Increased exam stress linked with eating poorer quality diet

Increased stress during university examinations is associated with eating a poorer quality diet including less fruit and vegetables and more fast food, according to an observational study being presented at this year's European Congress on Obesity (ECO) in Glasgow, UK (28 April-1 May).

"Stress has long been implicated in poor diet. People tend to report overeating and comfort eating foods high in fat, sugar, and calories in times of stress. Our findings looking at the eating habits of students during exam periods confirm this stress-induced dietary deterioration hypothesis", says Dr Nathalie Michels from Ghent University in Belgium who led the research.

"A healthy diet is needed for optimal academic and mental performance. Unfortunately, our findings suggest that students have difficulties eating healthily and find themselves adopting bad eating habits, which over a few weeks can considerably affect your overall health and be difficult to change."

The results are based on an anonymous online survey of 232 students (aged 19-22 years) recruited from Ghent University and other universities in Belgium. Before and after the month-long examination period in January 2017, respondents were asked to disclose their perceived stress and complete questionnaires that assessed changes to their dietary patterns and various psychosocial factors.

The researchers investigated the relationship between exam stress and change in dietary quality, and whether these associations were modified by psychosocial factors such as eating behavior (emotional/external/restrained), food choice motive, taste preference, reward/punishment sensitivity, impulsivity, coping strategies, sedentary behavior, and social support.

During the month-long exam period, participants found it harder to stick to a healthy diet, and only a quarter fulfilled the WHO recommended 400g of fruit and vegetables a day. What is more, students reporting higher levels of stress tended to snack more often.

The findings suggest that emotional eaters (who eat in response to negative emotions), external eaters (who eat in response to the sight or smell of food), sweet/fat lovers, people who are highly motivated by health (with health as a food choice motive), sensitive to reward and punishment, highly sedentary, and with higher stress levels are at greatest risk of making unhealthy food choices during this stressful time.

"To fight against stress-induced eating, prevention strategies should integrate psychological and lifestyle aspects including stress management (eg, emotion regulation training, mindfulness, yoga), nutritional education with techniques for self-effectiveness, awareness of eating-without-hunger, and creating an environment that stimulates a healthy diet and physical activity", says Dr Michels.

The authors acknowledge that their findings show observational differences, so no firm conclusions can be drawn about cause and effect. They point to several limitations including that dietary patterns were based on self-reported data which may have introduced information and recall bias; and that most (92%) of the participants were women, who tend to prefer sweet and fatty food as comfort items, which may limit the generalisability of the results to men. Finally, given the small sample size, further research is needed.