HABITS AND LEVEL OF AWARENESS ON FAST FOOD CONSUMPTION

AS A CONTRIBUTORY FACTOR TO OBESITY AMONG PAULINIAN

STUDENTS FROM THE COLLEGE LEVEL

A Thesis presented to
St. Paul University Iloilo
College of Hotel, Restaurant and Management, Tourism
and Nutrition and Dietetics

In partial fulfilment of the requirements for the degree

Bachelor of Science in Nutrition and Dietetics

Anna Veronique Lee

November 2018
 2

Chapter 1
THE PROBLEM

Introduction

Obese and overweight people dramatically increased over the past three

decades worldwide. They are categorized according to an individual’s body mass

index (BMI), which is calculated as weight (kg) divided by height 2 (m). Obesity is

a condition where a person has accumulated so much body fat that it might have

a negative effect on their health. If a person's bodyweight is at least 20 percent

higher than it should be, he or she is considered obese. If the Body Mass Index

(BMI) is between 25 and 29.9 one is considered overweight. If one’s BMI is 30 or

over, he/she is considered obese. Both can result in a wide range of serious health

consequences. Excess adiposity can be detrimental to psychological and

emotional well-being, lowering an individual’s overall quality of life (WHO, 2018).

Moreover, these individuals tend to face discrimination with respect to

employment, education, health care and etc. especially among Tourism students

and the like.

Among the Asean countries studied in the report, the Philippines has the

second lowest obesity and overweight prevalence at 5.1 percent and 23.6 percent

but despite low prevalence rates, obesity has a strong impact in the Philippines

due to the large number of obese persons in the country—18-million Filipinos are

obese and overweight (ARoFIIN, 2017).

 3

Obesity in childhood can add up to health problems, often for life. In adults,

overweight and obesity are linked to increased risk of heart disease, type 2

diabetes (high blood sugar), high blood pressure, certain cancers, and other

chronic conditions (Akil, 2011). Fast food can be a contributory factor to these

diseases since it is high in salt which is used as a preservative. It is consumed by

many people because it is more flavorful and satisfying (Fast Food Facts, 2017).

Although no comprehensive study has been made to identify the main

factors that contribute to the rise in obesity rates over time, weight gain rises from

an energy imbalance whereby a person consumes more calories that he/she

expends.

Presently, there has been a lack of strong evidence on the contribution of

fast food chains on weight status of Filipino college students. However, in this

study, it will be determined whether fast food consumption is one of the

contributory factors to obesity among young adults, specifically college Paulinian

students. Fast food consumption of these students will also be determined.

Statement of the Problem

The main problem of this study is: “What are the habits and level of

awareness on fast food consumption as a contributory factor to obesity among

Paulinian students from the college level?”

 4

This study also seeks to answer the following questions:

1. What is the profile of the respondents in terms of:

a. Sex

b. Age

c. Department

2. What are the college Paulinian students’ fast food consumption habits?

3. What is the level of awareness on fast food consumption as a contributory

factor to obesity among Paulinian students from the college level?

4. Is there a significant difference on the habits and level of awareness on fast

food consumption as a contributory factor to obesity among Paulinian

students from the college level?

Objectives of the Study

The researcher organized the objectives as the following:

General Objective, this study aims to:

1.To determine the habits and level of awareness on fast food consumption as

a contributory factor to obesity among Paulinian students from the college level.

Specifically, it aims to determine the following:

1. the college Paulinian students’ sex, age, and department,

2. the college Paulinian students’ fast food consumption habits,

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3. the level of awareness on fast food consumption as a contributory factor to

obesity among Paulinian students from the college level, and,

4. if there is a significant difference on the habits and level of awareness on

fast food consumption as a contributory factor to obesity among Paulinian

students from the college level.

Significance of the Study

The study could benefit the following:

Students. This study could serve as a self-assessment for them. It is also

important for one to evaluate his/her eating practices/habits.

Parents. This study could make the students’ parents be aware of what

their children are eating in school. This will help parents to encourage their children

to eat better food choices and also to provide them with food that are more

nutritious.

Educators. It is important that teachers know the changing lifestyle of their

students so they may relate well with them. It is known that poor eating habits could

lead to psychological and emotional being of an individual, this is why this study is

important for them to be able to guide their students to the right direction.

