adolescents in which depressive symptoms were positively associated with health-compromising attitudes (i.e., weight concerns) and depressive symptoms were negatively associated with health-promoting behaviors (i.e., eating breakfast), but most associations between depressive symptoms and dietary micronutrients were not statistically significant (Fulkerson, Sherwood, Neumark-Szainer, & Story, 2004). More research must be conducted in this area to resolve this controversy. For example, emotion is often related to stress, which can mediate a variety of different eating outcomes (Macht, 2008). In his five-way model of how emotions relate to eating, Macht (2008) proposed that eating (a) may be a way for Psychosocial Factors and Food Consumption 5 individuals to regulate their negative emotions and (b) may be caused by the stress-induced disruption of individuals' cognitive self-regulation. One area that may give insight into why people eat food is by comparing people with abnormal eating habits to people who are normal eaters. Abnormal Eating Patterns Many different abnormal eating patterns have been discovered and diagnosed in both women and men. Eating disorders such as anorexia nervosa, bulimia, and binge eating, which are clinically recognized in the DSM-IV, are all characterized as eating or not eating to extremes. It is estimated that ten million women and one million men have eating disorders (Crowther et aI., 1992; Fairburn et aI., 1993; Gordon, 1990; Hoek, 1995; Shisslak et aI., 1995 as cited by National Eating Disorder Association, 2005). This number, however, does not include people who demonstrate abnormal eating patterns. Such eating patterns can influence weight gain and weight loss, but are not extreme enough to classify for a diagnoses. Considering there are about 3,500 calories in a pound, a college student can gain 15 pounds his or her freshman year by simply consuming an extra can of soda or half of a large, sugar-filled energy drink each day. Eating habits and disordered eating are especially relevant in the college population because when one transitions to college he or she is living in a different environment from the one he or she grew up in, often experiencing new emotions and eating with different people. The transition to college may affect different eaters differently. For example, emotion is often related to stress, which can mediate a variety of different eating outcomes (Macht, 2008). In his fiveway model of how emotions relate to eating, Macht (2008) proposed that eating (a) may be a way for individuals to regulate their negative emotions and (b) may be caused by the stressinduced disruption of individuals' cognitive self-regulation. This is of primary importance in Psychosocial Factors and Food Consumption 6 restraint eaters ( those who overeat after breaking their diet), emotional eaters (those who eat in response to emotional arousal states such as fear), and external eaters ( those who eat in response to external food cues such as smelling food), because each of these types of eating patterns is largely dependent on the environment one is currently in and how they are able to cope with changes in their environment. Moreover, these abnormal eating patterns are linked to obesity, bulimia nervosa, and binge eating disorders which are linked to dissatisfaction (Delinsky & Wilson, 2008; Gluck, 2006). One type of abnormal eating pattern, which differ from clinically diagnosed eating disorders, is restraint eating. This is overeating after a period of restraint when one's resolve to dieting is abandoned (Herman & Polivy, 1975). Restrained eaters tend to be chronic dieters and are also likely to severely overeat when they break their diets. Studies using dieting preloads (i.e., a calorie dense chocolate milkshake) have shown that restrained eaters, but not nonnal eaters, will eat a significant amount of calories after a preload compared to if they were not given a preload. Normal eaters, on the other hand, will adjust their caloric intake and eat less after a preload compared not preload given. This highly counterintuitive effect, that restrained eaters eat more after violating their diet has been called the disinhibition effect and this effect has been shown with many stimuli and different participant groups (for a summary, see Herman & Polivy, 1984). Given that the college environment is often filled with temptations, such as free food and unhealthy food at every eatery, it is almost certain that restrained eaters are likely to face more obstacles in college than before. Similarly to restraint eaters, emotional eaters are also likely to have greater difficulty coping with their food struggles in college than beforehand. The new college environment along with the abnormal hours and irregular schedules that college student keep contribute to many Psychosocial Factors and Food Consumption 7 diverse and distinct emotions. This, paired with the physical transition away from family and long-term friends, whose social support it critical to coping with new emotions, can make people tum towards food as a means of support. Moreover, the lack of friends and feeling of homesickness, especially during the first years of college, can contribute to excessive eating, especially of comfort foods and cause weight