JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 59, NO. 3

Obesity and Food Choices Among Facultyand Staff at a Large Urban University

Marjorie R. Freedman, PhD; Rebecca J. Rubinstein, MS, RD

Abstract. Objective: In order to address increasing health carecosts associated with obesity, this study sought to determine preva-lence of overweight and obesity and examine eating behaviors, foodchoices, health beliefs, and attitudes of university employees. Par-ticipants and Methods: An online survey was distributed to >3,800 faculty and staff at a large public metropolitan university inWinter 2008. Results: Almost half (48%) of 806 respondents wereclassified as overweight or obese. Compared to those with normalweights, overweight and obese respondents consumed fewer fruitsand vegetables (p < .05), were less confident in making healthfulfood choices (p < .001), and were more influenced by food choicesavailable in on-campus dining facilities (p < .05). Conclusions:Obesity among university employees warrants attention. Becausethese employees have less self-efficacy and consume less health-ful diets than their normal weight colleagues, universities need toimprove on-campus access to healthful foods.

Keywords: faculty and staff, food choices, obesity, university

T he prevalence of overweight and obesity (body massindex [BMI] 25) has increased dramatically over thepast decades.1 Obesity increases the risk of chronicdisease, including cardiovascular disease, type 2 diabetes,certain forms of cancer, depression, and many other phys-ical and social comorbidities.2 These diseases, in turn, re-duce workforce productivity and increase employer healthcare costs.3 The annual medical cost of obesity was approxi-mately $78 billion in 1998, but rose to $147 billion by 2008.4Annual medical expenses are estimated to be 21% higher foroverweight and obese employees.5 These tremendous costs,coupled with poor treatment outcomes, call for public healthstrategies focusing on obesity prevention.

The Task Force on Community Preventive Services hasproposed public health strategies for preventing and control-ling overweight and obesity in worksite settings.6 Because

Dr Freedman is a professor and Ms Rubinstein was a graduatestudent in the Department of Nutrition, Food Science and Packagingat San Jose State University in San Jose, California.

Copyright 2010 Taylor & Francis Group, LLC

65% of the population 16 years of age is in the workforce,7the worksite is a natural place to implement obesity pre-ventive strategies that modify the food environment and/orincrease opportunities for physical activity.8 The worksiteaffords opportunities to modify food choices through socialand environmental supports and through policies that pro-mote healthful eating. Social supports include peer and or-ganizational norms, whereas environmental supports includeimproved access to healthful foods and decreased prolifer-ation of unhealthful foods.9 Worksite policies designed tomake healthful choices easier, such as increasing healthfulfoods served at meetings and in vending machines,10 arelikely to be sustained for a longer period of time than areindividually oriented strategies.11

Worksite obesity prevention programs have taken placein various settings, including large corporate settings, man-ufacturing sites, hospitals, hotels, and schools.6,9,1216 Moststudies have combined behavioral and education strategies toinfluence diet and physical activity. There is limited informa-tion on how the work environment can be modified to effectmeasurable changes in body weight. In addition, few studieshave focused on worksite wellness programs in a universitysetting,17,18 despite a recent call to action on the health andwellness of university students, faculty, and staff.19

Throughout the United States, there are over 4,300 in-stitutions of higher education employing over 3.5 millionfaculty and staff.20 Universities are important environmentsfor developing strategies and policies to address health careissues as they comprise diverse age, racial, and socioeco-nomic populations, and they face enormous cost pressuresand incentives to maintain a healthy workforce. Universitiesalso have the resources to support multicomponent inter-ventions at all levels: individual, interpersonal, community,and environment. Further, the university setting provides aunique environment for interaction and influence betweenand among faculty, staff, and students.

Unfortunately, little is known about the health status ofthe university employee population, including their rates of

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overweight and obesity, usual dietary intake, and eatinghabits. Consequently, the primary objective of this forma-tive research was to address these gaps in knowledge byconducting a study on a large, urban university that employsabout 3,900 full- and part-time faculty and staff. A secondaryobjective was to provide data to inform policy changes re-lating to food access and availability on this campus. Thesocial-ecological model was used to inform this research,because this model provides a framework to describe indi-vidual change within a context of social change, and it rec-ognizes both that an individuals behavior is affected by theirphysical, economic, policy, and sociocultural environments21and that individuals make significant health decisions withinthese complex environments.22

METHODS

Subject RecruitmentThe institutional review board for human subjects at a

large urban university approved this research. All full- andpart-time faculty and staff (N = 3,890) with e-mail ad-dresses provided by the university human resources de-partment were eligible to participate in this online survey(www.SurveyMonkey.com, Portland, OR). Participants pro-vided informed consent prior to survey access. During Febru-ary 2008, all employees were contacted via SurveyMonkeyse-mail messaging system; 3 follow-up e-mails were sent overthe next month. Participants who completed surveys were en-tered into a drawing for 1 of 4 $25.00 gift cards.

