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Chapter: Nutrition and Diet Therapy: Diet During Childhood and Adolescence

Special Considerations for the Adolescent Related to Nutrition Concerns

Adolescence is a stressful time for most young people.



Adolescence is a stressful time for most young people. They are unexpectedly faced with numerous physical changes, an innate need for independence, increased work and extracurricular demands at school, in many cases jobs, and social and sexual pressures from their peers. For many teens, such stress can cause one or more of the following problems.


Anorexia Nervosa


In general, adolescent boys in the United States are considered well nourished. Studies show, however, that girls sometimes have diets deficient in calories and protein, iron, calcium, vitamin A, or some of the B vitamins.


These deficiencies can be due to poor eating habits caused by concern about weight. A moderate concern about weight is understandable and possibly even beneficial, provided it does not cause diets to be deficient in essential nutri-ents or lead to a potentially fatal condition called anorexia nervosa.


Anorexia nervosa, commonly called anorexia, is a psychological disorder more common to women than men. It can begin as early as late childhood, but usually begins during the teen years or the early twenties. It causes the client to drastically reduce calories, causing altered metabolism, which results in hair loss, low blood pressure, weakness, amenorrhea, brain damage, and even death.


The causes of anorexia are unclear. Someone with this disorder (an anorexic) has an inordinate fear of being fat. Some anorexics have been over-weight and have irrational fears of regaining lost weight. Some young women with demanding parents perceive this as their only means of control. Some may want to resemble slim fashion models and have a distorted body image, where they see themselves as fat even though they are extremely thin. Some fear growing up. Many are perfectionistic overachievers who want to control their body. It pleases them to deny themselves food when they are hungry.


These young women usually set a maximum weight for themselves and become an expert at “counting calories” to maintain their chosen weight. They also often exercise excessively to control or reduce their weight. If the weight declines too far, the anorexic will ultimately die.


Treatment requires the following:


·  Development of a strong and trusting relationship between the client and the health care professionals involved in the case.


·  That the client learn and accept that weight gain and a change in body contours are normal during adolescence.


·  Nutritional therapy so the client will understand the need for both nutrients and calories and how best to obtain them.


·  Individual and family counseling so the problem is understood by everyone.


·  Close supervision by the health care professional.


·  Time and patience from all involved.


Bulimia is a syndrome in which the client alternately binges and purges by inducing vomiting and using laxatives and diuretics to get rid of ingested food. Bulimics are said to fear that they cannot stop eating. They tend to be high achievers who are perfectionistic, obsessive, and depressed. They generally lack a strong sense of self and have a need to seem special. They know their binge–purge syndrome is abnormal but also fear being overweight. This condition is more common among women than men and can begin any time from the late teens into the thirties.


A bulimic usually binges on high-calorie foods such as cookies, ice cream, pastries, and other “forbidden” foods. The binge can take only a few moments or can run several hours—until there is no space for more food. It occurs when the person is alone. Bulimia can follow a period of excessive dieting, and stress usually increases the frequency of binges.


Bulimia is not usually life-threatening, but it can irritate the esophagus and cause electrolyte imbalances, malnutrition, dehydration, and dental caries.


Treatment usually includes limiting eating to mealtimes, portion control, and close supervision after meals to prevent self-induced vomiting. Diet therapy helps teach the client basic nutritional facts so that he or she will be more inclined to treat the body with respect. Psychological counseling will help the client to understand his or her fears about food. Group therapy also can be helpful.


Both bulimia and anorexia can be problems that will have to be confronted throughout the client’s life.



Being overweight during adolescence is particularly unfortunate because it is apt to diminish the individual’s self-esteem and, consequently, can exclude her or him from the normal social life of the teen years, further diminishing self-esteem. Also, it tends to make the individual prone to overweight as an adult.


Although numerous studies have been done, the cause of being over-weight is difficult to determine. Heredity is believed to play a role. Just as one inherits height, color of hair, or artistic talents, it appears that one may inherit the tendency (or lack of it) to be overweight. Overfeeding during infancy and childhood also can be a contributing factor. Then, once a person is overweight, the overweight itself contributes further to the problem.


For example, if a teenager becomes the center of his classmates’ jokes, he or she may prefer to spend time alone, perhaps watching television and finding comfort in food. This behavior adds more calories, reduces activity, and, thus, worsens the condition.


The problem of being overweight during adolescence is especially diffi-cult to solve until the individual involved makes the independent decision tochange lifestyle habits. After making such a decision, the teenager should see a physician to ensure that his or her health is good. The health care provider can play an important role by offering guidance on changing eating habits, increasing exercise, and adopting a healthier lifestyle.

