On the Teen Scene



Should You Go On a Diet?



by Ruth Papazian



Graphic omitted





This article is part of a series with important health

information for teenagers.





What do the hula hoop, "grapefruit diet," and wearing your

clothes backwards have in common?  They are all fads.  Fads come

and go, but when it comes to fad diets, the health effects can be

permanent-especially for teenagers.



Not all teens who go on diets need to lose weight.  Pressure from

friends-and sometimes parents-to be very slim may create a

distorted body image.  Having a distorted body image is like

looking into a funhouse mirror.  You see yourself as fatter than

you are.



A national survey of 11,631 high school students conducted by the

national Centers for Disease Control and Prevention found that

more than a third of the girls considered themselves overweight,

compared with fewer than 15 percent of the boys.  More than 43

percent of the girls reported that they were on a diet-and a

quarter of these dieters didn't think they were overweight.  The

survey found that the most common dieting methods used were

skipping meals, taking diet pills, and inducing vomiting after

eating.



"The teenage years are a period of rapid growth and development,"

points out Ronald Kleinman, M.D., chief of the Pediatric

Gastrointestinal and Nutrition Unit of Massachusetts General

Hospital in Boston, and chairman of the Committee on Nutrition of

the American Academy of Pediatrics.  He explains that fad dieting

can keep teenagers from getting the calories and nutrients they

need to grow properly and that dieting can retard growth. 

Stringent dieting may cause girls to stop menstruating, and will

prevent boys from developing muscles, he says.  If the diet

doesn't provide enough calcium, phosphorus and vitamin D, bones

may not lay down enough calcium to help reduce the risk of

osteoporosis later in life.



Instead of dieting because "everyone" is doing it or because you

are not as thin as you want to be, first find out from a doctor

or nutritionist whether you are carrying too much weight or too

much body fat for your age and height.



"The most important dietary change you can make is to limit the

amount of high-fat foods that you eat."

                    -Jo Ann Hattner,

                     clinical dietitian





What if You Need to Lose Weight?



The flip side to feeling pressured to be thin is having

legitimate concerns about overweight that adults dismiss by

saying, "It's just baby fat" or "You'll grow into your weight." 

Most girls reach almost their full height once they start to

menstruate, notes Kleinman.  Although boys usually don't stop

growing until age 18, data from a study suggest that adolescent

obesity can carry serious lifelong health consequences for them.



The study, which followed the medical histories of 508 people

from childhood to age 70, found that men who had been overweight

teenagers were more likely to develop colon cancer and to suffer

fatal heart attacks and strokes than their thinner classmates. 

Women who had been overweight teens had an increased tendency to

develop clogged arteries (atherosclerosis) and arthritis.  By age

70, these problems made it difficult for them to walk more than a

quarter mile, lift heavy objects, or climb stairs.



While this study linked adolescent obesity to health problems

decades down the road, some adverse effects show up much earlier.

Sometimes teens develop high blood pressure, elevated

cholesterol, and conditions that often precede diabetes.  Also,

as Kleinman points out, "The longer you remain overweight, the

greater the likelihood that the problem will persist into

adulthood."



As with most everything else, there's a right way and a wrong way

to lose weight.  The wrong way is to skip meals, resolve to eat

nothing but diet bread and water, take diet pills, or make

yourself vomit.  You may make it through the end of the week and

maybe even lose a pound or two, but you're unlikely to keep the

weight off for more than a few months-if that.  And inducing

vomiting can lead to an eating disorder called bulimia, which can

result in serious health problems. (See "On the Teen Scene:

Eating Disorders Require Medical Attention" in the March 1992 FDA

Consumer.)



"The more you deprive yourself of the foods you love, the more

you will crave those foods.  Inevitably, you'll break down and

binge," says Jo Ann Hattner, a clinical dietitian at Packard

Children's Hospital in Palo Alto, Calif.  Then you'll not only

gain those pounds back, you'll likely add a couple more.



Experts call this cycle of weight loss and weight gain "yo-yo"

dieting, and believe that the repeated stress on your body of

losing and gaining weight may be at least as bad for long-term

health as being overweight.



Additionally, low-calorie diets that allow only a few types of

foods can be bad for your health because they don't allow you to

get enough vitamins and minerals.  Kleinman warns that rapid 

weight loss from very-low-calorie "starvation diets" can cause

serious effects in teenagers, such as gallstones, hair loss,

weakness, and diarrhea.