School Administrators. Since the health and welfare, and academic

performance of students are the primary concern of good school administrators,

the findings of this study, therefore, would be beneficial to them.

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Scope and Limitations

The study focuses only among Paulinian students of St. Paul University

Iloilo specifically only from the college level, from first year to fourth year in terms

of their habits and level of awareness on fast food consumption as a contributory

factor to obesity. The college level includes different departments, namely; College

of HRM, Tourism and Nutrition (CHTN), College of Arts, Sciences and Education

(CASE), College of Business and Information Technology (CBIT), College of

Nursing (CON), and College of Physical Therapy (CPT).

The total population of Paulinian students from the college level is 702

students and the researcher will obtain a sample size from the total population with

a margin of error of 5%.

This study is only limited to Paulinian students from the college level, from

first year to fourth year and the researcher will make sure that the respondents will

fill out the survey form without skipping some questions.

Definition of Terms

The following are defined conceptually and operationally for greater clarity

and understanding of this study:

Fast food. Conceptually, it refers to food that can be prepared and

served quickly. It can come from many places: sit-down restaurants, take-out,

drive-thru, and delivery (“Fast Food Facts”, 2017).

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In this study, it is characterized as a quick, easily accessible and cheap

alternative to home-cooked meals.

Fast food Consumption. Conceptually, it is the consumption of energy

dense food with high sugar, fat, salt content and low nutrient value in terms of

protein, fiber, vitamin and mineral content (Das, 2015).

In this study, it refers to high calorie dense food that are served readily for

consumption.

Health. Conceptually, it is a state of complete physical, mental and social

well-being and not merely the absence of disease or infirmity (Constitution of

WHO, 2016).

In this study, it refers to being free of disease or disorder but also some

degree of overall wellness.

Obesity. Conceptually, it occurs when the energy intake exceeds the

body’s energy requirements for physical activity and growth resulting to

accumulation of fat stored as adipose tissue. (Ruiz-Claudio, 2010) (p. 551) An

adult who has a BMI of 30 or higher is considered obese (Moore, 2013).

In this study, it refers to a person who has a BMI of 30 and above.

Overweight. Conceptually, it refers to body weight that is greater than what

is considered normal or healthy for a certain height. (Facts for Adult Overweight &

Obesity, 2018) An adult who has a BMI between 25 and 29.9 is considered

overweight (Moore, 2013).

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In this study, it refers to a person who has a BMI of 25 to 29.9.

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Chapter 2

THEORETICAL BACKGROUND

Review of Related Literature

Nutritional Awareness

According to Dimopoulos, et al. (2009), nutritional awareness is linked to

nutritional knowledge, attitudes, and actions. Moreover, it is related to the

knowledge of the interrelationships between nutritional matters and human life,

which may have an effect on a person's life. It also involves being aware of the

kind of foods an individual eats and the reasons for eating such foods. It is possible

that through generating awareness, individuals may be more likely to make

informed food choices and decisions conducive to their health despite their

occupation.

Fast Food

Fast food is consumed by many people because it is inexpensive,

convenient, and tastes good. However, fast food is made with cheaper ingredients

such as high fat meat, refined grains, and added sugar and fats, instead of

nutritious ingredients such as lean meats, whole grains, fresh fruits, and

vegetables. Fast food is also high in salt which is used as a preservative and

makes food more flavorful and satisfying (Fast Food Facts, 2017).
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In 2016, chicken prices were significantly lower than beef prices, giving

chicken chains a leg up on the burger-centric competition. While prices have

equalized, the success of new chicken items proved to chains that there is a

demand for poultry. (Taylor, 2017)

The most common vegetable served at fast food places is the potato in the

form of French fries. There is no problem with eating fast food occasionally, but if

you are eating it more than once a week, consider ordering some healthier options

that are more nutritional (Alto, 2015).

According to a study concentrating on determining the effects that proximity

of fast food chains have on obesity, there is a significant correlation. They found

that weight gain is more prevalent when the surrounding areas are dense with fast

food choices (Davis et al., 2009).

Fast Food Consumption of Filipinos

A study by the Food and Nutrition Research Institute-Department of Science

and Technology on food consumption of Filipinos showed that the average

consumption of green, leafy, and yellow vegetables and vitamin C-rich fruits is low

in the Filipino diet. Although fruits are plentiful in the Philippines, it was shown that

fruits are not a significant part of the daily diet of Filipinos. Fruits are often eaten

as desserts (Chakraborty et al., 2016).

