Adolescence is a transitional period. It marks the move into adulthood with intense physical and psychological change. Known for its emotional highs and lows, it's unpredictable and at times confusing behaviors, this age group has an awful lot going on. And, we can blame it all on puberty as growth hormones flood the bloodstream instigating all of the change. Hormone-inspired growth spurts increase height, weight, body shape, and musculature; and all of it requires adequate nutrition. Inadequate nutrition can impact overall growth potential. As with every other age group though, a balanced and varied diet will sufficiently provide for most nutrient needs.
[For the purposes of this series, ages 9 through 18 fall into this stage of life.]
Food Choices
In so many ways, adolescence can be characterized by heavily influenced individuality and independence. As we've discussed in this series, personal food preferences begin early and they BEGIN with influence (peers, social norms, and marketing); however, it is THIS stage that tends to solidify those food choices. Which foods are eaten and when they are consumed become largely controlled by the individual in this age group, and it's actually surprising the amount of factors that are considered when it comes to food choice. One study [Neaumark] aimed to determine how adolescent nutrition could be improved, and found all of the following to be major considerations in regards to food choice:
hunger
food cravings
food appeal
time
convenience
availability
parental influence on eating behaviors
culture/religion
health benefits
mood
body image
habit
cost
media
food beliefs (vegetarian, vegan, etc.)
As food choice becomes a teen's own responsibility, and when all of the above listed factors are taken into account, it is common for cheap, convenience foods and/or "foods on the go" to be predominantly selected. Fruits, veggies and whole grains are most often missed by this age group, and eating behaviors can easily shift toward the unhealthy.
Eating Behaviors
Disordered eating does not always begin at this stage of life (as commonly thought), but it often becomes so incredibly embedded in daily habits that it can become very dangerous. Disordered eating and body image concerns affect both boys and girls. The next special edition post will go further into this topic as adolescence is a prime time for disordered eating. For now, here are some warning signs and symptoms commonly exhibited by those struggling with disordered eating. The list below is NOT exhaustive, and symptoms/warning signs largely depend on the individual (as well as the type of eating disorder).
Warning Signs/Disordered Eating Symptoms:
preoccupation with weight, body image, calories, carbs, fat grams, dieting in general
excessive and/or rapid weight loss
excessive exercise/preoccupation with "burning calories"
frequent bathroom visits after meals
refusal to eat certain foods leading to major diet restrictions/limitations (avoiding whole food groups and/or macronutrients)
seeming uncomfortable eating around others
frequent mirror checks
skipping meals and/or taking too small of portions to support their nutritional need
mood swings
moving from one fad diet to another
noticeable weight fluctuations
menstrual irregularities (or complete loss of cycle)
dizziness/fainting
experiencing cramps and/or other GI complaints
muscle weakness
brittle/thin hair
getting sick often
dental problems
sleep problems
Have you witnessed any of the signs/symptoms, or a combination of behaviors, exhibited in a friend or family member? Do you recognize these behaviors in your own habits? Nutrition Counseling/Therapy are options for support. There are dietitians who are Certified Eating Disorder Specialists (CEDS) who work specifically with individuals struggling with disordered eating behaviors. Finding a healthy, non-adversarial relationship with food can be difficult and intimidating, and it can become harder with time as behaviors build. Help is available.
Macronutrients
Macronutrients are the nutrients the body requires in large amounts. They are what makes up our total caloric intake.
Carbohydrates
NEEDED FOR: Carbohydrates are the brain’s primary choice for energy.
NOTE: Low-carb diets are NOT suggested for adolescents.
AMOUNT: 45 to 65% of total intake (adult levels)
FOODS TO EAT: Complex carbs (whole grains, vegetables, lentils, peas and beans), but also nutrient-rich simple carbs like fruits and 100% fruit juice.
Fats
NEEDED FOR: Dietary fats support normal brain development. Fat also helps cushion and insulate the body, and it supports many body processes.
NOTE: Fats are needed to absorb some vitamins (A, D, E, K).
AMOUNT: 25 to 35% of total intake (adult levels)
FOODS TO EAT: Unsaturated fats (avocados, peanut butter, almonds, walnuts, olive oils, peanut oils, canola oils, flax seed, and salmon).
