Adolescent Eating Habits

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Adolescent eating habits

Authors: Debby Demory-Luce, PhD, RD, LD, Kathleen J Motil, MD, PhD
Section Editor: Amy B Middleman, MD, MPH, MS Ed
Deputy Editor: Alison G Hoppin, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jun 2020. | This topic last updated: Apr 08, 2020.
INTRODUCTION
Adolescence is a nutritionally vulnerable time period. Poor eating habits formed during adolescence can lead to
obesity and diet-related diseases in later years. In addition, the high incidence of dieting behaviors can contribute
to nutritional inadequacies and to the development of eating disorders. Primary care providers are in an optimal
position to provide nutrition screening, counseling to the adolescent patient and caregivers, and referral to a
dietitian if needed.
This topic review discusses characteristic adolescent eating habits, including skipping meals, fast food
consumption, frequent snacking, and dieting behaviors [1-4]. The nutritional requirements for adolescents are
discussed separately. (See "Dietary energy requirements in adolescents".)
OVERVIEW OF CHALLENGES AND TRENDS
Nutritional needs during adolescence are increased because of the increased growth rate and changes in body
composition associated with puberty [1,5,6]. The dramatic increase in energy and nutrient requirements coincides
with other factors that may affect adolescents' food choices, nutrient intake, and thus, nutritional status. These
factors, including the quest for independence and acceptance by peers, increased mobility, greater time spent at
school and/or work activities, and preoccupation with self-image, contribute to the erratic and unhealthy eating
behaviors that are common during adolescence [1,7]. In addition, adolescents may have formed beliefs
concerning the association between their eating behaviors and cultural background that coincides with their
parents' notions of both healthy and unhealthy food practices [8]. Unhealthy eating habits are seen in
adolescents in the United States and many other countries [9-13].
Sound nutrition can play a role in the prevention of several chronic diseases, including obesity, coronary heart
disease, certain types of cancer, stroke, and type 2 diabetes [14-22]. For this reason, nutrition remains an
important objective for Healthy People 2020 campaign [23]. To help prevent diet-related chronic diseases,
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researchers have proposed that healthy eating behaviors should be established in childhood and maintained
during adolescence (table 1) [24-27]. (See "Healthy diet in adults".)
● Nutritional deficits – National and population-based surveys in the United States have found that
adolescents often fail to meet dietary recommendations for overall nutritional status and for specific nutrient
intakes [28-34]. Many adolescents receive a higher proportion of energy from fat and/or added sugar and
have a lower intake of a vitamin A, folic acid, fiber, iron, calcium, vitamin D, and zinc than is recommended
[35-41]. The low intake of iron and calcium among adolescent girls is of particular concern. Vitamin D
deficiency is increasingly prevalent and is associated with decreased bone density and probably fracture risk
[42,43]. Vitamin D deficiency is typically defined as 25-hydroxyvitamin D concentrations <15 ng/mL (37.5
nmol/L), and target concentrations for 25-hydroxyvitamin D are at least 20 ng/mL (50 nmol/L). Iron deficiency
can impair cognitive function and physical performance, and inadequate calcium intake may increase
fracture risk during adolescence and the risk of developing osteoporosis in later life [44-49]. (See "Calcium
requirements in adolescents" and "Vitamin D insufficiency and deficiency in children and adolescents" and
"Iron requirements and iron deficiency in adolescents".)
Eating habits vary widely between individual adolescents and also display some general trends over time,
reflecting sociocultural trends in food availability and nutritional goals. As an example, data from six national
representative surveys showed that total energy intake among United States adolescents increased through
2004, then decreased through 2010 [50]. Seven food sources, including sugar-sweetened beverages, pizza,
full-fat milk, grain-based desserts, breads, pasta dishes, and savory snacks, consistently contributed to this
trend. Intakes of full-fat milk, meats, ready-to-eat cereals, burgers, fried potatoes, fruit juice, and vegetables
decreased, whereas nonfat milk, poultry, sweet snacks and candies, and tortilla- and corn-based dishes
increased through 2010. The changes contributing to the decline in caloric intake prior to 2010 included
significant decreases in sugar-sweetened beverages, pizza, pasta dishes, bread and savory snacks, and
significant increases in fruit. An analysis of national survey data between 1999 and 2016 noted a modest
improvement in diet quality (adjusted for energy intake), but more than two-thirds of adolescents still had
poor diet quality as defined by the American Heart Association and less than 1 percent had ideal diet quality
[34]. Consumption of sugar-sweetened beverages and added sugars generally decreased and sodium intake
increased.
● Knowledge deficits – During adolescence, young people are in a transition period when they gradually take
over the responsibility for their own eating habits. Knowledge is one of the factors necessary for a healthy
transition of responsibility. Questionnaires used to assess nutrition knowledge demonstrate that more than
two-thirds of adolescents, especially boys, adolescents from rural environments, and overweight
adolescents, have unsatisfactory knowledge about dietary recommendations, sources of nutrients, diet-
disease relationships, and dietary habits [51]. In this group, television was the main source of information
about nutrition for adolescents. A meta-analysis demonstrated a significant albeit small effect of media food
marketing on unhealthy eating behaviors in preadolescents and adolescents [52].
Parents have the opportunity to influence their child's dietary intake in a variety of ways, the most important
of which are the decisions made about what foods are available within their home [53]. Nutrition education
interventions focusing on spices and herbs also may be an effective tool to improve diet quality and healthy

