Lesson 9 Chapter 15 Adolescent Nutrition: Conditions and Interventions

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Lesson 9Chapter 15 Adolescent
NutritionConditions and Interventions
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Key Nutrition Concept 1

• Overweight adolescents are at increased risk for
  medical and psychosocial complications such as
  hypertension, hyperlipidemia, insulin resistance,
  type 2 diabetes mellitus, hypoventilation,
  orthopedic disorders, depression, and low
  self-esteem.

Key Concept
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Key Nutrition Concept 3

• Adolescents are concerned about their weight. A
  national study suggests that on any given day,
  approximately half of adolescent females and 15
  of adolescent males were attempting weight loss.

Key Concept
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Overweight and Obesity

• Prevalence of overweight adolescents has
  increased like that of adults

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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

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Assessing Weight Status

• BMI for age gender is used to assess weight
  status
• -BMI 85th to lt95 are at risk for
  overweight
• -BMI 95 are overweight
• Wt status assessed by plotting growth curve
  charts on the next slide
• Others charts are found at http//www.cdc.gov
  /growthcharts/
• The CDC BMI-for-age calculator is available at
  http//www.cdc.gov/nccdphp/dnpa/bmi/

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CDC Growth Chart United States
More info. can be found at http//www.cdc.gov/nccd
php/dnpa/bmi/
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Health Implications of Adolescent Overweight

• The range of complications associated with
  overweight include
• -Hypertension
• -Dyslipidemia
• -Insulin resistance or type 2 diabetes mellitus
• -Sleep apnea
• -Hypoventilation disorders
• -Orthopedic problems
• -Hepatic disease
• -Body image disturbances
• -Low self esteem

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Screening and Treatment of Overweight Adolescents

• Screen all adolescents for wt-for-ht annually
• Those at-risk for overweight or overweight
  require in-depth medical assessments
• Recommendations based on stage of physical growth
  presence of medical complications

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Recommended Screening Procedures for Overweight
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General Guidelines for Weight Management Therapy

• Early intervention
• Education on medical complications
• Involve the entire family
• Focus on improvement of eating and physical
  activity behaviors

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Other Considerations for Weight Management in
Adolescents

• Help adolescents develop sustain healthful
  eating habits
• Teach to reduce or eliminate problem foods
• Avoid encouraging good bad foods
• Teach how to select fast foods wisely

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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

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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 gt40 with medical complications or -BMI
  gt50 without complications

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Guidelines for Use of Bariatric Surgery
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Supplement Use

• Vitamin Mineral Supplements
• Use ranges from 16 to 33
• Prevalence of use by race
• 1-White females (most frequently)
• 2-White males
• 3-Mexican-American females
• 4-Black females
• 5-Mexican-American males
• 6-Black males (least frequently)
• Most common supplements are vitamin C, calcium
  iron

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Supplement Use

• Herbal Remedies
• Few data available on herbal use
• Reasons for taking them include
• -Weight loss
• -Treatment of ADD
• -To increase stamina
• More studies needed on herb use since many herbs
  have potentially dangerous side effect

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Supplement Use

• Ergogenic Supplements Used by Teens
• 4 of adolescents report taking illegal steroids
• Most common in Hispanic males
• Use peaks during 9th or 10th grade
• May be taken orally, injected, or as a patch
• Few high school athletic programs test athletes
  for ergogenic supplement use

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Examples of Ergogenic Supplements

• Anabolic-androgenic steroids
• Androstenedione
• DHEA
• Growth hormone
• Creatine
• Ephedra

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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
• Androstenedionea controlled substance
• DHEA (Dehydroepiandrosterone) widely available as
  supplements

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Anabolic-androgenic Steroids

• Claims risks of taking DHEA
• While not scientifically proven, claimed to
• -Reduce body fat
• -Decrease insulin resistance
• -Increase immune system function LBM
• -Decrease risk of osteoporosis
• Possible Side effects
• -Gynecomastia (breast enlargement)
• -Prostate enlargement
• -Hirsuitism (facial hair in females)

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Growth Hormone

• Benefit of growth hormone
• -Decrease subcutaneous fat
• Side effects include
• -Hyperlipidemia
• -Glucose intolerance

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Creatine

• Sold as supplement to increase LBM
• 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

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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

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Nutrition for Adolescent Athletes

• More than half of U.S. adolescents report playing
  one or more sports
• 62 of males
• 50 of females
• Sports participation reduces with age
• Nutrition concerns include
• Fluid hydration
• Carbohydrate loading
• High-protein diets

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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

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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

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Special Dietary Practicesof 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

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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

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Substance Use

• Racial differences among drug use in teens
  include
• -Tobacco alcohol use highest among whites,
  followed by Hispanics, lowest in
  African- Americans
• -Illicit drug use is highest among Hispanics
• Teen drug users have poor nutritional habits
• Drugs may deplete stores of thiamin, vitamin C
  iron

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Potential Effects of Substance Use on Nutrition
Status
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Disordered Eating, Dieting and Eating Disorders

• The Continuum of Eating Concerns Disorders

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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
• Binge-eating disorder
• -Characterized by periodic binge eating not
  followed by vomiting or use of laxatives

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Diagnostic Criteria

• Anorexia nervosa - Table 15.10
• Bulimia nervosa - Table 15.11
• Binge-eating disorder - Table 15.12

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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
• Early diagnosis treatment improves chances for
  recovery
• Recovery rates 40to 50

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Prognosis for People with Bulimia Nervosa

• 5 die from disease
• Deaths related to heart failure resulting from
  electrolyte abnormality or suicide
• Recovery rates 50 to 60

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Disordered Eating Behaviors

• Some adolescents have anorexic or bulimic
  behaviors, but with less frequency or intensity
  for formal diagnosis
• Results of 2005 YRBS
• -12 have fasted gt 24 hours
• -6 use diet pills or other diet formulae
• -7 of Hispanic white females vomit or use
  laxatives to control wt

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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

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Body Dissatisfaction

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

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Tips for Fostering a Positive Body Image Among
Children Adolescents
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Etiology of Eating Disorders

• Main groups of contributing factors for eating
  disorders
• 1) Sociocultural norms
• 2) Personal factors
• 3) Behavioral factors

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Treating Eating Disorders

• A multidisciplinary team approach
• Team may consist of
• Physician
• Nutritionist
• Nurse
• Psychologist
• Psychiatrist

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Preventing Eating Disorders
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Eating Disorders Among Adolescents Summing
Things Up

• Eating disordersa 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

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Case Study 15.1Pages 388-389

• Practice Plotting