Exploring the Relationship Between Physical Activity and Eating Disorder Attitude in Generation Z University Students a Cross-Sectional Study

Abstract

Aim:

This study was conducted to examine the association between PA levels and attitudes toward eating disorders in students at Sirjan University of Medical Sciences during 2022.

Methods:

Employing a descriptive correlational design, this study involved 212 students from Sirjan University of Medical Sciences located in southeastern Iran. Participants were selected using quota sampling. Data collection instruments included demographic questionnaires, the International Physical Activity Questionnaire, and the Eating Attitude Test-26 (EAT-26).

Results:

Data analysis utilized both parametric and non-parametric methods through Statistical Package for the Social Sciences (SPSS), version 20, with statistical significance set at p < .05. The average age of participants was 22.37 ± 7.4 years. Findings indicated eating attitudes showed a statistically significant but weak association with PA (p = .04, r = .13). Linear regression revealed that a one-point rise in eating attitude scores corresponded to a 0.14 increase in PA scores. Among factors significantly predicting attitudes toward eating disorders were academic year (p = .001) and frequency of fast-food consumption per week (p = .02). Gender was identified as a significant predictor for PA levels (p = .00).

Conclusions:

The study results suggest that attitudes related to eating behaviors can predict PA levels among Gen Z university students. Recognizing these predictors may help healthcare professionals develop targeted strategies that promote PA and foster healthier eating attitudes within this demographic, ultimately enhancing their overall well-being and academic success.

What is already known on this topic?

• University students often face risks of unhealthy eating attitudes and eating disorders due to stress and lifestyle changes.

• Physical activity can impact mental health and behavior, which may influence eating habits.

• Previous studies show mixed results about the relationship between PA and eating attitudes, especially among Iranian university students.

What does this study add on this topic?

• There is a small but meaningful positive link between PA levels and healthier eating attitudes in students.

• Students’ academic year and how often they eat fast food each week affect their attitudes toward eating.

• Gender is an important factor in PA levels, indicating that health programs should address differences between males and females.

Introduction

Generation Z (Gen Z), defined as those born and raised in the digital age, displays distinct behaviors influenced by their technological environment (Sitoayu et al., 2023). Unlike previous generations, Gen Z students have unparalleled access to the internet and digital devices, leading to an increase in sedentary behaviors such as prolonged internet use, binge-watching, and video gaming. This shift has contributed to a rise in health issues globally, as physical activity (PA) is often neglected in favor of these screen-based activities (Tagare, 2022).

Physical activity refers to any movement that requires energy expenditure and is an important aspect of daily life, including occupational, sports, household, and recreational activities (Diehl, Brassat, & Hilger-Kolb, 2021). However, physical inactivity has become a widespread issue, particularly in Iran, where many people lack regular PA (Aghakoochak, Vakili, & Modaressi, 2017). University students, particularly those from Gen Z, often demonstrate lower levels of PA and engage in more sedentary behavior (Zurita-Ortega et al., 2018). This trend is concerning, as recent evidence indicates that Gen Z university students are becoming less physically active, a shift that may be associated with unhealthy eating attitudes (World Health Organization, 2023). Eating disorders and poor eating habits are also common among university students, with some studies reporting that a significant proportion of students are at risk for developing atypical eating behaviors (Castelao-Naval et al., 2019).

These attitudes toward food can lead to poor academic performance and functional impairments (Zurita-Ortega et al., 2018). While diet and PA are closely related to health, the specific relationship between eating attitudes and PA remains underexplored. Jakicic et al. (2019) in a systematic review found that PA plays a significant role in preventing weight gain in adults. Yahia et al. (2016) reported that most undergraduate students were within a healthy weight range, though less than one-third were overweight or obese (Yahia et al., 2016). Furthermore, a survey of Gen Z and Millennial participants found that while most Gen Z individuals engage in PA regularly, a concerning 38% consume fast food at least twice a week, and 39% experience mental health issues such as anxiety and depression (Healthcareradius, 2022). Students in Iran identified nutrition and PA as their top health priorities (Bagheri et al., 2023).

