1. HUN 3403 Wk3 D2b Chapter 15 Adolescent Nutrition: Conditions and Interventions

2. Introduction Behaviors & nutrition concerns impacting significant numbers of youth are addressed including: –Overweight & obesity –Competitive sports –Substance use & abuse –Eating disorders –Hypertension & hyperlipidemia –Chronic health conditions

3. Overweight and Obesity Prevalence of overweight adolescents has nearly doubled during the past two decades Factors most likely to be causes of increase in overweight and obesity –Environmental factors –Genetic factors

4. Overweight and Obesity Additional 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

5. Assessing Weight Status BMI for age & gender is used to assess weight status –BMI ≥85th to <95% are “overweight” –BMI ≥95% are “obese” –Wt status assessed by plotting growth curve charts on the next slide

6. CDC Growth Charts: U.S.

7. 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

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

9. Assessment and Treatment of Adolescent Overweight and Obesity Screen all adolescents for wt-for-ht annually Those at-risk for overweight require in- depth medical assessments Recommendations based on physical growth & presence of medical complications

10. Primary Care Assessments Based on Adolescent BMI

11. 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

12. 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

13. 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

14. 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

15. 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

16. Overview of Staged Treatment

17. Management of Severely Obese Adolescents Rapid weight loss may be medically necessary Intensive medical supervision required with the following: –Very-low-calorie diets or protein-sparing modified fasts –Appetite suppressants or other drugs –Bariatric surgery

18. Bariatric Surgery and Severely Obese Adolescents Performed only if obesity has medical comorbidities Adolescent must have completed growth spurt and have either: –BMI >35 with major complications or –BMI >50 with minor complications

19. Guidelines for Consideration of Bariatric Surgery

20. Supplement Use Vitamin & Mineral Supplements: National data - >1/3 adolescents use Vitamin- Mineral supplements Most common supplements are –Vitamin C –Calcium –Iron –Vitamin E –B-vitamin complex

21. Supplement Use Vitamin & Mineral Supplements: Prevalence of supplement use: –Positively correlated with Household income High food-security status Some form of health insurance Parental education –Adolescents who take supplements tend to consume a more nutritionally adequate diet than those who don’t

22. Supplement Use Herbal Remedies: Few data available on herbal use Reasons for taking them include: –Weight loss –Treatment of ADD –To increase energy and stamina More studies needed on herb use since many herbs have potentially dangerous side effects

23. Supplement Use Ergogenic Supplements Used by Teens –4% of adolescents report taking illegal steroids Most common in males Use peaks during 9 th grade May be taken orally, injected, or as a patch Few high school athletic programs test athletes for ergogenic supplement use

24. Anabolic-androgenic Steroids Used to increase LBM & strength Linked to infertility, hypertension, physeal closure, depression, aggression, & increased risk of atherosclerosis –Two commonly used steroids that are precursors of testosterone & estrogen are: Androstenedione (Andro)— controlled substance DHEA (Dehydroepiandrosterone) widely available as supplements

25. Anabolic-androgenic Steroids Claims for taking DHEA and Andro While not scientifically proven, claimed to: –Reduce body fat –Decrease insulin resistance –Increase immune system function & LBM –Decrease risk of osteoporosis

26. Anabolic-androgenic Steroids Risks of taking DHEA and Andro Possible Side effects: –Gynecomastia (breast enlargement) –Prostate enlargement –Hirsuitism (facial hair in females)

27. Growth Hormone Benefit of growth hormone: –Decrease subcutaneous fat –Strengthen ligaments and tendons Side effects include: –Physeal closure –Hyperlipidemia –Glucose intolerance –Myopathy

28. Creatine Sold as supplement to increase LBM Naturally formed in liver & kidneys Main dietary sources are meats Studies show mixed results on benefits Side effects are numerous Chronic use may be associated with renal damage

29. Ephedra Was banned as OTC supplement in 2004 Does increase BMR but no known benefits to athletic performance Side effects include cardiac arrhythmia, hypertension, increased risk of myocardial infarction, cerebral vascular accidents, & death

30. Nutrition for Adolescent Athletes More than half of U.S. adolescents report playing one or more sports –62% of males –50% of females Nutrition concerns include: –Fluid & hydration –Carbohydrate loading –High-protein diets

31. Nutritional Considerations for Physically Active Adolescents High levels of activity combined with growth & development increase needs for energy, protein & certain vitamins & minerals Nutrient needs higher during intense training & competition seasons Monitor changes in body weight to assess for adequate energy and nutrient intake

32. Considerations for Assessing Nutrient Needs for Adolescent Athletes 1.What sport(s) are engaged in & duration of competition season(s)? 2.What is the level of competition? (Recreational, competitive, or highly competitive) 3.What kind of training does adolescent engage in?

33. Considerations for Assessing Nutrient Needs for Adolescent Athletes 4. Does the athlete typically sweat profusely or lose body weight during competition? 5. Does athlete follow a special diet or take supplements to improve athletic performance? The type, amount and frequency of supplement use should be noted and counseling provided as necessary.