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It has been found that the landscape of Filipinos’ diet and culture has

transformed over time. Buying of fast food has now become an everyday routine

for most people, especially for middle class earners engaged in productive

activities. However, there has been a lack of strong evidence on the contribution

of fast food chains on weight status of Filipinos. Most fast food establishments are

located in Metro Manila and in several major cities in Central Luzon and Southern

Tagalog. In 2009, there are around thirty-two thousand fast food outlets in Metro

Manila area alone (Limtingco, 2012).

According to the Philippine Statistics Authority (2009) the growth of fast-

food chains and restaurants are rapidly increasing. It was found that out of 10 fast-

food eaters with ages 20 and above, three are most likely overweight or obese.

They make up roughly 31.1 percent of respondents having a BMI greater than or

equal to 25. The study showed that there are more obese females with a

percentage of 34.4 percent in the adult age range and 27.6 percent obese or

overweight males (FNRI, 2010).

Fast Food Consumption on College Students

The transition to college brings tremendous life change, including stresses

related to increase academic pressures, changes in peer and family social

supports, as well as changes in food accessibility and eating patterns (Lightfoot,

2000). College life creates a new environment for meal preparation, planning, and

eating (Stockton et al., 2013).

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College students, often on a budget, look to fast food as the highest

quantity option for the lowest cost, but neglect to recognize how much fat and

calories are actually being consumed (Irimia et al., 2016). College students must

develop coping mechanisms to deal with the stress of independence as they are

no longer dependent upon parents or guardians for home-cooked meals, and often

these mechanisms include putting aside health and eating whatever is quickest,

easiest, and tastes the best. (Stockton et al., 2013).

With fat-laden foods increasingly becoming staples of the diets of college

students, other consequences include not meeting the recommended

requirements of nutrients attained in fruits, vegetables, and whole grains. The 1995

National College Health Risk Behavior Survey found that only 26% of students had

eaten five or more servings of fruits and vegetables, leaving the majority of

students at an unhealthy disadvantage (Centers of Disease Control, 1997).

There are many factors that contribute to the college-aged group consuming

more fast food meals. It is observed that fast- food restaurants are accessible to

college students who have limited time and those with busy schedule will most

likely visit these restaurants. Also, college students will benefit with the social

aspect of eating fast food with friends. There was sufficient evidence that shows

increasing the energy dense food in a diet with behavior characteristic of college

students, such as eating out and snacking, promote weight gain (Dingman, et al.,

2014).
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Fast Food Consumption and Sex

Gender differences in my study indicated that females more likely use

nutrition information and select smaller portion sizes. This may be because women

have been reported as more likely to be trying to lose weight than men, especially

during the college years (Lowry et al., 2000).

Meat is often perceived as masculine, and in Western society, masculinity

is strongly connected to Carnivorism (Sobal, 2005). Western male identity is also

generally equated with physical strength and toughness. This association

reinforces perceptions of male invulnerability and diminishes the importance of

bodily health. This concept is reflected in a study that attests to the difficulties of

convincing men to adopt healthier diets. In their study, it was demonstrated that

males are considered relatively stronger than females, which is reflected in both

food choice and portion size (Gough et al., 2006)

According to Levi et al. (2006), they conclude that food decisions are often

of greater importance to women, while men remain ignorant or uncaring with

regard to nutrition and health.

According to a study, it was indicated that among U.S. college students,

male and female perceptions of ideal physique are inverse. For women, a smaller

or slimmer figure is desirable, while the opposite holds true for men (Harring et al.,

2010).
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Obesity

Obesity is the result of energy imbalance that occurs when energy

consumption exceeds energy expenditure. Energy is required by the body to stay

alive, grow, keep warm and move around provided by the food that we eat and

beverages that we drink. It comes from the fat, carbohydrate, protein and alcohol

the diet contains. Energy requirements may differ from one person to another. It

depends on factors such as age, sex, body composition and physical activity level.

It is the sum of the basal metabolic rate (the amount of energy expended while at

complete rest), the thermic effect of food (TEF, the energy required to digest and

absorb food) and the energy expended in physical activity. In order to maintain

one’s body weight, it is necessary to balance the energy derived from food with

that energy expended in physical activity. To lose weight, energy expenditure must

exceed intake, and to gain weight, energy intake must exceed expenditure (Home,

2011).

