Eat, move, think: What you need to know about children’s health (teenage girls)

“Forty-three per cent of children in high-income households self-rate their general health as ‘excellent’ compared with 29 per cent of those in the lowest-income households.”

It’s not just socio-economics that plays a part, however. Gender differences also emerged in this self-reporting by Irish teenagers, with only 38 per cent of teenage girls self-reporting their health as “excellent” compared with 48 per cent of teenage boys.

The Growing Up in Ireland study reveals that "30 per cent of girls are overweight/obese" by the age of 17/18. Activity levels also drop more notably. "In general, there is a decline in physical activity levels among both boys and girls as they transition from middle childhood into adolescence, but the decline is more pronounced among teenage girls," Dr McCrory says.

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“A number of explanations for the gender differential in rates of physical activity have been advanced, including differing levels of parental support and engagement, different gender-role attitudes and expectations regarding sporting participation, differences in perceived self-efficacy and body consciousness and the experience of being teased about body shape,” Dr McCrory continues.

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When it comes to what our teenagers are consuming, socio-economics once again comes into play. “Forty-eight per cent of 17-18 year olds whose mother had a Junior Cert or equivalent qualification consumed at least one non-diet soft drink in the last 24 hours compared with 33 per cent of those from degree-level households. International evidence suggests that high-quality diets are more expensive than low-quality diets and that those on low incomes are more sensitive to the cost of food.”

While the “vast majority of adolescents are functioning well and are in good mental health,” Dr McCrory says, “there is good evidence across a large number of countries that the mental health of teenagers is worsening over time”. “There are a few studies from UCD which report across a large number of indicators of teenagers’ mental health and show rising levels of anxiety and depression in young people, and more so among teenage girls.”

So what can we do to protect the overall health and wellbeing of our teenage girls during such a sensitive period in their lives?

1) Nutrition

"Puberty is a time of huge growth within which significant physical, psychological and behavioural changes occur. Having enough energy to meet this increased requirement is essential, but we need to ensure that foods consumed contain the right types of energy and nutrients to meet their needs." nutritionist Laurann Reilly explains. "This is also a time when they set down many of the foundations for the rest of their lives. For instance, getting enough calcium during puberty is a key factor for both for preventing osteoporosis in later life as the Food Standards Association of Ireland state that '50 per cent of bone mineral density is laid down over this period'."

While teenage boys and girls have largely similar requirements in terms of micronutrients, girls have a higher “iron requirement due to loss during their period”.

Reilly recommends that teenage girls should aim, on a daily basis, for:
– two portions of meat/poultry/fish/eggs/beans/nuts,
– five portions of milk/yogurt/cheese,
– four portions of wholemeal cereals/breads/potatoes/pasta/ rice (for the moderately active, more if they are very active) and
– five to seven portions of fruit/vegetables/salad.

“Peer pressure can have a huge influence on the food choices of teenage girls particularly with the increased pressure of social media and a new false perfection. Often unaware of the long-term consequences of their food choices on their health, many teenage girls choose calorie-restrictive diets as a means to remain slim, which can result in nutrient deficiencies and impair growth in some cases. They may also feel an added pressure to experiment with alcohol as a means of fitting in. It’s important for parents to educate their children on the consequences of alcohol consumption and how to do so safely when the time is right,” she continues.

A helpful strategy to take is a whole family approach, where everyone participates in healthy eating

Striking a balance between encouraging teenage girls to eat healthily but not obsess about bodyweight “can be a little more challenging due to their heightened awareness of their image, being more self-conscious and comparing themselves to their peers,” Reilly concedes. “A helpful strategy to take is a whole family approach, where everyone participates in healthy eating. It may also be effective to remove unhealthy treats from the house and have a range of pre-prepared healthy snacks instead.

“One of the most common obstacles to a healthy diet for teen girls is knowledge and education. For our current teenagers and their parents, nutrition and healthy eating wasn’t a topic which was taught to them in school or at a young age.

“Having the knowledge of what foods to eat, why we eat them as well as the damage processed, and what high-fat and high-sugar foods can do to the body can be extremely effective. It’s also essential to teach both children and their parents how to prepare healthy meals within budget from a young age so it becomes natural to them.”

In encouraging a healthy diet in our teenage girls, Reilly says it’s important to remember to “think like they think. Remember, they’re not thinking of long-term health consequences like heart disease or diabetes. With many teenage girls being quite image conscious, discussing the benefits of healthy nutrition for healthy skin, hair and nails can be effective (rather than mentioning the weight word) and for those who play sports, improved performance, speed and strength is another strategy.”

2) Activity levels

More than 80 per cent of teenage girls are not meeting the current WHO recommendation of 60 minutes moderate to vigorous physical activity per day, Emmet Rushe, owner and head coach at Rushe Fitness, explains: "Findings from the Physical Activity and Wellbeing study showed that just 9.5 per cent of first-year girls surveyed were taking part in physical activity each day and this fell to just 1.1 per cent by the time they were in sixth year. Teenagers who were physically active as children are shown to have a more positive approach to physical activity as teenagers. But the variety of activities available to them, particularly in PE, could have an impact due to lack of enjoyment.