This study aims to contribute to the literature by addressing a gap in current research on the connection between PA and perspective on eating disorders among university students of Gen Z, a group that is both highly exposed to social media influences and undergoing critical lifestyle transitions. While previous studies have examined these variables independently or in older populations, few have explored their relationship in this unique cohort. By using a cross-sectional design, this study provides updated, population-specific data that can inform targeted interventions, prevention strategies, and future longitudinal research focused on mental and physical health in emerging adults.

Methods

Setting

This cross-sectional study was conducted in Sirjan University of Medical Sciences, located in southeastern Iran.

Participants

Sample

Data were collected over a 14-month period, from January 21, 2023, to March 20, 2024. The Sample size was calculated based on data from a previous study by Rouzitalab et al. (2019), assuming a correlation coefficient of r = .21. Based on prior studies, the estimated required sample size was 242 Gen Z university students; therefore, 250 questionnaires were distributed to account for potential nonresponse or incomplete data. Of these, 212 questionnaires were returned fully completed and included in the final analysis, resulting in a response rate of 84.8%. Participants were selected using a quota sampling method to ensure proportional representation across academic fields and years of study.

Inclusion criteria were being a Gen Z university student, current enrollment at Sirjan University of Medical Sciences, and willingness to participate in the study. Exclusion criteria included incomplete questionnaires and self-reported medical or psychological conditions that could substantially affect PA or eating behaviors.

wherer = .21

Data Collection Tools

After receiving the ethics approval and necessary permits from Sirjan University of Medical Sciences, the primary researcher obtained informed consent from Gen Z university students prior to data collection. The students were assured of the confidentiality of their information before the questionnaires were distributed. Data were collected through self-administered questionnaires completed in person at university campuses.

Demographic Characteristics Form

Demographic information includes age, gender, marital status, occupation, educational level, field of study, year of study, place of residence, BMI, amount of fast-food consumption per week, amount of breakfast per week, obesity in the family, and employment status.

International Physical Activity Questionnaire

This International Physical Activity Questionnaire (IPAQ) was designed and used in 1998 in Geneva by the World Health Organization and the Center of Disease Control for use in adults (age range of 15–69 years) (Al Sabbah & Muhsineh, 2016). This questionnaire was translated by the Office of Guidance of Talents of Iran University of Medical Sciences and is available on the IPAQ website (www.ipaq.ki.se). The IPAQ, a commonly used 7-item standardized questionnaire, evaluates PA levels. The IPAQ assesses PA levels by asking participants to recall all activities carried out during the previous 7 days, including light, moderate, and vigorous-intensity activities. Physical activity levels are quantified using Metabolic Equivalent of Task (MET) minutes per week, which are calculated considering the activity type, its duration, and the number of active days per week. Physical activity intensity is categorized based on MET values, with 3.3 MET for walking, four MET for moderate-intensity activities, and eight MET for vigorous-intensity activities. The overall PA score is calculated by adding the MET-minutes per day for walking, moderate, and vigorous activities over the past week. The IPAQ instruments demonstrate satisfactory measurement properties, comparable to other well-established self-report tools. Given the diverse sample in this study, the IPAQ shows adequate reliability designed to measure PA levels of individuals aged 18–65 years in diverse contexts (Mirghafourvand et al., 2016). The validity and reliability of this questionnaire were conducted by Baghiani Moghadam et al. (2015) in Iran, and Cronbach’s alpha was reported as 0.7, which indicates good internal consistency, and its reliability was reported by Spearman-Brown correlation as 0.9 Baghiani Moghadam et al. (2015)

Eating Attitude Test-26 (EAT-26)

Eating attitude test Garner et al. (1979) is one of the most widely used self-report instruments focusing on eating attitudes and behavior. The EAT scale included 26 items with 3 subscales: Dieting (avoidance of fattening foods and preoccupation with thinness), consisting of 13 items; and bulimia and food preoccupation (thoughts about food and bulimia) five items; and oral control (self-control about food and social pressure to gain weight) seven items. Items are rated on a Likert scale with six response options, from “Always” to “Never.” Scores of 20 and above were considered indicative of a risk for eating disorders.