Though obesity was once viewed as a problem limited to higher-income

countries, it is now clear that obesity is an emergent or existing public health

problem in many middle and lower-income countries as well, particularly in urban

areas (Dahly, 2011).

Fast Food Consumption and Obesity

According to Sampey et al. (2011), high fat diets are usually tested in

several animal models. They used rodent models and fed them a diet consisting
 15

of food regularly consumed by humans, including high-salt, high-fat, low-fiber,

energy dense foods such as cookies, chips, and processed meats. They found

significant differences between male Wistar rats fed with cafeteria diet and rats fed

with traditional lard-based high-fat diet. The rats that were fed with lard-based diet

displayed inflammation in white fat, brown fat, and liver, along with exaggerated

obesity, glucose intolerance and hepatosteatosis. Hepatosteatosis, a more benign

form of hepatocyte dysplastic changes, then steatohepatitis, which ultimately leads

to fibrosis and cirrhosis, are both present within the diagnosis of Nonalcoholic fatty

liver disease (NAFLD).

The lack of physical activity together with increased consumption of fast

food meals has a direct impact on health. In a study, it was found that majority of

students who engaged in only low levels of activity were either overweight or obese

(Shah, et al., 2014).

According to studies, the consumption of fast food has increased rapidly

over the past three decades. The increased calorie intake is a leading cause of

obesity worldwide. If caloric intake is not controlled, health issues are going to rise

in the coming years as more people will become obese eating unhealthy fast food

(Darcey, 2017).

According to Bariartric Surgery Source (2017), fast food restaurants are a

big part of the obesity problem. It has been shown that the frequent visits of

individuals in fast food restaurants is directly related to their weight. According to

a 15-year study of 3,000 adults, people who visited fast food restaurants more than

twice per week gained roughly 9 to 11 pounds more than people who visited them
 16

less than once per week. The reason behind the weight gain is that fast food is

less healthy than other food, but this assumption is only partially correct.

Consuming mainly refined grains may increase your visceral adipose tissue

(VAT), a type of fat found around your organs that may eventually lead to diabetes

and heart disease. Participants who consumed at least three servings of whole

grains per day had approximately 10 percent less VAT than people who consumed

only refined grains (Bruso, 2018).

According to Shanik et al. (2008), it was later found by endocrinologists that

hyperinsulinemia, or elevated blood insulin levels, is a cause of several detrimental

health conditions, including insulin resistance. As the relationship between obesity,

insulin resistance, and Type-2 diabetes become more clearly defined, medical

researchers such as Houben et al. (2012) recognize it as a global issue.

According to Kruger et al. (2008), based on the 2004 Styles survey, the

reducing consumption of fast food can help people to maintain lower weights.

Mozaffarian et al. (2011) found that consumption of French fries and soft drinks is

associated with weight gain.

According to Shanik et al. (2008), most fast food contains a large amount

of sugar, fats and carbohydrates and less minerals and vitamins. This means that

you are taking in large amount of unhealthy calories in the shape of fast food which

leads to weight gain and ultimately obesity. Fast foods have exceeding levels of

sugar and fats which are directly associated with increasing weight.
 17

Studies have shown that in poorer areas and those areas with greater

minority populations have disproportionately higher access to fast-food and lower

access to physical activity facilities or public transit (Macintyre, 2007).

Fast Food Consumption Habits

According to Yardimci et al. (2012), the frequency of fast food consumption

does not differ between male and female and the rate of going to fast-food

restaurants is high for both genders. It was found that 25.8 percent of the

participants eat at fast food restaurants a couple of times a week, 44.3 percent

participants visit fast food restaurants only a few times in a month. It was also

determined that fast-food consumption is high among university students.

According to Bipasha et al. (2013), twenty two percent of the respondents

consumed fast food for 4 days a week and more than one-fifth of the study eat fast

food every day. Fifty four percent of the respondents skipped their breakfast due

to a variety of reasons including class pressure and had fast food after finishing

their classes, either from varsity canteens or other fast-food outlets. Though 98

percent of the students were well informed about the negative effects associated

with excessive fast food consumption, they were still profoundly addicted to it.

