Adolescence: Ages 15-18

PILLAR ONE: Exercise

Guidelines suggest adolescents ages 15 to 18 get 60 minutes or more per day of moderate-to-vigorous intensity activity. This doesn’t need to be done all at once and can be broken down into several segments throughout the day.

They also should spend at least three days per week performing muscle- and bone-strengthening exercises and more vigorous activity. These activities can include everything from recreational games and organized sports to around-the-house chores and structured workouts with exercise equipment.

Adolescents who do regular exercise are more likely to maintain a healthy weight and avoid excess adiposity. Frequent bouts of activity also increase many aspects of their health, such as cardiorespiratory fitness, muscle growth, and bone strength. Active adolescents also tend to perform better in school and have higher self-esteem, a lower risk of depression, and enjoy a better quality of life.

Here are examples of the different types of activities adolescents can do to meet their daily and weekly quotas. Also, be mindful that any amount of movement is better than nothing, and doing 10 to 30 minutes at first is fine. Small steps can lead to lasting change.

Strategies to increase physical activity

It can be a challenge to keep teens active. Here are some plans to share with parents about how to motivate their adolescents:

• Restrict screen time to two hours per day. TV watching and screen time are associated with a higher risk of weight gain and poor overall health.
• The best activities for adolescents are the ones they enjoy, so work together to find something they want to explore.
• Replace sedentary behavior with activity whenever possible. This can include many at-home chores, such as walking the dog, helping with yard and garden work, and washing the car.
• Include low-cost or free activities at recreation centers, community sports leagues, and after school programs.
• Encourage activities that don't require equipment, like running or doing calisthenics.
• Overweight or obese adolescents benefit from non-weight bearing exercise, such as riding a stationary bike, doing resistance training (see below), or adopting a simple walking program.

PARENT EDUCATION

Lead by example

Kids are more motivated to exercise if their parents follow an active lifestyle, so lead by example. You can further encourage them by planning active family outings, such as bike rides (especially to places a short drive away, like the library or grocery store), neighborhood walks, and hikes in the park.

Wellness tip

Try resistance training

Adolescence is an ideal time to begin resistance training as it can help build growing muscle and bone as well as increase activity time. Resistance training can include exercises with weight machines, free weights, kettlebells, resistance bands, and even bodyweight. What kind of workout program teens adopt depends on their physical level and whether they also play a specific sport. Parents can help by signing up for a family or individual gym membership. It also is important that teens learn proper form and technique to avoid injury. Encourage parents to teach their adolescents how to perform specific exercises, or suggest they hire a personal trainer. Another option is for parents to explore physical education courses at their children’s high school as many offer weightlifting classes.

Adolescence: Ages 15-18

PILLAR TWO: Nutrition

The most common nutrition-related causes of obesity among adolescents is not much different than the younger age groups. These include consuming too many high-calorie sugar-sweetened beverages, eating “super-size” portions, and relying on low nutrient “junk foods.”

Teenagers also have more autonomy and independence as they begin to drive and spend more time away from home. As a result, they are exposed to unhealthy temptations, such as fast food, vending machine snacks, and fad diets.

Teenagers need to follow a similar balance of daily nutrients as other children. Here is a breakdown of the recommended daily intake and suggested meal portion sizes for adolescents:

Intake

• 11 ounces protein
• 3 cups dairy
• 3 cups non-starchy vegetables
• 2 cups fruit
• No more than 2 cups whole grains

Portion Sizes

Proteins - 3 ounces

Fruit - ½ cup

Vegetable - ½ to 1 cup

Dairy - 1 cup

Grains - ½ cup

Since teenagers often eat more meals on their own, or outside the home, encourage parents to speak with their adolescent about how and why to make healthier nutrition choices. Here are the main topics parents should address:

