Chapter 15Adolescent 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:– 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.):– Orthopedic problems– Hepatic disease– Body image disturbances– Low

Primary Care Assessments Based on Adolescent BMI

National Guidelines for Weight Management Therapy

• Four stages of treatment1. 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

– 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

• 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 life-threatening 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 Iron-Deficiency 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 – Calcium supplements – Dairy products– Coffee– Tea– High-fiber foods

Hypertension and Hyperlipidemia

Blood Pressure Levels

Risk Factors for Hypertension

• 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

• <35% calories from total fat

• <10% calories from saturated fat

• Cholesterol intake ≤300 mg/day

• Adequate fruits, vegetables, grains, & low-fat 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