Protein
NEEDED FOR: Protein is necessary for proper growth and development, especially during childhood.
NOTE: Most adolescents have little difficulty meeting protein needs.
AMOUNT: 10 to 25% of total intake (adult levels)
FOODS TO EAT: Lentils, nut butter, hummus, oatmeal, whole wheat products, salmon, fish sticks, eggs, turkey lunch meat, yogurt, mozzarella string cheese, and even veggies like peas, broccoli, and potatoes.
Calories
*Not a macronutrient, but worth including here.
NEEDED BECAUSE: Calories are the fuel our bodies require to survive.
NOTE: Calorie needs during adolescence are higher than ANY other time of life due to the rapid physical growth and development that occurs at this time. It is the second fastest growth stage after infancy.
NUTRITION TIP: Caloric need is largely dependent on activity level, and this is especially true at this age group as individual needs LARGELY become more evident. The tables below can be used as a guide (not as a rule).
Calories - Girls
Age | Not active | Somewhat Active | Very Active |
9 - 13 Years | 1,400 to 1,600 | 1,600 to 2,000 | 1,800 to 2,200 |
14 - 18 Years | 1,800 | 2,000 | 2,400 |
Calories - Boys
Age | Not Active | Somewhat Active | Very Active |
9 - 13 Years | 1,600 to 2,000 | 1,800 to 2,200 | 2,000 to 2,600 |
14 - 18 Years | 2,000 to 2,400 | 2,400 to 2,800 | 2,800 to 3,200 |
Micronutrients
Micronutrients are the nutrients the body requires in small amounts. Although they are recommended in smaller amounts compared to macronutrients, they are equally essential.
Vitamin A
NEEDED FOR: Vitamin A supports the rapid growth and development occurring at this age.
NOTE: Consuming 5 to 9 servings of fruits and veggies per day will adequately provide for this nutrient need; HOWEVER, this recommendation is often NOT met with this age group.
Calcium
NEEDED FOR: Calcium promotes bone structure. Bone building during this time can increase/decrease a person's risk of osteoporosis and bone fractures later in life.
NOTE: Bone density is nutritionally connected to calcium and vitamin D intake. Read more about bone density below.
NOTE: Girls tend to consume less calcium compared to boys at this age.
NUTRITION TIP: Although dark green veggies are a good source of calcium, children do not consume enough of these vegetables to meet their calcium needs. Some 70% of calcium needs are met through dairy products. Calcium-fortified orange juice, milk alternatives, supplements, etc. can replace dairy.
Vitamin D
NEEDED FOR: Vitamin D is needed for bone growth, hormone production, calcium absorption, and nervous system function.
NOTE: Bone density is nutritionally connected to calcium and vitamin D intake. Read more about bone density below.
NUTRITION TIP: Vitamin D is a fat soluble vitamin which means fat is required to enable absorption of the vitamin through the diet.
Iron
NEEDED FOR: Iron is needed for growth and development, energy production, muscle development, and wound healing.
NOTE: Iron is needed to replace blood loss in girls during menstruation.
NUTRITION TIP: Good sources of heme iron (animal proteins) are lean meats, fish, and poultry. Non-heme iron sources are primarily plant based (peanuts, lentils, peas, and beans, greens and fortified foods), but also include some animal proteins like egg yolks.
NUTRITION TIP: Vitamin C is suggested at the same meals when consuming non-heme iron sources as this will help increase absorption.
Fiber
*Not a micronutrient, but worth including here.
NEEDED FOR: At a minimum, fiber is needed for digestive health. Looking at the big picture, fiber efficiently assists in the removal of waste from our body and provides nourishment for the gut microbiome, both of which greatly impact our overall health.
NOTE: 91% of adolescence do not meet fiber recommendations. Fiber recommendations at this age are the same for adults. Girls = 26g days; Boys = 38g day
NUTRITION TIP: Fruits, veggies and whole grains are most often missed by this age group.
