Snacking among adolescents accounts for approximately two-thirds of their recommended daily limit of added sugar and one-third of the daily limit for solid fats and refined grains, according to data from National Health and Nutrition Examination Survey (NHANES) presented at Nutrition 2021 Live Online.1 Teens who are overweight or obese consume higher levels of empty calories from snacking compared with teens who are of normal weight.

Clinicians should push for high-protein, low carbohydrate/fat meals and snacks for their adolescent patients, commented Zhaoping Li, MD, PhD, Director of the Center for Human Nutrition and Chief of the Division of Clinical Nutrition at David Geffen School of Medicine at UCLA. She recommends inexpensive and easy-to-carry sources of protein such as ready-made, plant-based smoothies (Table).

Table. Protein Sources for Teens

Hardboiled eggs
Premixed protein smoothies (Orgain, Premier, Ensure Max Protein)
Plant-based protein powders
Precooked grilled chicken or salmon
Chicken, turkey, or beef patties
Low-fat cottage cheese

“Adolescents are more than willing to change if we show them the way,” said Dr Li, is was not affiliated with the NHANES study. “Patients at this age, regardless of their socioeconomic status, are thirsty for knowledge on how to take care of themselves and care about how they look.”


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Nutrient-Poor Snacking Common Among Teens

Christina Croce, MS, DTR, and colleagues evaluated 2005-2016 NHANES data to assess the composition of snack food among 6591 US adolescents aged 12 to 19 years.1 Of this group, 21% were obese, 18% were overweight, and 62% were normal weight. The survey included data from two 24-hour dietary recalls.

Adolescents consumed 64%, 38%, and 32% of the recommended daily limits of added sugars, solid fats, and refined grains from snacking. These proportions were highest among teens with obesity, according to findings from the National Institutes of Health-funded study.

Teens with obesity consumed approximately 200 more calories per day from snacks compared with teens with normal weight (Figure). Teens with obesity also consumed significantly higher amounts of refined grains, dairy, protein, oil, solid fat, and added sugar from snacks than teens who were overweight or normal weight (P <0.05).

Figure. Total daily energy consumed in snacks among adolescents by weight category.1

“Snacking choices matter and clinicians can provide parents and adolescents with the knowledge and behavioral strategies to improve snack choices,” said Croce, who is a senior research associate at the Center for Obesity Research and Education at Temple University. “Approachable food swaps include switching from soda to water, fruit-flavored snacks to whole fruits, and cookies or chips to whole-grain snacks like popcorn or whole wheat crackers.”

To make food swaps easy, parents should focus on “reducing the availability of high fat and high sugar snacks at home,” Croce said. “Limiting the size of snacks is another great strategy to ensure teens are not consuming excess calories from snacks.”

Changing Snacking Behaviors

Zhaoping Li, MD, PhD

The behavior of snacking is based on preventing malnutrition. “In today’s environment, we are predominantly dealing with overnutrition and snacking is not something we must have as part of a healthy dietary pattern,” explained Dr Li, who is also professor of medicine at UCLA, involved in the American Society for Nutrition’s Board of Directors, and Immediate Past President of the National Board of Nutrition Physician Specialists.

Instead, she counsels her adolescent patients and their parents to improve the quality of regular meals by focusing on high-quality proteins, vegetables, and fruits (particularly those with a low-glycemic index).

Healthy fats from tree nuts, avocados, and olive oil are also essential. Dr Li’s research has shown that avocados and tree nuts, despite being high in calories, can be part of weight-loss plans.2,3 Inclusion of tree nuts in a weight loss program not only resulted in significant weight loss but also increases in satiety, decreased heart rate, and increased serum oleic acid at 24 weeks, according to the study findings.2

Processed foods including cereal are not satiating and do not provide sufficient protein, she said. Instead, she recommends eggs or chicken, turkey, or beef patties with vegetables for breakfast.

Protein Shakes and Meal Prep

Protein shakes can provide up to 30 g of protein with 1 g of sugar and less than 200 calories, offering an ideal solution for meal replacements particularly in teens living in food deserts, Dr. Li said. Many brands of ready-to-drink protein shakes (eg, Ensure Max Protein, Orgain, Premier) can be purchased at warehouse stores for approximately $1 to $1.50. Plant-based protein powders that can be mixed with water or milk and carried in refillable bottles are even more affordable. Dr. Li prefers shakes over protein bars, which tend to require more processed additives to make them palatable, but said that protein bars are still preferred over candy, chips, and other low-nutrient snacks. 

Dr. Li educates teens that if they spend $1 on a protein shake versus $5 on a fast food meal, they can save the extra money to spend on clothes or events. Over a week, they could save $20 to $40. She tells patients that the added nutrients from a shake over a soda will help them grow, lose weight, and feel better.

“When the availability of healthy foods is limited, strategies like portion control are even more important, Croce said. “Clinicians should talk to teens about limiting portions of sugary drinks and snack foods high in fat and refined grains. And while healthy swaps might be more challenging in food deserts, they are still possible. Healthier options like water, nuts, and seeds, and unsweetened yogurt are usually still available at most corner stores so clinicians should make sure their recommendations are relevant and accessible in the communities they serve.”

Meal prep and planning can avoid reliance on processed foods, Dr. Li said. Tips include buying precooked high protein foods, such as hardboiled eggs and grilled chicken or turkey patties, weekly in bulk.

Easy to carry fruits include apples, pears, nectarines, peaches, or kiwis. Vegetables that can be eaten on the go include cherry tomatoes, baby carrots, or other precut vegetables.

Feed Your Microbiome

Another purpose of encouraging greater intake of vegetables, whole grains, and other plant-based foods is to feed the gut microbiome. She educates patients that the microbiome regulates body function including brain function, which helps teenagers in school.

Inclusion of a daily avocado in a hypocaloric diet increased the number of bacteria in the microbiome and supported weight loss in a clinical study by Dr Li and colleagues.3 Additionally, her research suggests that weight loss alone improves the microbiome in patients with obesity, and a high-protein, calorie-restricted diet can significantly increase microbiome diversity compared with a calorie-restricted normal protein diet.4

Dr. Li emphasized that patient education on diet among adolescents should be highly individualized based on factors such as socioeconomic status, social/cultural values, and patient preferences. 

References

1. Croce C, Tripicchio G, Coffman D, Davey A, Bailey R, Fisher J. Association of weight status with the types and quantities of foods consumed at snacking occasions among US adolescents. Curr Dev Nutr. 2021;5(Suppl 2):1207. Published 2021 Jun 7. doi:10.1093/cdn/nzab055_017

2. Wang J, Wang S, Henning S, Qin T, Pan Y, Yang J, Huang J, Tseng C, Heber D, Li Z. Mixed tree nut snacks compared to refined carbohydrate snacks resulted in weight loss and increased satiety during both weight loss and weight maintenance: a 24-week randomized controlled trial. 2021;13(5):1512. doi:10.3390/nu13051512

3. Henning S, Yang J, Woo S, et al. Hass avocado inclusion in a weight-loss diet supported weight loss and altered gut microbiota: a 12-week randomized, parallel-controlled trial. Curr Dev Nutr. 2019;3(8):nzz068. doi:10.1093/cdn/nzz068 

4. Dong TS, Luu K, Lagishetty V, et al. A high protein calorie restriction diet alters the gut microbiome in obesity. Nutrients. 2020;12(10):3221. doi:10.3390/nu12103221