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Expert Speak

The Challenged Eaters

Adolescence is period of dramatic physical, cognitive and behavioural changes. The nutritional needs of this period are special. Dr Varsha provides insights and guidelines.

The Great Growth Spurt
Height and Weight Charts
     Boys: Ages 10-12
     Boys: Ages 12-14
     Boys: Ages 14-16
     Boys: Ages 16-18

     Girls: Ages 10-12
     Girls: Ages 12-14
     Girls: Ages 14-16
     Girls: Ages 16-18
Food groups
Meal Schedules
Hurdles in delivering the Right Nutrition
Fallouts of Poor Nutrition
Affluent Adolescents
Bottomline

There is a lot of emphasis on child nutrition and women’s nutrition. Do you think there is enough focus on adolescent nutrition?

No, there isn’t. Being neither children nor adults they fall into a no man’s land from a health perspective. Adolescents are less prone to infections such as pneumonia and gastroenteritis than younger children and generally not in the chronic illness category as the ageing population is. Adolescence is famed for behavioral notoriety perhaps but it has generally been given little attention in health and nutrition areas.

Why is it important to focus on the nutrition of this age group?

The growth spurt that occurs in adolescent is almost equivalent if not more as at foetal rate. Boys and girls gain up to 50% of their adult weight, more than 20% of their adult height, and 50% of their adult skeletal mass during this period. Depending on racial characteristics kids can gain up 30cms [12 inches] of height and 9-14kgs [20-30 pounds] in weight between ages 12 and 18. Besides physical growth, sexual maturation simultaneously occurs and it has great significance in girls as they gear up for a regular event of menstruation.

To nourish this rapid growth, attention to nutrition is required. Height and weight should be monitored, regularly. In girls there should be adequate adiposity [fat deposition] for attainment of menarche.

Height and Weight Charts

Tables below provide weight in kilograms and height in centimetres according to age [10 – 18 years] and sex.

NCHS Standards BOYS: ages 10-12

Age Weight
Kgs
Height
Cms
10 0/12 31.4 135.7
10 1/12 31.7 136.1
10 2/12 32.0 136.6
10 3/12 32.4 137.1
10 4/12 32.7 137.5
10 5/12 33.0 138.0
10 6/12 33.3 138.4
10 7/12 33.6 138.9
10 8/12 33.9 139.4
10 9/12 34.3 139.9
10 10/12 34.6 140.3
10 11/12 35.0 140.8
11 0/12 35.3 142.3
11 1/12 35.6 142.8
11 2/12 36.0 144.3
11 3/12 36.4 144.8
11 4/12 36.7 145.3
11 5/12 37.1 145.8
11 6/12 37.5 146.4
11 7/12 37.8 146.9
11 8/12 38.2 147.4
11 9/12 38.6 148.0
11 10/12 39.0 148.5
11 11/12 39.4 149.1

NCHS Standards BOYS: Ages 12-14

Age Weight
Kgs
Height
Cms
12 0/12 39.8 149.7
12 1/12 40.2 150.2
12 2/12 40.6 150.8
12 3/12 41.0 151.3
12 4/12 41.4 151.9
12 5/12 41.8 152.5
12 6/12 42.3 153.0
12 7/12 42.7 153.6
12 8/12 43.1 154.2
12 9/12 43.6 154.8
12 10/12 44.0 155.3
12 11/12 44.5 155.9
13 0/12 45.0 156.5
13 1/12 45.4 157.0
13 2/12 45.9 157.6
13 3/12 46.4 158.2
13 4/12 46.8 158.7
13 5/12 47.3 159.3
13 6/12 47.8 159.9
13 7/12 48.3 160.4
13 8/12 48.8 161.0
13 9/12 49.3 161.5
13 10/12 49.8 162.1
13 11/12 50.3 162.8

NCHS Standards BOYS: Ages 14-16

Age Weight
Kgs
Height
Cms
14 0/12 50.8 163.1
14 1/12 51.3 163.6
14 2/12 51.8 164.2
14 3/12 52.3 164.7
14 4/12 52.8 165.2
14 5/12 53.3 165.7
14 6/12 53.8 166.2
14 7/12 54.3 166.7
14 8/12 54.8 167.2
14 9/12 55.2 167.6
14 10/12 55.7 168.1
14 11/12 56.2 168.6
15 0/12 56.7 169.0
15 1/12 57.2 169.4
15 2/12 57.7 169.9
15 3/12 58.1 170.3
15 4/12 58.6 170.7
15 5/12 59.1 171.1
15 6/12 59.5 171.5
15 7/12 60.0 171.8
15 8/12 60.4 172.2
15 9/12 60.8 172.6
15 10/12 61.3 172.9
15 11/12 61.7 173.2

