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Suzanne Haydu MPH RD
Sangi Rajbhandari MPH
Abby Silvester (MS Candidate/RD Intern, CWRU)
Krista Flores RD
Maternal, Child and Adolescent Health Division
Nutrition & Physical Activity
Guidelines for Adolescents
Introduction
Suzanne Haydu, MPH, RD
Agenda
Introduction - Suzanne Haydu, MPH, RD, Nutrition and
Physical Activity Coordinator, MCAH/CDPH
“What’s New” – Sangi Rajbhandari MPH
Most Recently Updated– Abby Silvester
Stories from the Field– Krista Flores RD
Questions/Answers
Objectives
By the end of this webinar you will:
1. Be able to locate the Nutrition & Physical
Activity Guidelines and related tools for
adolescents on the web
2. Be able to competently use the tools located
in the Nutrition & Physical Activity Guidelines
when working with adolescents
3. Be especially familiar with the Fruits and
Vegetables, Vegetarian Teens & Body
Image and Disordered Eating sections
NUPA Guidelines for
Adolescents
Photo Source: ClipArt
Speakers
Sangi Rajbhandari, MPH Abby Silvester
MS Candidate
Dietetic Intern
Krista Flores, RD
What’s New
Sangi Rajbhandari, MPH
What’s New
Updated Content
• Recent recommendations
consistent with national
guidance/research
• Addition of new chapter,
Infant Feeding
• Use of MyPlate
Photographs Included
Colorful Handouts
• Affixed to the end of each section
• Made available on a separate webpage http://www.cdph.ca.gov/HealthInfo/healthyliving/nutrition/Pages/NUPAAdolescentsGuideli
nesHandouts.aspx
Increased Interactivity
• Links to outside resources embedded
within the guidelines
• Links to handouts and other sections of
the guidelines also included
Web Links Referenced/
Additional Resources Page
• Specific resources available for each
section
• Additional resources page displays
– Title of resource
– Resource type
– URL (hyperlinks to resource websites)
Recent Sections
Abby Silvester
MS Candidate
Dietetic Intern
NUPA Guidelines
• Reference and guide for case managers
• Interventions/Referrals
• Follow-Up
• Web Links Referenced/Additional
Resources
Nutrition and Physical Activity
Screen
• How to use the screen
• Use these screens to determine
where the client needs improvement
• When applicable, additional
screening available in specific
sections
Fruits and Vegetables
Vegetarian Teens
Body Image and
Disordered Eating
Fruits and Vegetables
Inside this Section
• Why are Fruits and Vegetables Important?
– Benefits of fruit and vegetable rich diet
• Why the Concern about Fruit and
Vegetable Intake?
– CalTEENS, 2012
– National Youth Risk Behavioral Surveillance
System (YRBSS), 2013
Recommendations
Cups or Servings?
• Recommendation language changed from
“servings” to “cups” and may be confusing
• “Cups” used in 2010 DGA and MyPlate
• Hyperlinks to resources that contain
examples of what counts as a cup
• Availability
• Social Norms
• Perceptions
• Knowledge and/or Skills
• Parental Role Modeling
Why do Adolescents Avoid
Fruits and Vegetables?
Interventions/Referrals
• Explanation of how to utilize the handouts
• Hyperlinks to handouts included
Handouts
• Fruit and Veggie Quiz
– Intervention activities
• Fruit and Vegetable Tips
– How to incorporate more
fruits and veggies in the diet
More Handouts
Be Sure to Get your
Fruits and Veggies
Eat a Colorful Variety of
Fruits and Veggies
More Handouts
• Action Plan for Fruits and Veggies
Vegetarian Teens
Inside this Section
• What is a Vegetarian Diet?
– General information
• The Spectrum of Vegetarian Diets
– Definitions of common vegetarian diets
– Vegan / Raw Vegan
– Semi-Vegetarian
Why Teens Choose to Go
Vegetarian • Interest in animal rights
• Religious beliefs
• Health or wellness
• To lose weight
• Popular among friends
• Fitness
• Possible association with disordered eating
• Vegan diets
• Protein
• n-3 Fatty Acids
• Calcium and Vitamin D
• Iron
• Zinc
• Vitamin B12
• Pregnancy
Nutritional Concerns
Nutritional Concerns
• Table for quick reference
• Specific vegetarian diet
– Associated nutrients of
concern
– Some sources of the
nutrients
Additional Screening
• Food Habits screen first from the Nutrition
and Physical Activity Screen chapter
– Is vegetarianism present?