eating attitudes, especially among urban and African-American adolescents [54]. The addition of spices and
herbs was associated with modest improvement in the consumption of grain and protein food products, as
well as attitudes toward eating vegetables, whole grains, lean protein, and low-fat dairy products.
SKIPPING MEALS
Adolescents may skip meals because of irregular schedules [55]. Breakfast and lunch are the meals most often
missed, but social, school, and work activities can cause evening meals to be missed as well [1,56-58].
On any given day, 12 to 50 percent of adolescents skip breakfast; older adolescents (those age 15 to 18 years)
are twice as likely to skip breakfast as are younger adolescents, and girls are more likely to do so than are boys
(35 versus 25 percent in one study) [1,56,59-62]. In a 2015 nationally representative survey of high school
students, only 36.3 percent ate breakfast for all seven days before the survey. Subgroups that were more likely to
consume breakfast all seven days were the 9th grade students (39.6 percent) compared with 12th grade students
(33.8 percent) and boys (40.5 percent) compared with girls (32.1 percent) [31]. More than one-half of the
adolescents participating in the National Adolescent School Health Survey reported that they ate breakfast less
than twice per week [2]. Reasons for skipping breakfast include lack of time, early school activities, proximity of
fast food outlets and grocery stores near schools [10], or a poor appetite first thing in the morning [1,63].
The omission of breakfast can affect school performance and the overall quality of the diet [64-67]. In one cross-
sectional and longitudinal study of school breakfast programs, students with greater participation in the breakfast
program had greater increases in math grades, decreases in child and teacher ratings of psychosocial problems,
and decreases in absence and tardiness than did children with less participation [68]. In another large-scale
survey of schoolchildren from nine states, hungry children and children at risk for hunger were more likely to have
impaired function, hyperactivity, absenteeism, and tardiness than were not-hungry children [69].
Total nutrient intakes are lower among adolescents who skip breakfast as compared with those who consume
breakfast [1,9,67,70]. Adolescent breakfast consumers have a higher intake of calories; fiber; vitamins A, B6, and
B12; iron; and calcium and better overall eating habits than do adolescents who skip breakfast [57,59,62,71-74].
When breakfast is consumed, it contributes to approximately one-fourth (21 to 26 percent) of total daily energy
intake [75,76]. The foods that typically are skipped with breakfast include fruits, breads, and calcium- and iron-
rich foods (milk and iron-fortified cereals, respectively) [29,57,59,77-79]. Adolescents who skip breakfast tend not
to compensate for these losses at other meals [64,77,80].
Adolescents' busy lifestyles often conflict with family mealtimes [1,81,82]. There is a decline in family meal
frequency during adolescence, and family meals are associated with higher diet quality [4,29,78,83-85]. One
study of 16,000 children aged 9 to 14 years demonstrates that children who eat meals with their families most or
all of the time have healthier diets than do those who rarely or never do [86]. Compared with those who rarely eat
with their families, they consume less fried food and soft drinks and more fruits, vegetables, and whole grains
[86]. A five-year longitudinal study with 1700 adolescents found that family meal frequency during adolescence
predicts higher intakes of fruits and dark-green and orange vegetables and lower intakes of soft drinks during
early adulthood [29].

Adolescents, particularly females, may use skipping meals as a strategy for weight control [3,87,88]. However,
the calories that are "saved" are often made up through heavy snacking on nutrient-poor foods or by overeating
at the next meal [89,90]. This pattern tends to impair nutrition because high-fat/energy-dense snack foods rarely
compensate for the nutritional value of the meals that are skipped [56]. Moreover, skipping meals does not seem
to improve weight control, as illustrated by the following studies:
● A 1991 United States Department of Agriculture (USDA) survey showed that adolescents who had a
consistent meal pattern (at least two meals per day) were leaner than those who had an inconsistent meal
pattern (one meal or snacks only per day) [7].
● A Dutch study found that adolescents who ate breakfast on a daily basis were less likely to be overweight
than those who ate breakfast irregularly or never [91].
● A cohort study examined 2379 adolescent girls aged 9 to 10 years at baseline and followed them until 19
years of age [57,92]. Among girls with high body mass index (BMI) at baseline, those who ate breakfast
more often had a lower BMI at the end of the study compared with those who ate breakfast less often.
Similarly, in the full population, lower snack and eating frequencies at baseline were associated with greater
gain in adiposity during the 10-year follow-up period [93].
● A prospective study followed 9919 adolescents participating in the National Longitudinal Study of Adolescent
Health during the five-year transition period between adolescence and young adulthood [94]. This study
found that breakfast skipping was associated with weight gain during this time period.
● A study in Finland showed that the presence of fast food retailers near schools is associated with the
accumulation of irregular eating habits, skipping meals, and greater overweight among adolescents from low
socioeconomic backgrounds [10].
● A 1999 to 2006 National Health and Nutrition Examination Survey (NHANES) found that adolescents who
skipped breakfast had a higher BMI compared with those who consumed breakfast [70].
Possible explanations for this finding include [93]:
● Adolescents perceive that they are reducing energy intake by skipping meals, when in fact they are not
● Individuals with a propensity to gain weight are more likely to skip meals to compensate
● Skipping meals is a marker for other poor nutrition and physical activity habits [95,96]
In any case, it appears that meal skipping for weight control may result in an unhealthy diet and may cause
unintended weight gain during adolescence [3,57,71,87,94,97]. A meta-analysis documented that higher eating
frequency was associated with lower body weight status in adolescents, especially among boys [98]. (See
'Dieting' below.)
Counseling — Adolescents should be advised not to skip meals, particularly breakfast. Eating regular meals,
using the ChooseMyPlate tool as a guide, can increase total nutrient intake as well as the mean number and
amount of servings from food groups that typically are low in adolescents' diets (eg, iron- and calcium-rich foods,
fruits, and vegetables) [3,99,100]. (See 'Dietary balance' below.)

Adolescents should be informed that skipping meals does not help with weight control and indeed may promote
weight gain, as discussed above.
SNACKING
Most adolescents snack [2,56,75,101,102]. After approximately 12 years of age, teenagers seldom conform to a
regular pattern of three meals per day; more than one-half of teens admit to eating at least five times per day
[3,56,60,102]. Snacks are a major source of energy and nutrients, providing nearly one-quarter to one-third of
total energy intake for many adolescents [3,103]. In one study from Canada, after-school snacks represented 13
percent of total daily energy intake; the largest energy contributors were energy-dense, nutrient-poor foods such
as cookies, sugar-sweetened beverages, and sweets [104].
Depending upon their timing and composition, between-meal snacks can contribute in negative or positive ways
to the adolescent diet [105]. Poorly timed snacks that are high in calories and low in nutrients (ie, "junk food")
may blunt the adolescent's mealtime appetite and replace nutritious foods that are needed for growth and
development [1-3]. In particular, sugar-sweetened beverages often have a negative impact on diet quality [38,41]
and also contribute to weight gain [106,107]. In a national survey in the United States, sugar-sweetened
beverages or fruit juice comprised 10 to 15 percent of the calories consumed by children and adolescents [108].
Increased intake of sugar-sweetened beverages also may be an important predictor of cardiometabolic risk
independent of weight status [109]. Moreover, dietary sodium is associated with higher intake of sugar-
sweetened beverages, identifying a possible link between dietary sodium and excess energy intake [110]. In
contrast, healthy snacks can help meet the increased energy and nutrient needs of adolescence [5]. Snacks that
are nutrient-dense (ie, have a ratio of nutrients to calories similar to that of meals) can help to fill the "nutritional
gaps" (eg, fiber, vitamin A, calcium, and iron) that remain after traditional meals [1,3,111].
Television viewing is associated with increased snacking among children and adolescents and also with obesity
[61,112]. Spending more than 120 minutes watching television is associated with significantly higher intakes of
total fat and polyunsaturated fat and lower intake of several minerals and vitamins [113]. Adolescents with high
media exposure, including television and video and computer games, were more likely to drink sugar-sweetened
beverages rather than water or milk [114]. Exposure to advertising of poor-quality snack foods appears to be an
important mechanism for the association between television viewing and food intake or obesity. In an analysis of
food advertisements shown during television programs designed for children, more than 90 percent of the
advertised foods were high in fat, sodium, or added sugars or low in overall nutrients. The most commonly
advertised food included ready-to-eat cereals and cereal bars, fast food, snack foods (chips, cookies, fruit rolls),
and candy [115]. (See "Definition, epidemiology, and etiology of obesity in children and adolescents", section on
'Environmental factors'.)
Counseling — Adolescents should be taught how to improve the overall quality of their diets with nutritious
snacks [1,2]. Instead of selecting high-fat, high-sugar, nutrient-poor snacks such as candy, pie, cakes, cookies,
and chips, adolescents should select foods that are lower in fat and more nutrient-dense, such as [116]:
● Fresh fruit or vegetables with low-fat yogurt dip

