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*The views and opinions expressed in this episode are those of the guest alone, and do not necessarily reflect the views of the host, the Safety First team or any affiliated organizations.

Transcript of Safety First Episode 9

[Intro Music Plays]

Dr. Amanda Giordano: You're listening to Safety First. Tackling Tough Topics with Teens. Our goal is to provide useful information about issues that affect today's teenagers. To help support parents and professionals who work with youth.

Hello, everyone, and thank you for joining us today on another Safety First podcast. I'm so excited to introduce our guest, Dr. Erin Hennessy. Erin is an action oriented nutrition scientist with two decades of cross-sector experience spanning federal research leadership at the National Cancer Institute, industry collaboration and academic innovation at Tufts University. Her work in nutrition and physical activity interventions has generated evidence-based solutions that help children, families and communities eat better and move more.

Welcome, Erin, and thank you so much for being here today.

Dr. Erin Hennessy: Thank you. Thank you so much for having me.

Dr. Amanda Giordano: Why don't we start with you telling us just a little bit about your work and your professional journey?

Dr. Erin Hennessy: Sure. My professional journey has taken different twists and turns. You know, I envisioned my life a long time ago about being a medical doctor and then, through different experiences, realized that setting wasn't the best one for me, and also was fortunate to take a course in my undergraduate training in what was called essentially Nutrition 101. And as a student athlete, it was the first time I left class wanting to read more, study more, and just take it all in like a sponge. And that really kind of spoke to me and set me on a path toward pursuing my PhD in nutrition.

So I was fortunate to go to Tufts University as an undergrad. We have the only independent school of nutrition in North America. So I was exposed to kind of what opportunities look like in the field, what career pathways would look like. And I was also fortunate to start working in research with the faculty member who is now currently the Dean for the School of Nutrition.

And through that work really became engaged in community interventions, in working with communities to change like kind of policy systems, environments, to really, you know, create the structure that we all need to pursue a healthy lifestyle.

Dr. Amanda Giordano: Well, let's dive in and talk about adolescent nutrition. So what does a nutritious diet look like for teens?

Dr. Erin Hennessy: Sure. And it's, I also want to just disclose, I have lived experience. So, you know, I have two boys, one who just turned 15. And my thesis was actually on parenting and the development of eating behaviors.

And one thing I get asked a lot is like, is it different? You know, from what you like, learn and do is research and then you know how you parent. And actually it's more reinforcing and solidifying of what I know about science and how to approach it. But that does not by any means suggests that that I don't have struggles and that we don't have challenges in our household and that my child is not, quote unquote, a perfect eater.

So I think, you know, one thing to keep in mind is that, you know, a nutritious diet isn't necessarily looks exactly the same for everyone, especially when we really think about well, when we say adolescents what do we mean, right?

So we typically define it between 12 to 17 years of age. And if you think about the difference in growth, if you've ever engaged with a 12 year old and a 17 year old, it's really extraordinary. Right? And you think about that dramatic growth and physical development. It's actually some of the greatest in your period of life, including even more than infancy in terms of what's happening.

So we need a nutritious diet to help us achieve what that looks like. There is to say a common structure, right, the core elements of a healthy dietary pattern. And we use that phrase, healthy dietary pattern, is to include vegetables of all types. So think about your colors. Dark green, red, orange, starchy vegetables are okay to beans, peas and lentils.

We want to think about fruit, especially whole fruit. Grains and we want those grains, at least half of which to be whole grains. So trying to eat fewer of the refined grains so those white breads and things like that, they have a place. But we'd like to promote whole grains.

Dairy including milk, yogurt, cheese or dairy alternatives. If you follow a pattern that doesn't consume dairy. Protein, foods like lean meats, poultry, eggs, seafood, beans. And then we think about our oils and vegetable oils and other oils from foods like seafood and nuts.

So those overall patterns: veggies, fruits, grains, half of whole, dairy, lean proteins and some healthy fats or oils are really, you know, the core elements that we recommend that people lean into in addition to consuming water and trying to limit our consumption of sugar, saturated fat and sodium.

