Chapter 15 Adolescent Nutrition: Conditions and Interventions

1. Chapter 15Adolescent Nutrition:Conditions and Interventions Nutrition Through the Life Cycle Judith E. Brown

2. 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

3. 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

4. Health Implications of Adolescent Overweight • Range of complications associated with being overweight include (cont.): • Orthopedic problems • Hepatic disease • Body image disturbances • Low

5. Primary Care Assessments Based on Adolescent BMI

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Overview of Staged Treatment

13. 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

14. Guidelines for Consideration of Bariatric Surgery

15. Potential Effects of Substance Use on Nutrition Status

16. 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

17. Side Effects of Iron Supplements • Common side effects include • Constipation • Nausea • Cramps

18. 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

19. Hypertension and Hyperlipidemia

20. Blood Pressure Levels

21. Risk Factors for Hypertension • Family history of hypertension • High sodium intake • Overweight • Hyperlipidemia • Inactive lifestyle • Tobacco use

22. 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

23. Hyperlipidemia • ~1 in 4 adolescents have elevated cholesterol • Risk factors include: • Family history • Cigarette smoking • Overweight • Hypertension • Diabetes • Physically inactive

24. 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

25. Continuum of Weight-Related Concerns and Disorders

26. 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 Dieting Behaviors

27. Body Dissatisfaction • Adolescents with low levels of body satisfaction are more likely to use unhealthy weight control behaviors & participate in less physical activity

28. 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

29. Prevalence of Eating Disorders

30. Tips for Fostering a Positive Body Image Among Children & Adolescents

31. Etiology of Eating Disorders • Main groups of contributing factors for eating disorders 1. Environmental 2. Familial factors 3. Interpersonal factors 4. Personal factors

32. 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