Stress Level, Restrained Eating Behaviour, and Nutritional Status of

University Students During the Hybrid Learning Condition

Nila Reswari Haryana

, Edy Marjuang Purba

and Risti Rosmiati

Human Nutrition Study Program, Faculty of Engineering, Universitas Negeri Medan, Medan, Indonesia

Keywords: Body Mass Index, Eating Behavior, Impulsive Eating, Malnutrition, Pressure.

Abstract: Students will suffer from extreme stress due to unclear learning methods. A restrained eating to control food

intake is related to impulsive eating behaviour under stress. Therefore, this study aimed to determine the stress

level, restricted eating behaviour, and nutritional status of university students during the hybrid learning

condition. This study used a cross-sectional survey of 78 active students from Universitas Negeri Medan in

July 2023. Data were collected using a questionnaire with KoboToolbox software. Variables observed in this

study were composed of students’ characteristics stress score, restrained eating behaviour score, and BMI

score. Data were analysed using the Pearson’s test and linear regression. From the results, most students are

in a moderate stress level (75.6%) and more than 30% of the students are in malnutrition condition (under and

over nutritional intake). According to the restrained eating behaviour scores, the three behaviours related to

restrained eating behavior are ensuring what to eat (2.86 ± 1.24), associating the body weight with the food

consumed (2.50 ± 1.41), and consuming less food when the weight gains (2.36 ± 1.18). In the linear regression

results, the BMI score is positively correlated with the restrained eating score (p<0.05). As the restrained

eating score levels up to 1 point, the BMI score elevates by 2.51. So, the more students perform a restrained

eating behavior to lose or maintain weight, the higher BMI score of the students can gain.

1 INTRODUCTION

The hybrid learning policy has ever been enforced in

Indonesia due to the low effectiveness of online

learning and practical sessions that should be

conducted directly. These drawbacks emerge due to

several problems, such as unaffordable internet quota,

unevenly distributed internet access, and less

conducive learning. Hybrid learning is a learning

method that combines conventional learning methods

through face-to-face meetings and asynchronous

learning methods through electronic devices (Fauzan,

2017).

Every learning method has its advantages and

disadvantages, including hybrid learning. Changes in

the learning system that alternates asynchronous and

synchronous learning can increase students’ stress

(Noviana & Khoirunnisa, 2020). Previously, Resubun

(2021) reported that students who joined hybrid or

blended learning courses experienced mild stress

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(8%), moderate stress (26%), and severe stress (66%).

Stress is more at risk for university students because

they have many activities to do, that can finally make

the students feel pressured and stressed (Andiarna &

Kusumawati, 2020).

Among the body's balances, the body's

physiology can be disrupted by stress and is highly

related to food intake (Miliandani & Meilita, 2021).

When the body is stressed, the hypothalamus orders

the adrenal glands to release adrenaline and cortisol

hormones. The cortisol hormone influences food

appetite regulation. Whereas, decreasing appetite is

caused by the adrenal glands that release more

epinephrine, which triggers the body's response to

delay eating. (Rahmawati, 2020). The imbalance

between the intake of nutritional needs and adequacy

will lead to nutritional problems, both in overnutrition

and undernutrition conditions.

Controlling food consumption following the

eating behaviour to maintain weight and avoid

Haryana, N. R., Purba, E. M. and Rosmiati, R.

Stress Level, Restrained Eating Behaviour, and Nutritional Status of University Students During the Hybrid Learning Condition.

DOI: 10.5220/0012901200004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 93-97

ISBN: 978-989-758-727-6; ISSN: 2975-8297

nutritional problems is highly important in stress

conditions. Eating behaviours that tend to limit food

intake and prevent weight gain or weight loss are

commonly called restrained eating (Adams et al.,

2019). Surprisingly, some studies found that

restrained eating behaviour was associated with

impulsive eating behaviour on food or eating habits.

Restrained eating is a good behaviour when applied

to overweight individuals. However, restrained eating

is commonly associated with the reverse regulation,

when an individual consumes more frequent calories

as palatable (non-satiated) foods in small amounts

(Adams et al., 2019; Herman & Mack, 1975; Polivy

et al., 2020).

Polivy et al., (2020) mentioned that individuals

who refrained from eating are more likely to

experience episodes of overeating under stress,

compulsion, or exposure to tempting foods.

Therefore, this study was conducted to determine the

relationship between stress, restrained eating

behaviour, and nutritional status of students who are

studying through a hybrid-learning system.

2 SUBJECTS AND METHODS

This study used a cross-sectional design and was

conducted in July, 2023 on 78 students who attended

the hybrid lectures from Universitas Negeri Medan.

Data were composed of students’ characteristics,

body mass index (BMI), stress score, and restrained

eating score. Data on students’ characteristics

included gender (male and female), age, ethnicity

(Sumatran and other ethnicities), and faculty

affiliation (engineering, sciences, education,

languages and arts, economy, social). The BMI data

included body height and weight, while restrained

eating data were part of the eating behaviour aspects.

