Although associations between negative emotions, behaviors, and sociodemographic characteristics of people living with obesity have been well-established, most of past studies ignore the multiplicative associations of those predictors and obese and underweight groups of students. Studying those complex associations are especially important during a unique pandemic like COVID-19 as it expands our understanding regarding the emotional and behavioral reactions of those vulnerable groups of students.
The results highlighted that while higher father and students’ education, income and social class buffer against the likelihood of being obese students, lack of various negative emotions and taking less cautionary actions against COVID-19 contribute to the likelihood of being obese. while similarities were found between underweight and obese students, significant differences were also found across those groups, highlighting the importance of studying underweight in addition to obese students.
It was found that while feeling fear is interacting with relative income, higher feeling of fear due to COVID-19 is associated with higher likelihood of belonging to both groups. Also, higher income is associated with lower likelihood of being obese or underweight. Results are in line with the past studies showing a reverse association between obesity and higher income (Kim & von dem Knesebeck, 2018), and also between being underweight and higher income (Al Kibria et al., 2019). The association between income and negative feelings due to COVID-19 might be expected as lower income means lower control over life and consequently higher insecurity, social isolation, and various mental disorders (Marmot & Wilkinson, 2001). However, it is noteworthy the previous studies only considered the additive terms.
The subjective health was used to check its association with being obese students. The results highlighted that while there are negative association between subjective health and the likelihood of being obese and underweight, the impact is more pronounced for obese students. This result, to some extent, is in line with the previous study that there is a negative association between being obese and subjective health (Guallar-Castillon et al., 2002).
Moving to the associations between age and obese students. Our results highlighted that age has varied impacts on the two group, highlighting while higher age is positively associated with being underweight, it is negatively associated with being obese. Literature findings are not consistent. For instance, results are in line with the literature, which showed that the highest prevalence of underweight is in younger age, 15–24 years old, across women, while the middle age, 25–34 years old, has the lowest prevalence (Hashan et al., 2020). Our findings, however, differ from those in the previous study, which found that the prevalence of underweight individuals is higher across the young, while the old are more likely to be obese (Al Kibria et al., 2019).
Higher father education, social class, and income were found to be associated with a lower likelihood of being obese or underweight. That somehow could be contrasted with the literature, showing that home environment has the most important setting regarding shaping children’s physical and eating behaviors (Golan, 2006).
Specifically, the negative association between higher social class and obesity is in line with the past study, which found that there is a negative association between higher social class and obesity (Moore et al., 1962). The impact might be linked to the parents or even students’ level of educations. However, the interactions of those variables was checked but found not to be important. It is expected that there might be other confounding factors that shape the correlation between the social class with being obese students, which were not recorded by this study.
Although it is not practical to impact the social class of students, it is recommended from younger age to employ behavioral and educational programs targeting parents only, or parents and obese children to maintain a healthy lifestyle. The methodology has proven to be effective for families with obese children (Golan et al., 2006). The inclusion of parents in the program is especially important as they might act as a function of role models, shaping children’s’ behaviors in terms of physical or sedentary activity (Gustafson & Rhodes, 2006).
Higher father education was found to reduce the students’ risk of obesity. The result somehow is in line with the literature, highlighted that characteristics such as parents’ education, jobs, and even number of family members are important risk factors for weight gain and obesity (Troiano et al., 1995). The impact might be due to varied eating style, which predispose students to have certain food preference. The impact might be likelier to be shaped from the younger age, where the impact of parents might be more prevalent.
In this study, the level of education was only considered from undergraduate to graduate studies, highlighting association of minor changes of education on being obese students. The impact of this small change is expected to be due much confounding factors that were not recorded. It has been discussed that while income provides a material impact on health, education retain health, and while income takes place in adulthood, education take place in adolescence and adulthood (Geyer et al., 2006). In addition, the importance of higher education has been discussed to be associated with health literacy and behaviors (Cutler & Lleras-Muney, 2006). Policies should be designed not necessarily through persuading higher education but educating students at younger age regarding the consequences of being over-and underweight.
Despite the risk, while we found that obese students do not avoid interacting with large groups of people due to COVID-19, underweight students are more likely to avoid mixing with a large group of people, compared with normal-weight students. Similarly, past studies show that individuals with higher BMI are less concerned with the virus and taking behavioral precautions less seriously than individuals in other categories (Sutin et al., 2020). However, part of our results is against the previous study, which found a significant negative association between taking precautionary action and being underweight (Sutin et al., 2020). It should be emphasized that past studies just consider the additive effect.