Survey Design and MeasuresA quantitative, cross-sectional 40-question survey de-

signed specifically for this study was pretested, prior to beingfielded, by university employees excluded from participation.The survey collected demographic data on gender, universityaffiliation, number of days on campus, and length of employ-ment. Self-reported weight and height were used to calculateBMI ([weight in pounds .703)/(height in inches2]). BMIwas used as a categorical variable, based on the Centersfor Disease Control and Preventions classification of un-derweight, normal weight, overweight and obese.23 Dietaryhabits, food purchase behaviors, and influences on eating be-haviors were also assessed. Because intake of fruits and veg-etables have been associated with changes in body weight,24total intake of these foods was separately measured, basedon self-reported estimates of typical daily consumption us-ing survey-provided specified United States Department ofAgriculture (USDA) portion size definitions.25 Daily con-sumption of dairy products and grains were also assessed.

Measures of the physical nutrition environment were basedon respondents perceived access to food. Respondents wereasked a series of 5-point Likert scale questions on food ac-cess and availability (eg, How satisfied are you with theavailability of fruits and vegetables on campus? and Howsatisfied are you with the availability of dining options oncampus?), with 1 = not at all satisfied, 2 = somewhat sat-isfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied.

They were also asked whether they would purchase foodon campus more frequently if there were more places tobuy food. The influence of family, friends, and coworkerson food choices (social norms) (eg, The food my friendseat influences what I eat) and respondents perceived per-sonal attitudes about health and nutrition (eg, Maintainingmy health is important to me and What I eat affects myhealth) were also assessed with 5-point Likert scale ques-tions, with 1 = strongly disagree, 2 = somewhat disagree, 3 =neutral, 4 = somewhat agree, and 5 = strongly agree. At theend of the survey, respondents were given an open-endedprompt, Is there anything else you would like to tell usabout food options or eateries on campus?

Data AnalysisSPSS for Macintosh Version 16.0 (SPSS, Inc., Chicago,

IL) was used to analyze data. Frequencies determined foodgroup intake and where and how often food was purchased.Pearsons chi-square tests analyzed the association betweenethnicity, gender, affiliation, food intake, beliefs and atti-tudes about health and food choices, and BMI category (nor-mal weight, overweight, and obese), after elimination of thesmall number of respondents in the underweight category.One-way analysis of variance (ANOVA) examined the re-lationship between BMI category and age, days on campus,and years employed. The relationship between BMI and totalintake of fruits and vegetables was assessed using Pearsonscorrelation. Statistical significance was set at p < .05.

RESULTSOf the 3,890 employees sent e-mails, 180 had undeliver-

able addresses, and 16 employees opted out. Of the balance,954 employees answered at least 90% of survey questions(a 26% response rate). However, 30 respondents were ex-cluded because they worked exclusively from home, and 118respondents failed to provide height and weight data. De-mographic characteristics of the final sample (N = 806) areshown in Table 1. The distribution of respondents affiliationand ethnicity matches that for all university employees.

The mean BMI of respondents, as calculated fromself-reported height and weight, was 25.9 5.3 (range16.251.7). Thus, 48% of respondents were classified as be-ing overweight or obese (BMI 25). BMI was significantlyrelated to gender (p < .05), ethnicity (p < .001), and age(p < .05). More men (60%) compared to women (43%) hadhigh BMIs ( 25). Hispanic employees comprised the high-est percentage (61%) of overweight and obese respondents,followed by African American (59%), Filipino (54%), white(50%), and Asian (29%). BMI was higher in older respon-dents, but it was not related to affiliation (eg, faculty, staff, oradministrative status), number of days on campus (eg, full-or part-time status), or years of employment.