NCHS Standards BOYS: Ages 16-18

Age Weight
Kgs
Height
Cms
16 0/12 62.1 173.5
16 1/12 62.5 173.8
16 2/12 62.9 174.1
16 3/12 63.3 174.4
16 4/12 63.7 174.7
16 5/12 64.0 174.9
16 6/12 64.4 175.2
16 7/12 64.7 175.4
16 8/12 65.1 175.6
16 9/12 65.4 175.8
16 10/12 65.7 175.9
16 11/12 66.0 176.1
17 0/12 66.3 176.2
17 1/12 66.6 176.3
17 2/12 66.8 176.4
17 3/12 67.1 176.5
17 4/12 67.3 176.6
17 5/12 67.6 176.7
17 6/12 67.8 176.7
17 7/12 68.0 176.8
17 8/12 68.2 176.8
17 9/12 68.4 176.8
17 10/12 68.6 176.8
17 11/12 68.7 176.8
18 0/12 68.9 176.8

NCHS Standards GIRLS: Ages 10-12

Age Weight
Kgs
Height
Cms
10 0/12 32.5 138.3
10 1/12 32.9 138.8
10 2/12 33.3 139.4
10 3/12 33.6 139.9
10 4/12 34.0 140.4
10 5/12 34.4 140.9
10 6/12 34.7 141.5
10 7/12 35.1 142.0
10 8/12 35.5 142.6
10 9/12 35.8 143.1
10 10/12 36.2 143.7
10 11/12 36.6 144.2
11 0/12 37.0 144.8
11 1/12 37.3 145.3
11 2/12 37.7 145.9
11 3/12 38.1 146.5
11 4/12 38.5 147.0
11 5/12 38.8 147.6
11 6/12 39.2 148.2
11 7/12 39.6 148.8
11 8/12 40.0 149.3
11 9/12 40.4 149.9
11 10/12 40.8 150.4
11 11/12 41.1 151.0

NCHS Standards GIRLS: Ages 12-14

Age Weight
Kgs
Height
Cms
12 0/12 41.5 151.5
12 1/12 41.9 152.1
12 2/12 42.3 152.6
12 3/12 42.7 153.1
12 4/12 43.1 153.6
12 5/12 43.5 154.1
12 6/12 43.8 154.6
12 7/12 44.2 155.0
12 8/12 44.6 155.5
12 9/12 45.0 155.9
12 10/12 45.4 156.3
12 11/12 45.7 156.7
13 0/12 46.1 157.1
13 1/12 46.5 157.5
13 2/12 46.8 157.8
13 3/12 47.2 158.2
13 4/12 47.6 158.5
13 5/12 47.9 158.8
13 6/12 48.3 159.0
13 7/12 48.6 159.3
13 8/12 49.0 159.5
13 9/12 49.3 159.8
13 10/12 49.6 160.0
13 11/12 50.0 160.2

NCHS Standards GIRLS: Ages 14-16

Age Weight
Kgs
Height
Cms
14 0/12 50.3 160.4
14 1/12 50.6 160.5
14 2/12 50.9 160.7
14 3/12 51.2 160.8
14 4/12 51.5 161.0
14 5/12 51.8 161.1
14 6/12 52.1 161.2
14 7/12 52.4 161.3
14 8/12 52.7 161.4
14 9/12 52.9 161.5
14 10/12 53.2 161.6
14 11/12 53.4 161.7
15 0/12 53.7 161.8
15 1/12 53.9 161.9
15 2/12 54.1 161.9
15 3/12 54.4 162.0
15 4/12 54.6 162.0
15 5/12 54.8 162.1
15 6/12 55.0 162.1
15 7/12 55.1 162.2
15 8/12 55.3 162.2
15 9/12 55.5 162.3
15 10/12 55.6 162.3
15 11/12 55.8 162.4