● Iron-fortified cereal and low-fat milk

● String cheese
● Cheese and crackers
● Low-fat frozen yogurt
● Calcium-fortified cereal bars and juices
● Vegetarian pizza
FAST FOODS
As they become more independent, adolescents increasingly make their own decisions about what, when,
where, and with whom to eat [14]. With busy after-school schedules, adolescents frequently eat away from home.
Fast foods are popular choices because they are inexpensive, familiar, and available at almost any hour of the
day or night and because many adolescents socialize with their peers at fast food establishments [2,117,118].
Individuals younger than 18 years of age account for more than 80 percent of fast food restaurant visits [118,119].
The most popular food items consumed by adolescents at fast food establishments include french fries,
sandwiches (especially hamburgers and cheeseburgers), pizza, and Mexican dishes (tacos and burritos) [120].
The most common beverage choices are carbonated soft drinks, coffee/tea, and milk (in that order) [120]. (See
"Fast food for children and adolescents".)
The impact of fast food on the diets of adolescents depends upon the frequency of visits to fast food restaurants
and the food choices that are made, but fast food generally has adverse effects on diet quality [121-124].
Traditional fast foods are low in iron, calcium, vitamins A and C, fiber, and folic acid and high in energy, sodium,
cholesterol, and total and saturated fat (table 2) [1,2,36,122,123,125,126]. Fat provides more than 50 percent of
the calories in many fast food items [1,117]. In Project Eat (Eating Among Teens), the total energy intake of
adolescents who reported eating at a fast food restaurant more than three times in the preceding week was
almost 40 percent higher than those who did not [117]. Increased fast food consumption was associated with
greater intakes of soft drinks and lower intakes of fruits, vegetables, grains, and milk [127,128]. Fast food
consumption also has a modest association with overweight status among adults [129,130] and adolescent girls
[131]. (See "Fast food for children and adolescents", section on 'Association with obesity'.)
Counseling — Fast foods are a way of life for many adolescents. It is important to teach adolescents how to
make wise food choices at fast food restaurants. Many fast food restaurants offer lower-fat and nutrient-dense
food choices in addition to traditional selections, and a meal that provides important nutrients for adolescent
growth and development can be ordered [132]. Healthier choices include salad bars, baked potatoes, steamed
vegetables, low-fat frozen yogurt, and lower-fat sandwiches (table 2) [1,2]. (See "Fast food for children and
adolescents".)
In addition, because healthy snacks can compensate for nutrient deficiencies, adolescents should supplement
fast foods with nutritious snacks, including calcium-rich foods and fresh fruits and vegetables [2,111,133].
DIETARY BALANCE

The daily composition of a recommended diet is based upon the 2010 Dietary Guidelines for Americans [134],
which are taught by the United States Department of Agriculture (USDA) "ChooseMyPlate" tool. ChooseMyPlate
replaced the Food Guide Pyramid in 2011 [100]. The tool was developed to individualize dietary guidelines
according to age, sex, and activity level; it replaces the previous pyramid-based model. ChooseMyPlate focuses
on five food groups (fruits, vegetables, grains, dairy, and protein) rather than the six groups outlined in the food
group pyramid previously used and does not have a category for "discretionary calories." The plate provides a
visual tool for dietary balance; individuals are encouraged to cover one-half of their plate with fruits and
vegetables.
Examples of recommendations for individuals at several different calorie levels are provided in the table (table 3).
(See "Dietary history and recommended dietary intake in children".)
Vegetables and fruits — For an adolescent with low activity levels, the dietary recommendations translate to
approximately 2.5 cups of vegetables and 1.5 cups of fruit daily for girls (1800 calorie diet) and 3 cups of
vegetables and 2 cups of fruit daily for boys (2200 calorie diet).
Actual consumption of fruits and vegetables is well below these targets [135]. Using dietary recall data from the
2007 to 2010 National Health and Nutrition Examination Survey (NHANES) applied to the 2013 Youth Risk
Behavior Surveillance Survey, an estimated 8.5 percent of high school students met the USDA fruit
recommendations and 2.1 percent met the vegetable recommendations. The median consumption of fruits and
vegetables was 0.5 cup and 0.8 cup equivalents per day (100 percent fruit juice and fried potatoes were not
included) [32]. In a 2010 survey of high school students, the median consumption of fruits and vegetables was
1.2 times per day for both vegetables and fruits (100 percent fruit juice was included as a fruit) [136].
Consumption decreased between the beginning and end of high school. Overall, approximately 30 percent of
high school students consumed fruit less than once daily and 30 percent consumed vegetables less than once
daily. Low consumption of fruits and vegetables is associated with higher intakes of fast food. (See 'Fast foods'
above.)
Dairy — The dietary guidelines outlined in ChooseMyPlate also promote a high intake of dairy products
(approximately three to four servings/day for adolescents); low-fat or fat-free products are recommended. This
target provides a substantial proportion of the recommended intake for calcium and vitamin D, although actual
intake is considerably lower among most adolescents in the United States.
The recommended dietary allowance for calcium is 1300 mg for boys and girls 9 to 18 years of age. The
recommended three to four servings/day of dairy products provides 900 to 1200 mg of calcium, and many
adolescents fail to meet this goal [31]. Calcium intake can be increased to achieve the recommended level
through foods that are naturally rich in calcium, calcium-fortified foods, and calcium supplements. (See "Calcium
requirements in adolescents", section on 'Recommended intake'.)
In the United States, the prevalence of vitamin D deficiency or insufficiency (defined in these studies as serum
25-hydroxyvitamin D concentrations <20 ng/mL [50 nmol/L]) is approximately 15 percent in adolescents [137].
However, the prevalence varies considerably among different countries and subpopulations because of
differences in risk factors, including diet, skin pigmentation, sun exposure, and obesity.