34. Nutritional Considerations for Physically Active Adolescents Competitive athletes may need 500- 1500 additional calories per day Protein should supply no more than 30% of calories in the diet Special concern for vegetarian athletes or restricted caloric intake to maintain a particular weight

35. Dietary Recommendations for Adolescent Athletes Follow MyPlate guidelines –May need upper limit of food group servings because of increased energy needs Eat pre-event meal at least 2-3 hours prior to exercise Post-event meals should contain 400- 600 calories & be high in complex carbs & adequate non-caffeinated fluids

36. Dietary Recommendations for Adolescent Athletes Avoid foods high in fat, protein & dietary fiber for at least 4 hours before event Increased risk of bone fractures make adequate calcium intake important

37. Fluids and Hydration Reasons adolescents are at risk for dehydration: –Young adolescents do not regulate body temperatures well –Ignore physiological signs of fluid loss –May be unaware of need for fluids All athletes should be counseled on fluid needs

38. Fluids and Hydration Fluid recommendations: –6-8 oz fluids prior to exercise –4-6 oz every 15-20 minutes during activity –≥8 oz following exercise –Not more than 16 oz in 30 minutes to avoid nausea

39. Special Dietary Practices of Adolescent Athletes Carbohydrate loading –Used with endurance athletes such as distance runners –Consists of high-carb diet to increase glycogen stores combined with resting prior to athletic event

40. Special Dietary Practices of Adolescent Athletes High-protein diets –May consist of 3-4 times the DRI –Should be discouraged because: Protein foods typically high in total & saturated fats Protein & fat may delay digestion & absorption, limiting total energy available for activity More water required for protein breakdown which increases dehydration risk

41. Substance Use Use of substances can affect nutritional status –Tobacco increases Vitamin C needs –Alcohol replaces nutritious foods and beverages –Illicit drugs may increase risk for disordered eating behaviors

42. Potential Effects of Substance Use on Nutrition Status

43. Iron-Deficiency Anemia Iron-deficiency anemia is the most common nutritional deficiency Risk factors for iron deficiency: –Rapid growth –  intake iron- or vitamin C-rich foods –Vegan diets –Caloric restriction, meal skipping –Participation in strenuous or endurance sports –Heavy menstrual bleeding

44. Iron-Deficiency Anemia Effects of iron deficiency on adolescents: –Delayed or impaired growth & development –Fatigue –Increased susceptibility to infection –Depressed immune system –Impaired physical performance & endurance –Increased susceptibility to lead poisoning

45. Hemoglobin and Hematrocit for Iron- Deficiency Anemia

46. Treatment of Iron- Deficiency Anemia Treatment includes: –Increase intake of foods rich in iron & vitamin C –Iron supplements Under age 12—60 mg/day Over age 12—60 (males) to 120 (females) mg/day

47. Side Effects of Iron Supplements Common side effects include constipation, nausea, cramps –Reduce side effects by Taking small, frequent doses Take with meals –Factors  iron absorption include Calcium supplements Dairy products Coffee, Tea High-fiber foods

48. Hypertension and Hyperlipidemia

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

50. Nutrition Counseling for Hypertension Decrease 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

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

52. 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

53. Dietary Recommendations to Reduce CVD Risk

54. Children & Adolescents with Chronic Health Conditions About 18% of children & adolescents have a chronic condition or disability Condition may put person at risk for nutrition problems related to: –Altered consumption, digestion or absorption –Biochemical imbalances –Psychological stress –Environmental factors

55. Children & Adolescents with Chronic Health Conditions Common nutrition problems with special health care needs: –Altered energy and nutrient needs –Delayed growth –Oral-motor dysfunction –Elimination problems –Drug/nutrient interactions –Appetite disturbances –Unusual food habits –Dental caries, gum disease

56. Continuum of Weight-Related Concerns and Disorders

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

58. Disordered Eating Behaviors Anorexic or bulimic behaviors—with less frequency or intensity=unable to do a formal diagnosis Most frequently used behaviors –Vomiting –Laxatives –Fasting or extreme dieting –Excessive exercise

59. Three Main Eating Disorders Anorexia nervosa –Characterized by extreme wt loss, poor body image, & irrational fears of wt gain & obesity Bulimia nervosa –Characterized by recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time frequently followed by purging

60. Three Main Eating Disorders Binge-eating disorder –Characterized by periodic binge eating not followed by vomiting or use of laxatives

61. Prognosis for People with Anorexia Nervosa ~10% to 15% die from the disease Deaths related to –Weakened immune system –Gastric ruptures –Cardiac arrhythmia –Heart failure –Suicide

62. Prognosis for People with Anorexia Nervosa Early diagnosis & treatment improves chances for recovery Recovery rates –<50% fully recover –~33% show improvement –~20% chronically affected

63. Prognosis for People with Bulimia Nervosa ~2-3% die from disease Recovery rates –~48% full recovery –~26% improvement –~26% chronicity

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

65. Etiology of Eating Disorders Environmental factors: –Media Influences –Societal and cultural norms –Food availability and accessibility Family factors: –Family dynamics Weight-related behaviors of parents and siblings Feeding behaviors reinforced during childhood and adolescence

66. Etiology of Eating Disorders Interpersonal factors: –Peer norms and behaviors –Abuse experiences Personal factors: –Biological –Psychological –Knowledge, attitudes and behaviors

67. Treating Eating Disorders A multidisciplinary team approach Team may consist of –Physician –Dietitian –Nurse –Psychologist –Psychiatrist

68. Treating Eating Disorders Goal of eating-disorder treatment programs –Restore body weight –Improve social and emotional well-being –Normalize eating behaviors

69. Treating Eating Disorders Core components of programs: –Treatment of medical comorbidities –Restoration of body weight to normal –Nutrition education & counseling –Individualized psychotherapy –Family therapy –Group therapy

70. Eating Disorders Among Adolescents: Summing It Up Eating disorders—a continuum ranging from body dissatisfaction to clinically significant eating disorders Parents, peers, educators, & health care providers should take an important role to help decrease prevalence of eating disorders

71. Preventing Eating Disorders Programs that focus on changing weight-related attitudes of youth & promoted healthy weight-control strategies were found to be more effective Effects have lasted up to 2 years

72. 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