• Discuss the health risks of consuming sugar-sweetened beverages and foods with added sugar. The American Heart Association recommends children age 18 and younger consume no more than 25 grams of added sugar per day. Refer to the "Rethink Your Drink” handout for more information about how to curb high-sugar drinks.
• Explain the benefits of consuming more whole fruits and vegetables and encourage them to try new ones and revisit foods they avoided in the past.
• Explore different cooking methods. If children do like steamed broccoli, they may enjoy roasted broccoli.
• Teach children how to identify trustworthy sources for nutrition information, so food trends and marketing health claims won’t tempt them.
• Help children make healthier choices when eating with friends at school and in restaurants, such as:
  • Drink water instead of soda or milkshakes
  • Choose smaller portion sizes instead of large and “super” size
  • Select grilled or steamed foods instead of fried or breaded options
  • Avoid meals that come with sauces packed with extra calories, salt, sugar, and fat. Instead, ask that they are left out or placed on the side.

PARENT EDUCATION

Healthy eating strategies

Children are much more likely to eat healthier if they see their parents also follow good nutritional habits. Here are some ways to help both you and your teenager eat healthier at home:

• Meals and snacks should include healthy proteins with whole vegetables and fruits with less emphasis on grains.
• Choose low glycemic index foods, such as oats, quinoa, 100 percent whole-wheat pasta, and low-fat dairy foods. Low glycemic index foods can help control blood sugar levels and manage cravings.
• Make healthy foods easily accessible. Keep the kitchen well stocked with their favorite fruits and vegetables and healthy snacks. See the handout “25 Healthy Snacks” for suggestions.
• Serve desserts only on a special occasion and not with every dinner.
• Review food labels to look for hidden added sugar and other additives, and show teenagers how to do the same. See the “Nutrition Facts Label” handout for more information.
• Limit the number of fast-food meals.
• Whenever possible, eat structured meals as a family. Keep distractions away from the table, such as TV watching, phones, and other electronic devices. This helps avoid overeating as everyone is more focused on their food.

Adolescence: Ages 15-18

PILLAR THREE: Behavioral Health

Several behavioral factors during adolescence can raise the risk of disordered eating and contribute to weight gain and obesity. These include depression and anxiety, a poor relationship with food, and substance use like drugs and alcohol. Here is a look at each one.

Depression and anxiety

Approximately 3 percent of children ages 3 to 17 have diagnosed depression, according to the Centers for Disease Control and Prevention. However, the condition is more likely to occur between the ages of 12 and 17.

Depression and anxiety can arise from stressors like the unexpected death of a family member and problems at school, like bullying and poor grades. Depression may be an issue if sadness persists for a long time, and there are other behavioral changes, such as tearfulness, lack of interest in activities, low self-esteem, social withdrawal, and problems sleeping.

Depression and anxiety symptoms can alter children's eating patterns. They may eat larger portions or eat significantly less. You want to be mindful of the following warning signs and symptoms of disordered eating:

• Preoccupation with weight, food, and calories
• Refusal to eat certain foods (the child may begin with specific foods and then restrict whole categories, like no carbs, no sugar, and no dairy)
• Appears uncomfortable eating around others
• Frequent dieting
• Skipping meals or eating smaller than usual portions
• Difficulty controlling portions
• Hiding or sneaking extra food, like eating in the bedroom or when others are not around
• Compensatory behaviors, such as excessive exercise, purging food, restrictive eating, and taking laxatives or diet pills
• Shame and guilt associated with eating “too much” or eating unhealthy or undesirable foods
• Withdrawal from friends and activities
• A concern with body size and shape
• Frequently comparing their body to others

PARENT EDUCATION

Help your child during low times

Children often need support and encouragement during tough times. Here are some ways you can help them process their emotions and improve their mood.

