Psychologic and Physiologic Effects of Dieting in Adolescents

Allison Daee, Rd, Paul Robinson, MD, Melissa Lawson, MD, Julie A. Turpin, RD, Brooke Gregory, Joseph D. Tobias, MD

Disclosures

South Med J. 2002;95(9) 

In This Article

Abstract and Introduction

Obesity in adolescents has increased by 75% in the past three decades. Cross-sectional and prospective surveys have shown that a large percentage of adolescents, particularly females and even those of normal weight, diet at some time. While moderate changes in diet and exercise have been shown to be safe, significant psychologic and physiologic consequences may occur with extreme or unhealthy dieting practices. Moderate dieting has been shown to be associated with negative self-esteem in some adolescents. The very act of starting any diet increases the risk of eating disorders in adolescent girls. Extreme methods of weight loss can have adverse physiologic effects if not closely monitored. Electrolyte disturbances, cardiac dysrhythmias, and even sudden cardiac death can result from unhealthy or extreme dieting practices. Such practices are associated with other problem behavior in adolescents. We review current information on dieting in teenagers and discuss psychologic and physiologic effects of these practices.

Adolescents, especially females, are bombarded with messages from the media about thinness, images of so-called beauty, and ways to achieve a lower body-weight. These images, combined with a society that places a high value on physical beauty, send mixed messages to teenagers and may result in unhealthy, frequently unnecessary, attempts to lose weight.[1]

Dieting has become increasingly widespread, not only to achieve current ideals of thinness, but also because of the increased prevalence of adolescent obesity (an increase of 75% in the past three decades). Approximately 16% of adolescents are mildly overweight with body mass index (BMI) in the 85th to 95th percentile, while 9.9% of adolescents are severely overweight (BMI ≥95th percentile).[2,3] Being overweight as an adolescent (BMI >75th percentile) is a significant predictor of increased risk for later atherosclerotic coronary artery disease, colorectal cancer, gout, and arthritis.[4] Being overweight as an adolescent may be a greater risk factor for these conditions than being overweight as an adult.[4] Additionally, obese adolescents have a 70% chance of being obese adults, and obesity in adulthood is associated with several disease states, including obstructive sleep apnea, hypertension, adverse lipoprotein profiles, diabetes mellitus, coronary heart disease, stroke, colorectal cancer, and death from all causes. Aside from its association with various medical conditions and disease states, obesity is also associated with fewer years of education, increased poverty, and a lower marriage rate.[2,5] Given its prevalence, there is an obvious need for attention to obesity, preferably starting at an early age, in an effort to prevent such problems. The answer does not lie in the current trend of attempts to attain quick fixes using unhealthy dieting practices, including those that promise rapid weight loss over short periods of time.

Because dieting is commonplace among adolescents, health care practitioners should be aware of its potential adverse effects, both psychologic and physiologic. Concerns about dieting include its possible association with cycles of weight loss and re-gain that increase the likelihood of developing eating disorders and obesity; decreased self-esteem and other psychologic issues; and potential increases in cardiovascular risk factors and mortality, both long-term and acute. The potentially devastating outcome of dieting practices is tragically illustrated by the case report elsewhere in this issue, outlining the sudden death of a 16-year-old girl who was attempting to follow a high-fat, high-protein, low-carbohydrate diet regimen.[6] In this paper, we assess the current dieting practices among adolescents and review the potential adverse physiologic and psychosocial consequences associated with dieting during adolescence.

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