Public Health and the Freshman Fifteen

By Christine Hunter, MD

For many young adults, the college “freshman fifteen” marks the beginning of a lifelong struggle to balance calorie intake with activity level. Long days of studying are punctuated by trips to the dining hall to socialize over well-stocked buffets. Academic commitments, along with work or community service, leave little time for recreation. Left unchecked, weight gain is inevitable, and these young adults will enter the health system as the next generation of diabetics and hypertensives.

To reverse this trend, colleges often take the important steps of serving healthy entrees, displaying nutrition information, and providing ample fresh fruit and vegetables. Standout institutions encourage every student to participate in athletics—offering inviting gym facilities and a diverse array of intramural sports. On a recent trip to Boston University, I was struck by the lean builds of the student body—nary a “beer belly” or “muffin top” in sight. University leaders shared insights into their remarkable success, agreeing on three extra steps that earned them a spot among the “Top 25 Healthiest Colleges in the United States:”

On-campus living. Because Boston real estate is expensive and parking scarce, the University president and medical campus provost led an initiative to provide more housing in attractive residence halls on campus. Without commutes from remote apartments, students get time back in their days for recreational sports or personal exercise.

Public transportation rate changes. For many years, BU students could ride Boston’s Green Line streetcars from one end of the Commonwealth Avenue campus to the other without charge. When the transit authority’s financial circumstances ended this privilege, BU turned adversity into advantage. Students literally “took to the streets,” adapting their routines to walk or bike between classes. Boston’s new Hubway rental bikes provide a handy alternative.

Going trayless. This was the crowning move. Concerned about sustainability, staff and students sought to eliminate wasted food along with the water, energy, and chemicals used for tray washing. A campus-wide initiative to “go trayless” paid unexpected dividends as students selected only what they could carry—and consumed fewer calories in the process!

Medical schools should jump on the bandwagon to encourage adoption of similar strategies to prevent untimely deaths from heart disease, stroke, and complications of diabetes. In fact, BU School of Medicine Dean Karen Antman notes that medical schools “have a responsibility to lead; promoting lifelong habits that translate into health and longevity.”  Health care and medical education have long been criticized for teaching only about disease treatment and ignoring the importance of prevention. We acknowledge that the curriculum crunch leaves little room in formal didactic training…but there is a great informal environmental training opportunity here.  We can begin the discussion about how personal health connects to population and public health.

The resources are readily available. The Practical Playbook is an online repository of tools, resources and case studies that explain what happens when primary care and public health work in concert.  State by state public health metrics that reflect nutrition and daily activity are available from the CDC.

What are we waiting for?  Small changes add up to a big impact, and the Healthy Campus 2020 Initiative offers additional tips on how to get started. Whether by embedding more physical activity into daily routines or going trayless to reduce calorie consumption, and getting serious about measuring our impact, we can all lead by example.  Let’s lay the groundwork now for a healthier class of 2015!

Hunter_ChristineChristine Hunter ( is Chief Medical Officer at the U.S. Office of Personnel Management where she oversees health care quality for Federal employees and their families.  Dr. Hunter is a retired Navy Rear Admiral with over 30 years of experience in Federal health care.   She serves on the Boston University Board of Overseers.

The views expressed in this post are those of the author and do not necessarily represent the views of the Office of Personnel Management or the United States Government.