Adolescent Nutrition

Definition

It is important for teenagers and adolescents to eat healthy foods to help them grow and develop normally, as well as to help prevent obesity and obesity-related diseases. Proper nutrition includes following dietary guidelines recommended by federal agencies and medical professionals to ensure that the specific nutritional needs of adolescents are met. The U.S. Department of Agriculture's (USDA) MyPlate, for example, offers age-specific information for children and adolescents. By following these and similar recommendations, parents can ensure that their children eat a well-balanced diet that supplies the vitamins and calories they need to stay healthy as they grow through puberty and into adulthood.




Overweight and obese students at a summer camp in Zhengzhou city, China. Obesity has particularly affected adolescents above the age of 12.





Overweight and obese students at a summer camp in Zhengzhou city, China. Obesity has particularly affected adolescents above the age of 12.
(AP Images/Zhang tao)

Purpose

Calorie requirements by age, gender, and activity level

Age (years)

Sedentary

Moderately active

Active

Males

2-3

1,000-1,200

1,000-1,400

1,000-1,400

4-8

1,200-1,400

1,400-1,600

1,600-2,000

9-13

1,600-2,000

1,800-2,200

2,000-2,600

14-18

2,000-2,400

2,400-2,800

2,800-3,200

Females

2-3

1,000-1,200

1,000-1,400

1,000-1,400

4-8

1,200-1,400

1,400-1,600

1,400-1,800

9-13

1,400-1,600

1,600-2,000

1,800-2,200

14-18

1,800

2,000

2,400

2Sedentary refers to participating only in the light physical activity associated with day-to-day tasks. Moderately active refers to engaging in physical activity equivalent to walking about 1.5-3 miles per day at a 3-1 miles-per-hour (MPH) pace, in addition to everyday tasks. Active refers to daily physical activity equivalent to walking more than 3 miles per day at 3-4 MPH, in addition to routine tasks.

SOURCE: U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. 8th ed. Washington, DC: U.S. Government Printing Office, December 2015.

The nutritional status and health of children and adolescents in the United States has been of concern for a number of years. In 2015, the U.S. Centers for Disease Control and Prevention reported that approximately one-third of children and adolescents aged 2 to 19 were considered overweight or obese, with no change in prevalence from 2011. Of those children measured from 2011 to 2015, approximately 17% were classified as obese.

Many adolescents consume more calories than they need but do not meet recommended daily intakes for a number of nutrients. Adequate intakes of vitamins and minerals are an important part of nutrition. The body requires vitamins in small amounts to regulate metabolism and to maintain normal growth and functioning. Minerals help make up the muscles, tissues, and bones, and also support hormones, transport of oxygen, and enzyme systems. Of concern for children and adolescents is consuming adequate levels of calcium, potassium, fiber, magnesium, and vitamin E, and of particular concern for adolescent girls is iron intake. Studies have shown that eating habits and nutrition in adolescence can affect not only adult weight but also other health issues later in life. For instance, not eating enough calcium as a teenager can increase a person's risk of developing osteoporosis as an older adult.

Some teens have health conditions that require special diets. According to the Juvenile Diabetes Research Foundation (JDRF), approximately 200,000 US youths under age 20 live with type 1 diabetes. Treatment requires controlling both diet and lifestyle factors, which can be particularly difficult for busy teenagers. Increasing obesity rates have also correlated with a rise in type 2 diabetes among adolescents, which before had primarily been diagnosed in adults. Other factors such as poverty can affect food intake and result in poor health and malnutrition.

Description

Federal dietary guidelines for healthy eating are available for children age two and older. The U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) produce the Dietary Guidelines for Americans, last revised in 2015. The guidelines are based on research and outline advice for choosing a nutritious diet and maintaining a healthy weight. The guidelines include key recommendations for children and adolescents and also address physical activity and food safety. In the 2015 revision, the USDA place emphasis on healthy eating patterns and regular physical activity to help people of all ages achieve and maintain good health and reduce risk of chronic disease. It continues to use MyPlate as a tool to help people of all ages adopt healthy eating patterns.