gain (Brook & DuBois, 1995; Paul & Brier, 2001; Wansink, Cheney, & Chan, 2003). People who score high on emotional eating questionnaires are likely to exhibit such abnormal eating habits. A third abnormal, but not clinically recognized type of eating is called external eating. External eaters commonly eat in bouts catalyzed by positive social contexts in combination with high aromatic or high visually salient food (Galef, 1981; Wan sink, 1994). Other triggers for an external eater include the number of palatable food cues present and even the time of day (Schachter, 1971). A common reason for an external eater to eat a food is simple, "because it is there." External eaters must be very careful of their food environment because they are likely to use external food cues, such as food being available, as opposed to internal food cues, such as their current hunger level when deciding whether or not they should have something to eat. This is of critical importance to somebody in college, like restraint eaters, because the availability of food (i.e., large variety of food in college dormitory buildings) along with college norms that anything is free is good can influence an external eater to eat more than a normal eater. Each of these abnormal types of eating are different and each of them can cause superfluous stress in the lives of the people who have these behaviors. Even so, the connection between abnormal eating patterns and weight is not clear because individuals may react to being overweight by consciously restricting food intake regardless of the type of eater they are (Rodin, 1975; Rodin & Slochower, 1976). Some people may diet to lose weight. Even so, many Psychosocial Factors and Food Consumption 8 researchers believe that each person has his or her own range of body weight that is regulated by their body (Herman & Polivy, 1980). This means that even though some people have abnormal eating habits, many of which are do to lack of dietary control in the first place, abnormal eating habits is one among many factors that connects to weight. It is likely that college student who display abnormal eating habits are more likely to be overweight than their normal eating counterparts. Specifically, due to the transition to college, the freedom to eat whatever one wants, the constant availability of food, and the plethora of emotions students must cope with, restrained, emotional, and external eaters will, on average, weigh more than those who do not exhibit these eating patterns. Perceived Stress and Weight People do not use food solely for its nutritious properties. Food is also used to cope with stressful life events and life tension (Wardlea, Steptoeb, Olivera, & Lipseyb, 2000). People use food as a tool to modify their feelings of both mood and temperament (Folkman & Lazarus, 1980). Even so, results of stress and eating studies are mixed. Some studies have found that stress induces overeating, mainly by eating high fat and calories dense foods, and other studies have found no significant differences in food intake under varying lengths of time and ages of participants of stressful and control periods (Michaud, Kahn, Musse, Burlet, Nicolas, & Mclean, 1990; Weidner, Kohlmann, Dotzauer, & Bums, 1996; Oliver & Wardle, 1999; Stone & Brownell, 1994). The emotional response one has towards stress plays an important role in how stress should be considered when promoting healthy behaviors. In one study that measured stress during times of high academic demand and low academic demand the researchers found that during periods of high academic demand negative emotions increased and positive emotions decreased while nutrition and healthy behavior Psychosocial Factors and Food Consumption 9 worsened (Weidner, Kohlmann, Dotzauer, & Bums, 1996). In this study, decreases in amount of exercise and self-care behaviors correlated with high periods of academic stress. Importantly, decreases in the quality of nutrition were linked to decreases in positive emotions and increases in negative emotions, suggesting that emotional responses to stress establish an important role in health behavior change. Therefore, stress should be considered when promoting nutrition programs, especially during life stages when stress levels are constantly changing. Based on the fact that stress induces poor nutritional habits and lack of exercise it is likely that there will be a positive correlation between perceived stress and weight. We also expect that there will be an association between perceived stress and abnormal eating patterns because eating is one of the ways people may cope with stress. Perceived Social Support and Weight The transition from high school to college and the years one spends in college are often filled with changing relationships and new social pressures. In longitudinal studies, this is a period that has previously been associated with weight gain (Levitsky, Halbmaier, & Mrdjenovic, 2004; Holm-Denoma, Joiner, Vohls, & Heatherton, 2008). College students are going through a very tumultuous time in their lives, which makes them prime candidates for those who use food as a coping mechanism and are emotional eaters. Eating may serve as a distraction from one's worries and eating may provide comfort similar to the support students got from