• Let them talk when you are alone together. Children may feel embarrassed to discuss their feelings when others are around.
• Encourage children to talk about their feelings and provide support and comfort; for instance, “I miss Grandma, too. It’s okay to miss her.”
• Teach them how to express emotions by labeling and discussing your feelings of sadness. For example, “I’m feeling sad right now because this didn’t work out how I planned it.”
• Suggest that your child write about his or her feelings in a journal or draw pictures about what makes them feel sad.
• Schedule a fun activity. It can be something simple, like listening to music, doing an art project, or playing a board game. You also could take them to the park, pool, or museum. Let your child choose the activity.
• Build your child’s confidence. Give them a chore or task and then offer praise when it is completed, like "Thank you for putting your clothes away. That was a big help!"
• Let your child be a mentor. Pair him or her with younger or less-experienced children on a game or activity. This interaction gives your child a chance to lead and teach, which can improve self-esteem.
• Get active with your child. Take him or her for a walk or play an outdoor game. Regular exercise can help improve your child’s mood.
• Consult with teachers and school administrators if your child’s sadness is related to bullying or other school work.

Poor food relationship

Parents can help teens improve their relationship with food, and lower their risk of disordered eating, by encouraging healthy eating habits during mealtimes. Here are some strategies to share with parents:

• Be consistent: Sit down to family dinners regularly, so teens view eating as a social event.
• Stay positive. Do not discuss eating healthy during meals, such as suggestions for meals and snacks, and how much to eat. Instead, have these conversations away from the table.
• Offer encouragement. Praise the adolescent's effort to eat healthy rather than what they accomplished; for instance, say, "I'm proud of you. I can tell you worked hard."

TEEN EDUCATION

How to be mindful about eating

Adolescents can protect themselves from disordered eating by practicing mindful eating. For example:

• Focus on the present. Don’t dwell on the past (what you previously ate) or worry about the future (how much weight you want to gain or lose). Focus only on the meal you are about to enjoy.
• Announce intentions. Tell family and friends about your new healthy changes. For example, “I’m going to eat two vegetables at dinner tonight,” and “I’m packing a healthy lunch for school tomorrow.”
• Self-compassion. Use kind words to block your inner critic. Examples include: “I can do it,” “It’s okay,” “I'll make a better decision at the next meal,” “I'm proud of myself for making ___(healthy choice).”
• Invest in support. Exercise at the gym, play sports with friends, and cook with siblings and parents.
• Own your fears: Focus on addressing obstacles. For instance, if you tend to overeat, cut back on portions, or eliminate foods you often overindulge or do stress-relief activities before eating.
• Look at the big picture. Remind yourself how you feel after making healthier choices like proud, confident, and in control.

PARENT EDUCATION

Encourage greater teen participation with meals

Another way parents can instill healthy eating habits is to involve their adolescents with family meals. This type of interaction also improves their relationship with food since they have more input on food selection and meal preparation. Encourage parents to approach this team effort in stages where the adolescent and parent work together to complete a food task or activity and then progress to the teen taking over while the parent supervises. Here are some examples parents and adolescents can follow:

Meal planning

• Create a weekly meal plan together. Parents can ask for the adolescent’s input and provide feedback about healthy meals.
• During the planning, the parent should encourage discussion about healthy choices.
• Allow the adolescent to write down the meals on a weekly calendar.

Grocery shopping

• Create a shopping list using the meal plan as a guide.
• Both parents and adolescents should grocery shop together.
• Allow the adolescent to take the lead during shopping, but encourage him or her to stick to the list.
• Eventually, allow the adolescent to drive to the store (if they have a license) and shop themselves.

Meal prepping and cooking

• The parent should teach necessary cooking skills, such as chopping, slicing, and cutting, and how to measure portion sizes.
• At first, have the adolescent do meal specific prep tasks, like chopping bell peppers or cooking pasta.
• As the adolescent gets more comfortable, have him or her take on more meal prep and cooking tasks with parent supervision as needed.