Studies have also shown that hamburgers is the first in fast food products

to come to mind. 97.47 percent of the students continued to consume fast food

although they know the harmful effects of it. It was shown that male students prefer

fast food restaurants more than female students do. They have found that 11
 18

percent of the students eat several times a year at fast food restaurants, 35 percent

once or twice a month, 38 percent several times a week and 7 percent several

times a day (Segura, 2017).

Lifestyle

A sedentary lifestyle and poor nutrition contribute to obesity, a risk factor for

some of the leading causes of mortality, including cardiovascular disease,

diabetes, stroke, and some cancers. Sedentary behaviours are those that involve

sitting or minimal energy expenditure. Television viewing, computer use, computer

games, and driving/riding in cars are some of the largest contributors (Must et al.,

1999).

According to WHO, from 1993-98, the percentage of adults with a BMI>25

kg/m2 increased from 17 to 20 percent, and overweight prevalence doubled among

female adolescents. Currently, WHO estimates place the prevalence of obesity

and overweight combined at 29 percent in females and 21 percent in males (WHO,

2009).

Fast food Environment and Obesity

In the literature, the food environment has been generally defined to mean

availability and accessibility to food, as well as food advertising and marketing

(Lake et al., 2006), or any opportunity to obtain food that includes physical, socio-
 19

cultural, economic and policy influences at both micro and macro levels (Spilkova,

2016). This has also been referred to as the ‘foodscape’ (Dolphijn, 2004) and it

generally represents the multiplicity of sites where food is found or consumed.

It has been suggested by some findings that exposure to food in the

neighbourhood or in the daily activity space influences diet and is associated

weight status. Some researchers argue that “food deserts”, areas with little or no

provision of fresh and healthy food, may contribute to disparities in obesity and

related health problems, such as diabetes or hypertension (Beaulac et al., 2009).

One of the goals of their research has been to shape effective strategies to improve

access to healthy foods or decrease access to unhealthy foods to help tackle the

obesity epidemic that has been particularly pronounced in highly industrialized

countries, and on the rise in poorer countries as well (Bader et al., 2010).

According to some health behaviorists, one reason for the growing

popularity of fast food is the taste of menu items. Fast food cuisine is often

enhanced with copious amounts of fats and sugars. In Western societies, taste

surpasses health and nutrition in food choice, which is likely a by-product of a

mechanized food production system enabling excess calories (Rimer et al., 2008).

The availability of food in a neighborhood commonly interacts with its socio-

economic characteristics. Overall, it is thought that poor people are more affected

by their environments because of their smaller activity spaces and restricted

mobility, which can have implications for their ability to make healthful food

purchases (Cooke et al., 2005).

 20

Affordability refers to the purchasing power of individuals and the price of

foods. In a comparison of energy density of food to the energy cost of food, it has

been shown that energy-dense diets is lower in cost than nutrient-dense diets. This

study revealed a lower daily diet cost with higher levels of fats and sweets and an

increase in daily diet cost with higher intakes of fruits and vegetables (Drewnowski

et al., 2004).

Other research on food expenditure patterns indicates that low-income

groups purchase fewer amounts of fruits, vegetables, and milk products than

higher-income groups. These findings may be explained by an attempt to

extinguish hunger with palatable foods while conserving monetary resources, thus

purchasing foods such as inexpensive sources of fats and sweets which are often

calorically-dense. Additional factors contributing to the purchase of these foods

may be low access or reduced availability to these products in lower-income areas

(Kirkpatrick et al., 2003).

Some studies show that availability influences food choice. One Canadian

study found food-outlets in lower-income neighborhoods offered fewer fresh

produce items and fewer healthy foods in general (Latham et al., 2007).

One study measured the association between the presence of food

establishments and obesity among 1295 adults living in the southern region of the

United States. The prevalence of obesity was lower in areas that had supermarkets

and higher in area with small grocery stores or fast food restaurants. Its findings

are consistent with other studies showing that types of food stores and restaurants
 21

influence food choices and, subsequently, diet-related health outcomes (Morlan,

et al., 2009).

Summary of Related Literature

Nutritional awareness is linked to nutritional knowledge, attitudes, and

actions. It involves being aware of the kind of foods an individual eats and the

reasons for eating such foods.