The recommended intake for vitamin D is 600 international units daily, although some individuals appear to
require higher vitamin D intake to maintain serum concentrations in the target range. The recommended three
servings of fortified dairy products provides approximately 350 international units of vitamin D [138], which is
approximately one-half of the recommended daily intake for adolescents. Thus, intake of vitamin D-fortified foods
(breads, cereals, and juices), fatty fish (salmon, mackerel, sardines), and supplementation of vitamin D may be
needed, particularly for adolescents who have less than the recommended three servings of dairy products daily
or for those with low serum concentrations of 25-hydroxyvitamin D. (See "Vitamin D insufficiency and deficiency
in children and adolescents", section on 'Prevention in older children and adolescents'.)
DIETING
It is common for adolescents to be unhappy with and self-conscious about their changing bodies [139]. In many
cultures, thinness, no matter how unrealistic, is perceived as the desired body shape, particularly for females. To
avoid becoming overweight and to fit in, many adolescents attempt to lose weight by regulating their food intake
[14,140]. In the discussion below, we use the term "dieting" to describe the manipulation of food intake and food
choices that are specifically driven by weight concerns rather than health concerns. This type of dieting is distinct
from efforts to adopt healthy eating and other lifestyle behaviors (ie, physical exercise) that are recommended to
optimize nutrition and body weight as part of long-term health goals.
Dieting is more common among female adolescents because females typically are more dissatisfied with their
weight than are their male counterparts [87,141,142]. Unfortunately, many adolescent females perceive the
normal pubertal weight gain as becoming "fat" and engage in dieting behaviors in an attempt to reverse or slow
down the process [143]. Weight concerns and dieting are so common among female adolescents that they are
considered to be normative [139,144].
Dieting and disordered eating behaviors in adolescents include [87,88,145-149]:
● Exclusion of specific foods or food groups

● Adopting reduced-energy diets or fad diets
● Skipping meals
● Binge eating
● Fasting
● Self-induced vomiting
● Using laxatives, diet pills, and diuretics
● Excessive exercising
Adolescents indicate the following reasons for dieting: feeling "too fat," teasing by peers, pressure from family
members, advice of a coach or sports instructor, wanting to look better (ie, thin), and desire to improve health
[147,148,150-152].
Prevalence — A history of dieting can be obtained in approximately 40 to 70 percent of adolescents [31,88,153-

156]. As indicated above, more females than males diet (45 versus 20 percent in one study) [87,147,149], and

the gender difference increases significantly with age (56 percent of girls in grades 9 through 12 versus 36
percent of girls in grades 5 to 8) [87,147,154].
Of particular concern is the degree of dieting among adolescent females who are of normal weight. Many of
these girls have dissatisfaction with their bodies that stems from unrealistic perceptions of a healthy body shape
and/or body weight [87,155,157,158]. They perceive themselves to be fat although they are not. Self-perceived
weight status is associated strongly with weight loss behaviors among adolescent females [149,157,159].
The frequency of dieting varies by region and by nation. In a 1997/1998 World Health Organization (WHO) report
of 120,000 students aged 11, 13, and 15 years in 26 European countries, the United States, and Canada, dieting
was most common among adolescents in the United States, Israel, and Austria [154]. The percentage of 11-, 13-,
and 15-year-old girls and boys in the United States, Israel, and Austria who currently were dieting or thought they
should be dieting in these three countries is outlined below:
● Among 11-year olds – United States: 47 percent of girls, 34 percent of boys; Israel: 39 percent of girls, 27
percent of boys; Austria: 36 percent of girls, 29 percent of boys
● Among 13-year olds – United States: 53 percent of girls, 33 percent of boys; Israel: 55 percent of girls, 26
● Among 15-year-olds – United States: 62 percent of girls, 29 percent of boys; Israel: 57 percent of girls, 27
The observations that adolescents often perceive themselves to be overweight even when they are not and that
they frequently use unhealthy dieting behaviors when they try to lose weight were shown in several large
population studies, described below.
In a nationally representative survey of adolescents aged 16 to 19 years, 45 percent of females and 30 percent of
males reported trying to lose weight in the previous year [149]. The percentage of adolescents trying to lose
weight increased with weight status. Among obese adolescents, 78 percent tried to lose weight (80 percent of
males and 75 percent of females). Among those who were overweight, 59 percent tried to lose weight (47
percent of males and 67 percent of females). Even among adolescents of normal weight, 19 percent (10 percent
of males and 28 percent of females) reported attempts to lose weight.
Dieting techniques — The most common weight loss behaviors included exercising (84 percent); drinking a lot
of water (52 percent); eating less "junk" foods or fast foods (45 percent); and increasing intake of fruits,
vegetables, and salads (45 percent). In a separate older survey, disordered eating behaviors (self-induced
vomiting and binge eating) were reported by 13 percent of the girls and 7 percent of the boys. (See "Eating
disorders: Overview of epidemiology, clinical features, and diagnosis".)
Effects on nutrition — Dieting behaviors can compromise intake of energy and nutrients that are essential for
adolescents' growth and development. Most adolescents diet mainly by restricting food, either by excluding foods
or entire food groups that are perceived as "fattening" (eg, meats, eggs, and milk and dairy products) and/or by
skipping meals [160,161] (see 'Skipping meals' above). The result is a diet that is low in several major nutrients
that are already marginal in many adolescents' diets (eg, iron, calcium, and zinc) [47,99,162,163].