MyPlate

The food groups in the MyPlate recommendations for adolescents (ages 9–13) include:

Fats and oils are not listed as a separate food group in the MyPlate diagram, but the USDA points out that they do provide essential nutrients and should be included in an individual's diet in limited quantities. Adolescents are allotted approximately 5 tsp. (24.6 mL) per day.

Calcium

Calcium requirements are particularly important for teens, yet studies show that many adolescents fail to get the recommended daily allowance of calcium, which is 1,200–1,300 mg for teens aged 9–18. Calcium helps strengthen bones and teeth and is necessary for bones to reach their peak mineral density to help prevent osteoporosis, a condition characterized by a loss of bone density. Good sources of calcium include low-fat milk, cheese, and yogurt; calcium-fortified cereals; and low-fat pudding.

Iron

Iron requirements are very important for adolescent health and growth. Males need 8–11 mg of iron per day, depending on age. Females require more iron than males due to blood loss during menstruation; requirements range from 8 to 15 mg. Poor intakes of iron can result in iron deficiency anemia, causing symptoms of fatigue and weakness. The best sources of iron are found in the protein group (beef, poultry, fish). Other sources include iron-enriched foods such breads or ready-to-eat cereals, dark green leafy vegetables, and legumes such as peas and beans. Absorption of iron from nonmeat sources can be enhanced by consuming it along with a vitamin-C rich food.

Fluid

Many adolescents do not realize the important role that fluids play in nutrition. It is important to stay hydrated and to limit consumption of high-sugar beverages which can add extra calories but few nutrients to the diet. Caffeine from sodas and coffee drinks can interfere with sleep if consumed late at night, which can be a health and school performance issue. Adolescents should ensure that they drink an adequate amount of water; recommended intakes range from 2.4–3.3 L for males and 2.1–2.3 L for females. Teens who participate in sports especially need to remember to hydrate; some experts say an easy formula is one bottle (16 oz.) of fluid for every half hour of vigorous physical activity.

Physical activity

As with all population groups, teens are encouraged to be active in their daily lives. Teens aged 6–17 years should participate in 60 minutes of physical activity daily, changing to 150 minutes a week after the age of 18. A mix of aerobic, muscle strengthening, and bone strengthening exercises are recommended, including running, cycling, dance, muscle training, football, and gymnastics. Teens who are very active and participate in organized sports will have different nutrition needs than other teenagers of the same age. They will require more fluids while exercising and may require more carbohydrates, which provide energy. Carbohydrates should come from whole grains and fruits rather than from refined sugars. Some extra servings of lean protein may be helpful in building strong muscles, but eating too much of just one food group, rather than eating a balanced diet, is not recommended. According to the Dietary Guidelines, active teens aged 9–18 need between 2,000–3,200 calories per day for males and 1,800–2,400 for females.

Vegetarian diets

Some teenagers follow vegetarian diets. Although parents may worry that a vegetarian diet is harmful for children and teens, with proper planning, teenagers can meet nutritional requirements and achieve adequate growth with a vegetarian diet. Some people make the mistake of substituting meat with unhealthy choices, such as french fries and pizza. An imbalanced diet can result in nutrient deficiencies, leading to side effects such as stunted growth, fragile bones, and stress fractures. Some vegetarian teens may need vitamin supplements to make up for some of the vitamins normally obtained in meats or meat products; a physician or registered dietitian (RD) can help determine the proper type and level of supplement(s) needed. Teenagers should not start taking dietary supplements without first consulting with their physicians or dietitians.

