Beth Lulinski, MS, RD
2006 Wolf Rinke Associates, Inc. All rights reserved for this self-directed learning program. Reproduction in whole or in part without written permission from the publisher is prohibited.
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Customer Comments
Debra Finkelstein: "Thanks for sending me the materials so quickly. This was my first time getting CPE credits this way. It was a very enjoyable way to learn and review. I will definitely use the information."
Miriam Horowitz: "Terrific course, interesting and I learned a lot. Already incorporated it into clinical practice."
Holly Sherman: "This course was very interesting. I couldn't put it down."
Sandra Sullivan: "The inclusion of case studies helps to apply and review the material."
Jamie Pope: "I teach nutrition . . .to undergraduate students so was reinforced by all I already have learned and knew."
Bernardita Ruiz: "Very organized and resourceful on new research."
Susan Scott: "As a mother of an 11 and 13 year old, it contained a lot of information I could use personally as well as professionally."
Susanne De Matas: "The course material was thorough and interesting."
Overview and Instructions
The age of adolescence encapsulates a window of time when bodies are metamorphosizing
and evolving into that of adults. It is the time when adolescents try to boldly
establish their own identities yet desperately seek to be socially accepted
by their peers. The challenge for the nutrition professional is to reach teens
with the message about how to fuel their bodies in a manner that allows them
increased autonomy in the decision-making process. When the counseling strategies
are engaging, the teen mind is impressionable and open to new ideas. However,
once information is assimilated, teens are still vulnerable to the pressures
of peers, rebellious acts, and occasional self-destructive behavior.
This self-directed, accredited learning program begins by addressing the body
transformations that occur as sexual maturation progresses. The specific nutrient
demands for the adolescent growth spurt are presented, along with current recommendations
for assessing the needs of adolescents.
This learning program will help the practitioner educate teens to make food
choices and plan healthy meals based on established guidelines to reduce their
health risks. Healthy eating habits instilled early in life may play a vital
role in preventing the chronic diseases of aging. Often teens do not think far
into the future and make their food choices based on what tastes good now. Unfortunately,
with the rise in childhood obesity in the United States and related co-morbidities
such as Type 2 diabetes, we are addressing issues of adults in our youths. Prevention
of co-morbidities and long-term complications of these current health threats
of our youth have become a new priority for health care professionals.
Adolescents exert their independence by the choices of foods eaten away from
home or the snacks and meals they prepare for themselves. The pressure of peers
and mass media can impact the decision process. Too often adolescents compare
their developing bodies to the ideal bodies of the stars and athletes they see
on television or in magazines. Some teens fall victim to endless dieting or
even eating disorders.
For active adolescents, the proper fuel can give the edge to excel in the sports
arena. Common advice for pre-event meals, fluid replacement, and refueling will
be shared to help dispel common myths that may lead teens astray.
Substance abuse and cigarette smoking are rebellious and risky behaviors that
may be experimental initially, but can end up addictive or even deadly. It is
important to be educated as a nutrition professional regarding the nutritional
impact of substance abuse and to know what advice to give in the various stages
of the addiction.
Finally, the family can play a significant role in modeling healthy eating and
exercise behaviors and can assist teens on the road to lifelong healthy habits.
As teens grow up in a pop culture featuring videos, music, virtual reality games,
internet access, extreme sports, and graphic television, how do we compete for
their attention and have our nutrition message make an impact? In a recent survey
of 325 dietitians who work with adolescents, the top-rated area in which respondents
wanted more training was communicating with adolescents (1). Interactive tools
and tips to improve your communication skills will be presented throughout this
learning program to increase your comfort zone in working with this challenging
age group and provide you with the practical repertoire to approach teens with
confidence.
This self-directed learning program is a Category 2 Continuing Professional
Education (CPE) program approved for 12 Continuing Professional Education Units
(CPEUs), meaning that the reader has general knowledge of the literature and
professional practice within the area covered. The focus of the program is to
enhance knowledge and application.
To get the most benefit from this program, we suggest you adhere to the following
four steps:
Step 1: Review the objectives for the learning program.
Step 2: Study each chapter. As you read, think of patients from your own practice
who fit the situation described.
Step 3: Assess what you have learned by completing the self-assessment instrument
at the end of this learning program.
Step 4: Compare your answers to the answer key that has been provided. If you
score at least 80 percent correct, you are ready to transfer your answers to
the CONTINUING PROFESSIONAL EDUCATION (CPE) REPORTING FORM. If you scored less
than 80 percent correct, re-read this learning program until you score at least
80 percent correct.
To receive a Certificate of Completion, mail or fax the completed CPE REPORTING
FORM to:
Wolf Rinke Associates, Inc.
P.O. Box 350
Clarksville, MD 21029
Fax (410) 531-9282
Objectives
Upon successful completion of this learning program, the student should be able to:
Demonstrate effective communication strategies leading to behavior changes
in adolescent clients.
Apply effective teaching strategies leading to behavior changes in adolescent
clients.
Assess the nutritional adequacy of a teen's diet.
Identify the specific nutrient needs of adolescents as their bodies develop
and mature.