Albrahim et al., 2019, and Mintz & O’Halloran obtained the criterion validity of this test with DSM-IV criteria for eating disorders of 90% in 2000. In Iran, it was also used by Pourghasem et al. (2009) in research on the relationship between body mass index and dietary attitudes among female high school students in Tabriz city, and the validity and reliability were obtained as 0.84 and 0.89, respectively (Pourghasem et al., 2010).

Statistical Analysis

Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA).. Frequency, percent, mean, and standard deviation were used to describe demographic characteristics. Spearman correlation was selected because the main study variables were not normally distributed and included ordinal-level measures, making non-parametric analysis more appropriate. Linear regression was used to predict the role of each of the variables related to the main variables. The significance level was considered at p < .05.

Ethics Approval and Consent to Participate

The research commenced following approval of the ethical code (No. 2023.014 IR.SIRUMS.REC.) from the ethics committee of Sirjan University of Medical Sciences and taking permission from the Education and Research Vice-Chancellor. Written informed consent was taken from each student. The confidentiality of information and voluntary partnership were explained. Overall, the researchers confirm that this study was carried out following the principles outlined in the Declaration of Helsinki.

Result

Table 1 shows all the sociodemographic, academic, and dietary and food consumption characteristics for the total students. The study sample included 242 the students of Sirgan University of Medical Sciences, of whom 51.4% were female, the mean age was 22.37 ± 7.4 years, 87.3% were single, and all participants were enrolled in undergraduate programs.

Table 1.

Sociodemographic Characteristics of University Students (N = 212)

Variable	Frequency (%)
Age, years
18–20.1	76 (30.4)
>20.1	174 (69.6)
Sex
Female	109 (51.4)
Male	103 (48.6)
Marital status
Married	27 (12.7)
Single	185 (87.3)
Job
Employed	36 (17)
Unemployed	176 (86)
Field of study
Nursing	56 (26.4)
Medical emergency	20 (9.4)
Midwifery	10 (4.7)
Anesthesiology	34 (16)
Hygiene	14 (6.6)
Laboratory sciences	36 (17)
Health professional	7 (3.3)
Environmental health	35 (16.5)
Academic year
First	61 (28.8)
Second	69 (32.5)
Third	51 (24.1)
Fourth	31 (14.6)
Type of residence
Home (with family)	33 (15.6)
Rented outside the college	7 (3.3)
Hostel in college	172 (81.1)
BMI
Normal weight (<24.9)	158 (74.5)
Overweight/obesity (>25)	54 (25.5)
Amount of fast-food consumption per week
Less than once	131 (61.8)
2–3 times	67 (31.6)
3–5 times	14 (6.6)
Frequency of breakfast per week
Once	17 (8)
2–3 times	70 (33)
3–5 times	58 (27.4)
More than 5 times	67 (31.6)
Obesity of family members
Yes	93 (43.9)
No	119 (56.1)

The analysis revealed a weak but statistically significant positive relationship between PA levels and attitudes toward eating disorders (p = .04, r = .13) (Table 2). Stepwise regression analysis indicated that each one-point increase in eating disorder attitude scores was associated with a 0.14-point increase in PA scores, suggesting that attitudes toward eating disorders can serve as a predictor for PA Table 3).

Table 2.

Relationship Between Physical Activity and Eating Disorder Attitudes

Variable		Eating Attitudes
		Dieting	Bulimia and Food Preoccupation	Oral Control	Total Score
Physical activity	High	r = .12	r = .11	r = .12	r = .09
		p = .07	p = .10	p = .07	p = .16
	Moderate	r = .10	r = .19	r = .18	r = .13
		p = .13	p = .004	p = .008	p = .05
	Low	r = −.16	r = −.02	r = −.01	r = −.10
		p = .01	p = .77	p = .77	p = .13
	Total Score	r = .09	r = .10	r = .14	r = .13
		p = .18	p = .14	p = .03	p = .04

Table 3.