But really what I say, it doesn't look exactly the same for everyone, even within that pattern is that the amounts of foods that you need to eat, especially during 12 to 17 year olds, to support that growth. So that varies by life stage. It varies by how much you move, how much physical activity you get, your cultural preferences, whether you're food allergies or intolerances. So it's a general framework. And then a lot of tailoring in between those.

Dr. Amanda Giordano: Yeah. What, in your opinion, are the nutrients that teens tend to miss the most in their diets?

Dr. Erin Hennessy: Sure, yeah. And this is backed up also by science. So not just my opinion, but what the data tells us, at least here for the US, that the nutrients that children need the most and yet are struggling to get significant recommended amounts for, are things like calcium to help us achieve our peak bone mass.

So we are building and laying down the foundation of our bone up until about the age of 18, and then the window gets really narrow. So there's like a tiny little window and you finally complete that process in early thirties. But what you do to build your bone really matters up until the age of 18.

So we really want to make sure children are getting adequate levels of calcium, which is what our bones need, and alongside that vitamin D. So I live here in the Northeast and it's now December and we know between November and March for people in particular regions of the US and other parts of the world, we are not getting enough sunlight to be able to make vitamin D. And we know that children and adolescents and a lot of people are actually not getting the foods that they need to from their diet to get enough vitamin D. So we really want to think about our vitamin D levels, and that is a nutrient that pairs well with calcium to help us build our bone.

Then there's iron because we need it for growth, for blood volume, especially for adolescent girls during menarche. It's really important. And again, they can be really dangerous to sort of trigger anemia.

And then I would say, you know, protein is a funny one. I get asked this question the most when it comes to adolescence, most teens in the US get enough total protein. What we're missing, though, for adolescents is the diversity in the source of the protein. So we're taking in a lot of red meat and we want to try to balance that, maybe eat a little less and replace it with either plant-based proteins or other healthy proteins like seafood.

Dr. Amanda Giordano: And how might you suggest teens get more calcium, vitamin D and iron?

Dr. Erin Hennessy: You know, there's many different types of strategies that we think about to support that. One is at least you know, from the way that I approach it as a parent, I think about structure and support and those are kind of like the two big things.

And within those, that sort of nesting we want to think about, are we able to have healthy foods at home? Right. I think, one, knowing that these are nutrients of concern and, two, figuring out where they fit in your diet based on your dietary preferences and can we have access to them at home or at school or outside of school, depending on where we are?

So really, you know, thinking about what you're purchasing and including your teen in the conversation about what's being purchased and helping to educate yourself and them about what is part of a healthy diet.

I think family meals are a great way to continue to encourage and think about the foods that you're incorporating into your meals. So we're hitting those nutrients of concern. So, you know, where are they getting their dairy? Are they drinking milk? Are they eating yogurt? Are they having cheese? If they're not doing those things, there are plant sources like spinach and green leafy vegetables, almonds and other things. And so, you know, sprinkling those throughout your diet are great ways to kind of help you.

And then, of course, if you're still concerned about your teen's diet and, you know, perhaps the variety of foods that your teen is eating, I always encourage parents to talk to their clinicians and have this discussion to see is supplementation needed, right. So not necessarily like a multivitamin, but maybe your teen needs a calcium with vitamin D supplement. But that's a conversation that the family should have with their provider.

Dr. Amanda Giordano: And I like how you noted to have the conversation with your teen of why you're including what you're including in the meals and what's available in the household and letting them be a part of that process.

Dr. Erin Hennessy: Yeah, Teens, right. For anybody who's interacted with the teen knows that they're working hard to become independent people and want to exert that independence and want to build their autonomy.

So, you know, they really should have a say and it should be a conversation. And I think that's where the reasoning, the education and oftentimes the negotiation comes in. And is it a source of conflict? Right. Teens, some of them don't think that their parents should be making rules about certain things. And other teens are a little bit more open to it. So depending on your relationship, your teen's personality, it may take, you know, different types of strategies to help them, which is why our general approach when we think about this, is the family context.

