Teens at the Table:
The AMA Weighs in on Nutrition and Young People

Worried that your adolescent eats too much? Too little? All the wrong foods?
The fourth edition of the American Medical Association Family Medical Guide can help you get your teen started down a healthier path.

Hoboken, NJ (April 2005)--How healthy is your adolescent's lifestyle? Many young people go to one of two extremes: either they a) eat a lot of junk food, get little exercise, and end up overweight, or they b) struggle with a negative body image and deprive themselves of needed nutrients in their quest to be model-slim. And even if they fall into neither category, most adolescents (and their parents) have such busy lives that fast food often trumps balanced, nutritious, home-cooked meals. When you consider that the way a young person eats often establishes a lifelong pattern, you'll realize that now is the time to change those habits for good.

If you have any doubt about what--and how much--your adolescent should be eating, look to the AMA. The subject is covered thoroughly in the American Medical Association Family Medical Guide, 4th Edition (Wiley; ISBN: 0-471-26911-5; Cloth/$45.00). Below are some facts and advice excerpted from this indispensable reference book.

A Word about Calories and Young People

    Calorie needs depend on a teen's individual growth rate and physical activity level. During the rapid growth spurt between ages fifteen and nineteen, some boys are able to eat up to 4,000 calories a day without gaining weight. However, once this growth spurt ends, they can quickly gain unwanted pounds that will be difficult to lose as they get older. Girls usually stop growing by age fifteen and tend to be less physically active than boys. Girls (and inactive boys) can easily become overweight if they consume more calories than they burn. Most of the beverages (including soda, fruit juices, and whole milk) that teens drink are also very high in calories.
 
    Many teens have busy schedules that allow little time for nutritious meals. They find it easier to eat fast food meals and processed snacks, which tend to be high in calories and fat. As a result, an increasing number of American teenagers are overweight and beginning to have many of the health problems associated with obesity, including type 2 diabetes, high blood pressure, and early signs of heart disease. Parents have little control over their adolescent's diet outside the home so they should stock up on nutritious snacks--such as fresh fruit and vegetables, low-fat yogurt and cheeses, and whole grains--and resist buying high-calorie processed foods.

Some Basic Nutrition Needs

    Not eating the right foods, eating too much, or not eating enough during adolescence can lead to lifelong health problems or life-threatening diseases such as obesity, cancer, diabetes, heart disease, and osteoporosis. The tremendous physical growth that occurs during puberty requires good nutrition. To meet their energy needs throughout the day, teens should eat at least three healthy meals, including a good breakfast. Teens often eat on the run. A wide variety of healthful foods available at home--such as fresh fruits, low-fat cheeses and yogurt, and cut-up raw vegetables with a low-fat bean dip or salsa--may help keep teens from eating the high-fat, high-sugar, high-calorie foods they normally reach for first. Sodas and diet sodas have little or no nutritional value.

Calcium. Teens, especially girls, need to eat foods that are high in calcium, such as low-fat dairy products, fish with edible bones (such as salmon and sardines), and dark green vegetables (such as collard greens, broccoli, and kale). They should have three or more servings a day of calcium-rich foods. Nearly all of a person's total bone mass is formed by the end of the teen years. Children who don't take in enough calcium may not develop their maximum potential bone mass. Building optimal bone mass by doing weight-bearing exercise and eating foods high in calcium can prevent or delay the onset of the bone-thinning disorder osteoporosis later in life.

Iron. The daily requirement for iron increases dramatically starting at age ten, especially between ages eleven and eighteen, because of increased muscle mass and an expanded volume of blood. Iron can be found in animal foods such as beef, chicken, and turkey (especially the dark meat), or fish. Strict vegetarians can get their daily supply of iron from plant foods such as dried beans, leafy greens, nuts, and dried fruits, but they will have to eat a larger volume of them to get sufficient iron. Adolescent boys need more iron than when they were younger because of their increased growth rate. Girls need even more than boys to replace the iron lost during menstruation. Girls who lose a lot of blood during heavy menstrual periods are at risk of developing iron deficiency anemia. Symptoms of iron deficiency anemia include fatigue, irritability, headaches, and tingling in the hands and feet.

Folic Acid. Folic acid, a B vitamin, is an essential nutrient, especially for girls and women of childbearing age. A deficiency of folic acid during pregnancy can cause neural tube defects such as spina bifida in a fetus. All adolescent girls should get at least 400 micrograms of folic acid every day, either in a supplement (all multivitamin supplements include folic acid) or in food. Good sources of folic acid include green, leafy vegetables, fruit, cheese, legumes, liver, and fortified breakfast cereals and other grain products.

Eating Disorders: An Adolescent Danger

    Being obsessed with their weight or appearance leads some girls, and an increasing number of boys, to develop eating disorders such as anorexia or bulimia. Some teens think they need to be thinner than they should be based on their body build and height. During adolescence, girls often start dieting to lose the additional fat that comes with puberty. Boys usually develop eating disorders as a result of a desire to succeed in sports or to meet a sport's weight requirements.

    Most eating disorders start during adolescence. Having an eating disorder can lead to changes in the body's metabolism, damage to internal organs, and skin and dental problems. Symptoms include fainting, anxiety, dry skin, and fine hair all over the body. In girls who have bulimia, scars may form on the hands or knuckles. Girls who become too thin can stop having menstrual periods.

    Most people who have an eating disorder also have depression or an anxiety disorder. About 40 percent have obsessive-compulsive disorder. Eating disorders can severely and irreversibly harm the body and can be fatal. They can also cause serious psychological problems. In addition to placing tremendous pressure on a person's relationships with family and friends, eating disorders can lead to the following health problems:

 Irregular heartbeat or cardiac arrest
 Heart failure
 Kidney damage
 Liver damage
 Weakened immune system
 Permanent loss of bone mass, leading to bone fractures and osteoporosis
 Infertility (from interruption of the menstrual cycle)
 Anemia
 Malnutrition
 Depression
 Imbalances of electrolytes (sodium, potassium, and other minerals)

    Binge eating also increases the risk of obesity, heart disease, diabetes, and colon cancer. The most common types of eating disorders are binge eating, anorexia, and bulimia.

    If you are concerned that your adolescent is overweight or has an eating disorder, the American Medical Association suggests that you consult a physician. He or she will help you and your adolescent learn the basics of a healthy diet. If your child is overweight, the doctor can help your child develop a weight-loss plan that will include increasing the level of physical activity and adopting other health-promoting habits to follow throughout life. If your child has an eating disorder, the doctor will recommend treatment that is likely to include counseling by a mental health professional. Don't delay. Remember, a healthy relationship with food is a cornerstone of a healthy life--and one of the best gifts you can give your child.