Medical education is recognized as one of the most rigorous and stressful professional training programs. Medical students often experience high academic demands, irregular schedules and competitive environments, which may predispose them to unhealthy lifestyle behaviors such as inadequate diet, reduced physical activity, poor sleep, increased screen time and substance use. These factors, coupled with psychosocial stress, increase the risk of both immediate health concerns and long-term non-communicable diseases (NCDs) [1-5]. Globally, studies have documented elevated prevalence of obesity, stress, depression and risky lifestyle practices among medical students, highlighting the need for comprehensive health profiling in this group [6-12].   In India, medical students represent the future healthcare workforce, yet their own health and lifestyle behaviors remain understudied. While some regional studies have explored individual aspects such as smoking, alcohol use, stress or dietary patterns, there is a lack of large-scale, integrative assessments that capture the multidimensional health profile of medical undergraduates [13-16]. An evidence gap persists in understanding how demographic, anthropometric, dietary, lifestyle, mental health and academic variables interact to shape the overall wellness of Indian medical students.   Himachal Pradesh, a northern hill state of India, presents a particularly relevant setting for such an inquiry. Its unique geographic terrain, sociocultural practices and emerging educational infrastructure may influence student behaviors in distinct ways compared to other regions of the country. However, research examining the comprehensive health and lifestyle patterns of medical students in this state is scarce.   Against this backdrop, the present study was designed to provide an integrated analysis of medical students’ sociodemographic profile, dietary intake, physical activity, lifestyle habits, health status, mental health, academic and social behaviors and clustering of risk factors. By offering a holistic assessment, this work aims to generate critical insights that can inform student wellness initiatives, guide institutional health policies and ultimately contribute to the cultivation of a healthier future physician workforce.

Study Design and Setting A descriptive, cross-sectional survey was conducted in 2024 among MBBS students of Himachal Pradesh, India. The study encompassed all six government medical colleges in the state: Indira Gandhi Medical College (IGMC), Shimla; Dr. Rajendra Prasad Government Medical College (RPGMC), Tanda; Dr. Yashwant Singh Parmar Government Medical College, Nahan; Shri Lal Bahadur Shastri Government Medical College & Hospital, Mandi; Pandit Jawaharlal Nehru Government Medical College, Chamba; and Dr. Radhakrishnan Government Medical College, Hamirpur.   Study Population and Sampling The target population consisted of undergraduate MBBS students from first year to final year. Participation was voluntary and anonymous. A total of 999 students completed the survey, which formed the final sample size for analysis.   Data Collection Tool and Procedure Data were collected using a pre-designed, structured questionnaire developed in Google Forms. The link to the survey was disseminated electronically via WhatsApp groups and other social media platforms to ensure maximum reach. The questionnaire included sections on:   Sociodemographic and anthropometric profile (age, gender, height, weight, BMI, blood group) Dietary habits (diet type, fruit/vegetable intake, water intake, junk food consumption, meal frequency, breakfast/lunch/dinner skipping, caffeine use) Physical activity (regular exercise, frequency, duration, type of exercise) Lifestyle and other habits (smoking, alcohol use, sleep duration, screen/mobile use) Health status and family history (self-reported health, chronic illness, family history, medication/self-medication) Mental health and stress profile (perceived stress, sleep quality, coping strategies, academic burnout/anxiety) Academic and social habits (study hours, extracurricular involvement, social activities, leisure/social media use) Clustering of risk factors (smoking, alcohol, frequent junk food, inadequate sleep, excessive screen time, physical inactivity, stress) The tool was pilot tested on a small subset of students for clarity and feasibility before full deployment.   Ethical Considerations Participation was entirely voluntary. Informed consent was obtained electronically prior to accessing the questionnaire. Responses were anonymized and confidentiality was maintained throughout. The study adhered to the ethical principles of the Declaration of Helsinki. Institutional ethical approval was obtained prior to commencement of data collection.   Data Analysis Data were exported from Google Forms into Microsoft Excel and analyzed using statistical software Epi Info version 7. Descriptive statistics were applied and results were expressed as frequencies and percentages. Tables were prepared to present the distribution of variables in a structured manner.