As an example, one study compared the diets of 16- to 17-year-old English girls who dieted with those who did
not [164]. The mean energy intake of the dieters was less than that of the nondieters (1604 versus 2460
kcal/day). Dieters had significantly lower intakes of breakfast cereal, milk, meat, and meat products. Twice as
many dieters as nondieters failed to achieve recommended levels (dietary reference values for United Kingdom)
for calcium, zinc, and selenium. Both dieters and nondieters had low intakes of iron, but dieters' intakes were
lower. Mean daily intakes of the various nutrients are listed below:
● Calcium – 589 mg versus 856 mg among dieters and nondieters, respectively (United Kingdom reference
nutrient intake [RNI] = 800 mg/day)
● Zinc – 6.6 mg versus 9.1 mg among dieters and nondieters, respectively (RNI = 7 mg/day)
● Selenium – 45 mcg versus 62 mcg among dieters and nondieters, respectively (RNI = 60 mcg/day)
● Iron – 12.1 mg versus 13.1 mg among dieters and nondieters, respectively (RNI = 14.8 mg/day)
● Riboflavin – 1.2 mg versus 1.7 mg among dieters and nondieters, respectively (RNI = 1.1 mg/day)
Female adolescents may have difficulty obtaining the recommended 15 mg of iron per day from food sources if
energy intake is low. In particular, reduced intake of animal foods high in iron such as meat and eggs can
compromise iron intake [2]. In one study of 12- to 14-year-old British girls, the prevalence of iron-deficiency
anemia associated with lower dietary intake of iron was greater among girls who had tried to lose weight than
among those who had not (23 percent versus 7 percent, respectively) [165].
Dieting behaviors, particularly skipping meals, can reduce the opportunities to consume foods high in calcium.
Milk and dairy products are a major source of calcium for adolescents (table 4) [49,166]. (See "Calcium
requirements in adolescents".)
Avoidance of meats, eggs, and dairy products also can result in inadequate zinc intake. Other foods high in zinc
include ready-to-eat cereals, legumes, wheat germ, and whole grains (table 5). (See "Zinc deficiency and
supplementation in children" and "Vegetarian diets for children", section on 'Zinc'.)
Adverse effects on health — Long-term dieting may have adverse effects on an adolescent's health. Potential
adverse effects include irritability, difficulty concentrating, sleep disturbance, muscle wasting, cardiac dysfunction,
digestive tract disorders, menstrual irregularity, interruption in growth, delayed sexual maturation, and inadequate
bone mass accumulation [148,167-170].
Adolescents who diet frequently are at increased risk for developing eating disorders such as anorexia nervosa
and bulimia [162,171-174]. In one three-year prospective study of 1728 14- to 15-year-old adolescents in
Australia, girls who dieted at a moderate or severe level [175] were 5 and 18 times more likely to develop an
eating disorder, respectively, than were girls who did not diet [172]. A longitudinal study of 2500 adolescents
found that adolescent girls who dieted were at twice the risk for engaging in extreme weight-control behaviors
(including vomiting or laxative use) and reporting an eating disorder five years later compared with nondieters
[162]. Another study of 800 children and adolescents found a significant association between weight-reduction
efforts during adolescence and subsequent development of bulimia [176]. (See "Eating disorders: Overview of
epidemiology, clinical features, and diagnosis".)
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Lack of weight control — Many behaviors used by adolescents in an attempt to lose weight may be ineffective
in reducing weight. Paradoxically, they can lead to binge-eating behaviors and ultimately to weight gain
[93,95,143,174,177-179]. This was shown in an observational study of eating habits in 1902 adolescents who
completed a survey about their eating habits at baseline and were followed for ten years [96]. Unhealthy dieting
habits such as skipping meals, eating "very little," and the use of food substitutes or diet pills were associated
with substantially greater weight gain during the follow-up period even after adjustment for baseline weight
status. The body mass index (BMI) increased by 4.63 kg/m2 among adolescents using these unhealthy dieting
behaviors, as compared with a BMI increase of 2.29 kg/m2 among those who did not. The results suggest that
weight-reduction efforts reported by teenage girls are more likely to result in weight gain than in weight loss. In
addition, repeated dieting is highly correlated with cycles of weight loss and gain (ie, "yo-yo" dieting), a risk factor
for development of coronary heart disease [99,144].
Because of the dramatic increase in the proportion of obese adolescents in the United States between 1980 and
2012 (quadrupled from 5 to 20.5 percent) [180-182], dieting is a much debated issue [172,183,184]. Unless
medically indicated and guided toward healthy eating behaviors, dieting can be unhealthy for a growing
adolescent even if he or she is overweight [172,185,186]. Focusing on a well-balanced diet that includes a
decrease in consumption of foods with high-energy density and increasing exercise may offer a safer alternative
to food restriction for an adolescent who needs to lose weight [185,187-190].
Counseling — Health care professionals play a role in educating adolescents about the normal changes in
growth and development that occur during adolescence and in helping adolescents understand that self-imposed
dieting is neither healthy nor desirable for their growing bodies and may actually increase body weight
[145,148,150,151,191]. As part of the routine health maintenance examination, primary care providers should ask
about body image and dieting patterns and/or use a validated written measure such as the Eating Attitudes Test
(table 6). Counseling or referral to a dietitian is warranted if the adolescent is using unsound dieting or weight
loss practices [99]. Referral to a multidisciplinary team or professional with expertise in eating disorders is
indicated if an eating disorder is suspected. The team can consist of psychiatrists or psychologists, adolescent
medicine clinicians, dietitians, and exercise therapists with the necessary experience in treating eating disorders.
(See "Eating disorders: Overview of epidemiology, clinical features, and diagnosis" and "Eating disorders:
Overview of prevention and treatment".)
To avoid iron deficiency, adolescent females should be advised to consume iron-rich animal foods (ie, lean red
meats, chicken, fish, and eggs) or good nonheme sources (ie, iron-fortified cereals, whole grains, dried beans,
seeds, and nuts) (table 7) with foods rich in vitamin C (ie, citrus fruits, tomatoes, and pineapple). (See "Iron
requirements and iron deficiency in adolescents".)
Adolescents who shun milk should be encouraged to include other sources of calcium in their diets, such as low-
fat yogurt, cheese, or calcium-enriched foods (table 4) [49,166]. (See "Calcium requirements in adolescents".)
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions around the world are
provided separately. (See "Society guideline links: Healthy diet in children".)
https://www-uptodate-com.ezproxy.unbosque.edu.co/contents/adolescent-eating-habits/print?search=adolescent eating&source=search_result&sele… 11/35