Additional Nutrition Related Considerations
Adult-Sized Health Risks
What & Why
Adolescents are at risk for the same chronic diseases faced by adults (type 2 diabetes, coronary heart disease)
Inadequate nutrition (decreased intake of fruits, veggies, whole grains while simultaneously consuming + increased intake of sugar sweetened beverages) LARGELY influences risk of chronic diseases in both adolescents and adults. [Mandoh; 2020]
Physical inactivity LARGELY influences risk of chronic diseases in both adolescents and adults.
Chronic diseases LARGELY influence quality of life, especially as individuals age.
Tips
Chronic diseases are LARGELY preventable. Establishing healthy behaviors to prevent chronic disease is easier and more effective during childhood and adolescence than trying to change unhealthy behaviors during adulthood. [CDC]
Eat healthy - A balanced, healthy dietary pattern includes a variety of fruits, vegetables, whole grains, lean protein, and low-fat dairy products and limits added sugars, saturated fats, and sodium. [CDC]
"People with healthy eating patterns live longer and are at lower risk for serious health problems such as heart disease, type 2 diabetes, and obesity. For people with chronic diseases, healthy eating can help manage these conditions and prevent complications." [CDC]
Don't smoke. Don't start.
Be active. Regular physical activity can prevent or delay the development of high blood pressure, and reduces blood pressure in persons with hypertension. Regular physical activity is also important for maintaining muscle strength, joint structure, joint functioning, and bone health.
Limit drinking. Moderate to excessive drinking can greatly impact quality of life and overall health.
Bone Density
What & Why
Bone density is the amount of bone mineral found in bone tissue. It can determine overall bone strength, and susceptibility to fractures/breaks and bone disease later in life.
Peak bone mass is LARGELY complete by late adolescence. This bone structure is what we rely upon for all of our adult years.
Adolescence is a CRITICAL window for bone building.
WARNING: Severely restricting food intake during adolescence and young adulthood, and being underweight (and/or extremely thin) weakens bones. This also means less bone mass will be available during adult years.
A Bone Mineral Density (BMD) test measures bone health. A DEXA scan, is a type of low-dose x-ray test that measures calcium and other minerals in your bones to determine bone strength.
Tips
Nutrition - Adequate calcium and vitamin D contributes to bone strength and decreases risk of early bone loss and fractures.
Physical Activity - Bones and muscles both become stronger when we use them! The best kind of activity for bone building are weight-bearing activities like walking, running, hiking, dancing, tennis, basketball, gymnastics, and soccer. Body resistance exercises (push ups, pull ups, lunges, etc.) and lifting weights also strengthens bones.
Athletics
What & Why
As noted in the calorie needs above, nutritional need (calories and nutrients) is largely dependent on activity level, and this becomes especially true for this age group as individual needs become much more established.
Nutrition is integral to athletic performance, BUT high school athletes often "underfuel" or commit to unhealthy eating behaviors based on proposed sport "norms" and peer misinformation.
"Underfueling", and focusing too much on specific food groups, leaves young athletes susceptible to injury, burnout, long recovery, and are potentially incapable of performing at higher levels of competition.
Tips
Fuel properly - Eat, if you want to compete. This means eating intentionally to fuel practices and competition. Although main meals (breakfast, lunch, dinner) are important, so are snacks before and after practice/competition.
Choose foods wisely - A balanced and varied diet gives individuals the best shot they have at fueling their body with essential nutrients (macros and micros).
Include all the colors - When building meals and snacks remember to select fruits, veggies, and whole grains of different colors. "Eating a rainbow" supports a diverse nutrient intake.
Hydration is just as important as eating. Not only do you need fluids to help with digestion and body temperature, it is absolutely essential that fluid loss (via sweat, yelling) is replaced.
Keep a range of satisfying snacks in lockers, backpacks, cars, etc.
Skip the supplements, especially anything hormone related. Learn more about anabolic steroid use and the related risks for teens.
Watch Companion Video Here!
Other Nutrition Through The Ages Posts!
Nutrition Through The Ages: Special Edition - Lactation *Guest Author*
Nutrition Through The Ages: Special Edition - Child-Directed Marketing *Guest Author*
Nutrition Through The Ages: Special Edition - School Nutrition 101 *Guest Author*
Nutrition Through The Ages: Special Edition - Disordered Eating and Eating Disorders
Nutrition Through The Ages: Special Edition - Orthorexia (Clean Eating)
Nutrition Through The Ages: Special Edition - Drug/Nutrient Interactions *Guest Author*
Resources
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“A Teenager’s Nutritional Needs.” HealthyChildren.Org, https://www.healthychildren.org/English/ages-stages/teen/nutrition/Pages/A-Teenagers-Nutritional-Needs.aspx. Accessed 9 July 2022.