NCHS Standards GIRLS: Ages 16-18

Age Weight
Kgs
Height
Cms
16 0/12 55.9 162.4
16 1/12 56.0 162.5
16 2/12 56.1 162.5
16 3/12 56.2 162.6
16 4/12 56.3 162.6
16 5/12 56.4 162.7
16 6/12 56.5 162.7
16 7/12 56.6 162.8
16 8/12 56.6 162.8
16 9/12 56.6 162.9
16 10/12 56.7 162.9
16 11/12 56.7 163.0
17 0/12 56.7 163.1
17 1/12 56.7 163.1
17 2/12 56.7 163.2
17 3/12 56.7 163.2
17 4/12 56.7 163.3
17 5/12 56.7 163.3
17 6/12 56.7 163.4
17 7/12 56.7 163.4
17 8/12 56.7 163.5
17 9/12 56.7 163.5
17 10/12 56.7 163.6
17 11/12 56.7 163.6
18 0/12 56.7 163.7

Stages in Adolescence

Until 9 years of age the requirements are unisex and it is in the adolescent period that requirements are segregated as for boys and girls and could be grouped as per ICMR recommendations into following stages:

10-12 years: Pre/Early adolescence (or it could be 10-14 years)
13-15 years: Early Adolescence
15-18 years: Adolescence
16-18 years: Late Adolescence

Sex Age Weight
in Kgs
Energy
require- ments
Protein Fat Iron
Boys 10-12 35.4 2190kcal 54g 22g 34mg
Girls 10-12 31.5 1970kcal 57g 22g 19mg
Boys 13-15 47.8 2450kcal 70g 22g 41mg
Girls 13-15 46.7 2060kcal 65g 22g 28mg
Boys 16-18 57.1 2640kcal 78g 22g 50mg
Girls 16-18 49.9 2060kcal 63g 22g 30mg

What food groups are essential for Adolescents?

Components of a balanced meal/diet will differ according to Age, Sex, Physical activity, Economic status and Physiological state.

Food Groups to be included are: the various groups of foodstuffs such as energy yielding foods, body building foods, and protective foods in the correct proportions so that an individual is assured of obtaining Nutrients in the optimal requirements and in an appropriate Meal Schedule

Here are some requirement indicators based On Five Food Group Balanced Diet

  1. Cereals & Millets – Staple Food of the Human Race

    • 260-320g/day :Adolescent [Early 10-12 years]

    • 290-350g/day :Adolescent [13-15 years] – Girls

    • 370-430g/day :Adolescent [13-15 years] – Boys

    • 290-350g/day :Adolescent [Late16-18 years] – Girls

    • 390-450g/day :Adolescent [Late 16-18 years] – Boys

  2. Pulses, Legumes & Lentils – Proteins Of Human Race

    • 30-70g/day :Adolescent [Early 10-12 years]

    • 50-70g/day :Adolescent [13-18 years]
      I recommend the lower range when alternate protein sources (listed below0 are included in the diet:

    • Non vegetarian foods, – meat, fish & eggs @ 30-60g/day &/or

    • Nuts & oilseeds – peanuts, etc @ 30-50g/day

      Treat these as optional protein sources, as a bonus, not as a substitute for pulses etc.

  3. Milk & Milk Products – An Excellent Supplement Source Of Many Nutrients, especially of protein [inclusive of products such as curds, cheese, etc]

    • 1000mL/day : Adolescent [10-18 years]

  4. Vegetables – Natures Tonic To Human Race

    Divided into 5 groups from the nutritional point of view

    • Green Leafy vegetables – GLV

    • Roots – R – carrot, beet root, radish & onions

    • Tubers – T – can be used as partial substitute for cereals.

    • Other Vegetables – Group 1 – water containing – cucumber, etc

    • Other Vegetables – Group 2 – beans, peas, etc.

    Protective Food Group contributes to minerals, vitamins and fiber

    175g/day: Adolescent [Early 10-12 years] GLV 100g; R & T 25g; Others 1 & 2 – 50g

    200-250g/day: Adolescent [13-15 years] GLV 100 -150g; R & T 50g; Others 1 & 2 – 50g

    275-350g/day: Adolescent [Late16-18 years] GLV 100 -150g; R & T 50 -75g; Others 1 & 2 – 75 -100g

  5. Fruits – Natures Tonic To Human Race

    • Divided into 4 groups from the nutritional point of view

      1. Orange & yellow fruit – e.g. papaya, mango, banana

      2. Citrus fruit – e.g. sweet lime, lemon, and oranges.

      3. Other fruit – Cashew fruit, pineapple, tomato, amla [nellikai]

      4. Dry fruit, Nuts & Oilseeds – Figs, dates, raisins, sultanas, groundnuts, coconuts, sesame seeds [gingelly] etc

    • Protective Food Group contributes to minerals, vitamins and fiber

      Dry fruit, Nuts & Oilseeds, energy, fat and protein source also

      • Use seasonal fruit and on rotation each day of the week

      • 50-100g/day : Adolescent [10-18 years]

      30-50g/day 1st Recommendation is for Fresh fruits & 2nd for Nuts & Oilseeds

Why is a Meal Schedule important?

