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INTRODUCTION

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  • How can I safely and successfully intervene when an adolescent’s weight gain is escalating?

  • What background information do I require about adolescents and their unique needs in order to help them make healthy lifestyle changes?

  • What are the circumstances that facilitate behavior change for adolescents?

  • What interventions are appropriate in the primary care setting for adolescents with obesity, and when might I need to refer for specialty or more intensive treatment?

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This chapter will address the following American College of Graduate Medical Education competencies: interpersonal and communication skills, professionalism, and systems-based practice.

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Interpersonal and Communication Skills: Skills that enhance effective exchange of information and collaboration with teens and families are particularly important in adolescence as teens are increasing their decision making. This chapter will help pediatric health care providers enhance their communication skills around making healthy lifestyle changes with adolescents and their families.

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Professionalism: This chapter will help pediatric health care providers provide teen care that is individualized, evidence based, compassionate, and family centered by focusing on commitment to professional responsibilities, ethical principles, sensitivity to diversity, and values of respect, compassion, and kindness.

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Systems-Based Practice: This chapter will help pediatric health care providers caring for adolescents demonstrate an awareness of the larger system of health care delivery and ability to interact with the system to optimize teen outcomes.

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NORMAL EATING AND ADOLESCENT NUTRITION

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The onset of puberty and emergence into adolescence presents increased nutrition risk due to dramatic changes in physical, cognitive, and emotional development. There is increased demand for most nutrients due to pronounced linear growth and increases in muscle mass, vascular system, adipose layers, and bone density.1 At the same time, lifestyle changes—increased reliance on peers, greater independence in food choice, availability, and increased activity—add a level of complexity in helping an adolescent meet his or her needs.2

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In an ideal situation, the teen will be able to gradually emancipate from the feeding relationship that has been developing since infancy and begin to meet his or her nutrition needs independently. That said, special situations in which the teen may need some additional guidance and support include vigorous sports and physical training, female athlete triad, excessive dieting, eating disorders, obesity, pregnancy, drug and alcohol use, lifestyle diets (eg, vegetarian), and chronic illness.1,3

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Primary risks of undernutrition

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The special situations mentioned above often include an inadequate intake of nutrients, including energy (calories). The risks associated with undernutrition include delayed puberty, amenorrhea, decreased bone mineralization, bradycardia or tachycardia, growth stunting, iron deficiency, and dehydration.1,3

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Fad diets and unhealthy weight control practices

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In order to lose or control weight, adolescents may engage in unhealthy weight control practices such as dieting, food restriction, skipping meals, using diet pills, and vomiting.1 It ...

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