A total of 999 MBBS students from six government medical colleges of Himachal Pradesh participated in the survey. The results provide a comprehensive overview of their demographic profile, lifestyle behaviors, health status and related factors.   Among the 999 MBBS students, the majority (44.1%) were aged 19-20 years, followed by 28.9% in the 21-22 age group. Females (56.7%) slightly outnumbered males (43.3%). Blood group O+ was most common (29.9%), followed by B+ (28.6%) and A+ (22.1%). Regarding anthropometry, most students were within the height range of 160-169 cm (41.3%) and weighed between 50-59 kg (33.6%). The BMI distribution revealed that more than half (73.4%) of the students had normal BMI, while 14.3% were underweight, 11.2% overweight and 1.1% obese (Table 1).   Table 1: Sociodemographic and Anthropometric Profile of MBBS Students (N = 999) Variable Category Frequency (n) Percent (%) Age (years) ≤18 162 16.2 19-20 441 44.1 21-22 289 28.9 ≥23 107 10.7 Total 999 100.0 Gender Male 432 43.3 Female 567 56.7 Total 999 100.0 Blood Group A+ 221 22.1 B+ 286 28.6 O+ 299 29.9 AB+ 103 10.3 Others (-ve) 90 9.0 Total 999 100.0 Height (cm) <150 74 7.4 150-159 226 22.6 160-169 413 41.3 170-179 216 21.6 ≥180 70 7.1 Total 999 100.0 Weight (kg) <50 182 18.2 50-59 336 33.6 60-69 287 28.7 70-79 131 13.1 ≥80 63 6.3 Total 999 100.0 BMI (kg/m²) Underweight (<18.5) 143 14.3 Normal (18.5-24.9) 734 73.4 Overweight (25-29.9) 112 11.2 Obese (≥30) 11 1.1 Total 999 100.0   Dietary assessment showed that 57.7% of students consumed a non-vegetarian or mixed diet, whereas 42.3% followed a vegetarian diet. Fruit and vegetable intake was suboptimal, with 33.2% reporting rare fruit consumption and 28.6% reporting low vegetable intake. Daily intake of fruits and vegetables was limited to 25.6 and 29.2%, respectively. Water intake was moderate in most participants (48.7%), while 38.9% consumed more than 2 liters daily.   Caffeine/tea/coffee consumption was common, with about one-third reporting regular use (34.6%). Junk food consumption was widespread, with 51.3% reporting moderate intake and 33.1% reporting frequent intake (≥4 times/week). Most students reported eating three meals per day (65.5%). Skipping meals was also noted: 17.2% frequently skipped breakfast, 11.5% skipped lunch and 9.0% skipped dinner (Table 2).   Table 2: Dietary Habits of MBBS Students (N = 999) Variable Category Frequency (n) Percent (%) Diet Type Vegetarian 423 42.3 Non-vegetarian / Mixed 576 57.7 Total 999 100.0 Fruit Intake Rare (<3 servings/week) 332 33.2 Moderate (3-6 servings/week) 411 41.1 Daily (≥1 serving/day) 256 25.6 Total 999 100.0 Vegetable Intake Rare (<3 servings/week) 286 28.6 Moderate (3-6 servings/week) 422 42.2 Daily (≥1 serving/day) 291 29.2 Total 999 100.0 Water Intake <1 L/day 124 12.4 1-2 L/day 487 48.7 >2 L/day 388 38.9 Total 999 100.0 Caffeine/Tea/Coffee None 298 29.8 Occasional (≤3 cups/week) 356 35.6 Regular (≥4 cups/week) 345 34.6 Total 999 100.0 Junk/Fast Food Rare (<1 time/week) 156 15.6 Moderate (1-3 times/week) 512 51.3 Frequent (≥4 times/week) 331 33.1 Total 999 100.0 Meals per Day <3 meals 91 9.1 3 meals 654 65.5 >3 meals 254 25.4 Total 999 100.0 Breakfast Skipping Never 615 61.6 Sometimes (<2 days/week) 212 21.2 Frequent (≥2 days/week) 172 17.2 Total 999 100.0 Lunch Skipping Never 721 