Processed and prepared foods

At home, parents may choose snack and fast foods due to their convenience. Because of increased screen time instead of being physically active and bigger portions, the prevalence of obesity the United States remains high. Some adolescents are receiving and growing accustomed to less nutritional food choices. Highly processed foods can contain large amounts of energy, fats, sugar, and salt (sodium). To avoid relying on unhealthy foods, parents can save time by cooking meals on weekends and freezing them for busy weekdays and looking for cookbooks or online sources of quick and healthy recipes. To reduce fat in a teen's diet, parents and their teenage children can switch to low-fat or nonfat milk; remove skin from poultry or trim fat from red meat; reduce use of margarine and butter; use low-fat cooking methods such as baking, broiling, and steaming; and serve foods rich in fiber such as fruits, vegetables, and whole grains. Fresh salads can improve fiber in diet, as can adding oat or wheat bran to baked foods. Milk, cheeses, tofu, and salmon are good sources of calcium.

School lunches

In recent years, a major emphasis has been placed on improving the nutritional value of all foods and drinks consumed at schools. United States schools generally offer balanced lunches, and since 2014–2015, all snack foods and beverages sold in school stores, vending machines, and snack bars must satisfy commonsense nutrition guidelines. Some schools may not offer physical education classes or the classes may not include enough activity to meet daily recommendations, so adolescents need to ensure that they get enough exercise outside of school hours. Nutrition experts continue to work with educators to help adolescents make healthy decisions around eating and physical activity both inside and outside of the classroom.

Sleep

Getting enough sleep is recognized as being as important for staying healthy as getting enough physical activity and eating well. Getting enough sleep helps people to do well at school and to fight off sickness. Although more research is needed, some evidence has linked lack of sleep with poor dietary patterns and possibly weight gain. For teens between 13 and 18 years old, 8 to 10 hours of sleep each night are recommended.

Calories and weight management

Weight gain is caused by taking in more calories than are expended. By managing portions, eating a balanced diet from the food groups, limiting calories from high-sugar or high-fat foods, and participating in physical activity, adolescents can maintain a reasonable balance between calories in and calories out. Research has shown that subtracting just 100 calories a day from the diet can help manage weight, if needed, which could mean eliminating just one soda per day. Adults need to help teens understand that balanced eating and calorie management help control weight, not unhealthy stretches of fasting or reliance on fad diets. Physical activity also helps manage weight. Encouraging participation in sports or spending time outside with family and friends while limiting screen time can also help manage weight safely.

Children and their parents are cautioned not to turn to fad diets for teenage weight problems. Many diets and diet products on the market have not been proven by clinical studies to be effective in the long term for adults, and so they certainly have not been proven safe or effective as a solution to weight problems in children and teens. Often, teenagers are more susceptible to claims made about diet plans. If weight is becoming a health issue, parents should encourage their teens to talk to a physician or dietician to discuss safe weight-loss plans.

Eating disorders

Repeated fad dieting can be an important predictor of eating disorders among adolescents, especially teenage girls. Adolescents who worry too much about weight and appearance can develop social anxieties and eating disorders such as anorexia nervosa and bulimia nervosa. Anorexia usually occurs in teenage girls and young women who have a greater than normal fear of being fat. People with anorexia eat very little and obsess over the food they do eat. A teenager with anorexia might weigh every bit of food consumed, compulsively count all calories, or exercise excessively to work off calories. The difference between anorexia and normal dieting is the serious compulsion with weight loss and the desire to go beyond being fit and trim to being as thin as possible, no matter the consequences. Warning signs for anorexia include dropping weight to about 20% below the normal range, claiming to feel fat, exercising excessively, withdrawing from social activities, and finding excuses to avoid eating.

Eating disorders lead to poor nutritional status and can affect growth and development for teenagers of both sexes. They rank as the third most common form of chronic illness in adolescents; according to the American Academy of Child and Adolescent Psychiatry, as many as 10% of young women in the United States have some type of eating disorder. Children who are diagnosed with eating disorders should receive therapy to help treat both the disorder and the underlying causes. Nutritional therapy for teens with eating disorders is designed to correct possible malnutrition caused by the eating disorder. Refeeding must be carefully planned to avoid complications brought on by the sudden increase in calories leading to weight gain. The prescribed meal plan will gradually increase in calories as the teen's lean body mass increases.

