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

Suzanne.Haydu@cdph.ca.gov

(916) 650-0382

http://www.cdph.ca.gov/healthinfo/healthylivin

g/nutrition/Pages/TeenGuidelines.aspx