Tomorrow’s Doctors, Today’s Risks: A Comprehensive Assessment of Diet, Physical Activity, Stress and Lifestyle Factors among Medical Students in Himachal Pradesh

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)

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)

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)

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)

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)

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)

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)

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

This study provides an extensive overview of the sociodemographic, dietary, lifestyle, physical activity, health, mental health and academic behaviors of MBBS students in Himachal Pradesh. The results underscore the coexistence of health-promoting behaviors with significant high-risk practices, reflecting the complex realities of medical student life in India. With a large and representative sample, this survey highlights several patterns that resonate with findings from both national and international literature, while also offering region-specific insights.

The majority of participants were aged 19-22 years, aligning with the typical age distribution of undergraduate medical students in India. Female predominance reflects the growing trend of increased female enrollment in medical schools nationwide. The anthropometric profile indicates a mixed scenario: while three fourth of the students had normal BMI, one eighth were overweight or obese and about one in seven were underweight. This dual burden of malnutrition and overweight mirrors India’s broader public health challenges, where undernutrition persists alongside the rising epidemic of obesity and metabolic syndrome. Such findings are consistent with other Indian studies, suggesting that medical students are not immune to the nutritional transitions affecting the wider population [17-22].

Dietary practices emerged as a critical concern. Although a majority followed a mixed diet, daily fruit and vegetable intake remained low, with most students consuming them only occasionally. This is in line with global data showing inadequate fruit and vegetable consumption among young adults, despite their known protective role against NCDs. The widespread reliance on junk food, with one-third consuming it frequently, is alarming. Such eating patterns, often linked to hostel living and limited healthy food availability, have been documented in studies from India and other parts of world [9,12,15,18,19,21]. Skipping meals, especially breakfast, was notable in this cohort. Breakfast skipping has been associated with poor academic performance, reduced cognitive function and higher metabolic risk, suggesting significant academic and health consequences for this group.

While a majority of students reported engaging in exercise, only a small proportion engaged in daily or sustained physical activity. Aerobic exercise was most common, reflecting its accessibility but strength training and mixed forms were less prevalent. Comparable results have been observed in Indian and international studies, where medical students frequently cite time constraints and academic workload as barriers to regular exercise [6,8,11,14,22]. Physical inactivity, particularly in young adulthood, is a known risk factor for cardiovascular disease, obesity and mental health problems. The findings highlight the need for medical institutions to provide structured opportunities and encouragement for physical activity within campus life.

The study revealed a worrying increase in smoking and alcohol use during medical training compared to the time of admission. This suggests that exposure to stress, peer networks and hostel culture may contribute to the initiation or escalation of these habits. Similar trends have been observed in studies around the globe, where medical training years are often associated with rising substance use [13,22-24]. High screen time and inadequate sleep further compound these risks. With nearly 40% of students spending ≥5 hours daily on screens and 18% sleeping less than six hours, the implications include disrupted circadian rhythms, impaired academic performance and increased susceptibility to anxiety and depression.

Although most students self-reported good or excellent health, one-fourth rated their health as fair or poor, underscoring perceived health concerns even among future healthcare professionals. The prevalence of chronic illness among students was relatively low but family history of diabetes and hypertension was common. This finding mirrors the epidemiological profile of India, where NCDs contribute significantly to morbidity and mortality. The presence of family history increases students’ vulnerability to these conditions, especially when combined with lifestyle risks. Of particular note is the prevalence of self-medication, reported by over 11% of students. While this may stem from easy drug access and medical knowledge, it raises concerns about inappropriate medication use, masking of underlying conditions and risks such as antibiotic resistance.

High levels of stress were a defining feature of this cohort, with over two-thirds reporting mild to severe stress and more than one in ten experiencing severe burnout. Sleep quality was compromised for many, with almost 20% describing it as poor. These findings are consistent with global research documenting medical training as a period of heightened psychological vulnerability [25-28]. Stress, sleep disturbances and burnout not only affect academic performance but also jeopardize long-term mental health and professional development. Coping strategies varied, with nearly half adopting healthy methods such as exercise or hobbies, while one-fifth relied on maladaptive behaviors like alcohol and smoking. This underscores the need for early identification of stress and structured mental health support systems within medical institutions.

Academic demands were reflected in long study hours, with nearly half of students dedicating 3-5 hours per day to academics. While such dedication is expected, the limited engagement in extracurricular activities is concerning, as balanced involvement in sports, cultural and social events has been shown to foster resilience and reduce burnout. Social engagement was moderate in most students but high leisure and social media use (≥5 hours in nearly 40% of students) suggests potential displacement of healthier activities such as exercise, sleep or interpersonal interactions. This pattern aligns with studies worldwide reporting social media overuse among university students as both a coping mechanism and a contributor to stress [29-32].

Perhaps the most striking finding of this study is the clustering of multiple lifestyle risk factors. Nearly one-third of students had three or more coexisting risks such as poor diet, physical inactivity, high screen time, inadequate sleep, substance use and stress. This clustering has been recognized in youth health literature as a precursor to early onset of NCDs, including hypertension, diabetes and cardiovascular disease. The coexistence of these behaviors in such a young population is particularly concerning, as it may set the stage for lifelong patterns of ill health if not addressed early.

Regional Relevance and Public Health Implications

The setting of Himachal Pradesh adds a unique dimension to these findings. The hill state’s sociocultural practices, geographic constraints and relatively limited recreational infrastructure may contribute to specific lifestyle behaviors among students, including dietary reliance on high-calorie foods, limited access to varied fruits and vegetables and restricted opportunities for structured physical activity. These regional influences, combined with the universal pressures of medical training, create a distinctive health profile that requires tailored interventions.

From a public health perspective, these findings carry significant implications. Medical students are the future custodians of healthcare delivery and their health practices are likely to influence not only their personal well-being but also their professional attitudes towards patient counseling and community health promotion. Therefore, interventions aimed at fostering healthier diets, promoting structured physical activity, offering stress management programs and discouraging substance use must be prioritized within medical institutions.

Strengths and Limitations

This study represents one of the most comprehensive assessments of lifestyle, health and psychosocial factors among medical students in Himachal Pradesh, with a large sample size (N = 999) across all government medical colleges of the state, thereby ensuring strong representativeness and generalizability. The multidimensional approach-covering sociodemographic, dietary, physical activity, lifestyle, mental health and academic domains-adds significant value to the existing evidence base. However, the cross-sectional design precludes causal inference and reliance on self-reported online data may introduce recall bias or social desirability bias. Additionally, while the study captures breadth, objective clinical measures (e.g., biochemical parameters) were not included, which may have provided deeper physiological correlates of lifestyle patterns.

The findings demonstrate that medical students in Himachal Pradesh are exposed to a mix of positive health behaviors and concerning lifestyle risks, including inadequate dietary intake, high screen use, insufficient sleep, stress and clustering of multiple risk factors. Despite relatively good self-reported health, the presence of overweight/obesity, widespread stress and engagement in unhealthy coping mechanisms point to significant vulnerabilities in this young population. Addressing these issues is critical not only for safeguarding students’ well-being but also for shaping a healthier future physician workforce.

The authors gratefully acknowledge the participation of MBBS students across all government medical colleges of Himachal Pradesh. The cooperation of student representatives in facilitating survey circulation is deeply appreciated. The authors also thank colleagues and peers who provided valuable feedback during questionnaire development and pilot testing.

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