Some adolescents with diabetes have been known to use doses of insulin below those recommended by their physicians to promote weight loss. This is a very dangerous practice. Teens with type 1 diabetes are encouraged to receive nutritional counseling upon diagnosis and to schedule regular checkups with a dietician. Teens with type 2 diabetes should also be taught how to control blood glucose levels.

Precautions

Like adults, adolescents need to understand that it is best to achieve recommended levels of nutrients through consumption of foods instead of through vitamins and supplements. Use of supplements should be done only under the supervision of a professional medical provider who understands adolescent nutrition needs. Adolescents should understand that the best way to manage weight is through a balanced approach to eating fresh foods and through remaining physically active, not through fasting, use of drugs or supplements, or participation in fad diets.

Complications

Failing to eat a nutritious diet can cause growth and developmental problems in adolescents and long-term complications such as obesity or osteoporosis. Eating disorders can lead to serious complications in teens, including malnutrition, changes in heart function caused by starvation, stomach bleeding, and, in some cases, depression that may lead to suicide. Improper management of diabetes can lead to loss of consciousness and seizures, and in the longer term, eye disease, kidney and heart disease, or nerve damage.

QUESTIONS TO ASK YOUR DOCTOR
Eating disorders

Teens who weigh less than 15% of the normal weight for their height, may not have enough body fat to keep vital organs functioning. When a person is undernourished, the body slows down as if it is starving and blood pressure, pulse rate, and breathing slow. Girls with anorexia often stop having their menstrual cycles. People with anorexia can also experience lack of energy and concentration, as well as lightheadedness. They may become anemic, their bones can become brittle, and they can damage their heart, liver, and kidneys. In the most severe cases, anorexia can result in malnutrition or even death.

The repeated vomiting behavior of bulimia causes constant stomach pain and can damage the stomach and kidneys. Acids from the stomach that enter the mouth when vomiting can cause tooth decay. Teenage girls with bulimia may also stop having menstrual cycles. Constant vomiting may also cause the loss of too much potassium, which in severe cases can lead to heart problems and even death.

Parental concerns

Parents are up against the peer pressures and constant conflicting images that their children get from traditional and social media. Teens see unrealistic images of body types on television, in magazines, and on the internet but are also bombarded with advertisements for processed, convenient, and unhealthy foods.

KEY TERMS
Anemia—
A condition in which the body lacks enough healthy red blood cells to carry adequate oxygen to the body's tissues.
Anorexia nervosa—
A serious eating disorder characterized by extreme weight loss, distorted body image, and fear of gaining weight.
Bulimia nervosa—
An eating disorder in which an individual eats a large amount of food (binges) and then expels the food (purges) to maintain or lose weight.
Malnutrition—
Any disorder of nutrition caused by insufficient or unbalanced diet that can result in impaired absorption or use of foods.
Puberty—
The period of life in which boys' and girls' sexual organs begin to reach maturity and the ability to reproduce begins.

Magazines often feature articles about dieting and weight loss, which if followed obsessively can lead to unhealthy weight-control behaviors. Some internet websites provide advice to teens on how to hide their eating disorders and products that help people with bulimia nervosa in their purging of foods.

Parents can help their teens navigate these messages by promoting healthy habits at home. Teens can be encouraged to snack on healthy foods, and parents can educate their teens about nutrition and the nutrients that are essential for them as they grow. Participating in sports and recreational activities, or at least supplementing television or computer use with activities such as walking the family dog, can help instill long-lasting healthy habits and weight maintenance.

See also Anorexia nervosa ; Bulimia nervosa ; Calcium ; Calories ; Dietary guidelines ; Dietary supplements ; Eating disorders ; Metabolism ; MyPlate ; Obesity ; School lunches ; Sugar .

Resources

BOOKS

Pollan, Michael. Food Rules: An Eater's Manual. New York: Penguin, 2014.

Whitney, Eleanor Noss, and Sharon Rady Rolfes. Understanding Nutrition. 15th ed. Boston, MA: Wadsworth, Cengage Learning, 2019.