Substance use

Encourage families to adopt lifestyle strategies to help reduce the risk of substance use, such as alcohol and drugs, which can contribute to disordered eating. Here are some suggestions:

• Create an open environment. The family environment should encourage open dialogues, so teens feel comfortable discussing substance use without fear, guilt, or remorse.
• Talk freely about substance use. Discuss the effects of drugs and alcohol using facts and not emotion. Encourage your adolescent to ask questions.
• Engage in their adolescent's life. Parents should always talk with their teens about their daily lives, including their school life and friends.
• Support and acknowledge academic success. Parents should supervise their schoolwork, help with homework and studying, and assist with educational support like personal tutors or in-school tutoring programs if needed.
• Encourage teens to stay socially active. Parents should help them participate in school clubs, organized sports, community events, volunteer programs, or church activities.

Adolescence: Ages 15-18

PILLAR FOUR: SLEEP

The National Sleep Foundation and the American Academy of Sleep Medicine both recommend that teenagers ages 15 to 18 get eight to 10 hours of sleep per night; seven to 11 hours also may be appropriate, although this is less than ideal.

Studies show that 73 percent of high school students do not get enough sleep. African-American and Asian teenagers get the least amounts of sleep. Girls often sleep less than boys.

Research also has shown that children who sleep less than the recommended amounts are at a higher risk for obesity. According to one study, sleeping fewer than 7.5 hours each night increases the risk of obesity three-fold compared with sleeping nine or more hours.

It also matters what time adolescents go to sleep. Teens who go to bed earlier (closer to 9 p.m.) tend to have healthier weights than those who stay up later (closer to 11 p.m.), even if they sleep the same number of hours.

Poor sleep can affect teens in other ways, like poor school performance and a higher likelihood of drowsy driving, which can be as dangerous as drinking and driving. Lack of sleep also can impair their judgment and make them more likely to engage in risk-taking behavior.

There are many reasons for poor sleep among adolescents. Two of the most common are shifting circadian rhythm and overusing electronic devices.

A shifting circadian rhythm. Children’s circadian rhythm changes as they age and makes them naturally prefer a delayed sleep phase during their teenage years. This shift is why teenagers stay awake longer and wake up later. Their circadian rhythm can be affected by personal habits, such as caffeine consumption and irregular bedtimes, like staying up too late and sleeping in on weekends.

Screen time. Teenagers spend more time with electronic devices, like phones, laptops, and tablets, than any other age group. All that screen exposure can affect their sleep quality. The most common causes, according to much research, are mental and emotional stimulation from browsing social media and the Internet, and over-exposure to blue (short wavelength) light emissions from screens, which can further disrupt their natural circadian rhythm.

Both parents and teens should learn how to follow better healthy sleep hygiene. For example:

• Teens should watch their caffeine consumption during the day and don’t consume any caffeine drinks or foods at least two hours before bedtime.
• Teens should follow regular sleep schedules, especially during the school week, and avoid staying up too late.
• Parents should make efforts to curb their teen’s screen time at home, such as ban phones and tablets during meals, and cut off all screen time at least an hour before bedtime.

Check for Obstructive Sleep Apnea (OSA)

OSA also can affect sleep quality in teenagers. OSA is a disorder in which a sleeping person experiences either partial upper airway obstruction for prolonged periods or complete upper airway obstruction intermittently.

With OSA, teens frequently snore with periodic pauses or gasps in their breathing. Snoring can disrupt their sleep and cause problems with attention, concentration, and daytime sleepiness.

Overweight or obese children are at higher risk for OSA, but OSA symptoms often improve when children maintain a healthier weight.

Always screen children for snoring during wellness checks. Refer any child who snores three or more nights per week, and has any OSA symptoms, to a sleep medicine physician/sleep lab, or a pediatric ear, nose, and throat physician. A polysomnography—a test used to diagnose sleep disorders—can diagnose OSA.

Some children with OSA may need to use a Continuous Positive Airway Pressure (CPAP) machine at night. However, this is a second-line option for children who are not surgical candidates as it is often poorly tolerated.