Fast Foods


Many Americans have become extremely fond of fast foods. Many others are highly critical of their nutrient content. Examples of these foods—most of which are favorites of teenagers—include hamburgers, cheeseburgers, French fries, milkshakes, pizza, sodas, tacos, chili, fried chicken, and onion rings. Many fast-food companies have the nutrient content of their products available to help the public make better choices.


Generally speaking, fast foods are excessively high in fat and sodium, as well as calories, and contain only limited amounts of vitamins and minerals (other than sodium) and little fiber. In Table 13-2, the nutrient content of some varieties of fast foods are shown compared with the DRIs for a 16-year-old girl. This shows the potential for problems with a diet that regularly consists of these foods to the exclusion of others.


Nevertheless, these foods are more nutritious than sodas, cakes, and candy. When used with discretion in a balanced diet, they are not harmful. However, teens often use fast foods as a snack to hold them over until dinner, and this results in consumption of many extra calories.



In a process called fermentation, sugars and starches can be changed to alcohol. Enzyme action causes this change. Alcohol is typically made from fruit, corn, rye, barley, rice, or potatoes. It provides 7 calories per gram but almost no nutrients.

Alcohol is a substance that can have serious side effects. Initially, it causes the drinker to feel “happy” because it lowers inhibitions. This feeling affects the drinker’s judgment and can lead to accidents and crime. Ultimately, alcohol is a depressant; continued drinking leads to sleepiness, loss of consciousness, and, when too much is consumed in a short period, death.

Abuse (overuse) of alcohol is called alcoholism. Alcoholism can destroy the lives of families and devastate the drinker’s nutritional status and thus health. It affects absorption and normal metabolism of glucose, fats, proteins, and vitamins. When thiamine and niacin cannot be absorbed, the cells cannot use glucose for energy. Blood cells, which depend on glucose for energy, are particularly affected. Over time, if alcohol abuse continues, fat will accu-mulate in the liver, leading to cirrhosis. Alcohol causes kidneys to excrete larger-than-normal amounts of water, resulting in an increased loss of minerals. In a poor nutritional state, the body is less able to fight off disease.


In addition, excessive, long-term drinking can cause high blood pressure and can damage the heart muscle. It is associated with cancer of the throat and the esophagus and can damage the reproductive system.


The risks to the drinker are obvious. When a pregnant or lactating woman drinks, however, she puts the fetus or the nursing infant at risk as well. Alcohol can lower birth weight and cause fetal alcohol syndrome or fetal alcohol effect, with related developmental disorders.

Unfortunately, many teenagers ignore the dangers of alcohol and use it in an effort to appear adult. In addition to the damage to their own health and the accidents and the random acts of violence caused by their drinking, their behavior inspires younger children to emulate them. The health professional is in a good position to spread the message that alcohol is a substance and can cause severe economic and family problems, as well as addiction, disease, and death.




Marijuana use continues to increase among teenagers. Marijuana increases appetite, especially for sweets. One marijuana cigarette is as harmful as four or five tobacco cigarettes because the marijuana smoke is held in the lungs for a longer period of time. As marijuana is smoked, the lungs absorb the fat-soluble active ingredient, delta-9-tetrahydrocannabinol (THC), and store it in the fat (Indiana Prevention Resource Center, 2003). Experts believe that the use of marijuana can lead to the use of other drugs such as cocaine. Common street names for marijuana include grass, weed, pot, and dope.




Cocaine is highly addictive and extremely harmful. It causes restlessness, heightened self-confidence, euphoria, irritability, insomnia, depression, confu-sion, hallucinations, loss of appetite, and a tendency to withdraw from normal activities. Cocaine can cause cardiac irregularities, heart attacks, and cardiac arrests resulting in death. Weight loss is very common, mostly because it decreases appetite; addicts would give up food for the drug. The smokable form of cocaine is crack, which is more addictive than any other drug. It is estimated that half of all crimes against property committed in major cities are related to the use of crack cocaine and the addict’s need for money to buy the drug.




Cigarette smoking is addictive. Cigarette smoking by teenagers is very preva-lent. Teenagers smoke to “be cool,” to look older, because they think it will help them lose weight, or because of peer pressure. Smoking can influence appetite, nutrition status, and weight. Smokers need the DRI for vitamin C plus 35 mg because smoking alters the metabolism. Low intakes of vitamin C, vitamin A, beta-carotene, folate, and fiber are common in smokers. Smoking increases the risk of lung cancer and heart disease.


