Q: I am really concerned about the eating habits of my 16-year-old. An athlete, he’s always complaining about feeling tired, especially for his late afternoon classes. He has even fallen asleep in class a couple of times, much to the amusement of his classmates. It’s no laughing matter to us though. Grant skips breakfast nearly every day, claiming he’s not hungry that early in the morning. I have a feeling he’s not eating much at school either except quick sugary snacks and Coke. When I’ve packed him a lunch, he leaves most of it; I know because I often see the full brown bag peeking out of his backpack the same evening! When I question him, he says he’s fine and that I worry too much; he claims he just has no appetite at school. The biggest meal he eats is dinner and we don’t always manage to sit down together. Often our two teenagers have to make do on their own because their dad and I frequently work late. I try to leave a lot of food around but Grant often complains that we have nothing in the refrigerator. I should add that his grades have taken a nosedive in a couple of classes and the report cards noted inattention as a problem area. I keep wondering whether his diet is affecting his classroom performance and whether it will spill over into his athletic performance as well. How can I help my son eat more healthily without lecturing him?

A: Nutrition is indeed a factor in learning and achievement; a poor diet is all too infrequently identified as a direct cause of academic and behavior problems. In my practice as an educational therapist, I see teenagers arriving after school looking completely exhausted and totally unable to concentrate. My first question is when and what did they last eat. Often the response is a sheepish, "Dinner last night" or "I had a yogurt and a cookie for lunch." One boy even arrived in the early evening eating his way through a bag of powdered donuts. He had not eaten since noon. When I point out that 7-14 hours between meals is highly unhealthy they are often surprised. I have to give them an assignment to eat and describe healthy options!!

teenage boys require 2,800 calories per day, but only 64% eat breakfast

Your son’s diet is hurting him and you are right to be concerned. Remember the "Four Basic Food Groups" chart you grew up with? Nutritionists have modified this to reflect the need to restrict fat and improve vitamin and fiber intake. A great description of this new "Food Guide Pyramid" can be found on http://www.ring.com/health/food/food.htm. It explains what a serving is, and how many for each group with some excellent alternatives for vegetarians. In terms of calorie intake, teenage girls need about 2,200 a day while teenage boys require 2,800. The amount of servings of each food group varies accordingly. The differences between the needs of adults and children and those of teenagers are significant. For example, whereas young children and adult women need, on average, 2 servings from the fruit group per day, teenage boys need 4! Teenagers are notorious for consuming few fruits and vegetables. And while women and children require a mere 6 servings of breads and cereals, teenage girls need 9 and boys need 11. A national survey showed that only 1% of youth ages 2 to 19 met all the recommendations for a healthy diet with the Pyramid as the standard!

What else do we know about teen nutritional needs? As adolescence is a time of high growth, teenagers really need to eat vegetables to get the nutrients important in physical development. These include folic acid, vitamin A and essential fatty acids. Zinc is a critical nutrient in male sexual development and calcium and iron are particularly important for girls. Calcium is critical in building a strong skeletal structure and preventing osteoporosis, while having sufficient iron in the diet is a must for girls at the onset of menstruation. Iron deficiencies can lead to perpetual fatigue. Nutritionist Judy Levine, R.D., a staff member at UC San Francisco, emphasizes that even well-fed teens – those who have plenty of food available to them - can be in a state of malnutrition. Diets lacking in iron can lead to anemia, a widespread problem amongst American children of all ages and socio-economic groups and one that is all too often under-identified. Anemia can cause fatigue, decreased concentration, decreased attention span and irritability. Studies have shown that teens suffering from anemia may do poorly on vocabulary tests, problem solving and reading comprehension tasks. Protein is another essential nutrient often overlooked in teenage diets, especially for vegetarians. Teens need to be educated about how to create a balanced diet without meat. Protein in the morning can go a long way to giving teens the mental energy to tackle schoolwork and stave off hunger until lunchtime. The bottom line is that teenagers need diets that are high in fiber and protein and low in fats and sugars.

A diet too high in fat and sugar is just one of the many nutritional problems facing American teenagers. Other problems include high cholesterol, diabetes, hypertension, eating disorders and weight. Overweight adults and children are omnipresent in our society and their high calorie foods of choice are frequently low in nutrients. Thus well fed children can actually be anemic! Obesity is one of the most common problems for which nutritionists see teenagers. Overweight teens often suffer from diminished self-esteem and a parallel problem with poor academic performance overall.

Diet is inextricably connected to academic performance; it can certainly have an affect on athletic performance as well. Says author Laura Stevens, a nutritionist and specialist in biochemical factors affecting kids with ADHD, "If you put the wrong gas in your car, you wouldn’t be surprised if it sputtered, knocked and gave off smoke. So what your child eats is crucial. Garbage in, garbage out!" Every diet expert highlights the importance of breakfast. Stevens notes that only 64% of teenagers eat breakfast and those who do score better on tests and demonstrate more attentive and on-task behavior in class. Sugared cereals are all too frequent culprits in getting American children and teens off to the wrong start in the morning. It’s important to check the ingredients on the boxes you pull off the grocery store shelves; even those cereals with seemingly healthy names may well be laden primarily with sugar, fructose, corn syrup, honey and malt flavoring. Raisin Bran, for example, has more added sugar than Frosted Flakes! Too much sugar on an empty stomach sends blood sugar levels soaring, setting teens up for an equally dramatic tailspin a very short time later; an excess of carbohydrates can have the same effect. Unbalanced blood sugar levels set up a false sense of hunger and/or a real drop in energy. It’s all too easy to search for the next quick "pick-me-up", often yet another sugared snack or drink. Parents need to reinforce the necessity of a good breakfast. Says Walnut Creek nutritionist Linda Michaelis, who specializes in children and adolescents, "Eat breakfast like a king, lunch like a queen and dinner like a pauper." Parents themselves need to behave as role models, say all the nutritionists. Those who skip breakfast or down a cup of coffee and a bagel only reinforce for their kids the notion that breakfast is a superfluous meal.