SUMMARY AND RECOMMENDATIONS
Adolescence is a nutritionally vulnerable time period. Poor eating habits formed during adolescence can lead to
obesity and diet-related diseases in later years [15,16,192-194]. In addition, the high incidence of dieting
behaviors can contribute to nutritional inadequacies and to the development of eating disorders.
Primary care providers are in an optimal position to provide nutrition screening, counseling, and referral to a
dietitian if needed. The American Medical Association's Guidelines for Adolescent Preventive Services (GAPS)
recommend that primary health care providers provide annual guidance regarding dietary habits, including the
benefits of a healthy diet, ways to improve eating habits, and safe weight management. GAPS also recommends
annual screening for eating disorders and obesity. These guidelines are also consistent with those outlined by the
multidisciplinary task force Bright Futures. Asking about main meals can provide a neutral opening to discuss
more difficult topics [195]. (See "Guidelines for adolescent preventive services", section on 'Screening'.)
The following general approaches are useful for providing nutritional counseling to adolescents:
● Use ChooseMyPlate as a guide for a healthy diet and emphasize variety for supplying all the necessary
nutrients for growth and development.
● Recommend reduced-fat dairy and animal products, moderate portion sizes, and less frequent consumption
of higher-fat items. Along with increased intake of fruits, vegetables, and whole grains, this suggestion can
help adolescents achieve dietary guidelines without compromising energy, vitamin, and mineral intakes. (See
'Dietary balance' above.)
● Adolescent girls should be advised to consume iron-rich animal foods or good nonheme sources (table 7)
with foods rich in vitamin C. (See "Iron requirements and iron deficiency in adolescents".)
● Educate adolescents, particularly females, about the importance of calcium to bone health, recommended
intakes, and good sources of calcium, particularly lower-fat, calcium-rich dairy products and additional
sources such as calcium-fortified foods (table 4). (See "Calcium requirements in adolescents".)
● Stress the importance of eating all meals, particularly breakfast. Adolescents should be informed that
skipping meals does not help with weight control and indeed may promote weight gain. (See 'Skipping
meals' above.)
● Promote nutrient-dense snacks to help fill in nutrient gaps. (See 'Snacking' above.)
● Teach adolescents how to make nutritionally sound choices when faced with an array of foods that may be
convenient and appealing but are not necessarily healthy (table 2). (See 'Fast foods' above.)
● Educate adolescents that "dieting" (the manipulation of food intake and food choices driven by weight
concerns, as distinct from efforts to adopt healthy eating and other lifestyle behaviors in the interest of good
health) is not healthy. Efforts at weight reduction can compromise nutrition, growth, and health and can
increase the risk for the development of an eating disorder. (See 'Dieting' above.)

• Avoid categorizing foods as "good," "bad," "safe," or "fattening"; focus on foods that are recommended
rather than on foods to avoid
• Emphasize that no one body type is ideal and that adolescents' bodies develop at different rates; stress
the importance of body diversity
• Explain the importance of healthy eating habits to one's health, appearance, and energy
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Topic 5361 Version 30.0

GRAPHICS
Healthy People 2020: Selected nutrition objectives
Weight status 2020 targets*
Reduce the proportion of children 2 to 5 years who are obese 9.6%
Reduce the proportion of children 6 to 11 years who are obese 15.7%
Reduce the proportion of adolescents who are obese 16.1%
Reduce the proportion of adults who are obese 30.6%
Food and nutrient consumption (2 years and older) 2020 targets ¶
Increase the contribution of fruits to the diet 0.9 cup-equivalents per 1000 calories
Increase the contribution of vegetables to the diet, with at least one-third of these servings 1.1 cup-equivalents total vegetables
being dark green or deep-yellow vegetables per 1000 calories
Increase the contribution of whole grains to the diet 0.6 ounce-equivalents of whole grains
per 1000 calories
Reduce the consumption of calories from solid fats and saturated fat Solid fats no more than 16.7% of
caloric intake
Saturated fats no more than 9.5% of
caloric intake
Reduce the consumption of calories from added sugars Added sugars no more than 10.8% of
caloric intake
Increase consumption of calcium 1300 milligrams daily
BMI: body mass index.

* Target selected to represent a 10% improvement over baseline. In children and adolescents, obesity is defined as ≥95 th percentile of BMI
for age and gender. In adults, obesity is defined as BMI ≥30.
¶ Target selected to represent an achievable shift in the population intake, based on past trends and consideration of the target's applicability
to subpopulations.
From US DHHS. Healthy People 2020: Nutrition and weight status objectives. Available at:
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=29 (accessed 3/27/2012).
Graphic 57047 Version 4.0

Energy (calories) and fat content of fast food meals, comparing typical with healthier choices
Typical choices Healthier choices
Percent Percent
of of
Energy Fat Energy Fat
Menu item (serving size) energy Menu item (serving size) energy
(kcal) (g) (kcal) (g)
from from
fat fat
Pizza Hut [1]
Small cheese express hand- 510 18 31 Veggie Lover's small Thin 'N 200 6 25
tossed pizza (2 slices) Crispy pizza (2 slices)
Hershey's triple-chocolate 380 16 37 Cinnamon sticks (2 pieces) 160 4.5 25

brownie (1/6 th square)
Pepsi (20 fl oz) 250 0 0 Diet Pepsi (20 fl oz) 0 0 0
TOTAL 1140 34 30 TOTAL 360 10.5 30
McDonald's [2]
Big Mac hamburger 540 30 50 Hamburger 250 8 28
French fries (large) 490 23 42 Side salad with low-fat balsamic 50 2 36

vinaigrette dressing
Baked apple pie 240 11 41 Apple slices (1 pack) 15 0 0
Coca-Cola (large) 290 0 0 Dasani water bottle 0 0 0
TOTAL 1560 64 41 TOTAL 315 10 32
Burger King [3]
Double Whopper hamburger 980 65 59 Garden grilled chicken salad 320 14 38

with cheese
French fries (large) 430 19 40 Avocado ranch dressing 170 17 88
Hershey's ice cream sundae pie 300 18 53 Applesauce 50 0 0
Sprite (20 fl oz) 190 0 0 Unsweetened tea (20 fl oz) 0 0 0
TOTAL 1900 102 54 TOTAL 540 31 57
Kentucky Fried Chicken [4]
Extra crispy chicken drumstick 500 35 63 Grilled chicken thigh 150 9 54

and thigh
Mashed potatoes with gravy 130 4.5 31 House side salad with light 30 0.5 15
Italian dressing
Chocolate chip cake (1 slice) 300 15 45 Chocolate chip cookie 120 6 45
Mountain Dew (20 fl oz) 270 0 0 No-calorie peach iced green tea 5 0 0
(20 fl oz)
TOTAL 1200 54.5 45 TOTAL 305 15.5 51
Data from:
1. Pizza Hut Interactive Nutrition Menu. Available at: https://m.nutritionix.com/pizza-hut/menu/premium/ (Accessed on April 9, 2020).
2. McDonald's Nutrition Calculator. Available at: https://www.mcdonalds.com/us/en-us/about-our-food/nutrition-calculator.html
(Accessed on April 9, 2020).
3. Burger King USA Nutritionals (October 2017). Available at: https://fastfoodnutrition.org/burger-king (Accessed on April 9, 2020).
4. Kentucky Fried Chicken Nutrition Calculator. Available at: https://www.kfc.com/nutrition (Accessed on April 9, 2020).

