Negative Adolescent Nutrition Trends and the Protective Effects of Family Meals

By Abby Miller

April 9, 2013 NDFS 424

Abstract Current Adolescent diets in America are alarmingly poor. This paper seeks to investigate current trends in the adolescent American diet, the reason behind negative nutrition trends, and successful interventions against these trends. Data for this paper was collected through the Harold B. Lee Library Database. Many studies are showing that although calorie consumption among American teens is on the rise, intakes of fruits, vegetables, whole grains, and dairy are dangerously low and falling. The reasons for these changes are complex, but data shows strong correlations between poor home involvement and a poor diet. Research suggests that the solution to poor adolescent diets lies in the home. Increased family meals and food security are the most successful interventions in the adolescent diet.

Introduction Obesity rates have reached epidemic proportions in the American population.1 Concurrently disease rates of cancer, hypertension, diabetes, and cardiovascular disease are rising.1 Often these diseases are associated with a poor diet.1 Each food group adds essential nutrients to the diet which aid in chronic disease prevention.2,3,4 It is predicted that 35% of cancer rates are related to poor diet, including low fruit and vegetable intake.2 Calcium is the key component to osteoporosis prevention; in the typical American diet 65-70% of calcium intake comes from dairy products.3 During adolescents bones grow quickly, and it is important to build calcium stores at that time.3 Whole grains are a great source of fiber. Fiber can reduce cholesterol and promote gastrointestinal health.4 In addition to poor nutrition, many adolescents suffer from eating disorders and chronic dieting which often leads to malnutrition or sometimes to increased BMI values.5 In order to understand where adolescent diets are lacking, this paper will investigate consumption of fruits, vegetables, dairy, and whole grains, dieting patterns among the teenage population of the United States. Knowing about the negative health trends among teens is of little importance without an understanding of why these trends are occurring, and how they can be reversed. Analysis of the Minnesota Adolescent Health Survey (MAHS) has helped to pinpoint significant correlations between emotional, economic, and demographic states and balanced diets.6 Attempted interventions among teen diets vary widely, however having family meals has been the most consistent and successful intervention.6,7,8 Methods The referenced journal articles in this paper were found using the extensive Herold B. Lee Library database. The advanced search tool was used to run three separate searches. The first search was for adolescent nutrition trends; the search was narrowed by specifying that all three terms be found in the title, and by specifying that articles were published after 2007. This search yielded 8 results. From these results it was found that Project Eating Among Teens (Project EAT) included relevant data on teen nutrition. Consequently the second search in the advanced search was Project Eating Among Teens; this search was narrowed by specifying that this study be found in the title and that the results only included articles published within the last 10 years. This search yielded 10 results. Further sources were found through references in original sources. Results/Discussion Adolescent Trends Many adolescents are not meeting their requirements for fruit and vegetable consumption.9 In 1996 the MAHS Survey found that 28% of adolescents reported eating fruit less than once per day and 38% reported consuming vegetables less than once per day.2 From 1999 to 2004 adolescents decreased their average fruit and vegetable intake by 0.7 and 0.45 servings per day among females and males respectively.10 In another study among 20,000 students, 70% of teens reported that they had not eaten a vegetable in the previous day.11 Data from Project EAT, an additional longitudinal study, indicated that adolescent intake of fruits and vegetables declines sharply with age.10 As teens transition from early to middle adolescence,
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their combined fruit and vegetable intake decreased by 1.5 servings per day.10 During the transition from middle to late adolescents, fruit and vegetable intake decreased by another 0.6 servings.10 Collectively these results show that over the last decade teens have not consumed enough fruits or vegetables, and that their intake is continuing to drop at an alarming rate.10 Whole grain consumption has reached alarmingly low levels among adolescents. According to Project EAT, 11% of males and 13% of females reported eating more than one serving of whole grain per day.4 Between 1999 and 2004, intake of whole grains remained stable although the sources of these grains changed. Teens are now eating more whole wheat breads.4 However this increase is counterbalanced by a decrease of both cooked whole-grains and wholegrain cereal consumption.4 Although no significant decline has been seen in whole grain consumption over time, the fact that about 88% of teens are not consuming more than one serving of whole grains per day is alarming. Another vital food group that is usually far too low among teens is the dairy group.3 The dairy food group supplies 65%-70% of the calcium in a typical American diet, and teens are especially in need of calcium for healthy bone development.3 If calcium intake and bone development increase among teens, the prevalence of osteoporosis could be greatly decreased in future generations.3 According to the National Health and Nutrition Examination Survey only 10% of adolescent girls are meeting the AI for calcium.12 Men traditionally consume more calcium than women; still 58% of adolescent males do not meet their recommendation.12 The AI for Vitamin D, another nutrient supplied by the dairy group, was only met by 50% and 25% of adolescent males and females respectively.12 Despite a recent surge in calcium and vitamin D fortified foods, American teens are not meeting their needs.3 As teens eat less nutrient rich and more calorically dense foods, they are gaining weight. Unfortunately many adolescents are turning to extreme diets and even developing eating disorders as they try to counter their weight problems. According to Project EAT, 43.7% of adolescent females and 18.7% of males reported using unhealthy measures to manage weight.5 These measures included fasting, using diet pills, using food replacements, laxatives and even vomiting.5 In addition 37.8% of girls reported persistent dieting.5 It was also found that adolescents who participated in unhealthy dieting behaviors had a larger increase in BMI overtime than those who did not.5 Not only are teens going to unhealthy measures to lose weight, but these attempts are ineffective in weight management.5 Home Influence Several studies indicated that home habits and conditions are the most powerful influence on the teen diet.6,13 Part of the home environment is socioeconomic status (SES). According to MAHS, SES correlates strongly with adolescent nutrition.6 Those with a low SES are less likely to consume adequate fruits and vegetables, more likely to be overweight, and more likely to develop eating disorders than girls who have a high SES.6 Girls who have high socioeconomic status are more likely to diet.6 Reasons for these differences are believed to include food variety available in the home, and education.6 Studies have shown that higher levels of parental education are associated with higher adolescent intake of fruit, vegetables, and dairy.11 Low
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socioeconomic status is often tied to food insecurity.6 In homes with poor food security, attaining fruits and vegetables is a challenge.6 Studies have shown that availability ranks second, only to taste, in influencing the amount of fruits and vegetables consumed by adolescents.9 Because food insecurity prevents the availability of these two essential food groups in the home, it is suggested that community efforts to increase availability and affordability of fruits and vegetables to families could be one of the best interventions for teen health.9 Family meals and connectivity play important roles in adolescent health.14 Currently 1/3 of adolescents report eating less than three family meals per week.13 One study used adherence to my pyramid as a standard for diet measurement.14 This study found that increased meals and snacks from the home increased pyramid scores.14 Another study found that students who consumed more than three evening meals per week with their family were 20% less likely to have low fruit, vegetable, and dairy intakes, than those who had less than three evening meals with their family.11 These students were also less likely to skip breakfast.11 It is possible that the decrease in adolescent fruit and vegetable consumption from early to late adolescence is related to the finding that older adolescents are less likely to eat meals with their parents.11 Interestingly parental presence in the home is not enough; positive nutrition changes were only seen when evening meals were eaten with parents.11 In one study the adolescents general conformity to their parents was positively correlated to a more balanced diet.14 This is how easily the teens will listen and respond to parental advice.14 Similar Findings in the MAHS showed a strong correlation between family connectedness (defined as perceived level of caring and communication within the family) and a balanced diet.6 It was reported that 49% of students with low family connectedness ate less than one fruit or vegetable serving per day, compared to 28% of students with high family connectedness.6 Family connectedness is an important factor in preventing unhealthy dieting habits, as is eating as a family.6,7 Studies have shown that family meals are protective against unhealthy dieting and disordered eating behaviors.7 After adjusting for SES it was found that family meals were inversely associated with disordered eating and unhealthy diet patterns.7 When evaluating extreme weight control practices among female adolescents it was found that girls who participated in 3-4 family meals per week had 1/3 of the risk for eating disorders compared to girls without family meals.7 Girls with 5 family meals were at of the risk.7 Data from Project EAT supports these finding.10 In addition girls who participated in family meals were less likely to participate in unhealthy weight loss measures after five years.8 Conclusion The average American adolescent has an alarmingly poor diet.1-14 These dietary shortfalls are due to several factors but research shows that the most powerful indicator of teen nutrition lies in the home.6,7,14 If negative dietary trends are to be reversed it will take intervention at a community level to help families improve their access to fruits, vegetables, whole grains, and dairy.9 In addition it will require increased education to parents on the importance of their role in their childs diet.6,11,14 Ultimately improvement of the American adolescent diet will require a change within the home.
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References

