Academic journal article American Journal of Health Education

Designing a Weight Gain Prevention Trial for Young Adults: The CHOICES Study

Academic journal article American Journal of Health Education

Designing a Weight Gain Prevention Trial for Young Adults: The CHOICES Study

Article excerpt

Background: Young adults are at risk for weight gain. Little is known about how to design weight control programs to meet the needs of young adults and few theory-based interventions have been evaluated in a randomized control trial. The Choosing Healthy Options in College Environments and Settings (CHOICES) study was funded to create a technology-based program for 2-year community college students to help prevent unhealthy weight gain. The purpose of this article is to (1) provide a brief background on weight-related interventions in young adults; (2) describe the study design for the CHOICES study, the conceptual model guiding the research and the CHOICES intervention; and (3) discuss implications of this research for health educators. Translation to Health Education Practice: Our experiences from the CHOICES study will be useful in suggesting other theory-based models and intervention strategies that might be helpful in programs attempting to prevent unhealthy weight gain in young adults. In addition, this article discusses important considerations for working with 2-year colleges on this type of health promotion work.

INTRODUCTION

Obesity has reached epidemic proportions in American adults and youth. Over two thirds of adults and one third of youth are overweight or obese. (1-3) Being overweight or obese is a comorbidity for a multitude of chronic diseases, including cardiovascular disease, cancer, and diabetes. (4-7) Obesity accounts for nearly 10% of all annual medical spending (8) and its prevention has become a national priority.

Young adults are a particularly high-risk group for unhealthy weight gain. (9) The National Health and Nutrition Examination Survey data indicate that 67.1% of 20- to 39-year-old men and 55.8% of 20- to 39-year-old women were overweight or obese in 2010-2011. (2) Findings from epidemiological cohort studies suggest that young adults in their early to mid-20s may be gaining weight at higher rates than adults in their 30s. (10,11) Research suggests that approximately 5.5 million people are obese by the time they reach the third decade of life. (12)

Nelson et al. (13) conducted one of the first studies examining the prevalence of overweight and obesity in college students. Using a nationally representative sample, they found that between 1993 and 1999, the combined prevalence of overweight and obesity rose from 26.7% to 35.2% in the college population. Other research found overweight/obesity prevalence estimates ranging from 8% to 27% of the student population. (14-16)

We know much less about the prevalence of obesity in students attending 2-year community and technical colleges. In the past 4 decades, 2-year community or technical college enrollment has increased for those in the lowest socioeconomic status groups. (17) Compared to students attending 4-year colleges, 2-year college students are more likely to be married or have a domestic partner, be older, have dependent children, work for pay, have more credit card debt, and are less likely to have health insurance. Laska et al. examined data from a survey of students from 14 Minnesota colleges and universities. The data showed that 2-year college students had a significantly higher prevalence of overweight/ obesity, lower levels of physical activity, more television viewing, and a higher intake of soda and fast food compared to those attending 4-year colleges/universities. (18)

Due to the need for new approaches to help young adults reach or maintain a healthy weight, the National Heart Lung and Blood Institute of the National Institutes of Health released a Request for Applications (RFA) titled "Targeted Approaches to Weight Control in Young Adults." The RFA specified the use of a U01 cooperative agreement mechanism with the intent of conducting 2-phase clinical research studies to "... develop, refine, and test innovative behavioral and/or environmental approaches for weight control in young adults at high risk for weight gain" (RFA-HL-08-007, p. …

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