Patterns of lifestyle behaviors, self-efficacy for nutrition, and dietary diversity among adolescents of the Chamba and Mandi districts of Himachal Pradesh

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Background: The growing unhealthy lifestyle among adolescents, including decreased vegetable intake, high calorie-rich diet, and inadequate physical activity, are posing challenges. However, there is a lack of data on how dietary diversity and self-efficacy, crucial in determining food intakes, are interlinked and affect body mass index (BMI), an indicator of malnutrition. Hence, we aimed to assess unmarried boys’ and girls’ (10-19 years) lifestyle behaviors, self-efficacy for nutrition, dietary diversity, and their association with BMI in Himachal Pradesh. Methods: It was a cross-sectional quantitative study conducted in the Mandi and Chamba districts using a structured questionnaire. Self-efficacy was measured using a five-point Likert-scale-based tool, and dietary diversity was calculated from 10 major food groups consumed in the last 24h. Besides socio-demographic details, weight and height measurements were obtained to calculate the BMI. We performed linear regression analysis to assess the associations of self-efficacy, BMI, and dietary diversity with socio-demographic determinants. Results: Out of 942 adolescents, 473 (50.2%) were girls and 469 (49.8%) were boys. Marginalized populations had lower dietary diversity than the non-marginalized. Girls had a lower dietary diversity than boys. Adolescents possessing below-the-poverty-line cards had a lower self-efficacy than those possessing above-the-poverty-line cards. Adolescents who had higher dietary diversity had a lower BMI compared to their counterparts (beta coefficient (95% confidence interval); p value -0.30 (-0.51, -0.10); 0.004). Conclusions: Dietary diversity and BMI are affected by socio-demographic characteristics like education, income, religion, and social caste. BMI is inversely associated with dietary diversity and conversely, positively associated with self-efficacy.