Obesity and the university environment: Assessment of the campus and intervention in the student health services

Abstract

<p>One of the most substantial challenges facing colleges and universities today remains the creation of a healthy campus environment. With more than one-third of college students classified as overweight or obese by body-mass index (BMI) and the known negative health consequences associated with obesity, campuses have a deliberate responsibility to help mitigate this sobering statistic. A significant movement from The American College Health Association (ACHA) to address campus health, Healthy Campus 2020 (HC2020), provides a framework to support campuses in improving the health of their students, staff, and faculty. This project first sought to assess, explore and understand one campus community&rsquo;s level of engagement in promoting healthy behaviors and creating a healthy environment with respect to the HC2020 objectives. Second, this project introduced and evaluated the impact of a 5As behavioral model training intervention on obesity management for providers in the Student Health Services (SHS). Methods included structured interviews across campus departments, and pre- and post-electronic health record (EHR) reviews to evaluate the SHS intervention as well as a focus group with SHS providers to explore their experience with implementing the 5As intervention. Results from the campus interviews demonstrated that university leaders were cognizant of, and focused on, the campus community and voiced the desire to create a healthy campus environment that accommodated students&rsquo; health needs. Despite a number of healthy initiatives existing on campus, and the university&rsquo;s membership in ACHA, the university did not formally participate in the Healthy Campus 2020 initiative.</p> <p>Results from the SHS included a sample of 786 pre-intervention EHR records and 1233 post-intervention EHR records of students aged 18 to 24, approximately two-thirds of whom were female. Documentation of BMI by providers demonstrated a small but significant decline from pre-intervention (82.6%) to post-intervention (78.8%). Documentation of overweight and obese diagnostic codes by providers improved from 0.7% pre-intervention to 8.1% post-intervention showing a small but statistically significant increase. Overall, results from the 5As training intervention with providers to improve consistent documentation of overweight and obese students showed minimal success. Providers voiced support for continuing use of 5As but cited time, patient acuity level, and student&rsquo;s lack of willingness to change as a barriers. Nonetheless, these results open conversation and opportunities for further improvement, for example, initiating SHS protocols to document BMI at all student visits, and configuring electronic health records to facilitate consistent documentation of diagnosis and counseling. Despite evidence of some movement towards a healthier campus and membership in the ACHA, the university falls short of a full commitment to the HC2020 initiative and the resultant healthy campus environment. To ensure success, the university needs to develop a collaborative team prior to committing to the initiative, and ensure involvement of students, faculty, and staff.</p> <p>&nbsp;</p>