Results of Step Wise Regression Model Using Subscales of Physical Activity and Demographic Characteristics Variable for Total Sample

Predictor Variables	Standardized Coefficients Beta	T	p
Constant	-	0.61	.54
Eating disorder attitudes	0.14	2.27	.02
Sex	0.22	3.58	.001
Amount of fast-food consumption (per week)	0.08	1.35	.17
Frequency of breakfast (per week)	0.01	0.21	.82

Further analysis demonstrated a weak but significant positive association between moderate PA and the bulimia and food preoccupation subscale (r = .19, p = .004), as well as the oral control subscale (r = .18, p = .008). Low PA showed a significant inverse relationship with the dieting subscale (r = −0.16, p = .01). The total PA score was weakly but significantly correlated with the oral control subscale (r = .14, p = .03) (Table 2).

Gender and attitudes toward eating disorders were identified as significant predictors of PA (Table 3). The mean score of PA among male students was higher compared to female students and served as a predictor of PA (p < .05) (Table 3). Regarding predictors of attitudes toward eating disorders, academic year and weekly fast-food consumption were found to be significant. Specifically, a one-unit increase in weekly fast-food consumption was associated with a 0.14-point increase in eating disorder attitude scores, and each additional academic year corresponded to a 0.20-point increase in eating disorder attitude scores (Table 4).

Table 4.

Results of Step Wise Regression Model Using Eating Disorders Attitude and Demographic Characteristics Variable for Total Sample

Predictor Variables	Standardized Coefficients Beta	T	p
Constant	—	0.15	.87
Amount of fast-food consumption (per week)	0.14	2.31	.02
Physical activity	0.11	1.84	.06
Age	0.06	1.005	.31
Academic year	0.20	3.32	.001

Discussion

Physical inactivity is a phenomenon that may lead to the development of several non-communicable disorders, including disordered eating attitudes and related behavioral factors, particularly among Gen Z university students. This study aimed to explore the association between PA and disordered eating attitudes among Gen Z university students. The findings demonstrated that eating disorder attitudes play a predictive role in PA participation among the participants.

These findings are consistent with previous research by Kerrigan et al. (2019), Kerrigan et al. (2019), Carr and et al. (2019), Meagan et al. (2019), Modabari and et al. (2021) and Keyes et al. (2015), Faramarzi and et al. (2021), Faramarzi et al. (2021), and Harrison et al. (2021). Although some of these studies employed different instruments to assess PA and eating disorder attitudes, the overall conclusions were similar, reinforcing the robustness of this association. The significance of this relationship highlights the need for a deeper exploration of the underlying psychological and social mechanisms.

From a psychological perspective, this association suggests that disordered eating attitudes and PA behaviors may be influenced by shared psychological determinants. Holland & Tiggemann) 2023 ( emphasized that societal norms and cultural pressures play a substantial role in the development of disordered eating attitudes (Holland & Tiggemann, 2016). University students, in particular, experience major psychological and social transitions during this life stage. According to Chacón-Cuberas et al. (2019), students’ eating habits and PA levels often fluctuate considerably due to increased exposure to diverse sources of information related to diet, exercise, and sport participation (Chacón-Cuberos et al., 2019).

It is also important to consider that certain types of PA—especially those emphasizing appearance, weight control, or body shape—may be associated with maladaptive eating behaviors or attitudes. This raises critical questions regarding the motivations behind PA engagement among Gen Z university students and how these motivations may shape their attitudes toward eating.

Regarding gender differences, the results of the present study indicated that gender was a significant predictor of PA, with male students being more physically active than female students. These findings are consistent with previous studies, including

Smith et al. (2023) (Smith, Moyle, & Burton, 2023), (Yahia et al., 2016), the ACSM/AHA reports (“American College Health Association. American College Health Association – National College Health Assessment II: Reference Group Executive Summary Spring 2013. Hanover, MD: American College Health Association, 2013”). Towne et al. (2017), Holland & Tiggemann (2016), Sevil Serrano et al., 2017, Arzu et al. (2006), McCarthy & Warne (2022), and Espada and et al. ( 2023).

These gender differences may be explained by cultural constructs, social norms, psychological factors, and gender-based expectations. Males are often encouraged to engage in vigorous or competitive forms of PA, whereas females may be guided toward activities perceived as less intensive or more socially acceptable. Espada et al. (2023) reported that men exhibited higher levels of motivation across most motivational dimensions, except for external motivation and amotivation, where women scored higher. Women’s higher external motivation and amotivation may partially explain lower PA levels, as long-term goals and external pressures can make sustained engagement more challenging.

