Adolescence

• It is a transition period of human development that occurs between childhood and adulthood (13 to 19
years old). (book)
• This stage is one of the most rapid phases of development. (WHO, 2017)
• Adolescence begins at puberty, which now occurs earlier, on average, than in the past. (Cleveland
Clinic, n.d.)
• Adolescents are also developing socially and emotionally during this time. The most important task of
adolescence is the search for identity or in Erik Erikson’s Stages in Psychosocial Development.
(Cleveland Clinic, n.d.)
Nutrition of Adolescence
 Calories
- Boys require an average of 2,800 calories per day while girls need an average of 2,200 calories per
day. (Healthy Children, n.d.)
 Protein
- Teens 14 to 18 years need about 0.85 grams of protein for each kilogram of body weight. In
practical terms, this means that a 14 to 18 year old who weighs 61 kilograms (135 lbs) needs about
52 grams of protein each day. (Atchisa, 2017)
The densest sources of protein include teenage favorites such as:
• Beef • Eggs • Chicken
• Turkey • Cheese • Fish
• Pork

• Vitamins
– Allowance for Vitamin A is the same for all levels. Vitamin C allowance is constantly higher among
boys than among girls aged 16 to 19 years. Compared to their female counterparts, the older male
adolescents have higher recommended allowance for vitamin A, thiamine, riboflavin, niacin, and
vitamin C. (book)
• Minerals
– The recommended calcium allowance of the 13 to 15 age group is higher (700 mg) compared to the
16 to 19 age group (600 mg). (book)

Nutritional Problems of Adolescence and Interventions

• Low intake of calcium, Vitamin A, and • Underweight
Vitamin C • Skin problems
• Low intake of iron in girls

Obesity
 • Defined as a body mass index (BMI) equal to or greater than the 95th percentile for age and gender.
(Levy, 2019)
• Adolescents whose BMI is in the top 5% for their age and gender are considered obese. Being in the
top 5% means their BMI is higher than 95% of their peers (at or over the 95th percentile). (Levy, 2019)
• Obesity is twice as common among adolescents as it was 30 years ago. Obese adolescents are more
likely than their peers to have high blood pressure and type 2 diabetes. (Levy, 2019)