So maybe your teen is the only child in the house. Maybe you have other children. But thinking about, you know, how are we doing this as a family as opposed to you, my teen, need to be doing this.

Dr. Amanda Giordano: And I think our listeners will be very interested in your thoughts on sugar. What are some of the threats to a healthy diet, especially when it comes to sugar intake?

Dr. Erin Hennessy: So, I mean, the downside of too much sugar, right? And that's it's really what we're kind of talking about. And it's very easy to have too much sugar with the processing that we have in our food today. But teens are really kind of their major source, when you look at the data of sugar, it generally comes from sugar sweetened beverages.

And we know that there is a link between consuming too much sugar, consuming foods that are ultra processed. And I do want to put in the parking lot to come back to this like processed, ultra processed food conversation because it's really, really important for your listeners to understand.

But these foods and sugar itself are often linked to, even in childhood, in adolescence, and then tracking into adulthood higher excess weight, which we know to and define as obesity, diabetes, higher risk for heart disease and dental caries. So you can have oral health challenges as well.

And a lot of those things also carry challenges to a teen's mental health and well-being. So we really want to think about, you know, how this whole health ecosystem and their wellness are being considered and in what you're doing to kind of approach those challenges. So, you know, those are why we are concerned about them.

But like, you know, those are the foods that are marketed to you that are everywhere, that are all around us and really hard to avoid. And so stepping back when we think about it, that's where the nutrition education piece, educating yourself to help you educate your teen is really important to know how to be able to read labels and understand the information that's in front of you at a grocery store.

There's a lot of information coming at all of us through social media and other types of screens, and a lot of it isn't correct and accurate. So it's really hard for parents to be able to unpack and untangle, especially as it comes to processed foods.

So if you think about processed foods, almost everything in our grocery stores in the U.S. are processed, right? Like apples are processed. You buy a bag of cut apples that's technically processed, right? That's the definition of like anything that isn't in its natural form.

But what we're really talking about when it comes to your health and well-being is around a category of those called ultra processed foods. So ultra processed foods are the ones that are very processed. Often incorporate things that we don't want too much of, like salt, sugar, saturated fat.

And they also carry other things like artificial colors and flavors, preservatives, thickeners, emulsifiers, artificial sweeteners sometimes. All of those things help promote shelf stability, either preserve or enhance texture and increase palatability. Like, there's a reason why food companies have put these in our food to sell us food products that we want to eat because they taste good, they're convenient, they're often cheaper and easier. Right? But they're not carrying the health benefits that we need.

So if you were to think about an apple as a whole apple, a processed food would be that prepackaged apple slice with no additives, that's fine. Right? Unsweetened applesauce is also a processed food. And, you know, starting to look at the labels. You can also find applesauce that has other types of ingredients like high-fructose corn syrup. And now that starts to move us into the ultra processed food category.

So, you know, when we think about that, that's where you really want to become a savvy consumer. And, you know, look at those ingredients labels. When you look at an ingredient label, it's by weight. So the first ingredient is what's most in that product. And so you can start to educate yourself about what are these key trigger words, like an emulsifier, what's the word I'm looking for? So I can try to choose things, hopefully that have fewer of those things and really have naturally occurring sugars and aren't full of added sugars and other things that you want to avoid.

Dr. Amanda Giordano: What would be some of the negative effects if teens are consuming a lot of ultra processed foods, how might that impact them?

Dr. Erin Hennessy: Yeah, so, you know, as I mentioned, there's the health effects, right? Things like it's associated with higher weight and disease.

But there's there's other more subtle things in terms of affecting our mood, our attention, our energy levels, where they start to crash in the afternoon. And maybe we're all getting a little bit cranky. So, you know, those are certainly things that we want to be thinking about, I think especially. So I think it's in everybody's mindset today is our mental health and our mental well-being. And we do see a relationship between high consumption of these foods in these negative outcomes that we want to avoid.

They also displace healthy foods. Right? So it's not just that. It's these foods. It's like these foods because they're not allowing the healthy foods that we need that are going to promote our well-being, how well our brain functions, how well we move our body, how well we just feel on any given day. And we don't want them to crowd out those healthy foods and take away from how good our teens feel about who they are, what they're eating and how they feel on a day to day basis.