Recommended daily amount from each food group, by calorie level
Calorie level
Food group
1200 1400 1600 1800 2000 2200 3000
Grains* 4 ounces 5 ounces 5 ounces 6 ounces 6 ounces 7 ounces 10 ounces
Vegetables ¶ 1.5 cups 1.5 cups 2 cups 2.5 cups 2.5 cups 3 cups 4 cups
Fruits Δ 1 cup 1.5 cups 1.5 cups 1.5 cups 2 cups 2 cups 2.5 cups
Dairy ◊ 2.5 cups 2.5 cups 3 cups 3 cups 3 cups 3 cups 3 cups
Protein foods 3 ounces 4 ounces 5 ounces 5 ounces 5.5 ounces 6 ounces 7 ounces
* In general, 1 slice of bread, 1 cup of ready-to-eat cereal, or 0.5 cup of cooked rice, cooked pasta, or cooked cereal can be considered as 1
ounce equivalent from the grains group. At least one-half of these servings should be whole grains.
¶ 1 cup vegetables is approximately equal to 12 baby carrots or 1 large tomato. Because of high water content, a serving of lettuce must be
twice as large (1 cup of lettuce = 0.5 cup of other vegetables).
Δ 1 cup of fruit is approximately equal to 1 apple or banana, 2 plums, one-eighth melon, or 8 strawberries.
◊ Milk should be fat-free or low-fat after 2 years of age.
Data from: the United States Department of Agriculture "ChooseMyPlate" website, available at: www.choosemyplate.gov.

Dietary sources of absorbable calcium, in comparison with milk
Number of
Fractional Estimated servings
Serving size* Calcium
Food absorption Δ, absorbable needed to
(g) content ¶ (mg)
(percent) calcium ◊ (mg) equal 240 mL
milk
Milk 240 300 32.1 96.3 1
Beans
Pinto 86 44.7 26.7 11.9 8.1
Red 172 40.5 24.4 9.9 9.7
White 110 113 21.8 24.7 3.9
Bok choy 85 79 53.8 42.5 2.3
Broccoli 71 35 61.3 21.5 4.5
Cheddar cheese 42 303 32.1 97.2 1
Cheese food 42 241 32.1 77.4 1.2
Chinese cabbage 85 239 39.6 94.7 1

flower leaves
Chinese mustard 85 212 40.2 85.3 1.1

greens
Fruit punch with 240 300 52 156 0.62

calcium citrate
malate
Kale 85 61 49.3 30.1 3.2
Spinach 85 115 5.1 5.9 16.3
Sweet potatoes 164 44 22.2 9.8 9.8
Rhubarb 120 174 8.54 10.1 9.5
Tofu with calcium 126 258 31 80 1.2
Yogurt 240 300 32.1 96.3 1
* Based on one-half-cup serving size (~85 g for green leafy vegetables) except for milk and fruit punch (1 cup or 240 mL) and cheese (1.5
ounces).
¶ From references 4 and 5 (averaged for beans and broccoli processed in different ways) except for the Chinese vegetables, which were
analyzed in our laboratory.
Δ Adjusted for load by using the equation for milk (fractional absorption = 0.889 to 0.0964 in load (6)) then adjusted for the ratio of calcium
absorption of the test food relative to milk tested at the same load, the absorptive index. The absorptive index was taken from the literature
for beans (7), bok choy (8), broccoli (8), Chinese vegetables (9), fruit punch with calcium citrate mulate (10), kale (8), sweet potatoes (9),
rhubarb (9), tofu (11), and dairy products (12).
◊ Calculated as calcium content × fractional absorption.
Reproduced with permission from: Weaver CM, Proulx WR, Heaney R. Choices for achieving adequate dietary calcium with a vegetarian diet.
Am J Clin Nutr 1999; 70 (suppl):543S. Copyright ©1999, American Society for Clinical Nutrition.

Zinc content of selected foods
Food Amount Zinc
Oysters 6 medium 80 mg
84 g
Liver 3.5 oz 6.1 mg
100 g
Hamburger 3.5 oz 4.9 mg
100 g
Cheerios 1 cup 3.7 mg
22.4 g
Chickpeas (canned, drained) 1 cup 3 mg
150 g
Pumpkin seeds 1 oz 2.2 mg
28 g
Sunflower seeds 1 oz 1.6 mg
28 g
Cashews (dry roasted) 1 oz 1.6 mg
28 g
Pecans 1 oz 1.5 mg
28 g
Scallops 3 oz 1.32 mg
85 g
Chicken (white meat) 3.5 oz 1.0 mg
100 g
Milk (whole, skim) 1 cup 0.9 mg
240 g
Brown rice 1/2 cup 0.6 mg
97 g
Egg (1 whole) 1 large 0.5 mg
50 g
White rice 2/3 cup 0.4 mg
124 g

Eating attitudes test
Always Usually Often Sometimes Rarely Never Score
1. Am terrified about being overweight 0 0 0 0 0 0 ___
2. Avoid eating when I am hungry 0 0 0 0 0 0 ___
3. Find myself preoccupied with food 0 0 0 0 0 0 ___
4. Have gone on eating binges where I feel that 0 0 0 0 0 0 ___

I may not be able to stop
5. Cut my food into small pieces 0 0 0 0 0 0 ___
6. Aware of the calorie content of foods that I 0 0 0 0 0 0 ___

eat
7. Particularly avoid foods with high 0 0 0 0 0 0 ___

carbohydrate content (ie, bread, rice, potatoes,
etc)
8. Feel that others would prefer if I ate more 0 0 0 0 0 0 ___
9. Vomit after I have eaten 0 0 0 0 0 0 ___
10. Feel extremely guilty after eating 0 0 0 0 0 0 ___
11. Am preoccupied with a desire to be thinner 0 0 0 0 0 0 ___
12. Think about burning up calories when I 0 0 0 0 0 0 ___

exercise
13. Other people think that I am too thin 0 0 0 0 0 0 ___
14. Am preoccupied with the thought of having 0 0 0 0 0 0 ___

fat on my body
15. Take longer than others to eat my meals 0 0 0 0 0 0 ___
16. Avoid foods with sugar in them 0 0 0 0 0 0 ___
17. Eat diet foods 0 0 0 0 0 0 ___
18. Feel that food controls my life 0 0 0 0 0 0 ___
19. Display self-control around food 0 0 0 0 0 0 ___
20. Feel that others pressure me to eat 0 0 0 0 0 0 ___
21. Give too much time and thought to food 0 0 0 0 0 0 ___
22. Feel uncomfortable after eating sweets 0 0 0 0 0 0 ___
23. Engage in dieting behavior 0 0 0 0 0 0 ___
24. Like my stomach to be empty 0 0 0 0 0 0 ___
25. Enjoy trying new rich foods 0 0 0 0 0 0 ___
26. Have the impulse to vomit after meals 0 0 0 0 0 0 ___
For all items except #25, responses receive the following value:
Always = Usually = Often = Sometimes = 0 Rarely = Never =

3 2 1 0 0
For item #25, the responses receive these values:
Always = Usually = Often = Sometimes = 1 Rarely = Never =

0 0 0 2 3
The cutoff score in screening patients for the presence of a Diagnostic and Statistical Manual of Mental Disorders-4 (DSM-IV) eating
disorder is 20 [1].
Reference:
1. Mintz LB, O'Halloran MS. The Eating Attitudes Test: validation with DSM-IV eating disorder criteria. J Pers Assess 2000; 74:489.
Reproduced with permission from: Garner DM, Garfinkel PE. Psychol Med 1979; 9:273. Copyright © 1979 Cambridge University Press.