Carey, Dennis E., and Neville H. Golden. “Bone Health in Adolescence.” Adolescent Medicine: State of the Art Reviews, vol. 26, no. 2, Aug. 2015, pp. 291–325.
CDC. “Promoting Health for Children and Adolescents.” Centers for Disease Control and Prevention, 23 May 2022, https://www.cdc.gov/chronicdisease/resources/publications/factsheets/children-health.htm.
Commissioner, Office of the. “Teens and Steroids: A Dangerous Combo.” FDA, Jan. 2022. www.fda.gov, https://www.fda.gov/consumers/consumer-updates/teens-and-steroids-dangerous-combo.
Everything You Wanted to Know About Puberty (for Teens) - Nemours KidsHealth. https://kidshealth.org/en/teens/puberty.html. Accessed 9 July 2022.
How Many Calories Does My Teen Need? https://www.eatright.org/food/nutrition/dietary-guidelines-and-myplate/how-many-calories-does-my-teen-need. Accessed 9 July 2022.
“How to Keep Your Bones Healthy.” Mayo Clinic, https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/bone-health/art-20045060. Accessed 9 July 2022.
How You Can Prevent Chronic Diseases | CDC. 23 May 2022, https://www.cdc.gov/chronicdisease/about/prevent/index.htm.
Interactive Nutrition Facts Label.
https://www.accessdata.fda.gov/scripts/interactivenutritionfactslabel/vitamins.cfm. Accessed 29 Mar. 2022.
Kids and Their Bones: A Guide for Parents | NIH Osteoporosis and Related Bone Diseases National Resource Center. https://www.bones.nih.gov/health-info/bone/bone-health/juvenile#:~:text=The%20two%20most%20important%20lifelong,ensure%20optimal%20peak%20bone%20mass. Accessed 9 July 2022.
Life Stages | MyPlate. https://www.myplate.gov/life-stages. Accessed 17 Feb. 2022.
Loud, Keith J., and Catherine M. Gordon. “Adolescent Bone Health.” Archives of Pediatrics & Adolescent Medicine, vol. 160, no. 10, Oct. 2006, p. 1026. DOI.org (Crossref), https://doi.org/10.1001/archpedi.160.10.1026.
Mandoh, Mariam, et al. “Adolescent Participation in Research, Policies and Guidelines for Chronic Disease Prevention: A Scoping Review Protocol.” International Journal of Environmental Research and Public Health, vol. 17, no. 21, Nov. 2020, p. 8257. PubMed Central, https://doi.org/10.3390/ijerph17218257.
Neumark-Sztainer, Dianne, et al. “Factors Influencing Food Choices of Adolescents.” Journal of the American Dietetic Association, vol. 99, no. 8, Aug. 1999, pp. 929–37. DOI.org (Crossref), https://doi.org/10.1016/S0002-8223(99)00222-9.
“Physical Activity Fundamental To Preventing Disease.” ASPE, https://aspe.hhs.gov/reports/physical-activity-fundamental-preventing-disease-0. Accessed 9 July 2022.
RED-S | Boston Children’s Hospital. https://www.childrenshospital.org/conditions/red-s. Accessed 9 July 2022.
“The Problem with Nutrition and High School Athletics.” The Tower - 93rd Year, https://thetowerphs.com/2021/04/sports/the-problem-with-nutrition-and-high-school-athletics/. Accessed 9 July 2022.
Thompson, Janice, et al. The Science of Nutrition. 2nd ed., Student ed, Pearson Benjamin Cummings, 2011.
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What Are Eating Disorders. www.nationaleatingdisorders.org. Accessed 12 July 2022
Why It Matters | Nutrition | CDC. 25 Jan. 2021, https://www.cdc.gov/nutrition/about-nutrition/why-it-matters.html.
Good post. Wish I cared more when I was younger!