Dr. Amanda Giordano: I love that you're bringing up that connection because I don't know if many people think about the food that we eat and relate it to mental health.

Dr. Erin Hennessy: And it's all connected, right? I mean, actually, your brain controls a lot of what you eat and why and how. Right. With the different hormones that we have and how that regulation and that crosstalk happens between your brain and your gut.

But, yes, we're all one part of this system. And really, I think that's where we gave birth to an area called mindful eating and really allowing ourselves to kind of step back and think about, how do I feel after I eat these foods in the short term.

And least my, you know, 15 year old son would tell you, like, that's super tasty. But I'm but, you know, I've helped them really start to think and reconsider like wait, like in an hour. I really don't feel good. And, you know, building that connection of like, do you think that's related to what you just put in your body?

And so it isn't to say that you have to be perfect all the time or that you can never enjoy certain things that you enjoy. It's just really about balance.

And also, you know, having the teen build that sense of ownership and understanding that how I fuel my body affects its performance.

Dr. Amanda Giordano: Can you tell us a little bit about physical activity and exercise among adolescents? What's the recommendation for physical activity among teens?

Dr. Erin Hennessy: Sure. The recommendation is common for children and teens. So it is 60 minutes of what we call moderate to vigorous physical activity every day. So that means you're moving in a way where you're starting to, you know, breathe a little heavier. You can carry on a conversation, right? So moderate physical activities like a brisk walk, vigorous physical activity would be something like our run, right? We're starting to break into a sweat.

So in that category, we call it moderate to vigorous. So any type of activity that's really going to get your heart moving and you feel that kind of pumping and energy through your body. But within that, we do also want to think about the types of activities that teens are engaging in. So we want to think about aerobic activities like a brisk walk. You know, if they enjoy jogging, swimming, etc.

But we also want to think about muscle strengthening and bone strengthening activity. So, you know, I'm a big zealot around making sure we're building bone in the way that we should be so we prevent osteoporosis later in life and really have that helpful, you know, healthy foundation at the start.

So bone strengthening activities are things like skipping, hopping, jumping, running, even, right. Like you're putting that force on your bone. So something like swimming is great for the aerobics workout. It's not great for building bone, right? But that doesn't mean you shouldn't do it. It's about getting those different types of activities.

So we want to think about, in addition to the recommendation of 60 minutes every day of some kind of movement, it should be something they enjoy and it should be a variety of different types. And I think those are the other pieces that we have to remember. If you don't enjoy it, it's going to be a behavior that's going to be really difficult to have stick with you or have something that you do like. We don't like doing things that we don't like doing. So whether your teen enjoys yoga or dance or sport, whatever it might be, any body movement is great and then trying to help them and support them. But think about the other ways that they're doing that they may not get a lot of.

So when I say muscle strengthening for somebody who's young like 12, that might be using their own body as a weight. So push ups, you know, or their own kind of squats without weights, and then as they get older, they can start introducing what I think many adults recognize as muscle strengthening activities, where it might be more weightlifting and other types of activities.

Dr. Amanda Giordano: What do you think are the biggest threats to teens getting that recommended 60 minutes of physical activity a day?

Dr. Erin Hennessy: Sure. Teens. You know, it's funny. They're busy. Not busy. Right.

So teens can be, you know, really pulled in a lot of directions at this stage in life of, you know, I might have school followed by extracurricular activities or work. I want to spend time with my friends, you know. So there's lots of things going on in their lives.

And yet we also know teens spend an extraordinary amount of time in front of their screens.  Like we can easily find time to spend 4 hours when nobody's looking, you know, in front of a screen. But everybody would notice if I spent 4 hours walking, right? So there's sort of that difference.