Dietary sources of iron
Food Approximate measure Iron (mg)
High-iron sources
Cream of Wheat (quick or instant)* 1/2 cup 7.8
Kidney, beef ¶ 2 oz (60 g) 5.3
Liver, beef ¶ 2 oz (60 g) 5.8
Liver, calf ¶ 2 oz (60 g) 9
Liver, chicken ¶ 2 oz (60 g) 6
Liverwurst ¶ 2 oz (60 g) 3.6
Prune juice 1/2 cup 5.1
Spinach 1/2 cup 3.2
Moderate-iron sources
All-Bran cereal 1/2 cup 2.9
Almonds, dried, unblanched 1/2 cup 3
Dried beans and peas

Baked beans, no pork 1/4 cup 1.5
Blackeye peas, cooked 1/4 cup 0.8
Chick peas, dry 1/4 cup 3.5
Great northern beans, cooked 1/4 cup 1.3
Green peas, cooked 1/4 cup 1.4
Lentils, dry 1/4 cup 3.4
Lima beans, cooked 1/4 cup 1.3
Navy beans, cooked 1/4 cup 1.3
Red beans, dry 1/4 cup 3.5
Soybeans, cooked 1/4 cup 1.4
White beans, dry 1/4 cup 3.9
Beef, cooked 2 oz (60 g) 2 to 3 Δ
Ham, cooked 2 oz (60 g) 1.3
Lamb, cooked 2 oz (60 g) 1.9
Peaches, dried 1/4 cup 2.4
Peanuts, roasted without skins 3 1/2 oz (100 g) 3.2
Pork, cooked 2 oz (60 g) 2 to 3 ◊
Prunes, dried 2 large 1.1
Scallops 2 oz (60 g) 1.6
Turkey, cooked 2 oz (60 g) 1.7
Approximate iron content of children's favorite foods
Hamburger, small 1 3
Large 1 5.2
Big Mac 1 4.3
Quarter Pounder 1 5.1
Spaghetti with meatballs 1 cup 3.3
Frankfurter and beans 1 cup 4.8
Pork and beans 1 cup 5.9
Raisins § 5/8 cup 3.5
Cereals, fortified 1 serving 4.5 to 17.8
Nuts § 1 cup 5 to 7
Seeds, sunflower § 3 1/2 oz (100 g) 7.1
Chile con carne 1 cup 3.6

Beef burrito or tostado 1 medium 3.4 to 4.6
Cheese pizza 2 slices 3
Cheese pizza with beef 2 slices 4.8
White bread 1 piece 0.7
* Or other fortified cereals that contain 10 mg of iron per ounce or 100% recommended dietary allowance per serving.
¶ As organ meats are generally high in cholesterol, these iron-rich foods should be eaten in moderation.
Δ Depending on cut, the greatest amounts of iron are generally found in the chuck, flank, and bottom round cuts of beef.
◊ Depending on cut, the greatest amounts of iron are generally found in the loin, sirloin, tenderloin, and picnic shoulder cuts of pork.
§ Raisins, nuts, and seeds are not generally recommended for children under age 3, because of risk of choking.
Data from: Walker WA, Watkins JB (Eds), Nutrition in Pediatrics, 2nd ed, BC Decker, Inc, London 1997.

Contributor Disclosures
Debby Demory-Luce, PhD, RD, LD Nothing to disclose Kathleen J Motil, MD, PhD Nothing to disclose Amy B
Middleman, MD, MPH, MS Ed Grant/Research/Clinical Trial Support: Pfizer [Meningococcal serogroup B vaccine]. Alison G
Hoppin, MD Nothing to disclose
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by
vetting through a multi-level review process, and through requirements for references to be provided to support the content.
Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.
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OVERVIEW OF CHALLENGES AND TRENDS

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Possible explanations for this finding include [93]:

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● Fresh fruit or vegetables with low-fat yogurt dip

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Dieting and disordered eating behaviors in adolescents include [87,88,145-149]:

● Exclusion of specific foods or food groups

Prevalence — A history of dieting can be obtained in approximately 40 to 70 percent of adolescents [31,88,153-

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SOCIETY GUIDELINE LINKS

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SUMMARY AND RECOMMENDATIONS

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4. Cutler GJ, Flood A, Hannan P, Neumark-Sztainer D. Multiple sociodemographic and socioenvironmental

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23. Healthy People 2020. Available at: http://www.healthypeople.gov/2020/default.aspx (Accessed on January

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Am Diet Assoc 2005; 105:938.

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134. USDA Dietary Guidelines 2010. Available at: www.cnpp.usda.gov/dietary-guidelines-2010 (Accessed on Se

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Topic 5361 Version 30.0

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Healthy People 2020: Selected nutrition objectives

Weight status 2020 targets*

Reduce the proportion of children 2 to 5 years who are obese 9.6%

Reduce the proportion of children 6 to 11 years who are obese 15.7%

Reduce the proportion of adolescents who are obese 16.1%

Reduce the proportion of adults who are obese 30.6%

Food and nutrient consumption (2 years and older) 2020 targets ¶

Increase consumption of calcium 1300 milligrams daily

BMI: body mass index.

Graphic 57047 Version 4.0

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Typical choices Healthier choices

Pizza Hut [1]

Hershey's triple-chocolate 380 16 37 Cinnamon sticks (2 pieces) 160 4.5 25

Pepsi (20 fl oz) 250 0 0 Diet Pepsi (20 fl oz) 0 0 0

TOTAL 1140 34 30 TOTAL 360 10.5 30

Big Mac hamburger 540 30 50 Hamburger 250 8 28

French fries (large) 490 23 42 Side salad with low-fat balsamic 50 2 36

Baked apple pie 240 11 41 Apple slices (1 pack) 15 0 0

Coca-Cola (large) 290 0 0 Dasani water bottle 0 0 0

TOTAL 1560 64 41 TOTAL 315 10 32

Burger King [3]

Double Whopper hamburger 980 65 59 Garden grilled chicken salad 320 14 38