Diet Pills



Last year, FDA banned 111 ingredients in over-the-counter (OTC)

diet products-including amino acids, cellulose, and grapefruit

extract-after manufacturers were unable to prove that they

worked.



A number of products (Cal-Ban 3000, Cal-Lite 1000, Cal-Trim 5000,

Perma Slim, Bodi Trim, Dictol 7 Plus, Medi Thin, Nature's Way,

and East Indian Guar Gum) were also recalled because they posed

serious health risks.  The products contained guar gum, which

supposedly swelled in the stomach to provide a feeling of

fullness.  However, the swelling from the guar gum caused

blockages in the throat and stomach.



In May 1991, FDA also began a formal inquiry into the safety of

phenylpropanolamine hydrochloride (abbreviated PPA), an

ingredient in many OTC diet pills, because of concern that the

drug may increase the risk of stroke when taken at or over

recommended doses.  FDA has determined that additional studies

need to be done to resolve this safety concern.



Previously, an advisory review panel of outside experts in 1982

advised FDA that PPA was an effective appetite suppressant.  But

questions remain about PPA use by teenagers and those with eating

disorders.



Recently, manufacturers of OTC diet pills proposed a voluntary

program in which they would include on the product labels a

statement cautioning: "Persons between 12 and 18 are advised to

consult their physician before using this product."



Michael Weintraub, M.D., a consultant to FDA's Office of OTC Drug

Evaluation, says, "PPA is not recommended for use by teenagers

because they are still growing and if they suppress their

appetite, they may not get proper nutrition."  The author of

studies on PPA published in scientific journals, Weintraub adds,

"This is especially true of teens who don't need to lose weight

but think that they do."





Fad dieting can keep teenagers from getting calories and

nutrients they need to grow properly and can retard growth.



The Real Skinny on Weight Loss



If going to extremes won't do the trick, what will?  Believe it

or not, it's as simple as making a few changes in your eating

habits to emphasize healthy foods and exercise-good advice even

if you don't need to lose weight.



Hattner describes a good diet as one that has balance, variety

and moderation in food choices.  "Balance your favorite foods

(which are usually high in fat) with fruits and vegetables (which

are almost always very low in fat); eat a wide variety of foods

to keep from getting bored and to make sure your diet is

nutritionally sound; and keep portion sizes reasonable so that

you can have your (thin) slice of cake and lose weight too."



In devising a healthy diet, Hattner suggests using the U.S.

Department of Agriculture's "Food Pyramid."  These guidelines

call for six to 11 servings a day of grains (bread, cereal, rice

and pasta), three to five servings of vegetables, two to four

servings of fruit, and two to three servings each of dairy (milk,

cheese and yogurt) and protein-rich foods (meat, eggs, poultry,

fish, dry beans, and nuts).  (See "The Food Pyramid-Food Label

Connection" in the June 1993 FDA Consumer.)



"Teens who need to lose weight should limit the number of

recommended servings to the lower end of the scale for each

category except dairy," Hattner advises.  "The most important

dietary change you can make is to limit the amount of high-fat

foods that you eat," she adds.



To keep fat intake down, Hattner recommends making simple lower

fat substitutions for the foods that you eat: Switch to 1 percent

or skim milk instead of whole milk, nonfat frozen yogurt

sweetened with a low-calorie sugar substitute instead of ice

cream, and pretzels instead of corn chips.  High-fat foods such

as french fries, candy bars, and milkshakes that have no low-fat

substitutes should only be eaten once in a while or in very small

amounts.





Move It and Lose It



Whether you are overweight or not, regular exercise (at least

three times a week) is important to look and feel your best.  If

you do need to lose weight, stepping up your activity level will

cause you to burn calories more quickly and help make weight loss

easier.



"Exercise increases lean body weight.  Also, you will appear

slimmer as you develop your muscles because muscles give shape

and form to your body," notes Hattner.

Fad or starvation diets and diet pills offer temporary solutions,

at best.  At worst, they may jeopardize your health.  To lose

weight and keep it off, your best bet is to reduce fat intake and

to exercise.







Ruth Papazian is a writer in Bronx, N.Y.





FDA Consumer/September 199