Food Group Intake and Body Mass IndexFifty-one percent (n = 411) of respondents consumed the

recommended 5 servings of fruit and vegetables/day. Meandaily fruit and vegetable intake for normal weight employees

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TABLE 1. Respondents Demographic Characteristics (N = 806)Variable Mean SD Range % n

Age in years (Range) 44.8 11.9 2085Years employed at this university (Range) 9.0 9.0 158University affiliation

Full-time faculty 20.7 167Full-time staff 41.8 337Part-time faculty 20.3 164Part-time staff 5.4 44Administration 11.6 94

GenderMale 29.0 233Female 71.0 573

EthnicityAfrican American 3.8 29Asian 14.5 111Filipino 3.1 24Hispanic 12.6 96White 65.9 503

BMI categoryUnderweight (BMI < 18.5) 1.4 11Normal weight (BMI 18.524.99) 50.6 408Overweight (BMI 2529.99) 28.5 230Obese (BMI 30) 19.5 157

Days on campus each week1 5.0 402 11.7 943 9.0 734 12.5 1015 61.8 498

was significantly greater than that of overweight and obeseemployees (5.2 2.3, 4.7 2.1, and 4.4 2.1, respectively)(p < .05). There was a weak negative correlation betweenBMI and total daily fruit and vegetable intake (r = .101;p < .01).

Only 8% (n = 61) of respondents consumed the recom-mended 6 servings/day of grains. Mean daily intake was3.1 1.4 servings. Seventy-nine percent (n = 638) of respon-dents failed to consume the recommended 3 servings/day ofdairy products (mean intake was 1.7 1.0 servings/day).There were no significant differences between normal, over-weight, or obese respondents in daily intake of grains or dairyproducts.

More than 80% of respondents (n = 662) reported theydid not consume nondiet sodas or energy drinks. There wasno significant difference in consumption of these bever-ages among BMI groups (normal weight, overweight, andobese respondents consumed 0.2, 0.3, and 0.4 servings/day,respectively).

Campus Food Purchases and Attitudes About CampusFood Choices

Of the 806 respondents, 541 (62%, n = 498) reported be-ing on campus 5 days/week and 672 (83%) reported at least

3 days/week. Of the employees on campus 5 days/week, 5%(n = 23) purchased lunch on campus daily, whereas 21% (n =102) purchased lunch at least 3 days/week. Although a ma-jority of respondents (60%, n = 469) purchased lunch oncampus at least 1 day/week (irrespective of number of dayson campus), only 6% (n = 47) purchased lunch on campusevery day that they were on campus, whereas 72% (n = 570)brought lunch from home at least once a week. Twenty-eightpercent (n = 229) ate at off-campus restaurants at least oncea week. Few employees ate breakfast or dinner on campus.Of the 23% of respondents (n = 179) who purchased break-fast on campus at least once a week, just over half (n = 84)purchased breakfast only once a week. Dinner was consumedon campus at least once a week by 14% (n = 107) of respon-dents. Almost all employees (88%, n = 707) ate snacks daily;41% (n = 331) purchased snacks from on-campus eateries atleast 1 day/week, whereas 40% (n = 319) snacked on foodprovided by their department, another 19% (n = 151) pur-chased snacks from vending machines, and 77% (n = 620)ate snacks brought from home.

Forty-two percent of respondents were not satisfied withfood choices on campus. Only 13% were satisfied with theavailability of fruits and vegetables on campus, and only 11%were satisfied with the number of places to eat on campus.When asked what would induce them to purchase food more

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frequently on campus, the top 3 responses were there weredifferent food choices (eg, more vegetarian, low-fat, ethnicfoods) (71%), an on-campus Farmers market (58%), andmore places to purchase food on campus (53%). Eating oncampus more frequently had little to do with an employeesschedule.

Beliefs and Attitudes About Health and Individual FoodChoices

Of all respondents, 80% agreed or strongly agreed thatthey were in good health. Significantly more normal weightand overweight, compared to obese respondents, perceivedthemselves to be in good health (p < .001), and 73% of allemployees strongly agreed that it is important to maintaintheir health, although significantly fewer obese respondentsprovided this response (p < .05). Seventy-six percent of re-spondents strongly believed that what they eat affects theirhealth, and 69% strongly agreed that what they weigh affectstheir health. There were no differences in these responsesbased on BMI categories.

Obese employees, compared to normal and overweight,were significantly less confident in their ability to makehealthful food choices (p < 0.001). Overweight and obese,as compared to normal weight employees, were signifi-cantly more influenced by their friends and colleagues foodchoices (p < .01, p < .001, respectively), but were not moreinfluenced by the foods their spouse or children ate. Employ-ees with high BMIs were more influenced by food availableon campus and the surrounding neighborhood (p < .05).

Qualitative CommentsOver 250 respondents (31%) provided qualitative feedback

to the open-ended question at the end of the survey, andcomments were collated into categories. The 4 categoriesthat received the most comments were those related to foodchoices/offerings, faculty/staff dining options, retail diningfacilities hours of operation, and dining locations.