So I think one of the biggest threats, because we know physical activity declines with age, right? Because they're getting busy. Other things are competing for their time. They haven't maybe found something that they enjoy. Sports are a funnel. And, you know, as it gets more competitive, you have fewer opportunities depending on where you live. There may not be as many opportunities to engage. So lots of threats coming, but the biggest one by far is trying to get your teen away from the screen and at least find balance with their screen so that they can still enjoy the time that they have, but also not too much that they're crowding out other important healthy behaviors.

Dr. Amanda Giordano: I'm curious, just because you shared with us that you also have children yourself. So when you are in the grocery store and you personally are looking at a nutrition label, what are some of the questions you're asking or what thoughts are going through your mind before you make a decision about a purchase?

Dr. Erin Hennessy: Sure. That's great. I'm going to first answer that with a different kind of way to think about your engagement with the grocery store. Grocery stores are purposely set up in a certain way where many of the healthier foods are on the outer side and a lot of those processed, packaged, ultra processed foods are the things in the middle, right?

So it's really easy to think about, like, let's prioritize my time over here in the fruit and vegetable land or choosing my lean meats or thinking about where dairy is and all that. But when you get to go inside, when you go in the middle to the dark place of the grocery store is really where you got to get a bit more savvy with label reading and understanding.

So my first look is almost always at the ingredient list. As I said, it's by weight, so you will know very quickly what is driving the majority of ingredients in that product. If sugar is one or two, that's a red flag, you know, and then it moves down the list and might become a pink flag. Right. It still might be something that you want, but be aware of what it is to really look at that.

If there are words that you can't pronounce or understand or know how to say, also another flag, right? When things are whole and in their form, we know what they are and they're easy to see. So those are, to me, the two big like, I don't know what these are or this ingredient has numbers in it. So generally that's some kind of color additive or something. So is that really something that I want? And is there another product like it that doesn't have that in it? And I think depending on where you shop, there might be a comparable type of product in there.

Then I try to look at like the rest of the nutrition facts label that has the daily value and it tells you what you know, the percentage of certain nutrients are. And so depending on what you're looking for, is it, you know, how much of like other carbohydrates are there, how much of the added sugars are there? Because that's the number you want to see lower as opposed to higher. How much protein's in there and how much, you know, certain types of essential nutrients like calcium might be present.

So I generally take a glance at that, but by far I spend most of my time on the ingredient lists and trying to understand what's in the product.

Dr. Amanda Giordano: I'd love to give you the last word. If you have any advice or encouragement for parents who are listening to this with teens just trying to navigate nutrition and exercise, what might you say to them?

Dr. Erin Hennessy: First and foremost, be kind to yourself. You know, this is not easy. It takes a lot of dedication and passion and enthusiasm and patience to be a parent, especially for teenagers. And while it may not always seem like they're listening and watching, they are. And even if you don't see a response yet, you are setting the foundation for them to become these independent humans who are able to make good decisions when they are out of your purview and out of your nest.

So, you know, I really encourage you to embrace what we often tell children, right? So practice balance. Find a routine that works for you in your life, help your teen achieve those things you know, help educate yourself, help educate your child. Do it together, especially depending on the age of your child, is a really great opportunity to have these conversations.

Help build skills. Like do you need skills like lots, lots of people in my network and moms who are like, I hate cooking. And it's like, okay, you know, that's fine. What are the other alternatives that we can look at? Is it either like a meal program you can be part of or a class you can take or something that you can do together or, you know, help your family in some way really, you know, deal with those challenging days and weeks where you're like, what am I doing? What are we eating? How are we doing this? Because it does take a lot of planning and preparation and making space for that can be difficult in our busy lives.

And as always, you know, keep an open mind and a positive mindset, you know, even just a simple change of consuming more water or drinking a little less sugar sweetened beverage or getting one more fruit and vegetable. All of those things matter. So don't think you have to make drastic changes overnight or that every day has to be perfect. Just really celebrate those little wins and try to, you know, come up with them together as a family.

Dr. Amanda Giordano: Thank you so much for all of this wisdom and all of the insight that you shared, Erin. And listeners, thank you so much for joining us on the Safety First podcast, where we tackle tough topics affecting today's teens. I'm your host, Amanda Giordano, and we hope you'll join us for our next episode.