PERIODICALS

Larson, N., and D. Neumark-Sztainer. “Adolescent Nutrition.” Pediatrics in Review 30, no. 12 (December 2009): 494–496. http://dx.doi.org/10.1542/pir.30-12-494 (accessed May 6, 2018).

Rehana A. Salam, Mehar Hooda, Jai K. Das, et al. “Interventions to Improve Adolescent Nutrition: A Systematic Review and Meta-Analysis.” Pediatrics in Review 59, 4 Suppl. (October 2016): S29–39

WEBSITES

American Academy of Child and Adolescent Psychiatry. “Eating Disorders in Teenagers.” AACAP.org . https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teenagers-With-Eating-Disorders-002.aspx (accessed May 6, 2018).

Centers for Disease Control and Prevention. “BMI Percentile Calculator for Child and Teen.” U.S. Department of Health and Human Services. https://nccd.cdc.gov/dnpabmi/calculator.aspx (accessed May 6, 2018).

Centers for Disease Control and Prevention. “Healthy Schools: Nutrition Facts.” U.S. Department of Health and Human Services. https://www.cdc.gov/healthyschools/nutrition/facts.htm (accessed May 6, 2018).

Cynthia L. Ogden, Margaret D. Carroll, Cheryl D. Fryar, et al. “Prevalence of Obesity Among Adults and Youth: United States, 2011–2014.” National Center for Health Statistics, U.S. Department of Health and Human Services. https://www.cdc.gov/nchs/data/databriefs/db219.pdf (accessed May 6, 2018).

National Association of Anorexia Nervosa and Associated Disorders. “Eating Disorders Statistics.” ANAD.org . http://www.anad.org/get-information/about-eatingdisorders (accessed May 6, 2018).

National Institute of Diabetes and Digestive and Kidney Diseases. “Taking Charge of Your Health: A Guide for Teenagers.” Department of Health and Health Services. https://www.niddk.nih.gov/health-information/weight-management/take-charge-health-guideteenagers (accessed May 6, 2018).

Nemours Children's Health System. “Eating Disorders.” Nemours Foundation. https://www.nemours.org/service/medical/eating-disorders.html (accessed May 6, 2018).

U.S. Department of Agriculture. “Choose My Plate.” ChooseMyPlate.gov . http://www.choosemyplate.gov (accessed May 6, 2018).

U.S. Department of Agriculture. “For Tweens and Teens.” Nutrition.gov . https://www.nutrition.gov/subject/lifestages/teens/tweens-and-teens (accessed May 6, 2018).

U.S. Department of Agriculture. “Teen Nutrition.” National Agricultural Library. https://www.nal.usda.gov/fnic/teen-nutrition (accessed May 6, 2018).

ORGANIZATIONS

Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Ste. 2190, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www.eatright.org .

American Academy of Pediatrics (AAP), 345 Park Blvd., Itasca, IL, 60143, (847) 434-4000, (800) 433-9016, Fax: (847) 434-8000, http://www.aap.org .

International Food Information Council Foundation, 1100 Connecticut Ave. NW, Ste. 430, Washington, DC, 20036, (202) 296-6540, info@foodinsight.org, http://www.foodinsight.org .

Juvenile Diabetes Research Foundation International, 26 Broadway, 14th Fl., New York, NY, 10004, (800) 533-CURE (2873), Fax: (212) 785-9595, info@jdrf.org, http://www.jdrf.org .

National Eating Disorders Association, 200 W 41st St., Ste. 1203, New York, NY, 10036, (212) 575-6200, (800) 931-2237, Fax: (212) 575-1650, info@NationalEatingDisorders.org, https://www.nationaleatingdisorders.org .

U.S. Department of Agriculture, 1400 Independence Ave. SW, Washington, DC, 20250, (202) 720-2791, http://www.usda.gov .

Teresa G. Odle
Revised by David Newton
Revised by Anne P. Nugent, PhD RNutr

  This information is not a tool for self-diagnosis or a substitute for professional care.