Health Status and Lifestyle Habits of US Medical Students: A Longitudinal Study

Abstract

Background: Evidence shows that physicians and medical students who engage in healthy lifestyle habits are more likely to counsel patients about such behaviors. Yet medical school is a challenging time that may bring about undesired changes to health and lifestyle habits.

Aims: This study assessed changes in students' health and lifestyle behaviors during medical school.

Subjects and methods: In a longitudinal study, students were assessed at both the beginning and end of medical school. Anthropometric, metabolic, and lifestyle variables were measured at a clinical research center. Data were collected from 2006 to 2011, and analyzed in 2013-2014 with SAS version 9.3. Pearson's correlations were used to assess associations between variables and a generalized linear model was used to measure change over time.

Results: Seventy-eight percent (97/125) of participants completed both visits. At baseline, mean anthropometric and clinical measures were at or near healthy values and did not change over time, with the exception of increased diastolic blood pressure (P = 0.01), high-density lipoprotein-cholesterol (P < 0.001), and insulin (P < 0.001). Self-reported diet and physical activity habits were congruent with national goals, except for Vitamin D and sodium. Dietary intake did not change over time, with the exceptions of decreased carbohydrate (percent of total energy) (P < 0.001) and sodium (P = 0.04) and increased fat (percent of total energy) and Vitamin D (both P < 0.01). Cardiovascular fitness showed a trend toward declining, while self-reported physical activity increased (P < 0.001).

Conclusions: Students' clinical measures and lifestyle behaviors remain generally healthy throughout medical school; yet some students exhibit cardiometabolic risk and diet and activity habits not aligned with national recommendations. Curricula that include personal health and lifestyle assessment may motivate students to adopt healthier practices and serve as role models for patients.

Keywords: Lifestyle; Medical school; Medical students; Nutrition; Prevention.

Figure 1

Percent of participants displaying borderline and at-risk metabolic values during year 1 (n = 97). Borderline risk (black) indicates values above normal but below the level classified as having active disease or risk; these include body mass index between 25 and 29.9 kg/m²; body fat 24.9–29.7% (males) or 37.0–41.7% (females); systolic blood pressure 120–139 mmHg or diastolic blood pressure 80–89 mmHg; total cholesterol 200–239 mg/dL; low density lipoprotein-cholesterol 130–159 mg/dL; and triglycerides 150–199 mg/dL. Risk (grey) indicates values that are in the defined “risk” range according to established guidelines for these measures. These include body mass index ≥30 kg/m²; body fat ≥29.8% (males) or ≥41.8% (females); waist circumference >100 cm (males) or >88 cm (females); systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg; total cholesterol ≥240 mg/dL; low density lipoprotein-cholesterol ≥160 mg/dL; triglycerides ≥200 mg/dL; high density lipoprotein-cholesterol <40 mg/dL (males) or <50 mg/dL (females); fasting glucose ≥100 mg/dL. Values (%) on each bar represent the proportion of study participants who have “at risk” values for that measure

Figure 2

Cardiovascular fitness scores and usual physical activity scores of participants during year 1 and year 4 of medical school. Fitness scores were based on recovery heart rate following the step test, and adjusted for age and sex. The numeric fitness score corresponds to a fitness category ranging from “superior” to “very poor.” Physical activity scores reflect the sum of self-reported individual scores for occupational, sport, and nonsport leisure activity captured in the Baecke physical activity questionnaire. Physical activity scores can range from 3 to 15. *P = 0.05 (for change in value from year 1 to year 4);^†P < 0.001 (for change in value from year 1 to year 4)

Figure 3

Mean caloric intake and distribution of macronutrients (as percentage of total kilocalories) of participants during year 1 and year 4 of medical school. *P = 0.02, change from year 1 to year 4;^†P < 0.01, change from year 1 to year 4;^‡P < 0.001, change from year 1 to year 4. Stripes represent carbohydrate; dots represent protein; solid black represents fat; solid white represents alcohol