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Adolescent Nutrition

Adolescence is a time of major physical change. Girls gain an average of 12.5 pounds per year and boys gain an average of 20 pounds per year during puberty. Although both gain weight during adolescence, males have a decrease in body fat percentage to an average of 12% during this time, while females experience an increase to 16–27% body fat. Weight gain is only one of the countless changes a young person will experience during adolescence. The adolescent period is characterized by profound biological, psychosocial, and cognitive changes. Teens are also gaining increasing independence as they grow into young adulthood. Where previously, their parents were making the decisions about where, when, and what they would eat, a teenager starts to make some of these decisions on their own. Adolescence is a critical period in the development of lifelong health behaviors, and ideally, they have been given the skills to make healthy choices when confronted with this new-found freedom. Unfortunately, teens that develop unhealthy habits may be at risk for serious health consequences. Some problems, like obesity, might have started developing at a younger age. Others, like an eating disorder, might only come to light once puberty occurs and changes start to happen to a person’s body. The choices that a teenager makes with regard to his or her diet can have lasting effects; healthy eating can reduce risk of diseases such as heart disease, cancer, stroke, and diabetes. Unhealthy eating can have the opposite effect. In addition, being a teenager today means being exposed to media constantly. From magazines emphasizing the ‘right’ size for your waistline and social media sites like Facebook and Tumblr allowing teens to view ‘thinspiration’ posts to TV commercials and website pop-up advertisements encouraging teens to drink more soda and eat more fast food, no one can avoid being influenced by the media. The setting where adolescents eat can have an impact on the quality of their food intake. A recent review article of family meals found that adolescents who have more frequent family meals also have healthier diets. Higher frequency of family meals is also associated with reduced prevalence of overweight and obesity. Unfortunately for many families, evening meals together are not feasible given busy schedules or the lack of interest in these gatherings on the part of the adolescent. American adolescents who eat the lunch provided at their school will be eating a meal that is nutritionally balanced and meets the nutrition standards set forth by the National School Lunch Program. The meal will have no more than 30% calories from fat and less than 10% calories from saturated fat. Each meal must provide one-third the recommended dietary allowance (RDA)of protein, vitamin A,vitaminC, iron, calcium,and calories. Additionally, recent changes to school lunch guidelines involve increasing fruits and vegetables and whole grains in school meals. Skipping meals is prevalent among adolescents, with breakfast being the meal skipped the most often. According to the YRBSS, 13.7% of teens surveyed had not eaten breakfast 7 days preceding the survey and only 38.1% had eaten breakfast on all 7 days. Meal skipping has been associated in numerous studies with risk of overweight and obesity. Nutrition counseling can help a teenager identify quick and easy breakfast items for those who cite lack of time in the morning as the main reason that they are missing this important meal. Counseling would also be warranted for a teen who might mistakenly think that skipping a meal is an effective strategy for weight loss. Snacking is also common among adolescents and has only increased over time. The types of snacks showing the biggest increase within this age group are nutrient-poor, energy-dense foods including desserts, candy, salty snacks, and sugar sweetened beverages (SSBs). One study showed that more than 27% of a child’s calories each day came from snacks, often three or more per day. While snacking is not necessarily unhealthy, calories should ideally come primarily from balanced meals in addition to small, nutrient-dense snacks throughout the day. See articles by Popkin and others, based on NHANES and Nielsen datasets.

 What Are Teenagers Eating?

Many teenagers are not meeting the suggested requirements for major food groups, especially fruit and vegetables. According to the Continuing Survey of Food Intakes by Individuals and the National Health and Nutrition Examination Survey, major contributors to the adolescent diet in the United States include sugar-sweetened beverages, pizza, full-fat milk, grain-based desserts, breads, pasta dishes, and savory snacks. Recent data from the Youth Risk Behavior Surveillance System (YRBSS) show that 6.6% of high school students surveyed had not eaten a single vegetable 7 days preceding the survey and 5% had not eaten fruit or had 100% fruit juice to drink. A recent study on dietary adequacy in teenage girls specifically found that they were lacking in fruits, vegetables, and diary, giving them lower than adequate intakes (AIs) of calcium, magnesium, potassium, and vitamins D and E.  The setting where adolescents eat can have an impact on the quality of their food intake. A recent review article of family meals found that adolescents who have more frequent family meals also have healthier diets. Higher frequency of family meals is also associated with reduced prevalence of overweight and obesity. Unfortunately for many families, evening meals together are not feasible given busy schedules or the lack of interest in these gatherings on the part of the adolescent. American adolescents who eat the lunch provided at their school will be eating a meal that is nutritionally balanced and meets the nutrition standards set forth by the National School Lunch Program. The meal will have no more than 30% calories from fat and less than 10% calories from saturated fat. Eachmeal must provide one-third the recommended dietary allowance (RDA)ofprotein, vitamin A,vitaminC, iron, calcium,and calories. Additionally, recent changes to school lunch guidelines involve increasing fruits and vegetables and whole grains in school meals. Skipping meals is prevalent among adolescents, with breakfast being the meal skipped the most often. According to the YRBSS, 13.7% of teens surveyed had not eaten breakfast 7 days preceding the survey and only 38.1% had eaten breakfast on all 7 days. Meal skipping has been associated in numerous studies with risk of overweight and obesity. Nutrition counseling can help a teenager identify quick and easy breakfast items for those who cite lack of time in the morning as the main reason that they are missing this important meal. Counseling would also be warranted for a teen who might mistakenly think that skipping a meal is an effective strategy for weight loss. Snacking is also common among adolescents and has only increased over time. The types of snacks showing the biggest increase within this age group are nutrient-poor, energy-dense foods including desserts, candy, salty snacks, and sugar sweetened beverages (SSBs). One study showed that more than 27% of a child’s calories each day came from snacks, often three or more per day. While snacking is not necessarily unhealthy, calories should ideally come primarily from balanced meals in addition to small, nutrient-dense snacks throughout the day. See articles by Popkin and others, based on NHANES and Nielsen datasets.

 Factors Influencing Food Choice

There are many factors that can influence an adolescent’s food choice; some are external such as peer pressure, and others are internal such as cravings. Some are affected by cultural or religious beliefs (such as not eating meat during Lent), and others are based purely on availability. A teenager who does not have access to a car, has no nearby grocery store, and mainly shops at a neighborhood convenience store is not likely to develop a strong affinity towards fresh fruits and vegetables. Current food trends, home environment, body image, and health status are other factors that can readily contribute to the decisions that adolescents make daily regarding food choices.

What adolescents themselves identify as factors that influence their intake do differ from internal/cultural factors that a teen might not personally think are relevant factors. One focus group study showed that adolescents identify hunger/food cravings, appeal of food, time, and convenience as the most important factors influencing food choices. This same group of teenagers identified making healthy food look and taste better as the primary suggestion to increase adolescent healthy eating.

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