“Safe Foods” or “Fear Foods”: the implications of food avoidance in college students from low- and middle-income countries

  • C. JamesEmail author
  • A. Harrison
  • A. Seixas
  • M. Powell
  • S. Pengpid
  • K. Peltzer
Original Article
Part of the following topical collections:
  1. Orthorexia Nervosa



The primary objective of this study was to explore if self-reported food avoidance (fats, carbohydrates and protein) exists among college students in low- and middle-income countries (LMICs) and its relationship with body mass index (BMI), dieting, mood/anxiety symptoms, physical activities and general health knowledge.


This study is a subset (N = 6096) of a larger 26 LMICs cross-sectional survey, which consisted of 21,007 college students. We ascertained socio-demographic information, food avoidance, physical activities, dieting behaviours, depressive and PTSD symptoms, and recorded anthropometric measurements. Chi-square analyses assessed the relationship between predictor variables and food categories eliminated from participants’ diet. Multiple logistic regression assessed if food avoidance predicts outcome variables such as binge drinking, high physical activity, being underweight, exhibiting significant depressive and PTSD symptoms.


Food avoidance exists in as many as one-third of college students in low- and middle-income countries, with this being more likely in persons who are trying to lose weight whether by dieting or otherwise. Food avoidance was associated with higher BMI, depressive symptoms, and high intensity exercises, as well as the level of health knowledge influencing the types of food avoided. A significant difference was noted between lower middle-income and upper middle-income countries with respect to the foods they avoided.


Despite being knowledgeable about health-related behaviours, we found that college students in our sample were not that different from those in developed countries and may be influenced by a similar advice given by non-experts about macronutrients. These results hold implications for intervention programmes and policy makers.

Level of evidence

Level V, descriptive cross-sectional survey.


Food avoidance LMICs Anxiety Depression BMI 



The following colleagues participated in this student health survey and contributed to data collection (locations of universities in parentheses) Bangladesh: Gias Uddin Ahsan (Dhaka); Barbados: T. Alafia Samuels (Bridgetown); China: Tony Yung (Hong Kong); Colombia: Carolina Mantilla (Pamplona); Grenada: Omowale Amuleru-Marshall (St. George); India: Krishna Mohan (Visakhapatnam); Indonesia: Indri Hapsari Susilowati (Jakarta); Ivory Coast: Issaka Tiembre (Abidjan); Jamaica: Caryl James (Kingston); Kyrgyzstan: Erkin M Mirrakhimov (Bishkek); Laos: Vanphanom Sychareun (Vientiane); Madagascar: Onya H Rahamefy (Antananarivo); Mauritius: Hemant Kumar Kassean (Réduit, Moka); Namibia: Pempelani Mufune (Windhoek); Nigeria: Solu Olowu (Ile-Ife); Pakistan: Rehana Reman (Karachi); Philippines: Alice Ferrer (Miagao); Russia: Alexander Gasparishvili (Moscow); Singapore: Mee Lian Wong (Singapore); South Africa: Tholene Sodi (Polokwane); Thailand: Tawatchai Apidechkul (Chiang Rai); Tunisia: Hajer Aounallah-Skhiri (Tunis); Turkey: Neslihan Keser Özcan (Istanbul); Venezuela: Yajaira M Bastardo (Caracas).

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing AG Switzerland 2017

Authors and Affiliations

  1. 1.Department of Sociology, Psychology and Social Work, Faculty of Social SciencesThe University of the West IndiesKingstonJamaica
  2. 2.Department of Child and Adolescent Health, Faculty of Medical SciencesThe University of the West IndiesKingstonJamaica
  3. 3.Department of Population Health, Center for Healthful Behavior ChangeNYU School of MedicineNew YorkUSA
  4. 4.College of Education and Human DevelopmentGeorge Mason UniversityVirginiaUSA
  5. 5.ASEAN Institute for Health Development, Mahidol UniversityNakhon PathomThailand
  6. 6.University of LimpopoSovengaSouth Africa
  7. 7.Human Sciences Research CouncilPretoriaSouth Africa

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