Fast-Food Culture – Prevalence, Pattern, and Preference Trends and its Association with Body Mass Index of Medical Students

Abstract

Background: 

Fast-food culture is an uprising trend among the younger age groups. Stressful life due to increased study load, staying away from home, peculiar working hours, etc., negatively influences the food choices of medical students. Hence, this study was conducted to describe the prevalence, pattern, and preferences of fast-food consumption and also to determine the relationship of frequency of fast food with body mass index (BMI) of students of a medical college in Western Maharashtra.

Methods: 

A cross-sectional study was done among 398 students of a medical college in Pune for 6 months. The data collection was done using a self-administered pretested structured questionnaire and analyzed using Microsoft Excel and SPSS version 20 software.

Results: 

Three hundred and ninety-eight medical students responded. We found a 100% prevalence of fast-food consumption with different frequencies. 13.8% of the students were found to be overweight. Pizza was the most frequently consumed fast food. The taste factor was the most common reason to consume fast food among both sexes. The majority of the study participants (98.5%) were aware that fast foods are hazardous to health. A statistically significant association was found between the frequency of consumption of fast food with the type of diet (P = 0.008) and BMI (P = 0.023).

Conclusion: 

High prevalence and preference for fast-food consumption can result in various noncommunicable diseases among students of the medical profession and is a major concern. Thus, there is a need for educating the students regarding nutritional information and counseling to bridge the gap between their knowledge and practice about healthy eating behavior.

INTRODUCTION

The fast-food market is growing at a compounded annual growth rate of 4.6% worldwide.^[1] India stands at 10^th position in the fast-food industry in terms of per capita spending on fast food. The Indian fast-food market is estimated to be $27.57 billion and is estimated to grow at a faster rate of 18% as compared to the world.^[2]

Oxford dictionary defines fast-food as “easily prepared processed food served in snack bars and restaurants as a quick meal or to be taken away.”^[3] It includes sandwiches, burgers, fried chicken, pizza, and French fries.^[4]

Fast foods are rich in calories, saturated fat, trans fat, carbohydrates, and sodium and, at the same time, poor in essential nutrients, and dietary fibers.^[5,6] Recent studies have associated such dietary habits with the increasing trends of noncommunicable diseases (NCDs) such as Type 2 diabetes mellitus, hypertension, obesity, syndrome X, and cardiovascular diseases.^[7–10]

Fast-food culture has transformed the food habits and overall diet quality of children and adolescents,^[11] resulting in an increased prevalence of childhood NCDs.^[12] The trend has the potential to negate and put a deterrent to much of the work that has been done to increase life expectancy around the world.^[13] As per 2020 report by the Indian Council of Medical Research, a worrying trend-disease burden has been increased from 10% to 25% since 1990.^[14] Physical activity was an important determinant factor and a significant risk factor for chronic diseases. A low level of physical activity and an imbalanced diet due to fast foods has been associated with increased weight gain that may lead to chronic diseases.^[15]

Numerous studies conducted among elementary school children, teenage students and adolescents, and undergraduates of various disciplines^[16–20] have documented the increased popularity of junk food. Recent technology advancements in smartphone apps such as Zomato, Uber, and Swiggy have made door-to-door delivery of fast food easily available and accessible,^[20] thus further propelling the fast-food demand.

Medial students have increased propensity for fast food due to their odd working hours and sociocultural milieu. However, very few studies have been conducted among students of the medical profession in India regarding food preference and habits, including the prevalence and pattern of fast-food consumption. Hence, the present study was conducted to describe the prevalence, pattern, and preferences of fast-food consumption and its association with body mass index (BMI).

Methods

Study design and study setting

The study was conducted among medical students of a medical college in Western Maharashtra. The college has a mess facility for all the students, which caters for all the meals of the day. The meal timings are fixed, and students are expected to dine in the mess. A student mess committee decides the menu of the mess.

Study period

The study was conducted for 6 months, from October 2020 to April 2021.

Sample size

A sample size of 384 was calculated, taking a prevalence of 50% and an absolute error of margin of 5% at a 95% confidence interval. However, 398 responses were received and analyzed.

