Abstract

Adult obesity has remained a key health concern globally. Theory-based social marketing interventions are considered effective for improving dietary and physical activity (PA) behaviours. However, their application in universities is not yet established. This review aimed to identify social marketing strategies targeting healthy eating and/or PA behaviours of young adult university students and outline the intervention effectiveness. Literature search, screening, and data extraction followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. PubMed/Medline and Scopus databases were searched for intervention and exploratory studies published between January 1, 2000, and September 20, 2023. Twelve articles were selected based on the eligibility criteria. Although different in study design, all studies reported improved healthy eating-related outcomes, while three showed improved PA-related outcomes. One study incorporated all six of the social marketing benchmarks, but the majority identified two. Most studies focused on behavioural objective, formative research, and marketing mix in their intervention design. Four studies incorporated behaviour change theories in development of the social marketing campaigns. Social marketing using social media could be a significant approach for improving healthy eating and PA in young adult university students when behavioural change theories and all social marketing benchmarks are adopted. More generalizable longer-term investigation into the effectiveness of this approach in university young adults is needed to tackle adult obesity related health issues.

Introduction

Obesity has remained a global epidemic and represents a key risk factor for the development of many chronic diseases [1]. This epidemic is reflected by the prevalences and trends of adult obesity in Australia and the US, with females showing higher rates of becoming obese than males [2,3]. For example, approximately 12.5 million Australian aged ≥۱۸ years were categorized as overweight or obese in 2017/2018, equivalent to 2 in 3 adults being overweight or obese [4]. The prevalence of overweight and obesity in Australian aged ≥۱۵ years has also demonstrated a steady upward trend, with a combined incidence of 60 % over the period 2006 to 2019, particularly those living in rural and regional city urban areas [5]. This trend aligns with recent observation from five US national studies where obesity incidence increased from age 15 years into young adulthood [6]. Similarly, obesity prevalence rates among Canadian young adults (≥۱۸ years) increased from 23.9 % in 2007/09 to 26.4 % in 2012/13 [7]. These trends highlight the need for more efficient interventions targeting key modifiable risk factors to prevent and manage obesity in young adults. Obesity in young Australians, Americans, and Canadians (aged ≥۱۸ years) is attributed to several risk factors such as poor diet, physical inactivity, sedentary behaviours, low socioeconomic status, and stressful life events [8, 9, 10, 11, 12, 13, 14].

One such life event is the transition to university life [15]. It represents a critical period where changes in lifestyle behaviours (e.g., decrease in physical activity (PA) and fruit/vegetable intake) and weight gains are more commonly documented [15]. Starting university in Australia, Canada, and the US is influenced by several barriers perceived to healthy eating/lifestyle such as unsupportive institutional environment, availability/cost of healthy foods, neglect of PA, easy access to fast food, peer influence on unhealthy eating behaviour/physical inactivity, insufficient sleep, and stress [16, 17, 18, 19]. Students appeared to maintain those detrimental behavioural patterns such as excessive screen time and physical inactivity during the transition [20,21]. Alarmingly, a higher psychological distress risk was found in students who followed unhealthy patterns of behaviour such as physical inactivity and unhealthy diet while studying transition to university courses [22, 23, 24]. Different types of interventions have been used to improve dietary, PA, and weight-related outcomes (e.g., body fat, lean mass, waist-to-hip ratio, waist circumference) in the university setting, including strategies promoting healthy food purchases, online education and using web resources, and social media/technology devices [25].

Results

Our search identified 32,928 records for possible inclusion, with 32,571 duplicates removed. A total of 357 articles were screened by title and abstract for inclusion, and 325 articles were excluded based on Table 1. Of the 32 full-text articles that we screened as potentially relevant, 12 met the inclusion criteria (Table 1), which involved more than 52,280 university students/young adults (aged 18–۳۵ years). A PRISMA flow diagram of articles inclusion is summarized in Fig. 1. The results were divided into two themes: university setting and young adults.