Espada et al., 2023 reported that men exhibited higher levels of motivation across most motivational dimensions, except for external motivation and amotivation, where women scored higher. Women’s higher external motivation and amotivation may partially explain lower PA levels, as long-term goals and external pressures can make sustained engagement more challenging. Similarly, Seo et al. (2019) noted that male college students are more likely to participate in exercise due to intrinsic factors like enjoyment and challenge, whereas female students tend to exercise for extrinsic reasons, such as weight control (Yeong-Ja & Yeongmi, 2019). Moreover, perceptions of physical competence and access to PA resources may differ by gender, further contributing to these disparities.

The findings also revealed a significant association between eating disorder attitudes and fast-food consumption. This result aligns with the findings of Kuila et al. (2017). Previous research suggests that fast-food consumption is influenced not only by individual characteristics such as age, gender, and genetic predisposition but also by broader social, cultural, and environmental contexts (Kipke et al., 2007). Additionally, students’ knowledge, attitudes, and ethnicity have been identified as influential factors in food consumption behaviors (Didarloo et al., 2019).

The convenience and accessibility of fast food may contribute to maladaptive eating attitudes among university students. Fast food, typically high in fat, energy-dense, and low in nutritional quality, may reinforce unhealthy dietary patterns and negative body image perceptions. A shift away from homemade traditional meals toward fast food options may negatively affect nutrient intake and disrupt energy balance, particularly among non-athlete students who engage in exercise (Kuila et al., 2017).

Another key finding of this study was that academic year predicted eating disorder attitudes, with students in higher academic years exhibiting greater disordered eating attitudes. This result contrasts with some previous studies. Power (2016) reported a higher prevalence of disordered eating behaviors among first-year students, while Banna et al. (2021), Tariq et al., (2021), and Alhazmi (2019) found younger students to be more vulnerable than older students.

The findings of the present study may be explained by several factors. As students progress through university, they often experience increased academic pressure, career-related concerns, and cumulative stressors, which may exacerbate disordered eating attitudes. Advanced coursework and higher academic expectations can elevate stress levels, potentially influencing eating behaviors and body image perceptions. Prolonged exposure to university culture may also increase internalization of societal or peer-driven body ideals.

Additionally, higher-year students may have reduced access to support systems, as they are often assumed to have fully adapted to university life. Life transitions such as internships, job preparation, and personal challenges may further impact mental health and coping strategies, leading to maladaptive eating behaviors. Increased autonomy over time may also influence dietary habits, sometimes resulting in unhealthy patterns if not properly managed.

Nevertheless, these findings should be interpreted with caution. Correlational data do not imply causation, and unmeasured confounding variables—such as family history, mental health status, or individual psychological predispositions—may have influenced the results.

Study Limitations

Finally, despite the strengths of this study, several limitations should be acknowledged.

First, the cross-sectional design limits the ability to draw causal inferences regarding the relationships between PA and eating disorder attitudes.

Second, the use of self-reported measures may introduce reporting bias, including recall bias and social desirability effects.

Third, the study did not account for potential confounding variables, such as mental health status, family history of eating disorders, or individual psychological traits, which may have influenced the observed associations.

Conclusion and Recommendations

This study demonstrates a significant positive correlation between PA and eating attitudes among young adults from Gen Z attending university, indicating that higher engagement in PA is associated with healthier eating attitudes. Although the associations observed were small in magnitude, the findings highlight that academic year and weekly fast-food consumption are important predictors of attitudes toward eating disorders, while gender significantly predicts PA levels. These results suggest that interventions aiming to improve eating attitudes and promote PA should consider these demographic and behavioral factors to effectively address the risk of eating disorders in this population. Further research is recommended to explore causal relationships and to develop targeted strategies that enhance both physical and psychological well-being among university students.

Future research employing longitudinal designs and objective measures of PA and eating behaviors is recommended to better elucidate causal pathways and strengthen the evidence base in this population.

Funding Statement

This research received no external funding.

Data Availability Statement:

The data that support the findings of this study are available on request from the corresponding author.