Promote current dietary recommendations to reduce the risk of chronic disease
and to address the current health threats in adolescents (Obesity, Type 2 Diabetes).
Recognize what influences the food choices of adolescents.
Describe the risks of eating disorders to adolescents.
Implement therapeutic approaches that will enable the recovering of eating disorder
clients.
Assist overweight or obese adolescents with embracing healthy weight loss measures.
Calculate the fuel needs for athletic teens and plan meals to enhance peak performance.
Identify common ergogenic aids adolescents may use to gain the competitive edge.
Identify teens experiencing the female athlete triad and provide dietary steps
to aid in the recovery process.
Counsel teens regarding the nutritional impact of risky behaviors.
Table of Contents
1-The Changing Body and Nutrient Needs of Adolescents……………..
1
The Changing Body..………………………………………………………
1
Sexual Maturation..…………………………………………………………
1
Height…………………………….…………………………………………
4
Body Composition………………………………………………………….
4
Measuring Growth………………………………………………………….
5
Nutrient Needs……………………………………………………………...
6
Energy Needs……………………………………………………………….
12
Protein………………………………………………………………………
12
Fat…………………………………………………………………………..
13
Calcium……………………………………………………………………..
16
Iron………………………………………………………………………….
18
Fiber………………………………………………………………………...
19
Vitamins…………………………………………………………………….
20
References…………………………………………………………………..
21
2-Dietary Recommendations………………………………………………….
23
Dietary Guidelines for Americans……………..……….…………………..
23
MyPyramid Food Guidance System…………………………………..……
27
Healthy People 2010: Objectives for the Nation…………………………...
32
Five a Day for Better Health……………………….……………………….
34
References…………………………………………………………………..
37
3-Eating Independence…………………………………………………………
39
Food Choices………………..……………………………………………..
39
Breakfast……………………………………………………………………
41
School Influences………………..…………………………………………
42
Snacking…………………………………………………………………….
45
Television …………………………………………………………………..
47
Fast Food……………………..…………………………………………….
48
Vegetarianism……………………………………………………………..
48
References…………………………………………………………………..
51
4-The Perfect Body Illusion……………………………………………………
53
Body Image……………………………..………………………………….
53
Eating Disorders…………………………………………………………….
58
Anorexia Nervosa…………………..………………………………………
60
Bulimia Nervosa……………………………………………………………
69
Binge Eating Disorder………………...……………………………………
74
Obesity……………………………………..………………………………
77
References…………………………………………………………………..
87
5-Active Teens…..………………..……………………………………………..
91
Energy Needs…..…………………………………………………………..
92
Pre-Event Fuel……………..……………………………………………….
94
Fluid Replacement………………………………………………………….
95
Recovery Fuel…………………..………………………………………….
98
Energy Bars and Gels……………..………………………………………..
99
Ergogenic Aids…………………………..…………………………………
100
Protein Pushers……………………..………………………………………
103
Weight Gain……………………..………………………………………….
104
Female Athlete Triad……………………………………………………….
105
References…………………………………………………………………..
109
6-Risky Behavior……………………..…………………………………………
111
Peer Pressure………………………………………………………………..
111
Drug Use…………………..………………………………………………..
112
Smoking……………..……………………………………………………...
115
Alcohol……………………..………………………………………………
117
Marijuana…………………………..………………………………………
120
Cocaine………………………………….………………………………….
122
Amphetamines……………………………………………………………...
123
Caffeine……………………………………………………………………..
123
Teen Pregnancy……………………………………………………………..
124
References…………………………………………………………………..
131
7-Counseling Teens……………………………………..……………………..
133
Family Ties…………………………………………………………………
136
References…………………………………………………………………..
140
Case Study……………………………………..………………………………...
141
Appendix A: CDC Pediatric Growth Charts…….………………………….
147
Appendix B: NCAA Banned Drug Classes, 2004-05……..…..…………..
157
List of Abbreviations…………..……………………………………………….
161
Glossary………………………………..…………………………………………
163
Resources…………………..……………………………………………………
165
Self-Assessment Questions…………………………..………………………
167
Answer Key……………………………….………………………………………
177
Explanation to Questions………………………………..……………………
179
About the Author…………………………………..……………………….…..
183
About Wolf Rinke Associates, Inc.…………………………………..….…..
184
Beth Lulinski, MS, RD, LDN, is a registered dietitian with a bachelor's degree
in dietetics from the University of Illinois and a master's degree in nutrition
and dietetics from Rosalind Franklin University of Medicine and Science. She
has a strong background in nutrition science and health promotion, and has worked
for the last sixteen years providing nutrition therapy in the healthcare setting.
Lulinski is currently an Instructor in the Department of Nutrition, Dietetics,
and Hospitality Administration at Northern Illinois University in Dekalb, IL;
and an outpatient dietitian at Centegra Health System in Woodstock, IL, teaching
SHAPEDOWN classes for children and teens. She has a passion for adolescent nutrition
issues and feels that the future health of the nation depends on reaching the
youth with nutrition messages that will impact their quality of life and help
prevent chronic diseases. She has embraced a well-rounded approach to healthy
living and has presented numerous wellness programs on nutrition, fitness, stress
management, and smoking cessation to groups of all ages.