Nutrition in Adolescence
Jamie S. Stang and Brittany Stotmeister Key Points
- • Rapid changes in body weight, shape, and composition due to pubertal growth place adolescents at high risk for body dissatisfaction, disordered eating, and health-compromising eating behaviors.
- • Many adolescents skip meals but frequently snack.
- • A stepped approach to obesity treatment is recommended for adolescents, with strategies in each step based on the degree of obesity and the presence of comorbid conditions.
- • Screening for body mass index and hypertension should be performed at least annually.
- • Screening for hyperlipidemia and insulin resistance is recommended only for obese adolescents or those with a family history of cardiovascular disease and/or type 2 diabetes.
Keywords Adolescent • Adolescent nutrition • Disordered eating • Adolescent obesity
Nutrition, Growth, and Development
Adolescence is a time of dramatic physical, social, and cognitive development, which directly affects nutritional status. Since chronological age of sexual maturation varies dramatically, Tanner stages are generally used to describe periods of adolescent growth and development based on the assessment of secondary sexual characteristics. Approximately 15-25% of adult height is gained during early to middle adolescence (typically within stages 2 and 3 of the Tanner stages of sexual maturation); the average gain among females is 9.5 in. (24.1 cm) with up to 12 in. (30.5 cm) gained by males . Up to half of adult body weight is gained during the growth spurt. In females, gains in height precede weight gain by about 3-6 months, dramatically slowing around the onset of menses. Girls will gain an average of 18 pounds (8.1 kg) per year during the active growth spurt, with up to 14 lb (6.3 kg) gained after menses . Body fat levels rise among females throughout adolescence as a result.
J.S. Stang, Ph.D., M.P.H., R.D.N. (*)
B. Stotmeister, R.D.N., C.D.
Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA © Springer International Publishing AG 2017
N.J. Temple et al. (eds.), Nutrition Guide for Physicians and Related Healthcare Professionals, Nutrition and Health, DOI 10.1007/978-3-319-49929-1_4
Consequently, body composition changes tremendously within females which places them at risk for body dissatisfaction, dieting, and disordered eating . In males, peak weight and height accretion occur simultaneously . Males will gain about 20 lb (9 kg) per year during the peak of growth; however, body fatness decreases due to the larger percentage of lean body mass which is gained reflecting the increase in testosterone.
Approximately half of adult bone mass is gained during adolescence, with more than 90% of adult bone mass formed by age 18 [1, 3]. Adolescence is a critical time for bone development, and bone accretion is sensitive to adequate intakes of many nutrients including calcium, vitamins D and K, phosphorus, boron, strontium, magnesium, iron, and protein . Nutrient and energy needs are higher during adolescence than at any other period in life as a result of the velocity of physical development. The growth spurt ceases by age 16 in females but may continue in small increments in males until age 20 .
Social and cognitive development also occurs rapidly during adolescence. The teenage years are a time during which individuals develop a sense of personal identity and a moral and ethical value system . Self-esteem is critical during adolescence and can be dramatically affected by changes in body shape and size and the timing of development in comparison to other adolescents. Peer pressure peaks between the ages of 14 and 16; thus teens are very self-conscious about their appearance and strive to adopt behaviors consistent with their peer group . In terms of nutrition, this can alter eating habits in ways that place adolescents at risk of nutrition deficiencies. Some of the common behaviors are described below. A more detailed description of nutritional recommendation to treat eating disorders is included in the chapter by Allison and Hopkins.