Data on characteristics, stress levels and

restrained eating were taken using a questionnaire

through KoboToolbox software, that was filled

independently by the students accompanied by

trained enumerators. The body height data were

collected with a mechanical measuring tape (GEA

SH-2A) at 0.1 cm scale and the body weight data were

collected with a digital scale (Karada Scan OMRON

HBF-375).

Stress levels were measured using the Perceived

Stress Scale (PSS-10) questionnaire, which

categorized stress level into three conditions, i.e. mild

stress (0 to 13 score), moderate stress (14 to 26 score),

and severe stress (27 to 40 score) (Cohen et al., 1983).

Restrained eating aspect variable was constructed

following the Dutch Eating Behaviour Questionnaire,

which consists of 10 questions answered using a

Likert scale of never (1), seldom (2), sometimes (3),

often (4), and very often (5). Then, the assessment

was carried out by summing the score divided by the

number of questions on the restrained eating aspects

(Snoek et al., 2013). Furthermore, the body mass

index (BMI) was generated using formula, whereas

the body weight (kg) was divided with the square of

body height (m). From these data,

the individuals

were then classified as mildly thin (BMI <17.0),

severely thin (BMI 17.0 to <18.5), normal (BMI 18.5

to <25.0), mildly overweight (BMI >25 to 27.0), and

severely overweight (BMI >27.0) (Kemenkes, 2014).

The univariate analysis was conducted to

determine the characteristics of students based on the

sociodemographic, stress level, mean score of

restrained eating and nutritional status. Meanwhile,

the bivariate analysis was carried out by the Pearson’s

correlation test which used the data ratio from stress

score, restrained eating score, and BMI score

variables. This study has been ethically approved by

the Commission of Research Ethics, Faculty of

Medicine, Maranatha Christian University with

approval number: 127/KEP/V/2023.

3 RESULTS

The univariate analysis results present that most

students were female (61.5%) with an average of 20

years old. Most students participate in this study are

originated from Sumatran ethnic groups (64.1%),

such as Toba, Nias, Mandailing, Simalungun, Karo,

Pakpak, and Minang, while the rest are originated

from Javanese, Malay, and Banjar ethnic groups. The

students involved are mostly studying at the Faculty

of Engineering (51.3%) (Table 1).

The present study research involving students

from Universitas Negeri Medan showed the number

of students from Sumatran ethnic groups to be higher.

In addition, with an average age of 20 years old, most

students are currently entering their 3rd year or equal

to the 6th semester this year.

Table 1. Students’ Characteristics.

Characteristics n %

Sex

Women 48 61.5

Men 30 38.5

s ol

)

–

20 39 50

–

23 39 50

Mean ± SD 20.4 ± 1.2

Ethnicit

ICSDH 2023 - The International Conference on Social Determinants of Health

Characteristics n %

Sumatran 50 64.1

Others 28 36.9

Facult

Engineering 40 51.3

Science 11 14.1

Language and Arts 10 12.8

Econom

8 10.3

Education 7 9

Social 2 2.6

The nutritional status of the students was

dominantly categorized by normal nutritional status

(62.8%), but the number of students with severe

overweight status was higher than mild overweight

status, whereas 12.8% to 6.4% (Table 2). The mean

of BMI score was 22.3 ± 4.1 kg/m

with the minimum

and maximum BMI score of 16.2 kg/m

and 33.7

kg/m

, respectively. Table 2 also shows that most

students are in a moderate stress level (75.6%),

although there are 9% of the students who perceive a

severe stress level.

Table 2. Students’ distribution on nutritional status

and stress level.

Catego

n %

Nutritional Status

Severely thin

2 2.6

Mil

thin 12 15.4

Normal 49 62.8

Mil

overwei

ht 5 6.4

Severel

overweight 10 12.8

BMI score

Mean ± SD 22.1 ± 3.8

Minimu

15.7

Maximu

33.7

Stress Level

Mil

12 15.4

Moderate 59 75.6

Severe 7 9

Table 3 indicates the restrained eating behaviour

aspect with the mean score. There are three most

behaviour aspects regarding the restrained eating,

namely always ensuring what to eat, (2.86 ± 1.24),

associating the body weight with the food consumed

(2.50 ± 1.41), and consuming less food when the

weight gains (2.36 ± 1.18). The results of this study

are similar to Nurdiani et al., (2023) which showed

three behaviours from the same aspect, but with a

higher mean score.

Table 3. Mean score of restrained eating aspect.

No. Aspect Mean SD

Consuming less food, when the

wei

ains

2.36 1.18

Trying to eat less at mealtimes

than intende

2.32 1.11

Frequently refusing food or drinks

offered because of worrying about

the weight

1.88 0.97

4 Ensuring what to eat 2.86 1.24

Consuming foods that can

maintain the slim

ody

1.82 1.07

Eating less food than usual, when

eating too much from the previous

1.96 1.05

Deliberately eating less to not gai

wei

1.99 1.12

Frequently trying not to eat

between meals due to weight

concerns

1.96 1.11

Frequently trying not to eat meals

at night because of weight

concerns

2.05 1.13

Associating the body weight with

the food consume

2.50 1.41

The Pearson’s test results showed that no

significant correlation occurs between the BMI score

and stress score (p>0.05). Meanwhile, a significant

positive correlation between the BMI score and the

restrained eating behaviour score (p<0.05). This

condition implies that the higher BMI score, the

higher restrained eating score, the more frequent for

students to maintain what to eat.