Study tool

A structured online-based questionnaire was used. It had four sections. Section 1 contained basic sociodemographic information, anthropometry. We have taken the heights and weights of participants from recent annual medical examination data and calculated BMI to screen for overweight and obesity based on standard guidelines was used to categorize BMI.^[21] Section 2 contained food preferences, practices, and factors that attract toward fast food. The frequency of fast-food intake was estimated with the question: During a typical week, how many times do you eat something from a fast-food restaurant and was categorized into a dichotomous variable with <3 times as less frequent and ≥3 times as frequent consumers.^[22] Section 3 contained knowledge and awareness about hazards and diseases related to fast food, and Section 4 contained physical activity status using the International Physical Activity Questionnaire – Short Form^[23] and was compared with guidelines of the World Health Organization (WHO), Geneva.^[24] The questionnaire was pretested among 20 students using cognitive thinking techniques, and the data from them were not included in the final analysis. Minor changes were made in the forms.

Sampling technique

A line listing of all students, including their e-mail id, was obtained from the concerned academic section. Web-based questionnaire was sent to all students through e-mail id. Students who had filled all the sections of the questionnaire were included in this study.

Ethical permission

The study was given ethical clearance from the institute ethical clearance.

Statistical analysis

The data were collected and analyzed using Microsoft Excel and IBM SPSS 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Discrete variables were summarized as proportion and continuous variables as means ± standard deviation. Bivariate analysis was done using the Chi-square test to determine the association between the frequency of consumption of fast food to various sociodemographic variables, the type of diet, and BMI P < 0.05 was considered statistically significant.

RESULTS

Sociodemographic profile, body mass index, and physical activity

A total of 398 students participated in the study. The mean age of study participants was 21.8 ± 0.4 years, with more than half of the study participants falling in the age group of 19–24 years, with the predominance of male participants 280 (70.4%). Almost all students were residing in the hostel (89.9%). The mean BMI of the subjects was 22.3 ± 0.22, with most of the students in the range of normal BMI and a few (13.8%) of the total students falling in the overweight category, and mostly all (91.7%) students were physically active, and a few found physically inactive (8.3%). Female students were found to be less physically active than male students, as shown in Table 1.

Table 1: Sociodemography, body mass index, and physical activity (n=398)

Food preferences and practices

More than half of the study participants were (55.8%) nonvegetarian. All the participants consumed fast food at various frequencies. Most of the participants (80.4%) consumed fast food at a frequency of less than three times a week. The most preferred fast food was pizza (59.8%), followed by rolls and burgers [Table 2]. The beverage most frequently ordered along with fast food was aerated drinks (38.7%), followed by hot coffee and tea among both sexes. The taste was found to be the most common reason (88.9%) for the consumption of fast food. However, only a few students (8.5%) stated clean ambience and good hygiene as a reason to consume fast food. Other factors, such as peer pressure, anxiety, tension, and stress, were also brought out by some students that influenced their decision to consume fast food. Dinner was the most common meal that was being replaced by fast food, as shown in Table 2.

Table 2: Food preferences and practices (n=398)

Knowledge and awareness regarding adverse effects of fast food

Almost all students (98.5%) were aware of hazards and diseases related to the consumption of fast food. Most of the students stated that obesity was the most common hazard related to fast food (91.7%), followed by coronary artery disease (72.3%), hypertension (64.8%), and diabetes (57.2) [Figure 1]. Bivariate analysis was done between the frequency of fast-food consumption with sociodemographic variables; BMI; the type of diet and physical activity [Table 3]. Statistically significant associations were found between the frequency of consumption of fast food with BMI and the type of diet consumed on bivariate analysis. The association between diet frequency and BMI remained even after adjustment for the type of diet (P = 0.03).

Figure 1: Knowledge and awareness regarding fast food hazards and diseases

Table 3: Association of frequency of consumption of fast foods with various variables

DISCUSSION

The demand of fast food has increased with industrialization and increased job opportunities within cities. With improved socioeconomic status, many families can now afford and often send their wards to cities for better educational facilities. In the present study, students belong to different states, socio-economic status and cultures within India. All the students were staying in hostel facilities. The prevalence of fast-food consumption was 100%, with almost one-fifth (19.6%) of the students being found to be consuming fast food more than three times per week. A nonvegetarian diet was found to be in the majority of the students. Most of the students were consuming fast food less than three times per week, and the most preferred items were pizza and aerated drinks. The majority of the respondents cited taste as the deciding factor for fast-food consumption. Most of the students were aware of the ill effects of consuming fast food.