Intervention
• Overweight and obese teens should check with their doctor or dietitian about their individualized
calorie needs to move toward a healthier body weight.
• Calorie intake can be reduced by establishing a well-balanced diet of ordinary foods and making
permanent changes in eating habits.
• Calorie burning is increased by increasing physical activities
Anemia
• When the number of RBC in the body gets too low. (Miller, 2019)
• Red blood cells carry hemoglobin, a protein that carries oxygen throughout the body. Without enough
of them, the organs can’t work normally. (Miller, 2019)
• Iron-deficiency Anemia can cause teens to become sluggish, tired, and weak and have slower cognitive
development, decreased immune function and show a decrease in performance at school. (Coleman,
2018)
Intervention
• The recommended dietary allowance for iron is 11 milligrams for teen boys and 15 milligrams daily for
teen girls.
• Iron-rich foods for teens include lean red meats, poultry, fish and other seafood, egg yolks, raisins,
spinach, legumes and iron-fortified breads and cereals.
• Taking iron supplements
Nutritional problems related to:
• Psychological Factors – food aversions and emotional problems
• Crash diets/Fear of becoming overweight
• Food Diets
• Poor choice of snack foods
• Irregular eating pattern
• Additional stress of pregnancy
Eating Disorders
Anorexia nervosa
• it generally develops during adolescence or young adulthood and tends to affect more women than
men.
• People with anorexia generally view themselves as overweight, even if they’re dangerously
underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and
severely restrict their calories.
 • Such individuals may also have difficulty eating in public and exhibit a strong desire to control their
environment, limiting their ability to be spontaneous.
• Two subtypes — the restricting type and the binge eating and purging type
• Anorexia can be very damaging to the body. If left untreated, anorexia can lead to serious
complications such as malnutrition and organ failure.
S/x:
• Dramatic weight loss
• Wearing loose, bulky clothes to hide weight loss
• Preoccupation with food, dieting, counting
calories, etc.
• Refusal to eat certain foods, such as carbs or fats
• Avoiding mealtimes or eating in front of others
Anorexia Nervosa Meal Plan
• The preferred meal plan model for anorexia
nervosa recovery is the exchange system. It
is often used in hospital, residential and
outpatient eating disorder recovery
treatment. Originally designed for patients
with diabetes, the system is versatile in
recovery because it takes into consideration
macronutrient proportions (protein,
carbohydrate, fat) without a direct focus on
calories. An illustrative 3,000-calorie
Exchange System Meal Plan for a day might
comprise 12 starch, 4 fruit, 4 milk, 5
vegetables, 9 meats, and 7 fats.
A daily regimen might divide the exchanges into
meals and snacks as follows:
• 2 slices of toast (2 starch exchanges) with 1 tsp.
butter (1 fat exchange)
• 2 scrambled eggs (2 meat exchanges) made with
2oz whole milk plus 6oz of whole milk on the
side to drink (total-1 milk exchange),
• 4 oz of orange juice & 1/2 cup fruit salad (total –
2 fruit exchanges)
Bulimia Nervosa
• Preparing elaborate meals for others but refusing
to eat them
• Exercising excessively
• Making comments about being “fat”
• Stopping menstruating
• Complaining about constipation or stomach pain
• Denying that extreme thinness is a problem
Lunch: 2 Starch, 2 Vegetable, 3 Meat, 2 Fat, 1 Milk
• Grilled cheese sandwich: 2 slices of bread (2
starch exchanges), 2 tsp butter (2 fat
exchanges), 3 slices of cheese (3 meat
exchanges)
• Tomato soup (1 cup tomato soup condensed-2
vegetable exchanges) made with 1 cup whole
milk (1 milk exchange)
Other Weight Gain Strategies In order to increase
caloric intake to achieve a steady weight gain
course, you can always remember some simple
tactics:
• Increase the frequency of eating (from three
times per day to six times per day)
• Increase the actual portion size
• Increase caloric density (add fat while cooking
such as oil, butter, cream, cheese which can
increase calories without increasing portion size)
• Increase the actual portion size
• Increase caloric density (add fat while cooking
such as oil, butter, cream, cheese which can
increase calories without increasing portion size)
• Bulimia is from a Greek word meaning “ox
hunger”
• Tends to develop during adolescence and
early adulthood and appears to be less
common among men than women
• This disorder involves episodes of rapid
consumption of a large amount of food,
followed by compensatory behavior, such
as vomiting, fasting, or excessive exercise to
prevent weight gain.
• Side effects of bulimia may include an
inflamed and sore throat, swollen salivary
glands, worn tooth enamel, tooth decay,
acid reflux, irritation of the gut, severe
dehydration, and hormonal disturbances -
In severe cases, bulimia can also create an
imbalance in levels of electrolytes, such as
sodium, potassium, and calcium. This can
cause a stroke or heart attack.
• In bulimia, binges typically occur in secret;
they may be triggered by stress and the
negative emotions. It arouses, and continue
until the person is uncomfortably full.
• The DSM defines a BINGE as eating an
excessive amount of food within less than 2
hours.
• The DSM diagnosis of Bulimia Nervosa
requires that the episodes of binging and
purging occur AT LEAST TWICE A WEEK FOR
3 MONTHS.
• “BULIMIA NERVOSA IS NOT DIAGNOSED IF
THE BINGING AND PURGING OCCUR ONLY
IN THE CONTEXT OF ANOREXIA NERVOSA
AND ITS EXTREME WEIGHT LOSS; THE
DIAGNOSIS IN SUCH A CASE IS ANOREXIA
NERVOSA, BINGE-EATING-PURGING TYPE.
INDEED, ONE STRIKING DIFFERENCE
BETWEEN ANOREXIA AND BULIMIA IS
WEIGHT LOSS: INDIVIDUALS WITH
ANOREXIA NERVOSA LOSE A TREMENOUS
AMOUNT OF WEIGHT WHEREAS