their collocated relationships before their transition to college. Theories behind the reasons why people partake in emotional eating posit that eating is a way, even if only temporarily, to relieve distress and mask emotions one is trying to avoid (Polivy, Herman, & McFarlane, 1994). The side effects of the transition to college, like any major life transition, is often a source of distress for people and this can cause people to eat more than they normally would. It is Psychosocial Factors and Food Consumption 10 therefore likely that freshman, due to their transition to college, will exhibit lower social support scores than upperclassman. We also believe that there will be a negative association between perceived social support and emotional eating because the less people feel like they can rely on their friends the more likely they are to tum to food. Depression and Weight Dietary habits influence how people live their lives and how people cope with challenges and rewards. Patterns of food consumption have been studied in the past and have investigated the relationship between ingesting carbohydrates and different emotional states (Benton, 2002; Prasad, 1998; Benton & Donohoe, 1999). Studies have shown that eating carbohydrates can reduce symptoms of depression (Wurtman & Wurtman, 1989). People, including abnormal eaters, often eat food without regard for its nutritional content when their mood changes. People will eat food to celebrate their accomplishments and they will also eat to feel better. Lack of a healthy diet has been correlated with depression (Brooks, Harris, Thrall, & Woods, 2002). Moreover, stress can mediate depression, which, in tum, can make eating and nutrition habits, especially in females, worsen (Mikolajczyk, Ansari, & Maxwell, In Press). Because people who display high levels of stress tum to carbohydrates we think this will be the case in our sample. It is also likely that there will be an connection between abnormal eating habits and stress as well as BM!. Food Frequency In previous research various connections have been shown between different foods people consume, changes in weight, and changes in mood. For example, carbohydrate consumption has been shown, in some cases, to reduce depressive symptoms (Wurtman & Wurtman, 1989). Men and women choose to eat different foods to comfort themselves with men Psychosocial Factors and Food Consumption 11 preferring meal-like foods (i.e., steak) and woman preferring sweets (Wansink, Cheney, & Chan, 2003). Other studies have found that consumption of fresh fruit, ready-to-eat food and fast food were significantly associated with depression (Liu et aI., 2007). Separate studies have shown that greater stress was associated with more fatty food intake, less fruit and vegetable intake, more snacking, and a reduced likelihood of eating breakfast each day (Cartwright, Wardle, Steggles, Simon, Croker, & Jarvis, 2003). It is probable that there will be an association between the types of food people eat and they way that they feel. We believe that people who eat fatty foods and foods high in carbohydrates will report more negative feelings of perceived stress, perceived social support, and depression. Moreover, this should correlate with abnormal eating habits because emotional, restrained, and external eaters use food to cope more than normal eaters. Study Goals and Hypotheses The main goal of this study is to learn more about the connection between perceived stress, perceived social support, and depression as it relates to normal and abnormal eating behaviors in college students. Many studies have looked at the relationship between two of these three concepts but, to the best of our knowledge, research ascertaining the relationship between these three variables and eating patterns is lacking. A second goal of this study is to learn more about the types of foods college students are eating when they feel stressed, lack social support, and are depressed. We predict that there will be a positive correlation between emotional, external, and restraint eating patterns. We also predict there will be a positive correlation between abnormal eating patterns and BMI (HI). Psychosocial Factors and Food Consumption 12 It is likely that there will be a correlation between perceived stress, perceived social support, and depression. We think that there will be a positive correlation between perceived stress and abnormal eating patterns, a negative correlation between perceived social support and abnormal eating habits and a positive correlation between depression and abnormal eating patterns (H2). We also predict that there will be an association between perceived stress, perceived social support, and depression along with abnormal eating patterns that will be correlated with BM!. In other words, pending on the first two hypotheses being supported, we believe that lack of social support, too much stress, and depression will influence abnormal eating habits (or vice versa) which will then influence BMI (H3). Lastly, we predict that people who are stressed and depressed will turn towards carbohydrates and fatty foods more than other foods and that men and women will eat different types of foods when they are experiencing lack of social support, too much stress, or feelings of