Fast-food consumption appeared to be a common phenomenon among students living in the hostel because they found it tasty and easily available at doorsteps. Studies done in India and Egypt among medical students revealed a similar pattern.^[25–28]

We found that in those consuming fast food more than three times a week, nonvegetarians form a majority (54/78).^[29] Nonvegetarians had fast-food consumption more frequently (more than three times a week) than vegetarians (54/222 vs. 24/176; P = 0.008). Overweight/obese was eating fast food more frequently than students with normal BMI (17/55 vs. 61/343; P = 0.023)

Daradkheh et al. showed that frequent consumption of fast food and increased caloric intake will lead to obesity.^[30] In our study, among students who were consuming fast food on frequent basis 21.8% of the (17 of 78) students were found overweight, whereas in students consuming fast food with relatively lesser frequency showed, 11.9% of the (38 of 320) students were overweight which was found similar to other studies among medical students.^[31,32]

Pizza and burgers were the most preferred fast food consumed by students in South Mumbai.^[33] In the present study also, pizza (62.5%) was found to be the most preferred fast food. Studies done among medical students in Karnataka, Patna, and Egypt showed that soft drinks and energy drinks were the most preferred beverage consumed along with fast food.^[26–28] Our study has similar findings.

Choice of food by the consumer is a multifaceted phenomenon. There are many aspects reported in the literature which elucidates why people are attracted to fast foods.^[26–32] In the present study, taste (88.9%) and variety of cuisines (44.7%) were the most common reasons for selecting fast food and precarious work timings (31.7%), emotional states such as peer pressure (18.3%), anxiety, tension, and stress (15%) were also one of the major reasons for fast-food consumption. The finding of other studies also revealed similar reasons governing the selection of any fast food in general.^{[26–28,34–37]}

In the current study, we found that more than half of the participants had fast food during dinner. On the contrary, according to Vaida et al. that about half of the participants had fast food for snacks during prelunch period.^[4] However, the findings of the present study of fast food during dinner time are similar to studies conducted among medical students elsewhere.^[31,32]

The study conducted among medical students in Egypt, Patna, and Karnataka revealed that the majority (94.3%, 88.3%, and 87%) of students were aware of hazards related to fast-food consumption.^[26–28] In our study also, almost all students (98.5%) were aware of hazards and diseases related to fast-food consumption.

A recent annual review of public health stated that increased cell phone use, playing video games, and protracted use of the Internet are contributory factors to increased sedentary behavior during leisure time, which leads to a decrease in physical activity.^[38] In the present study showed that most (91.7%) of students were physically active through various activities such as walking, running, and cycling. However, no association was found between physical activity and the frequency of fast-food consumption.

The study was conducted in a medical college setting. There are very few studies done in a similar study population with an adequate sample size. The study was also conducted during the COVID-19 period when the country was under lockdown, and the availability of fast food was only by a plethora of mobile apps and home delivery services. The prevalence of fast food was found to be 100% at various frequencies, which shows a statistically significant association between students having nonvegetarian diet and students with increased BMI.

Limitations

The data were collected using a questionnaire; hence, there is a possibility of desirability bias. The collected data were not objectively cross-checked. The study included both medical and nursing cadets; however, these two groups may differ in their habits, and stratification of sampling would have been ideal. Nevertheless, the study gives important insight into the fast-food habits of the participants.

After the study, an awareness campaign was conducted for the students regarding the harmful effects of frequent fast-food consumption. Students were encouraged to eat the meal prepared in a mess, with changes in the weekly menu if possible. Overweight/obese individuals were counseled one to one after the study.

CONCLUSION

All students were consuming fast food, with one-fifth of them consuming fast food every alternate day or more. Frequent consumption of fast food positively correlates with BMI and dietary preferences. Similar studies may be done frequently to identify the preference and food habits of the students, and they may be made aware of the effects of fast food using awareness and behavior change modification campaigns.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.