teens are more influenced by their parents’ diets than by those of their peers

Studies have shown that teens are, in fact, more influenced by their parents’ diets than by those of their peers. It is important to look at your own eating habits and those of your partner’s. What messages are you unconsciously sending your children? If you’re eating few fruits or vegetables, for example, it wouldn’t be difficult to source the absence of such foods in your children’s diets. You complain that your son is a picky eater. What foods are available to him at home? Judy Levine counsels parents to give kids foods they like. "There’s always something. Make a list and take(your teenagers) to the grocery store. Rotate foods so they don’t get bored." Help prevent cravings brought on by low blood sugar; buy "healthier substitutes that teens find acceptable: sandwiches, burritos, hamburgers (they’re rich in iron and protein). In addition, parents need to educate themselves about proper nutrition, to take responsibility for grocery shopping and to teach kids how to create and maintain a balanced diet. Be creative and aware of alternatives in each of the food groups. Mealtimes should be times for the family to sit down together, times that are special. Michaelis advises parents be adventurous in types of foods, tastes and ethnic styles. She emphasizes the importance of organizing a food plan each week: "Do a menu on Sunday and do lots of batch cooking on the weekend." Planning and organizing properly is the key, especially for working parents. "Make it simple and easy. You don’t have to have a deluxe nightly dinner! Even if a teen does not like the meal the family is having that night, have healthful alternatives available and avoid berating your child! If you’ve made a broccoli and chicken casserole and your son wants a roast beef sandwich, no problem! You can still all sit down together. Keep meals relaxed and pleasant. Don’t use food to reward or punish.

Helping create a more balanced diet for your son does not necessitate removing all of his favorite foods! The key is acquiring healthy habits, and putting more fiber and protein in his diet. But he can eat more nutritiously and still keep his favorite foods. Even a little dessert may be in order. Michaelis buys single-portion sized items like jellos and puddings to finish off a dinner high in vegetables and low in starches. Keep starches to a minimum at dinner; as such foods are harder to burn off during the evening when teens are less active.

American parents are so overly concerned with fat now that they are too often ignoring the importance of protein. A poor dinner, for example, might consist of two to three cups of pasta and several pieces of bread with butter. (If you’ve already had pizza or macaroni at lunch, this meal is even worse!) Such a meal is loaded with what nutritionists like to call "empty calories." Instead, cut down the pasta to one cup, add veggies and a piece of chicken. Protein is most important during daytime hours when physical and mental energy requirements are at their peak.

You want to increase your family’s protein intake but you don’t eat red meat? There are a number of specific food alternatives available to parents working to improve their own and their teen’s diets. For breakfast, have a bagel with lox or peanut butter on it. Create breakfast burritos, freeze them and microwave them in the morning to take along. Healthy portable foods are great for rushed mornings. Homemade smoothies are excellent (the store bought ones are heavy in sugar and fruit). Consider oatmeal with fruit, and whole-wheat toast with cottage cheese and preserves. Dinner leftovers make great breakfasts! (Except that entire container of white rice from last night’s Chinese dinner does not constitute a complete meal!) Brunch options include string cheese, celery with apple and/or peanut butter or humus, yogurt and cottage cheese. You can even substitute sodas with 100% fruit juice mixed with sparkling water – all the fun of fizz and none of the drawbacks of canned preservatives and sugar water masquerading as a proper drink!

Laura Stevens urges parents to include "essential" fatty acids in their teens’ diets because the body doesn’t produce them on its own. Of the two families of oils; omega-6 and omega –3- Americans tend to be low in omega 3. Says Stevens, "Essential fatty acids are important because they are major building blocks of all cell membranes; this is especially important in the brain…Your body turns them into hormones that help cells communicate with each other." Sources for omega-3 include soy, canola and walnut oils, walnuts, beans (kidney, soy, etc.), tofu and cold water fish like salmon, fresh tuna and sardines.

Whether you choose sardines or chicken stir-fry for your dinner, it is important to find nutritional solutions that suit the entire family. Discuss with teens the benefits of improved nutrition. Teens often respond well to articles and statistics that give a data based foundation to your recommendations. Approach the problem as a team and work together to find solutions. One visit to a nutritional counselor may well benefit everyone by providing a fresh perspective from an expert. When I’ve given my clients "assignments" to eat they’ve often been completely surprised by how much better they feel in class and out. Most importantly, adolescents need a sense of control over their lives. And diet, in most cases, is something they can manage themselves. Indeed, says Judy Levine, "Motivation goes up when kids feel like they have power over their school performance through eating properly."

Note: Laura Stevens’ web site may be found at http://users.nlci.com/nutrition/. She publishes the ADD/ADHD Monthly On-Line Newsletter.

Copyright © 1998-2002 by Beth Samuelson