Chapter 15
Adolescent Nutrition:
Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown
Overweight and Obesity
• Factors contributing to the increase include:
– Having one or more overweight parents
– From a low income family
– African American, Hispanic, American
Indian or Native Alaskan descent
– Having a condition that limits mobility
– Inadequate physical activity
– Diets high in calories, sugars, & fat
Health Implications of
Adolescent Overweight
• Range of complications associated with
being overweight include:
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Hypertension
Dyslipidemia
Insulin resistance or type 2 diabetes mellitus
Sleep apnea
Hypoventilation disorders
self esteem
Health Implications of
Adolescent Overweight
• Range of complications associated with
being overweight include (cont.):
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Orthopedic problems
Hepatic disease
Body image disturbances
Low
Primary Care Assessments Based
on Adolescent BMI
National Guidelines for Weight
Management Therapy
• Four stages of treatment
1. Prevention plus
2. Structured weight management
3. Comprehensive multidisciplinary intervention
4. Tertiary care intervention
National Guidelines for Weight
Management Therapy
1. Prevention plus
– BMI >85th but <95th without co-morbidity
conditions
– Level of treatment builds upon
• Basic nutrition
• Physical activity
– Goal
• Promote health
• Prevent disease
National Guidelines for Weight
Management Therapy
2. Structured weight management
– Same behaviors as stage 1
– More structured
• Screen time is limited to <1 hour per day
• Emphasize nutrient-dense foods
• Minimize energy-dense foods
National Guidelines for Weight
Management Therapy
3. Comprehensive multidisciplinary
intervention
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Same behavioral goals as stage 2
More structured eating
More structured physical activity plan
Designed to lead to negative caloric balance
National Guidelines for Weight
Management Therapy
4. Tertiary care intervention
– Appropriate with severely obese youth or those
who have significant, chronic co-morbidity
conditions
– Level of treatment provided through a tertiary
wt management center
– Diet and activity counseling with behavior
modifications
National Guidelines for Weight
Management Therapy
4. Tertiary care intervention (cont.)
– Treatments may include
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Meal replacement
A very low energy diet
Medication
Surgery may be implemented
Overview of Staged Treatment
Bariatric Surgery and Severely
Obese Adolescents
• Performed only if obesity has lifethreatening medical complications
• Adolescent must have completed growth
spurt and have either:
– BMI >40 with medical complications or
– BMI >50 without complications
Guidelines for Consideration of
Bariatric Surgery
Potential Effects of Substance
Use on Nutrition Status
Treatment of IronDeficiency Anemia
• Treatment includes:
– Increase intake of foods rich in irons &
vitamin C
– Iron supplements
• Under age 12—60 mg/day
• Over age 12—60 to 120 mg/day
Side Effects of Iron Supplements
• Common side effects include
– Constipation
– Nausea
– Cramps
Side Effects of Iron Supplements
• Reduce side effects by
– Taking small, frequent doses
– Take with meals
• Factors  iron absorption include
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Calcium supplements
Dairy products
Coffee
Tea
High-fiber foods
Hypertension and
Hyperlipidemia
Blood Pressure Levels
Risk Factors for Hypertension
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Family history of hypertension
High sodium intake
Overweight
Hyperlipidemia
Inactive lifestyle
Tobacco use
Nutrition Counseling for
Hypertension
• Limit sodium intake
• Limit fat to 30% of calories
• Consume adequate fruits, vegetables, whole
grains, & low-fat dairy
• Weight loss if overweight
• Dietary recommendations should be
encouraged even if meds are prescribed
Hyperlipidemia
• ~1 in 4 adolescents have elevated cholesterol
• Risk factors include:
– Family history
– Cigarette smoking
– Overweight
– Hypertension
– Diabetes
– Physically inactive
Dietary Recommendations to
Reduce Hyperlipidemia
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<35% calories from total fat
<10% calories from saturated fat
Cholesterol intake ≤300 mg/day
Adequate fruits, vegetables, grains, & lowfat dairy
Continuum of Weight-Related
Concerns and Disorders
Dieting Behaviors
• Dieting most common in Hispanic females
followed by white females
• Dieting & unhealthy wt control behaviors may
increase chance of future overweight or obesity
• Effective nutrition messages should focus on
lifestyle changes
Body Dissatisfaction
• Adolescents with low levels of body
satisfaction are more likely to use unhealthy
weight control behaviors & participate in
less physical activity
Disordered Eating Behaviors
• Anorexic or bulimic behaviors—with less
frequency or intensity=unable to do a
formal diagnosis
• Results of 2005 YRBS:
– 12% have fasted > 24 hours
– 6% use diet pills or other diet formulae
– 7% of Hispanic & white females vomit or use
laxatives to control wt
Prevalence of Eating Disorders
Tips for Fostering a Positive
Body Image Among Children &
Adolescents
Etiology of Eating Disorders
• Main groups of contributing factors for
eating disorders
1. Environmental
2. Familial factors
3. Interpersonal factors
4. Personal factors
Preventing Eating Disorders
• Characteristics of successful eating disorder
prevention programs:
– Target high-risk groups
– Target adolescents > 15 years of age
– Information provided by trained
interventionists
– Multiple sessions
– Integrated interactive learning