Written comments supported the surveys quantitative re-sults, thereby indicating that employees wanted healthierfood choices and more options. Some respondents expressedconcern with the quality of current food options; for exam-ple, I am appalled at all the soft drinks and unhealthy snacksavailable. . . I envision a salad bar where the ingredients areall wholesome and natural. Another employee responded,Most of the food options are too high in fat and calories.Other respondents wanted more variety; for example, Thevariety is lacking, and I would like to see more variety,more home-cooked healthy options.

Several responses supported the quantitative finding thatemployees would purchase food more frequently if therewere convenient access to better food choices: My job is soconsuming that access to healthful food needs to be quickand convenient; Food options on campus are extremelylimited. I would buy food on campus more if there were morehealthy and diverse options; Both students and faculty needhealthier options. There appears to be the same old highly

processed, nutritionally lacking junk. There may be otheroptions, but not very visible ones.

COMMENTThis research found that 48% of employees on a large

metropolitan campus self-reported high BMIs, and that obe-sity rates were highest in Hispanic and African Americanemployees. Although prevalence of overweight and obesityon this campus is lower than the 68% currently reported forthe US adult population,26 that on-campus rate is still highand warrants attention.

Employees with high BMIs reported eating fewer fruitsand vegetables than their normal weight peers. BMI wassignificantly, albeit weakly, correlated with total fruit andvegetable intake. This finding is important, since diets highin fruits and vegetables may protect against weight gain.24Universities have an opportunity to increase access to fruitsand vegetables (and to positively affect food choices) throughexisting food venues on campus, as well as through the es-tablishment of a farmers market or a community-supportedagriculture program.27

A surprising finding of this study was that even thoughmost university employees had some experience with diningoptions on campus, the majority did not eat on campus ona regular basis. Only 5% of full-time employees purchasedlunch on campus daily. The attitudes and beliefs about thecampus food environment indicate that employees percep-tions of current food offerings on this campus directly impactwhether employees eat on or off campus or bring food fromhome. These data further suggest that employees care abouteating healthfully, but do not perceive that the university doesan adequate job of providing healthful food choices. In addi-tion, the current research indicates that overweight and obeseemployees are less confident in their ability to make healthfulfood choices, and are more influenced by food choices in thedining facilities, their peers, and their friends.

Together, the above findings suggest 3 important oppor-tunities to encourage healthful eating and support wellnessof university employees: (1) increase the availability and ac-cess to healthful foods in all on-campus eating venues,9 (2)increase awareness of healthful options in these establish-ments via marketing and promotion,28 and (3) provide point-of-purchase nutrition information in campus dining venuesto assist employees to help employees identify more health-ful options.2930 The studys findings also point out the needfor universities to sponsor wellness programs that increaseemployee self-efficacy to make healthful food choices, and toadopt policies that increase availability and access to health-ful foods on campus. These changes, individually and espe-cially in tandem, are likely to encourage more employees toeat on campus and to consume more healthful foods.

This studys main limitation is its reliance on self-reportedmeasures of body weight, food consumption, and purchas-ing behaviors. Those with an interest in the topic may havebeen more likely to respond to the survey, creating bias. Fi-nally, this studys findings may have limited applicability to

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universities with different physical, sociocultural, economic,and policy environments, and may not be representative ofuniversity faculty and staff at other institutions.

ConclusionThis study is the first to characterize BMI, food intake

patterns, food-purchasing behaviors, and health beliefs andattitudes among university employees. This studys findingsprovide needed insights into the multifarious factors thatinfluence food choices, and these findings support recom-mended strategies to effectively combat overweight andobesity in a university setting. At a minimum, this studysfindings strongly counsel for increased access to fruits andvegetables on campus. It is thus hoped that universities willoffer a wide variety of culturally acceptable, healthful choicesin the campus-dining environment to help overweight andobese employees (already suffering from lower self-efficacy)eat healthier meals and snacks. In sum, universities shouldenact policies that support health and wellness among allpersons who attend or work at these institutions.

ACKNOWLEDGMENTSFunding was provided by a Kaiser Permanente, Northern

California HEAL grant.

NOTEFor comments and further information, address correspon-

dence to Marjorie R. Freedman PhD, Department of Nutri-tion, Food Science and Packaging, San Jose State University,One Washington Square, San Jose, CA 951920058, USA(e-mail: marjorie.freedman@sjsu.edu).

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