• Additional screening
– What specific type of vegetarian diet is being
followed?
Interventions
• Utilize the handouts to encourage a
healthy vegetarian diet
Handouts
• Vegetarian Food Guide
– Tool to guide healthy vegetarian diet
• Tips for Vegetarians
More Handouts
• Smart Choices
– Activity sheet for teens
• Vegan Foods with Protein
– Includes serving size (in cups and ounces)
– Includes grams of protein each food provides
Body Image and Disordered
Eating
Inside this Section
• What is Body Image?
• Poor Body Image
• Influences on Body Image
– Pressure from parents, teachers, friends
– Society
Inside this Section
• Risk Factors for Developing Disordered
Eating
– Family dysfunction
– Focusing on weight
– Stress, anxiety, depression
– Trauma
• Poor Body Image can Lead to Disordered
Eating
Inside this Section
• Disordered Eating and Exercise
– Binge eating, anorexia nervosa, bulimia
– Other Specified Feeding or Eating Disorder
– Unspecified Feeding or Eating Disorders
– Orthorexia Nervosa
(Orthorexia)
Inside this Section
• Eating Disorder Warning Signs
• Common Misconceptions
– You can tell by looking whether a
person has an eating disorder.
False. There are many people
with eating disorders who are of
average weight
Interventions
• How to Start the
Conversation
– Krista Flores RD
– Dr. Judith Brisman
• How to Help
Someone
Interventions/Referrals
• How to use handouts
• If an eating disorder is suspected, refer to
a specialist
– Hyperlink to Additional Resources page
Handouts
• What is Body Image?
– Definition
– How it is shaped over
time
• Develop a Positive
Body Image
– Activity sheet
More Handouts
• Ask Yourself
• The Important People in My Life
• Accept All Body Shapes
Stories from the Field
Krista Flores, RD
Eating Recovery Center of California
Eating Disorders
and Body Image
By: Krista Flores, RD
June 25, 2015
Outline How to approach and talk to an adolescent with
an eating disorder
Signs to Look For
Body Image and Disordered Eating Screening Tool
What to Say- Step by Step
Questions and Answers
How to Approach and Talk to an
Adolescent with an Eating Disorder
Build rapport = trust and openness
Express your concern in a relaxing and calm
environment. Eating disorders have the highest mortality rate of any mental
illness
Discuss your worries sooner rather than later to prevent damaging physical and emotional effects of the eating disorder
Know your limits Use your resources and refer
Signs to Look for
Focused on weight for sports
Dieting
Weight changes
Negative comments about food/body image
Depression
Perfectionist
Food intake
Screening Tool
http://www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Documents/MO-NUPA-02NutritionalRiskScreening.pdf
Use of Screening Tool
What to look for
How to Interpret
What to Say- Step by Step
Set a time to talk
Communicate your concerns
Ask the adolescent to explore these concerns
Avoid conflicts or a battle of wills
Avoid placing shame, blame, or guilt regarding their actions or attitudes
Avoid giving simple solutions
Express your continued support
Body Image and Disordered Eating Handouts http://www.cdph.ca.gov/HealthInfo/healthyliving/nutrition/Documents/Body%20Image%20Handouts%20May%2029%202015.pdf
(National Eating Disorders Association, 2015)
The Frontline
The sooner an eating disorder is detected
the sooner the adolescent can get
treatment and have a better prognosis of
recovery
The adolescent and/or their family may be
resistant to getting their child help
Follow up, reassess, review handouts and provide support
Questions?
References National Eating Disorders Association. What should I say. http://www.nationaleatingdisorders.org/what-should-i-
say. 2015. Accessed July 8, 2015.
Prevention of Eating Problems with Elementary Children, Michael Levine, USA Today, July 1998.
Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The Spectrum of Eating Disturbances. International Journal of
Eating Disorders, 18 (3): 209-219.
Zucker NL, Womble LG, Williamson DA, et al. Protective factors for eating disorders in female college athletes. Eat
Disorders 1999; 7: 207-218.
Questions?
Suzanne Haydu, MPH, RD Nutrition and Physical Activity Coordinator
Maternal, Child & Adolescent Health Division
Center for Family Health, California Department of Public Health
(916) 650-0382
http://www.cdph.ca.gov/healthinfo/healthylivin
g/nutrition/Pages/TeenGuidelines.aspx