Other Addictive Drugs


Methamphetamine is the most potent form of amphetamines. Amphetamines cause heart, breathing, and blood pressure rates to increase. The mouth is usually dry, and swallowing is difficult. Urination is also difficult. Appetite is depressed. The users’ pupils are dilated, and reflexes speed up. As the drug wears off, feelings of fatigue or depression are experienced. Street names include crank, speed, crystal, meth, zip, and ice.

Inhalants are chemicals whose fumes are inhaled into the body and produce mind-altering effects. Some inhalants are gasoline, lighter fluid, tool-cleaning solvents, model airplane glue, typewriter correction fluid, and permanent ink in felt-tip pens. Inhalants are both physically and psychologically addictive. Indi-viduals who inhale may risk depression and apathy, nosebleeds, headaches, eye pain, chronic fatigue, heart failure, loss of muscle control, and death.


Nutrition for the Athlete


Good nutrition during the period of life when one is involved in athletics can prevent unnecessary wear and tear on the body as well as maintain the athlete in top physical form. The specific nutritional needs of the athlete are not numerous, but they are important. The athlete needs additional water, calories, thiamine, riboflavin, niacin, sodium, potassium, iron, and protein.


The body uses water to rid itself of excess heat through perspiration. This lost water must be regularly replaced during the activity to prevent dehydra-tion. Plain water is the recommended liquid because it rehydrates the body more quickly than sweetened liquids or the drinks that contain electrolytes. The “electrolyte” drinks are useful to replenish fluids after an athletic event but not during one. Salt tablets are not recommended because despite the loss of salt and potassium through perspiration, the loss is not equal to the amount contained in the tablets. If there is an insufficient water intake, these salt tablets can increase the risk of dehydration.


The increase in calories depends on the activity and the length of time it is performed. The requirement could be double the normal, up to 6,000 calories per day. Because carbohydrates, not protein, are used for energy, the normal diet proportions of 50% to 55% carbohydrate, 30% fat, and 10% to 15% protein are advised.


There is an increased need for B vitamins because they are necessary for energy metabolism. They are provided in the breads, cereals, fruits, and vegeta-bles needed to bring the calorie count to the total required. Some extra protein is used during training, when muscle mass and blood volume are increasing. This amount is included in the DRI for age and is provided in the normal diet. Protein needs are not increased by physical activity. In fact, excess protein can cause increased urine production, which can lead to dehydration.


The minerals sodium and potassium are needed in larger amounts because of loss through perspiration. This amount of sodium can usually be replaced just by salting food to taste, and orange juice or bananas can provide the extra potassium.


A sufficient supply of iron is important to the athlete, particularly to the female athlete. Iron-rich foods eaten with vitamin C–rich foods should provide sufficient iron. The onset of menstruation can be delayed by the heavy physical activity of the young female athlete, and amenorrhea may occur in those already menstruating.


When weight is a concern of the athlete, such as with wrestlers, care should be taken that the individual does not become dehydrated by refusing liquids in an effort to “make weight” for the class.


When weight must be added, the athlete will need an additional 2,500 calories to develop 1 pound of muscle mass. The additional foods eaten to reachthis amount of calories should contain the normal proportion of nutrients. A high-fat diet should be avoided because it increases the potential for heart disease. Athletes should reduce calories when training ends.


In general, the athlete should select foods using MyPyramid. The pregame meal should be eaten 3 hours before the event and should consist primarily of carbohydrates and small amounts of protein and fat. Concentrated sugar foods are not advisable because they may cause extra water to collect in the intestines, creating gas and possibly diarrhea.

Glycogen loading (carboloading) is sometimes used for long activities.To increase muscle stores of glycogen, the athlete begins 6 days before the events. For 3 days, the athlete eats a diet consisting of only 10% carbohydrate and mostly protein and fat as she or he performs heavy exercise. This depletes the current store of glycogen. The next 3 days, the diet is 70% carbohydrate, and the exercise is very light so that the muscles become loaded with glycogen. This practice may cause an abnormal heartbeat and some weight gain.


Currently, it is recommended that the athlete exercise heavily and eat carbohydrates as desired. Then, during the week before the competition, exer-cise should be reduced. On the day before competition, the athlete should eat a high-carbohydrate diet and rest.


After the event, the athlete may prefer to drink fruit juices until relaxed and then satisfy the appetite with sandwiches or a full meal. Many athletes will use “power drinks” or “energy drinks,” which are not any better than soda and contain mostly sugar and empty calories.


There are no magic potions or diet supplements that will increase an athlete’s prowess, as may be touted by health food faddists. Steroid drugs should not be used to build muscles (Figure 13-6). They can affect the fat content of the blood, damage the liver, change the reproductive system, and even alter facial appearance. Good diet, good health habits, and practice combined with innate talent remain the essentials for athletic success.

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