Table 4. Correlation test between BMI score, stress

score, and restrained eating score.

Variable

Mean ±

Min -

Max

BMI Score

-value

Stress Score 18.5 ± 5.5 0 - 33 0.332

Restrained

Eatin

Score

2.2 ± 0.7 1 - 3.8 0.001*

To determine the effect between the restrained

eating score and BMI score, multivariate analysis was

applied. According to the linear regression test, the p

value = 0.000 (p <0.05), which means that it has a

significant effect on the BMI score. Meanwhile, the

value of the analysis results is 22.7%, which means

that the BMI score is explained by the Restrained

eating score by 22.7%. The regression equation is Y

= 16.64 + 2.51 X, which means that when

the

restrained eating score levels up to 1 point, the BMI score

will elevate by 2.51.

Stress Level, Restrained Eating Behaviour, and Nutritional Status of University Students During the Hybrid Learning Condition

4 DISCUSSIONS

The prevalence of malnutrition, both undernutrition

and overnutrition, was lower than the national

prevalence for nutritional status of adults over 18

years old, whereas 10.8% of whom are thin,

overweight are 12.1%, and suffering obesity are

14.5% (Kemenkes RI, 2019). However, the one-third

of the total students are issued with abnormal

nutritional status. In addition, the maximum value of

the BMI score is 33.7 kg/m

, so this needs more

attention from the institution that conducts the study.

The stress category experienced by the students is

academic stress, as the students perceive academic

demands as a disturbance that cannot be handled

(Barseli et al., 2017) Different students' preferences

for learning can also cause stress. Some students are

comfortable with online learning due to more

practical and flexible, while others choosing offline

learning because they can focus more on their studies

(Fitriansyah, 2022).

Previously, the various studies using the DEBQ

mentioned that only restrained eating was used to

examine the correlation between DEBQ and other

variables, such as age, gender, socioeconomic status,

nutritional status, psychology, and family

socioeconomics (Ohara et al., 2014; Poínhos et al.,

2015; Snoek et al., 2013; van Strien et al., 2020).

Restrained eating indicates the person’s condition

who maintains the food consumed to deliberately

limit the food intake and prevent the weight gain or

lose weight (Meule, 2016; Polivy et al., 2020).

Wijayanti et al., (2019) stated that stress is related

to emotional overeating, but not relating to BMI

values. The results also show that the emotional

overeating has no effect on the nutritional intake, so

it has no effect on the nutritional status. The

nutritional status is also caused by other factors, such

as energy and macronutrient intake, physical activity,

nutritional knowledge, peer and parental influence,

etc (Deliens et al., 2014; Nawaz et al., 2016).

The results of this study indicate that no

correlation is occurred between the restrained eating

score and BMI score, which is in line with the

restrained eating, as someone who skips meals can

cause an irregular eating pattern. A counter regulation

occurs when someone is no longer urged to restrain

eating, which causes a weight gain due to eating as

much as possible to compensate the restrained eating.

(Nurdiani et al., 2023; Polivy et al., 2020).

Restrained eating is expected to lead weight gain

rather than weight loss over time, although restrained

eaters perceive that they are deprived of food, even if

they do not eat less than the unrestrained eaters

(Timmerman & Gregg, 2003). Indeed, perceived

restrained eating is less likely to lead weight loss and

is even associated with the weight gain over time in a

number of prospective studies on diet populations

(Konttinen et al., 2018; Lowe et al., 2013). The

restrained eating practices are often easily disrupted,

that lead to overeating. In the end, the people tend to

be unsuccessful in losing or even maintaining their

weight (Polivy et al., 2020).

5 CONCLUSIONS

Students as samples were mostly female with an

average of 20 years old. Most of them are originated

from Sumatra and study at the Faculty of

Engineering. More than 30% of the students are

having malnutrition problems (over and under

nutrition). The minimum BMI value is at 15.7 kg/m

and the maximum value is at 33.7 kg/m

. Stress level

is dominated by moderate stress levels, although

some students are in severe stress level. The

correlation test results showed that no correlation is

described between the BMI and stress scores, but a

positive correlation occurs between the BMI and

restrained eating behaviour scores, which means that

the more participants perform the restrained eating

behaviour to lose or maintain weight, the higher BMI

score obtained. This condition should be a concern,

when students are under the stressful conditions that

can lead to overeating.

ACKNOWLEDGMENTS

We would like to thank the Research and Community

Service Institute of Universitas Negeri Medan for

funding for our research project. We also thank the

human nutrition study program for the assistance in

data collection.

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Stress Level, Restrained Eating Behaviour, and Nutritional Status of University Students During the Hybrid Learning Condition