Five Tips for Health Care Providers to Address Unhealthy Teen Dieting

Discouraging unhealthy dieting -- and reminding teens that dangerous diet practices could lead to added pounds -- could prevent obesity and other weight-related problems in youth, according to recent recommendations based on a large-scale study of teens.

"Many health care providers struggle with how to address obesity and eating disorders in adolescents," said study author Dianne Neumark-Sztainer, Ph.D. "They are sensitive to these issues, and they are concerned about obesity, but they don't want to make patients feel bad about their bodies."

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Using data from Project EAT, a five-year study of eating and weight-related issues in 2,516 middle and high school students, Neumark-Sztainer developed five key recommendations for health care providers who deal with teens.

Neumark-Sztainer is a registered dietitian and professor of epidemiology and community health at the University of Minnesota. Her recommendations appear online in the Journal of Adolescent Health.

The first step is to let teens know that dieting, especially dangerous methods such as skipping meals, taking diet pills and inducing vomiting after meals, could have the opposite effect than intended and actually lead to weight gain.

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"We have found in our research that these practices are associated with increased risk for eating disorders, but also for obesity. I think a big deterrent for teenagers is to show them that dieting can actually backfire," Neumark-Sztainer said.

Neumark-Sztainer also recommended that health care providers focus on helping teens feel better about their body image, rather than using body dissatisfaction as a route for change. Teens who were the most dissatisfied with their bodies gained more weight over time and reported more binge eating, Project EAT research found.

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Other recommendations included encouraging families to enjoy healthy meals together more often and to talk less about weight and do more to become active. The final piece of advice for practitioners was to assume that teens have experienced maltreatment because of their weight and address the issue with their families.

"I agree philosophically with all of the recommendations in this paper, but some of them are going to be harder to implement than others," said Marlene Schwartz, Ph.D., deputy director of the Rudd Center for Food Policy and Obesity at Yale University.

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The trickiest one, Schwartz said, is helping providers explain the difference between dieting and healthy weight management. "Many popular diets and commercial weight loss programs have already rejected the word 'diet' and say that their goal is 'lifestyle change,' which sounds a lot like 'healthy weight management,'" she said.

Providers also might want to provide handouts or other resources to teens and their parents, Schwartz said.

Journal of Adolescent Health: Contact Tor Berg at (415) 502-1373 or [email protected] or visit www.jahonline.org

Neumark-Sztainer D. Preventing obesity and eating disorders in adolescents: What can health care providers do? J Adolesc Health online, 2009.

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