Health Concerns During Adolescence PDF

Health Concerns During Adolescence - Adequate adolescent nutrition is necessary for optimal growth and development. Dietary choices and habits established during adolescence greatly influence future health, yet many studies report that teens consume few fruits and vegetables and are n...

Health Concerns During Adolescence - Adequate adolescent nutrition is necessary for optimal growth and development. Dietary choices and habits established during adolescence greatly influence future health, yet many studies report that teens consume few fruits and vegetables and are not receiving the calcium, iron, vitamins, or minerals necessary for healthy development. - Reason for poor nutrition: anxiety related to body image (body dissatisfaction) - Fften associated with body mass, low self-esteem, and atypical eating patterns. Obesity: BMI (kg/m\^2) is used to classify: 1. Overweight: BMI 25.0--29.9 2. Obesity: BMI greater than or equal to 30.0 3. Extreme obesity: BMI greater than or equal to 40.0 - The CDC also indicated that one's 20s are the prime time to gain weight as the average person gains one to two pounds per year from early adulthood into middle adulthood. The average man in his 20s weighs around 185 pounds and by his 30s, weighs approximately 200 pounds. The average American woman weighs 162 pounds in her 20s and 170 pounds in her 30s. - Causes of obesity: Societal factors include culture, education, food marketing and promotion, the quality of food, and the physical activity environment available. Behaviors leading to obesity include diet, the amount of physical activity, and medication use. Lastly, there does not appear to be a single gene responsible for obesity. Rather, research has identified variants in several genes that may contribute to obesity by increasing hunger and food intake - Obesity can lead to: - All-causes of death (one of the leading causes of death worldwide) - High blood pressure (Hypertension) - High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia) - Type 2 diabetes - Coronary heart disease - Stroke - Gallbladder disease - Osteoarthritis (a breakdown of cartilage and bone within a joint) - Sleep apnea and breathing problems - Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver) - Low quality of life - Mental illness such as clinical depression, anxiety, and other mental disorders - Body pain and difficulty with physical functioning Eating Disorders Dissatisfaction with body image can explain why many teens, mostly girls, eat erratically or ingest diet pills to lose weight and why boys may take steroids to increase their muscle mass. Although eating disorders can occur in children and adults, they frequently appear during the teen years or young adulthood. Men can have muscle dysmorphia or an extreme concern with becoming more muscular. Causes of Eating Disorders: Eating disorders appear to run in families, and researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders. Researchers have also found differences in patterns of brain activity in women with eating disorders in comparison with healthy women - Anorexia Nervosa- Usual onset during adolescence. Person has a preoccupation with their weight/body image, resulting in poor food/caloric intake and BMI \< 18.5. - Anorexia nervosa has the highest mortality rate of any mental disorder - Restrictive: weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to lose weight - Binge/purge (eats but follows with vomiting or diarrhea or overexercise). Often coexists with perfectionism, depression. - Medical issues r/t anorexia: nutritional deficiencies can lead to osteoporosis, amenorrhea, low iron, muscle wasting, emaciation, brittle hair and nails, dry, yellow skin, lanugo, constipation, hypotension, brain damage, hypothermia, lethargy, infertility, bradycardia (40-49), unstable VS, swollen feet (low albumin), dizziness, abdominal bloating, weight loss \> 10% body weight. - Watch for electrolyte disturbances when refeeding (hypophosphatemia and refeeding syndrome). Body goes into hypothyroid state (low T3 and T4 and low/normal TSH). - Treatment: psychotherapy. Admit if very sick/underweight. Atypical antipsychotic: Olanzapine. Unclear if antipsychotic effects are it or the metabolic side effect of Olanzapine that is helping. SSRIs do not work in anorexia, only bulimia. - Bulimia- binge eating followed by compensatory behavior (Purge type by vomiting or diarrhea with laxative, or takes diuretic to pee). - Can tell vomiting by- teeth/enamel erosion, esophageal tears, parotitis (carotid salivary gland inflammation), thickened/callus knuckles by inducing vomit. - Non-purge Bulimia- increased exercise or diet. - Treatment- psychotherapy, less common to admit patients, SSRIs (fluoxetine). Bupropion is contraindicated in anorexia and bulimia because it lowers seizure threshold Key difference between anorexia and bulimia: Bulima are overweight or normal weight (BMI \> 18.5) and anorexia is always underweight (\< 18.5) - Binge eating disorder- similar to bulimia that there is binge eating, but without compensatory behavior. - To be diagnosed, must have at least three of following: eat quick, eat alone, eat until uncomfortably full, eat when mot hungry, feelings of disgust/guilt/depression after eating. - Often overweight, can suffer from CV disease, diabetes, metabolic syndrome. - Treatment: Can use stimulants to suppress appetite or Orlistat. - Binge-eating disorder is the most common eating disorder in the U.S. Anorexia- only one that has low BMI, can be purging (NO SSRIs, Olanzapine, Bupropion contraindicated) Bulimia- High or normal BMI, binging then purging (SSRIs: Fluoxetine, Bupropion contraindicated) Binge eating- High or normal BMI, binging without purging (Stimulants or Orlistat) Treatments: Psychotherapy, all of them can contain binge eating (cannot use as a differential). A 20-year-old female patient with co-occurring bulimia nervosa presents to the clinic for treatment of major depressive disorder. What medication is contraindicated for this patient? A. Paroxetine (Paxil) B. Fluoxetine (Prozac) C. Bupropion (Wellbutrin) D. Duloxetine (Cymbalta) Exercise and Sports - Children's activities are no longer children's activities once adults become involved and approach the games as adults rather than children. - Exercise is important for children because: - Higher levels of satisfaction with family and overall quality of life in children - Improved physical and emotional development - Better academic performance - While there are many factors involved in the decisions to drop out, one suggestion has been the lack of training that coaches of children's sports receive may be contributing to this attrition - Physical education in school is a key component in introducing children to sports Lifestyle Behavior Recommendations - Lifestyle recommendations should be promoted in settings to help decrease mental health visits - Mental illness in adolescence is associated with compliance to lifestyle recommendations in childhood, with stronger associations seen when more recommendations are met. - Emphasizing lifestyle recommendations in pediatric practice may reduce the future burden of mental illness