Fast food is made with cheaper ingredients such as high fat meat, refined

grains, and added sugar and fats, instead of nutritious ingredients such as lean

meats, whole grains, fresh fruits, and vegetables and is very high in sodium. Fast

food restaurants are a big part of the obesity problem. It has been shown that the

frequent visits of individuals in fast food restaurants is directly related to their

weight.

College students on a budget, look to fast food as the highest quantity

option for the lowest cost, but neglect to recognize how much fat and calories are

actually being consumed. They develop coping mechanisms to deal with the stress

of independence as they are no longer dependent upon parents or guardians for

home-cooked meals, and often these mechanisms include putting aside health and

eating whatever is quickest, easiest, and tastes the best.

It was demonstrated that males are considered relatively stronger than

females, which is reflected in both food choice and portion size. Food decisions
 22

are often of greater importance to women, while men remain ignorant or uncaring

with regard to nutrition and health.

Obesity is the result of energy imbalance that occurs when energy

consumption exceeds energy expenditure. The consumption of fast food has

increased rapidly over the past three decades. The increased calorie intake is a

leading cause of obesity worldwide. If caloric intake is not controlled, health issues

are going to rise in the coming years as more people will become obese eating

unhealthy fast food.

A sedentary lifestyle and poor nutrition contribute to obesity, a risk factor for

some of the leading causes of mortality, including cardiovascular disease,

diabetes, stroke, and some cancers.

The availability, affordability, accessibility, the taste, level of awareness are

the main factors of an individual’s perspective in food choices.

 23

Conceptual Framework of the Study

Independent Variable Dependent Variable

 Food
CHTN students
Consumption
CBIT students Habits
 Level of
CASE students
Awareness on
CPT students fast food
consumption as
CON students a contributory
factor to obesity

Statement of Hypothesis

There is a significant difference in the habits and level of awareness on fast

food consumption as a contributory factor to obesity among college Paulinian

students as a whole and when classified according to their profile.

 24

Chapter 3

METHODOLOGY

Research Design

This is a non-experimental descriptive study that will determine the habits

and level of awareness on fast food consumption as a contributory factor to obesity

among Paulinian students from the college level.

Setting of the Study

The setting will be inside St. Paul University Iloilo, General Luna Street,

Iloilo City. Survey forms will be distributed in the hallway outside the cafeteria area.

Cafeteria tables will be available for the students to write on and pens will be

provided for the students to use.

Sample and Sampling Scheme

The sampling method that will be used for this study is the stratified random

sampling method. Stratified random sampling will be applied in taking the number

of respondents per department. The total population of Paulinian students from the

college level, from first year to fourth year is 702 students. To determine the size

of the study population, the researcher will use the Slovin’s formula (n= N/ [1+Ne2]),

where n is the size of the sample, N is the size of the population, e is the margin
 25

of error. The margin of error will be 5%. The sample size is 255 students, hence,

the researcher will take 51 students per department.

Research Instrumentation

A 5-point Likert-type scale will be used to develop the survey. The scale

options will be (1) Not At All Aware, (2) Slightly Aware, (3) Moderately Aware, (4)

Very Aware, and (5) Extremely Aware. The researcher will provide a researcher-

made survey form.

Scale Description
4.1-5.0 Extremely Aware
3.1-4.0 Very Aware
2.1-3.0 Moderately Aware
1.1-2.0 Slightly Aware
0-1.0 Not At All Aware

Data Gathering Procedure

The Paulinian students from the college level will be the respondents for

this study. The Paulinian students are subdivided according to their department.

The researcher will then use the Slovin’s Formula to determine the population size

of respondents for each subgroup. The researcher-made survey form will be

provided by the researcher. The survey form will determine the habits and level of

awareness on fast food consumption as a contributory factor to obesity among

Paulinian students from the college level. The researcher will use a 5-point likert

scale for the respondents to answer according to their level of awareness and fast
 26

food habits. The data that will be gathered will then be subjected to descriptive

data analysis. The descriptive analysis includes the frequency and percentage

distribution.

Statistical Tools

The data that will be gathered will be subjected to descriptive data analysis.

The descriptive analysis includes the frequency distribution and percentage. The

descriptive analysis will be used to determine the habits and level of awareness

on fast food consumption as a contributory factor to obesity among Paulinian

students from the college level.

 27

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