1. The Surgeon General's call to action to prevent and decrease overweight and obesity. Rockville, MD; US Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001. 2. Blum RW. Correlates of inadequate fruit and vegetable consumption among adolescents. Preventive Medicine. 1996;25(5):497-505. 3. Rafferty K, Watson P, Lappe JM. The selection and prevalence of natural and fortified calcium food sources in the diets of adolescent girls. J Nutr Educ Behav. 2011;43(2):96-102. 4. Burgess-Champoux T, Larson N, Neumark-Sztainer D, Hannan P, Story M. Longitudinal and secular trends in adolescent whole-grain consumption, 1999-2004. Am J Clin Nutr. 2010;91(1):154-159. 5. Neumark-Sztainer D, Wall M, Story M, Standish AR. Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass index. J Adolescent Health. 2012;50(1):80. 6. Neumark-Sztainer D, Story M, Resnick MD, Blum RW. Lessons learned about adolescent nutrition from the Minnesota adolescent health survey. J Am Diet Assoc. 1998;98(12):1449. 7. Neumark-Sztainer D, Eisenberg M, Fulkerson J, Story M, Larson N. Family meals and disordered eating in adolescents - longitudinal findings from project EAT. Archives Pediatrics Adolescent Med. 2008;162(1):17-22. 8. Neumark-Sztainer D, Wall M, Story M, Fulkerson JA. Are family meal patterns associated with disordered eating behaviors among adolescents? J Adolescent Health. 2004;35(5):350-359. 9. Neumark-Sztainer D, Wall M, Perry C, Story M. Correlates of fruit and vegetable intake among adolescents: Findings from Project EAT. Preventive Med. 2003;37(3):198-208. 10. Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Trends in adolescent fruit and vegetable consumption, 19992004: Project EAT. Am J Preventive Med. 2007;32(2):147-150. 11. Videon TM, Manning CK. Influences on adolescent eating patterns: The importance of family meals. J Adolescent Health. 2003;32(5):365-373. 12. Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R. What we eat in America, NHANES 2005-2006: Usual nutrient intakes from food and water compared to 1997 dietary reference intakes for vitamin D, calcium, phosphorus, and magnesium. July 2009. Available at: http://www.ars.usda.gov/ba/bhnrc/fsrg. Accessed on February 4, 2013.
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13. Cusatis DC, Shannon BM. Influences on adolescent eating behavior. J Adolescent Health. 1996;18(1):27-34. 14. Cusatis DC, Shannon BM. Influences on adolescent eating behavior. J Adolescent Health. 1996;18(1):27-34.