“Issues with body image and being self-conscious” can discourage teenage girls from wanting to partake in PE, Rushe continues. “Even the idea of changing rooms can be enough to prevent participation in a PE class, due to the issue with changing in front of others. Body image and different rates of development among teenage girls is a normal but inhibitive issue for teenagers.

“Then you have the focus on exams and the pressure of the Junior Cycle and Leaving Cert which could be another reason for the steep decline in participation from first to sixth year. Unfortunately, students and parents often still prioritise academic subjects and fail to see the importance of less-academic subjects and activities. The idea of studying instead of participating in these classes has been an issue in schools for years.”

The benefits to teenage girls of being physically active are clear, Rushe explains. “Better cardio-respiratory and muscular fitness, stronger bones, better cardiovascular and metabolic health, healthier body-fat composition, lower levels of anxiety, depression and stress, better self-image and self-confidence, better concentration and better sleep.”

Striking the necessary balance between healthy exercise levels versus obsessive body-conscious issues in teenage girls "will come through education and the promotion of exercise for health rather than for weight loss," Rushe says. "We are fighting against decades of promotion of certain body types as ideal and now, with social media platforms like Instagram and the heavily edited pictures that are being shown to girls, this perception of 'normal' is more exaggerated than ever.

“Exercise needs to be promoted for health rather than for weight loss or for changing body shape. The benefits of exercise are so much more than just for fat loss, so these need to be taught in a way that teenagers can relate to that will help them to see it as beneficial to do it.”

We need to look at the different ways that teenagers can be physically active when they do not like sport

“Team sports aren’t for everyone,” Rushe explains. “We need to look at the different ways that teenagers can be physically active when they do not like sport. “If team sports are the issue, then individual sports could be a better option. Things like boxing, tennis, kickboxing, jiu-jitsu, karate, squash, handball, badminton, etc can all be done individually or with a partner and they aren’t participating in a team or vying for a team ‘spot’.” Other suggestions include “dancing, walking, outdoor activities with friends” or playing “active computer games that involve movement”.

“The idea here is to get them moving in a way that they will enjoy and keep doing. As long as they are being physically active, what they are doing isn’t as important.”

3) Mental wellbeing

Puberty can be a "big stressor" for teenage girls, Dr Colman Noctor, child and adolescent psychotherapist and podcaster at Asking for a Parent, explains. "Many girls present with maturity fears. The world changes quite dramatically for teenage girls and many go from liking boybands and cartoons, to alcohol, teenage discos and sexualised pressure very quickly, and often prematurely. The pressure to look a certain way and act a certain way is different now than before. The move into being an object of desire is uncomfortable for many girls and they feel pressured into growing up quickly. But this is a case of 'acting older' not 'being older'.

“Childhood is shrinking and children are expected to be older younger and teenage girls are at the forefront of that pressure.”

The challenges teenage girls face can manifest themselves differently than in teenage boys. For one, girls struggling with their mental health “tend to present with more ‘expressive’ mental distress, in that the incidence of self-harm, eating disorders and classical anxiety is more visible in girls”, Dr Noctor explains. Bullying also takes a different shape. “Bullying is more divisive in girls. There is a quality of strategy and social politics that is not seen in their male counterparts.

“Therefore it can be more sneaky, underhand and hurtful. And perhaps more random. The investment girls place in friendship means that the fallout affects them more as they place more self-worth in their friendships, perhaps.”

When it comes to technology, the debate is “a futile one”, Dr Noctor says. “It is not good or bad technology, it’s good and bad usage. Individuals who are particularly vulnerable to the importance of feedback or are emotionally dysregulated will struggle in the online space. And in some ways the platforms hack our vulnerability. So the age debate is too arbitrary and we need to see personality variables as the guide to whether someone is ready to have social media or indeed if they are suited or have an emotional allergy to it. Some are more vulnerable than others.

"But we need to move away from the time spent or screen-time currency and look at time well spent. An hour learning a song on YouTube is different to an hour of scrolling through Insta profiles and feeling miserable about yourself and we need to look at it differently. See it as a tech diet – there are good foods and not so good ones but portion sizes of the not so good stuff is often the real issue."

The homework debate has been rumbling for primary school-aged children for some time now but Dr Noctor believes the situation for teenagers “is getting out of hand”. “The cost benefit analysis of homework bears no reason for me. It serves to damage far more children’s relationship with school than it offers in terms of good habit building.”

Teachers are loading on the work and children and teens are crumbling under it

He believes the situation is perhaps worse following on from school closures. “Teachers are loading on the work and children and teens are crumbling under it. It is completely unreasonable and does not cater for the mental health needs of young people whatsoever.”

For parents who find themselves at loggerheads with their teenage girls, Dr Noctor says they can rest assured this is actually a normal thing. “These girls are finding their voice and their autonomy and this is a good thing, (obviously within reason). But the child who does not use their voice or assert their views can also develop mental health problems.”

Dr Noctor recommends that parents support their teenage daughter’s mental health by concentrating on “their self-worth, not their self-confidence. Confidence is how we project ourselves outwardly, self-worth is the relationship we have with ourselves.

He also advises “less concentration on external/confident or performative variables (you are bright, you are sporty, you are talented) and much more emphasis on internal variables (you are kind, you are strong, you are loyal)”.

Eat, move, think
Part 1: 0-8 years
Part 2: 9-12 years
Part 3: Teenage girls