72.2 Sometimes (<2 days/week) 163 16.3 Frequent (≥2 days/week) 115 11.5 Total 999 100.0 Dinner Skipping Never 782 78.3 Sometimes (<2 days/week) 127 12.7 Frequent (≥2 days/week) 90 9.0 Total 999 100.0   Regular exercise was reported by 61.3% of students, whereas 38.7% did not engage in structured physical activity. About one-third (31.2%) exercised 1-2 days per week, while 14.2% exercised daily. Exercise duration varied, with 41.2% exercising 30-59 minutes per session and 24.3% exceeding 60 minutes. Aerobic activities such as running and cycling were most common (38.9%), followed by mixed exercise (32.6%), strength/resistance training (14.1%) and other forms such as yoga and dance (14.3%) (Table 3).   Table 3: Physical Activity Profile of MBBS Students (N = 999) Variable Category Frequency (n) Percent (%) Regular Exercise Yes 612 61.3 No 387 38.7 Total 999 100.0 Exercise Frequency Rarely/Never (<1 day/week) 296 29.6 1-2 days per week 312 31.2 3-5 days per week 249 24.9 Daily (≥6 days/week) 142 14.2 Total 999 100.0 Exercise Duration <30 minutes/session 344 34.4 30-59 minutes/session 412 41.2 ≥60 minutes/session 243 24.3 Total 999 100.0 Type of Exercise Aerobic (running, cycling, sports) 389 38.9 Strength/Resistance 141 14.1 Mixed (aerobic + strength) 326 32.6 Other (yoga, dance, etc.) 143 14.3 Total 999 100.0   Smoking at admission was reported by 6.7% of students, though current smoking prevalence was higher at 11.3%. Alcohol use at admission was 7.8% but current use rose to 19.7%. Sleep patterns indicated that 62.2% slept 6-8 hours per night, while 18.2% slept less than 6 hours. Screen/mobile use was high: 39.2% used devices for 5-7 hours daily and 14.6% for ≥8 hours, with only 10.9% reporting <2 hours daily (Table 4).   Table 4: Lifestyle and Other Habits of MBBS Students (N = 999) Variable Category Frequency (n) Percent (%) Smoking at Admission Never smoked 932 93.3 Smoker (occasional/regular) 67 6.7 Total 999 100.0 Smoking (Current) Non-smoker 886 88.7 Smoker (occasional/regular) 113 11.3 Total 999 100.0 Alcohol at Admission Never 921 92.2 Yes (occasional/regular) 78 7.8 Total 999 100.0 Alcohol (Current) Non-user 802 80.3 User (occasional/regular) 197 19.7 Total 999 100.0 Sleep Duration <6 hours 182 18.2 6-8 hours 621 62.2 >8 hours 196 19.6 Total 999 100.0 Screen/Mobile Use <2 hours/day 109 10.9 2-4 hours/day 352 35.2 5-7 hours/day 392 39.2 ≥8 hours/day 146 14.6 Total 999 100.0   Regarding self-reported health, 47.1% of students rated their health as good, 26.8% as excellent, while 20.1% reported fair and 5.9% poor health. Chronic illness was uncommon, with 88.3% reporting none, though 8.1% had one condition and 3.6% reported multiple illnesses. Family history revealed that 22.1% had a history of diabetes, 18.2% hypertension and 9.4% heart disease or stroke, while 8.3% reported other illnesses such as cancer or thyroid disorders. Medication use showed that 78.1% used none, 11.7% engaged in self-medication and 10.1% were on regular prescribed medications (Table 5).   