INDIVIDUALS WITH BULIMIA DO NOT.”
(Davison, 2007)
Two types of Bulimia Nervosa
• Purging Type: during the current episode of
Bulimia Nervosa, the person has regularly
engaged in self-induced vomiting or the
misuse of laxatives, diuretics, or enemas.
• Nonpurging Type: during the current
episode of Bulimia Nervosa, the person has
used other inappropriate compensatory
behaviors, such as fasting or excessive
exercise, but has not regularly engaged in
self-induced vomiting or the misuse of
laxatives, diuretics, or enemas.
TREATMENTS:
• The overall goal of treatment in bulimia
nervosa is to develop normal eating
patterns.
• Patients need to learn to eat 3 meals a day
and even some snacks in between meals
without sliding back into binging or purging.
• Consult a nutritionist to learn about
healthy, low-calorie foods that can sooth
your cravings without making you gain
weight.
• The key to eating a healthy, balanced diet is
to not deprive yourself of a certain food
groups (such as fats or carbohydrates).
• 1/3 of your diet should consist of starchy
carbohydrates. Carbohydrate is the body's
predominant source of energy.
• 1/3 of your diet should consist of fruit and
vegetables. The government recommends
Binge eating disorder
• They typically eat unusually large amounts
of food in relatively short periods of time
and feel a lack of control during binges.
• People with binge eating disorder do not
restrict calories or use purging behaviors,
such as vomiting or excessive exercise, to
compensate for their binges
• People with binge eating disorder often
have overweight or obesity. This may
increase their risk of medical complications
linked to excess weight, such as heart
disease, stroke, and type 2 diabetes
OTHER DISORDERS
• DSM-5: Other Specified Feeding or Eating Disorders (OSFED)
- for disorders of eating that do not meet the criteria for any specific eating disorder.
we aim to eat 5 portions of fruit and
vegetables every day.
• The remaining 1/3 of your diet should
consist of dairy and protein. This can
include milk, cream, cheese, meat, fish,
nuts, beans and eggs.
• Avoid saturated fats from processed foods-
these are high in cholesterol and increase
the risk of fatty build-up in the arteries
leading to cardiovascular disease.
•  Avoid calorie restriction. - the researchers
discovered that over the long-term, mice
who underwent calorie restriction
demonstrated an increase in binge eating
when subjected to stress. Being too
restrictive with a BED recovery meal plan
could have the opposite intended effect and
put you at risk.
S/X:
• Eating unusually large amounts of food in a
specific amount of time, such as over a two-
hour period.
• Feeling that your eating behavior is out of
control
• Eating even when you're full or not hungry
• Eating rapidly during binge episodes
• Eating until you're uncomfortably
full.disgusted, ashamed, guilty or upset
about your eaieting, possibly without
weight loss
How is BED diagnosed?
• To be diagnosed, a person must have had at
least one binge eating epeisode per week
for a minimun of three months.
 - Atypical Anorexia Nervosa
- Subthreshold Bulimia Nervosa
- Binge-eating disorder (of low frequency or limited duration)
- Purging disorder
- Night eating syndrome
• Avoidant Restrictive Food Intake Disorder (ARFID)
• Unspecified Feeding or Eating Disorder (UFED)
Nursing Interventions
• Perform complete nursing assessment noting skin, muscle tone and neurological status; include weight
(BMI) and vital sign assessment
•  Assess nutritional status and set a weight goal.
• Assess client for depression and suicide potential
• Supervise client during meals and for at least one hour after eating (in inclient treatment) 
• Encourage liquid intake over solid foods.
• Provide small meals and snacks appropriately
• Outline the risks of laxative, emetic, and diuretic abuse for the patient.
• Identify the patient’s elimination patterns.
•  Monitor for signs of food hoarding or disposing of food.
• Monitor exercise program and set limits and goals accordingly
• Administer TPN supplemental nutrition as appropriate
• Monitor fluid balance and administer oral and IV fluids as appropriate
• Record routine weights per facility protocol
•  Monitor skin for wounds, dryness, excoriation or deep tissue injuries
• Provide education for clients and family members regarding disease, treatment and support resources
DAILY FOOD GUIDE FOR ADOLESCENT
Food Groups Recommended Amounts
13 – 15 years 16 – 19 years
Rice and Rice and others  6 – 7 cups, 6 ½ - 8 cups,
alternatives cooked cooked
1 serving of rice or alternative = 1 cup
rice, cooked, or 4 pcs pan de sal/ 4 slices
of loaf bread (about 17 g each), or 1 cup
macaroni or spaghetti, cooked or 1 pack
instant noodles, or 1 small-sized root
crop, 180 g
 Meat and Fish/Meat/Poultry/Dried beans/Nuts    
alternatives      
1 serving of fish = 2 pcs (55-60g) each    
about 16 cm long; 1 serving of 2 ½ servings 2 ½ servings
meat/poultry = 30g lean meat, cooked,    
or 1 ½ cups cooked dried beans,    
preferably taken at least 3 times a week    
     
Egg    
     
Milk    
1 glass = 240 mL (1 glass whole milk is    
equivalent to 4 tbsp powdered whole 1 medium size 1 medium size
milk or ½ cup evaporated milk diluted in 3 – 4 times a 3 – 4 times a
water to make 1 glass of milk week week
1 glass 1 glass
Vegetables Green leafy and yellow vegetables ¾ cup, cooked ¾ cup, cooked
     
Others    
¾ cup, cooked ¾ cup, cooked
Other 2 servings fruit and ½ cup cooked 2 servings fruit 2 servings fruit
Fruits and vegetables and ½ cup and ½ cup cooked
vegetables cooked vegetables
vegetables

• This plan is therefore aimed both at parents of teenagers who have a responsibility to ensure that the
adolescent eats a good food, and at teenagers themselves – they may well be searching on the internet
for good, healthy meal plans including food choices that they like.