A meal schedule helps to:

  • Equi-distribute nutrients to sustain health

  • Maintain body’s internal environment steadily

  • Curtail snacking in between meals

Mealtimes can be made enjoyable and a time of sharing. One of the best methods of developing good food habits is for the whole family to eat wisely and take a firm stand about overall behaviour

A sample meal schedule for the day:

Time Meal Name Meal Significance Guidelines
6am Morning Activator Beverage Milk based
8am Breakfast Energiser Meal DO NOT SKIP
10am Mid morning Elixir Drink Juice/water based drink
12noon Lunch Sustainer meal Include all food groups
2pm Mid noon Rejuvenator Drink Juice/water based drink
4pm Tea Supporter Meal DO NOT SKIP
7pm Dinner Revitalizer Meal DO NOT IMBALANCE
9pm Bed time night Relaxer Beverage Milk based

What are the common hurdles encountered in delivering adequate nutrition to adolescents?

Adolescence is a time of rebellion when peer pressure is a driving force. In the 15-18 age group adolescents in higher income groups have access to money, motorised transport, access to energy dense food, tobacco, alcohol. Some of them are staying in hostels where personal supervision may be lacking. In poorer income groups also they are probably on to jobs with access to junk food and alcohol. Meal times can become irregular; tendency to skip meals, eat unbalanced meals can become a habit.

Media has a powerful influence on adolescents who are in a flux. Self image that is just forming can be influenced by the media. Girls can make the “thin look” their ideal and become poor eaters. Barbie doll ideals make girls dysfunctional sexually.

Other social factors like poverty, lack of awareness, gender biases can also lead to neglect of adolescents.

What are the common fallouts of poor/unbalanced nutrition in adolescence?

Both under and over nourishment together constitutes malnutrition. In chronic undernourishment cases there may be growth retardation and wasting, but even in mild to moderate undernourishment when consumption of some foods especially vegetables and fruits is restricted totally or partially or there is over dependence on junk or fast foods adolescents not only adversely affect their height and weight but also predispose to the development of micronutrient deficiencies known as the hidden hunger:

  • Mineral deficiencies especially of iron [anemia] and zinc [growth retardation].

  • Vitamin deficiencies, especially Vitamin A [besides eye problems, skin and respiratory problems too] and Folacin [result in deformed babies – abnormal next generation!!!].

Conversly, when consumption is more, adolescent obesity or even super obesity sets in. At one time we had more of undernourished rather than overnourished but now the pendulum swings at both extremes are becoming more and more common. Adolescent obesity is said to be a pandemic [societal problem of great magnitude and involving large numbers] now. Even in poorer nations, in urban and wealthier pockets this is prevalent.

Obesity at adolescence is an issue because it tends to persist in adulthood. There is a higher risk of high fasting blood glucose levels, elevated blood pressure and adverse lipid profiles. It is difficult to cure adolescent obesity and preventive methods are to be advocated.

There is also another problem about adolescent obesity. These adolescents are made fun of, have a poor self-image or try to be over aggressive or shy. They also feel that they are stigmatized and that the others feel that they are lazy, dumb or strong. These attitudes can lead to behavioural problems or eating disorders.

Are affluent children partying too much?

I always ask my young patients how many birthdays they have in a year. All the so called goodies that replace sensible eating are permitted as aberrations on one day – the birthday and if they are sensible compliant individuals they are permitted to celebrate besides their own birthday, birthdays of their siblings and parents. Parents should also plan if the child is attending birthday parties of friends and schoolmates and monitor the intake on day-to-day basis.

What is your advice to adolescents regarding nutrition?

  • Do not skip meals

  • Have a regulated meal schedule

  • If you are type to snack, snack on veggies: add a pinch of salt and some lime to salad vegetables.

  • Eat snacks that are fat free and chewable like legumes and lentils: Chewing sends a message to the satiety center in the brain. This gives a feeling of having eaten something filling. (When advised to eat a fistful of legumes or nuts, it should be the adolescent’s fistful as a measure.)

Dr Varsha: Consultant Clinical Nutritionist and MD, Vaajini Nutrihealth.

Dr Varsha won the Wimpfheimer-Guggenheim Fund for International Exchange in Nutrition, Dietetics and Management for year 2004. More about Dr Varsha

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