Table 5: Health Status and Family History of MBBS Students (N = 999) Variable Category Frequency (n) Percent (%) Self-Reported Health Excellent 268 26.8 Good 471 47.1 Fair 201 20.1 Poor 59 5.9 Total 999 100.0 Chronic Illness (Student) None 882 88.3 One condition (asthma, DM, etc.) 81 8.1 ≥2 conditions 36 3.6 Total 999 100.0 Family History of Illness None 419 41.9 Diabetes mellitus 221 22.1 Hypertension 182 18.2 Heart disease/Stroke 94 9.4 Other (cancer, thyroid, etc.) 83 8.3 Total 999 100.0 Medication Use None 781 78.1 Self-medication (OTC/without Rx) 117 11.7 Regular prescribed medication 101 10.1 Total 999 100.0   Perceived stress was prevalent, with 37.6% reporting mild and 33.3% moderate stress, while 14.9% reported severe stress. Sleep quality was fair in 38.5% of students and poor in 19.4%. Coping strategies varied: 46.8% adopted healthy approaches such as exercise and hobbies, 31.1% used mixed methods and 22.1% relied on unhealthy practices such as smoking or binge behaviors. Academic burnout/anxiety was reported at varying levels, with 41.8% mild, 22.9% moderate and 11.5% severe cases (Table 6).   Table 6: Mental Health and Stress Profile of MBBS Students (N = 999) Variable Category Frequency (n) Percent (%) Perceived Stress Level None 142 14.2 Mild 376 37.6 Moderate 332 33.3 Severe 149 14.9 Total 999 100.0 Sleep Quality Good (restful, refreshing) 421 42.1 Fair (occasional disturbance) 385 38.5 Poor (frequent disturbance/insomnia) 193 19.4 Total 999 100.0 Coping Strategies Healthy (exercise, hobbies, talking) 468 46.8 Mixed 311 31.1 Unhealthy (smoking, alcohol, binge) 220 22.1 Total 999 100.0 Academic Burnout/Anxiety None 238 23.8 Mild 417 41.8 Moderate 229 22.9 Severe 115 11.5 Total 999 100.0   Nearly half of the students (47.2%) studied for 3-5 hours daily, while 24.6% studied 6-8 hours and 9.8% more than 8 hours. Extracurricular participation was limited, with 42.8% reporting none; however, 21.7% engaged in sports, 20.3% in academic clubs or volunteering and 15.1% in cultural activities. Social interactions were moderate in most students (44.2% reported 1-2 outings/ week), while 26.9% reported frequent social outings. Leisure and social media use was widespread, with 41.3% spending 2-4 hours daily and 38.6% ≥5 hours daily (Table 7).   Table 7: Academic and Social Habits of MBBS Students (N = 999) Variable Category Frequency (n) Percent (%) Study Hours per Day <3 hours 184 18.4 3-5 hours 471 47.2 6-8 hours 246 24.6 >8 hours 98 9.8 Total 999 100.0 Extracurricular None 428 42.8 Sports 217 21.7 Cultural/Arts 151 15.1 Academic clubs/volunteering 203 20.3 Total 999 100.0 Social Activities Rare (<1 outing/week) 288 28.8 Moderate (1-2 outings/week) 442 44.2 Frequent (≥3 outings/week) 269 26.9 Total 999 100.0 Leisure/Social Media <2 hours/day 201 20.1 2-4 hours/day 413 41.3 ≥5 hours/day 385 38.6 Total 999 100.0   Analysis of combined risk factors revealed that only 11.4% of students reported no risk factors, while 28.1% reported one and 29.8% reported two. Nearly one-third of students exhibited clustering of multiple risks, with 19.4% having three and 11.3% having four or more risk factors. The most common risk factors included physical inactivity, frequent junk food intake, inadequate sleep, excessive screen use and moderate-to-severe stress (Figure 1).       Figure 1: Clustering of Lifestyle and Health Risk Factors among MBBS Students (N = 999) *Risk factors included: current smoking, current alcohol use, frequent junk food intake (≥4 times/week), inadequate sleep (<6 hrs), high screen/mobile use (≥5 hrs/day), physical inactivity (<2 days/week) and moderate-severe stress