The dietary habits of UK teenagers do not make for good reading. Only 9% of 11-18 year-olds are meeting the ‘five a day’ recommendation for fruit and vegetables. Intakes of saturated fat and free sugars are too high and obesity rates have increased by around 5% among 11-15 year-olds over the past 20 years and are now higher than in those aged 2-10 years.1 While this implies that teenagers consume too much, interestingly, data from the UK National Diet and Nutrition Survey shows that a considerable proportion of 11-18 year-olds have low intakes of a number of vitamins and minerals,2 suggesting that they are making poor dietary choices.
Insufficient nutrient intakes during a period of rapid growth and development like adolescence can impact upon health, both in the short and long-term. For example, more than a quarter of teenagers have low intakes of iron (when split by gender this figure increases to 46% in girls), which increases the risk of iron deficiency anaemia and therefore may impact mood, energy levels and their ability to concentrate at school.3 Evidence of iron deficiency is present in 5% of 11-18 year-old girls.2
Meanwhile skeletal growth and building bone can be impaired by low intakes of calcium and vitamin D, and data shows that more than one-in-10 adolescents are not getting enough calcium and one-in-five have inadequate blood vitamin D levels. Deficiency of these nutrients can result in low bone mass, which increases the risk of osteoporosis in later life.4 Similarly, low intakes of nutrients involved in immune, reproductive and thyroid function, such as selenium, zinc and iodine, are also lacking, particularly in girls, which has the potential to influence fertility and pregnancy outcomes.5-7
So why are dietary intakes so poor in this age group compared with younger children? Is it because adolescentshave more independence and therefore freedom to choose what they want to eat, is there a lack of motivation to choose foods that are healthy due to taste preferences or because they are not perceived to be ‘cool’? Perhaps lifestyle and developmental changes as well as peer pressure during the teenage years make healthy eating a low priority. Exam stress, school moves or family situations may affect dietary behaviour. Additionally, social pressures may lead to heightened body consciousness and the perception to look a certain way, causing some teenagers to develop a negative body image and to adopt unhealthy behaviours (such as dieting and skipping meals) to control their weight.8 This can subsequently lead to a lack of energy and important nutrients but may also have more severe consequences. Body dissatisfactionis associated with the onset of an eating disorder,10 many of which can develop during adolescence.11Recent statistics show that there has been a rise in hospital admissions for eating disorders, with the most common age for admission being 15 and 13 years in girls and boys, respectively.9
It is evident that more must be done to encourage teenagers to incorporate nutrient-rich foods into their diets to support healthy growth and development, and as healthcare professionals you have a role to play. Although, this may prove challenging; teenagers are a notoriously difficult group to motivate in terms messages around health, and there may be less contact time with this age group compared to during early childhood, limiting the available opportunities to discuss such issues. Nonetheless it is still important when possible, to reiterate the importance of consuming a healthy balanced diet, together with plenty of physical activity, and remain vigilant to any behaviours that may indicate, for example, that an eating disorder is manifesting. This is particularly important for teenage girls as they enter childbearing age, because poor nutrient intakes and poor weight management (whether under or over) may have repercussions for their unborn child as well as their own health. So make every contact count!
1. Health and Social Care Information Centre (HSCIC). Health Survey for England 2012. Health, social care and lifestyles. Summary of key findings. hscic.gov.uk/catalogue/PUB13218/HSE2012-Sum-bklet.pdf (accessed 28 October August 2015).
2. Bates B et al. National Diet and Nutrition Survey Results from Years 1,2,3 and 4 (combined) of the Rolling Programme (2008/2009 - 2011/2012). gov.uk/government/uploads/system/uploads/attachment_data/file/310995/NDNS_Y1_to_4_UK_report.pdf (accessed 28/10/15)
3. Ballin A, Berar M, Rubinstein U et al. Iron state in female adolescents. American Journal of Diseases in Children 1992;146(7):803-805.
4. Arthritis Research UK. What causes osteoporosis? arthritisresearchuk.org/arthritis-information/conditions/osteoporosis/causes.aspx (accessed 28 October 2015).
5. Mistry HD, Broughton Pipkin F, Redman CW et al. Selenium in reproductive health. American Journal of Obstetrics & Gynecology 2012;206(1):21-30.
6. Zimmermann MB. The effects of iodine deficiency in pregnancy and infancy. Paediatric Perinatal Epidemiology 2012; 26(Suppl 1):108-17.
7. Walczak-Jedrzejowska R, Wolski JK, Slowikowska-Hilczer J. The role of oxidative stress and antioxidants in male fertility. Central European Journal of Urology 2013;66(1):60-67.
8. Neumark-Sztainer D, Story M, Hannan PJ et al. Weight-related concerns and behaviours among overweight and nonoverweight adolescents: implications for preventing weight-related disorders. Archives of Pediatrics & Adolescent Medicine 2002; 156(2):171-8.
9. Health and Social Care Information Centre (HSCIC). Eating disorders: Hospital admissions up by 8 per cent in a year. hscic.gov.uk/article/3880/Eating-disorders-Hospital-admissions-up-by-8-per-cent-in-a-year (accessed 28 October 2015).
10. Rohde P, Stice E, Marti CN. Development and predictive effects of eating disorder risk factors during adolescence: implications for prevention efforts. International Journal of Eating Disorders 2015;48(2):187-98.
11. BEAT. Eating Disorder Statistics. b-eat.co.uk/about-beat/media-centre/information-and-statistics-about-eating-disorders (accessed 3 November 2015)
Ayela Spiro, Helena Gibson-Moore and Sarah Coe are all nutrition scientists at The British Nutrition Foundation. All three work together to be expert bloggers in the Nursing in Practice nutrition resources centre. Individual descriptions are below:
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