Taking precautionary action of avoiding large group of people is interacting with gender. The interactive factor of gender highlighted that females are more likely to be obese, which is in line with the past research that due to behavioral and biological characteristics of women, they are more prone to be both underweight and obese compared with men (Kanter & Caballero, 2012).
It is worth reiterating the importance of studying the underweight, in addition to obese students. That is especially important as underweight individuals were found to be at higher risk compared with obese students (Dobner & Kaser, 2018). As a result, the policy makers should aim at targeting both groups simultaneously. There are both similarities and differences of associated factors across obese and underweight students, which the following paragraphs highlight few of them.
While the majority of factors and the interactions terms were significant for obese students, they were found to be not important for underweight students. For instance, students’ educations, social class and father’s education were found not to be important for underweight students. Also, differences were found in terms of taking cautionary actions against COVID-19. For instance, we found that while obese students do not avoid interacting with large groups of people due to COVID-19, underweight students are more likely to avoid mixing with a large group of people compared with normally weighted students.
In addition, although feeling of guilt was not significant for underweight students, it was for obese students. The weight-related guilt and shame were highlighted as prospective predictors of coping with obesity (Conradt et al., 2008). Although that case study and its implication differ from ours, the contrast might be still made. Our result is expected to be due to a possible impaired emotional feeling of the obese, who feel less guilt due to COVID-19 compared with normally weighted students.
Turning to limiting exercise at home. Despite the fact that limiting exercise at home does not pose a risk of being infected, normally weighted students are more likely to limit that behavior. It should be also noted the association of guilt and being obese students is interacting with limiting exercise at home due to COVID-19.
It should be noted that there are inconsistent results for the association between emotion impairment and obesity. For instance, people with higher BMI are unrelated to the concerns of the virus (Sutin et al., 2020). Also, the other study found that being obese does not unequivocally imply cautiousness (Bíró et al., 2021). However, other studies found that the obese are associated with emotional impairments (Elfhag & LUNDH, 2007). Although we cannot for certainty prove our hypothesis that the obese are associated with lack of emotions, the interaction between some emotions and different precautionary actions supports our hypothesis.
The study findings should be interpreted with caution due to the possible limitations. That is especially important as this study only focused on students in seven universities across the US. So, the scope might be limited to students in the same geographic characteristics. There is also a recall bias related to the self-reported web-based survey. In other words, this study relied upon the recall and honesty of students in question, especially questions related to the weight and height. However, it has been discussed that women and men overestimate their height and underestimate their weight (Danubio et al., 2008). The consideration is especially important as those factors were used for estimation of BMI. However, no viable method could be used to address the uncertainty regarding those factors. For future studies, random checks of some observations are recommended to assure the accuracy of the results.
Another limitation is the cross-sectional limitation of the study. That was mainly due to the unique circumstances and possible impracticality of observing the participants in varied time spans due to change in circumstances. Another noteworthy limitation was lack of validated questionnaire Again, because of the unique circumstances, it was very challenging to elongate the process of data collection due to validating the questionnaires. Another limitation is related to the populations of underweight and obese, which might not be representation of the US students. It should be noted that the data was not originally collected to evaluate those groups but the psychological impacts of COVID on students in general sense. So, the generality of the findings should be taken into consideration.
In summary, this study found that in response to the pandemic, compared with normally weighted individuals, obese individuals are associated with less adoptive behaviors, e.g., taking precautionary behaviors, and less emotional feelings, e.g., having negative emotions with lower scales. Also, the results highlighted the important role of parents on the well-being and physical health of students.
The findings point to some potential take-away that could be considered by policy makers. The results implicate while designing the educational policies for targeting obese students, the population should be stratified based on students’ characteristics such as levels of income, education, and their parents’ characteristics. That is due to identified significant interaction terms. The program should also be supported by the governmental entity to take a more holistic approach to prevent the obese and underweight in future generations.
To finalize, we showed that both obese and underweight student experience impaired levels of emotions. To our knowledge, this is one of the earliest studies that investigate both underweight and obese students while considering the complex interaction terms of negative emotions during a unique pandemic.
