Assessment of nutritional status and motivation to make behavior changes among adolescents. (Research).

Comprehensive nutrition screening identifies adolescents who have poor nutritional status, as well as those who are at risk for developing or who already have nutrition-related problems. The Guidelines for Adolescent Preventive Services (GAPS) and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents recommend that adolescents receive annual health supervision, including nutrition supervision and anticipatory guidance related to adopting healthful dietary habits and achieving a healthful weight (1,2). Nutrition supervision begins with getting to know the teen then screening for indicators of nutritional risk. All adolescents should be provided with preventive nutrition counseling. Those who are found to be at risk for developing nutrition-related problems and those with marginally poor nutritional intake should receive anticipatory guidance, including appropriate nutrition education.

Adolescents who are found to have a nutrition-related health problem or who consume poor-quality diets will require in-depth nutrition assessment to determine problem behaviors that require modification. The results of the nutrition assessment must then be interpreted to determine what type of nutrition intervention is most appropriate, and the level of motivation to change must be assessed. Each component of nutrition assessment must be conducted in a manner that is appropriate to the developmental level of the teen. The processes of nutrition screening and in-depth nutrition assessment, along with assessment of motivation to change behaviors, are described in this article.

NUTRITION SCREENING

A comprehensive nutrition screening should present a complete nutritional profile of the adolescent. A review of available medical, laboratory, psychosocial, and socioeconomic assessments and histories should provide relevant information on physiological, psychological, and economic factors that may influence nutrient needs and dietary adequacy among adolescents. Figure 1 provides a summary of the components of an initial nutrition screening and rationale for a more extensive nutrition evaluation. Critical factors that should be assessed during a nutrition screening include the following:

* Existing acute or chronic conditions, such as recurrent infections, genetic or congenital disorders, metabolic disorders, anaphylactic allergic reactions, or diabetes mellitus;

* Current or previous nutritional deficiencies such as iron deficiency anemia;

* Physical disabilities or congenital anomalies that may affect nutrient needs or the person's ability to feed himself or herself;

* Sexual maturation rating--for girls, age at menarche, presence of heavy menstrual bleeding, and history of current or past pregnancy;

* Family history of coronary artery disease, hypertension, hypercholesterolemia, diabetes mellitus, cancer, obesity, eating disorders, depression, alcoholism, and substance use;

* Frequency of use and dose of over-the-counter and prescription medications, nonnutritional supplements, diet pills, laxatives, herbs, vitamin-mineral supplements, and anabolic steroids;

* Past or current use of tobacco, alcohol, or other substances;

* Current or past diagnosis of eating disorder, dysthymia, or depression;

* School attendance; academic performance; and presence of speech, language, or learning disorders;

* Current or past history of physical, sexual, or emotional abuse or neglect; and

* Economic status, including appropriate housing with adequate food supply and cooking and food-storage facilities; use of food stamps or commodity foods; and access to medical, mental health, and dental care.

Much of this data can be gathered during a review of medical records; however, some information may need to be garnered from the adolescent. Health professionals should avoid the use of medical terminology whenever possible and should be conscientious that some questions asked may invoke resistance or embarrassment because of the sensitivity of the issue. Level of psychosocial development, including literacy and cognition, should be assessed when data is not available in the psychological or medical histories.

Nutrition screening often occurs during the first visit with a teen, so it is imperative that dietetics professionals have a good understanding of adolescent psychosocial development and the vast cognitive differences between early and late adolescence. This information can be used to build rapport during the initial minutes of the assessment process. Figure 2 illustrates a developmentally appropriate nutrition assessment and sample dialog. A discussion of each of the steps follows.

Establish a …