By Shannon Herbert, PhD, RD, RYT, CDN
What is metabolic syndrome?
Metabolic syndrome is a group of conditions that can increase one’s risk for heart disease, stroke, and type 2 diabetes.1
Metabolic syndrome is usually defined as having three or more of the following risk factors:
- Elevated blood pressure
- Elevated blood glucose (sugar)
- Elevated blood triglycerides
- Low blood levels of high density lipoprotein (HDL) cholesterol (“good” cholesterol)
- Large waist circumference
Approximately 7.8% of US adolescents (13-18 years) are estimated to have metabolic syndrome, compared to 2.8% of US children (6-12 years).2 Puberty may play an important role in the increase in prevalence of metabolic syndrome from childhood to adolescence. During puberty, there is a decrease in insulin sensitivity that occurs to aid in the adolescent growth spurt. Yet this change in insulin sensitivity is usually recovered by early adulthood.3
Due to the physiological changes that occur during adolescence, measuring metabolic syndrome can be challenging.1 Since adolescence isn’t a static period of time, the risk factors a teen may face can vary throughout this period. Focusing on reducing these risk factors throughout adolescence is recommended to reduce the risk of cardiovascular disease and type 2 diabetes in adulthood.
In teens, lifestyle management is the first line of treatment to reduce the risk factors associated with metabolic syndrome.1 Lifestyle management usually consists of changes to nutrition, movement, and other lifestyle behaviors, including limiting screen time. While weight management programs have been studied, it is important to note that achieving a “normal” body mass index (BMI) is not necessary to decrease cardiometabolic risk.1 There are benefits to improving health behaviors, even in the absence of weight loss.
Adolescence can be a particularly vulnerable time to focus on weight management efforts. Adolescence is a time marked by increased body image concerns, often driven by peer pressure, social influences, as well as hormonal and body changes.4 The teen years are full of physical, emotional, and social changes which may contribute to the development of disordered eating behaviors.4 Thus, it is imperative to foster supportive eating habits during this time, even while focusing on addressing metabolic syndrome risk factors.
What is intuitive eating?
Intuitive eating is an approach to health that is rooted in interoceptive awareness, or our ability to recognize sensations in our bodies. Intuitive eating is focused on connecting to physiological cues of hunger and fullness. Intuitive eating aims to improve health behaviors, without explicitly focusing on weight, making it a possibly suitable approach to support health in teens with metabolic syndrome. Intuitive eating is based upon 10 principles that honor both physical and mental health.
The ten principles of intuitive eating are outlined below:5,6
Reject the diet mentality. Become aware of diet culture. Learn to challenge and dismiss the associated thoughts.
Honor your hunger. Learn to listen and honor this biological signal, keeping your body fueled with adequate energy.
Make peace with food. Give yourself unconditional permission to eat all foods without fear or guilt.
Challenge the food police. Challenge dieting rules and develop a more neutral stance towards food.
Discover the satisfaction factor. Identify the pleasure and satisfaction that can be found in eating, through listening to your personal tastes and eating mindfully.
Feel your fullness. Learn to listen to the body signals that indicate you are no longer hungry.
Cope with your emotions with kindness. Identify ways to cope with uncomfortable emotions without food.
Respect your body. Accept your body, treating it with respect and kindness.
Movement – feel the difference. Prioritize movement that makes you feel good.
Honor your health – gentle nutrition. Make food choices that honor your health and taste buds.
Can intuitive eating be used to reduce metabolic syndrome?
Following intuitive eating style practices, such as responding to hunger/satiety cues and minimizing dieting behaviors is associated with positive health outcomes. Intuitive eating has been associated with lower body mass index (BMI)7–10 and better cardiovascular risk factors, including total cholesterol, low density lipoprotein (LDL) cholesterol, and systolic blood pressure,11,12 irrespective of weight. Intuitive eating has been shown to improve diet quality, leading to higher fruit and vegetable intake13–15 and lower glycemic load.16
In adolescents, specifically, intuitive eating is negatively associated with eating disorder behaviors.17 Intuitive eating during adolescence has been associated with lower odds of depression, low self-esteem, unhealthy weight control behaviors (e.g. fasting, skipping meals), extreme weight control behaviors (e.g. taking diet pills, vomiting), and binge eating behaviors in adulthood.18
How can we foster intuitive eating in teens?
Several strategies can be used to help foster intuitive eating practices in teenagers while improving their metabolic syndrome risk factors.
1. Encourage body positivity. Focus on health and well-being rather than appearance. Have an open dialogue on how bodies change over time and come in diverse shapes and sizes. Foster communication with teens about their evolving feelings related to body image.
2. Educate about nutrition. Emphasize the importance of nourishing the body with a variety of foods to support teens’ needs. Avoid labeling foods as “good” or “bad,” recognizing that all foods can fit into a varied, health promoting dietary pattern. Prioritize whole foods, such as fruits, veggies, whole grains, and high quality protein, to support the nutrient needs of growing teens.
3. Cooking. Involve teens in meal planning, grocery shopping, and cooking as a way to model and promote positive nutrition.
4. Work on mindful eating. Encourage teens to pay attention to their hunger and satiety cues. Prioritize family meal time, where teens can take their time eating, savoring each bite, in order to better recognize when they are comfortably satisfied.
5. Promote self-compassion. Support teens in recognizing and challenging negative self-talk related to food and body image. This also means that parents should be mindful of their own negative food and body talk! How you talk about your body can be internalized in your teens. Model self-compassionate behaviors, grounded in kindness and respect towards your body.
6. Watch out for “diet” talk. Refrain from discussing restrictive eating behaviors. Model balanced eating and a positive relationship with food.
7. Encourage physical activity. Encourage teens to engage in forms of movement they find pleasurable. Find the joy in movement, and reap the benefits for mood, energy, stress management, and overall health.
8. Seek help when needed! If a teenager displays signs of disordered eating, has body image concerns, or has metabolic syndrome, seek guidance from a registered dietitian. The team at Laura Cipullo Whole Nutrition + Yoga is here to support.
References
1. Magge SN, Goodman E, Armstrong SC, et al. The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering. Pediatrics. 2017;140(2):e20171603. doi:10.1542/peds.2017-1603
2. Noubiap JJ, Nansseu JR, Lontchi-Yimagou E, et al. Global, regional, and country estimates of metabolic syndrome burden in children and adolescents in 2020: a systematic review and modelling analysis. Lancet Child Adolesc Health. 2022;6(3):158-170. doi:10.1016/S2352-4642(21)00374-6
3. Kelsey MM, Zeitler PS. Insulin resistance of puberty. Curr Diab Rep. 2016;16(7):64. doi:10.1007/s11892-016-0751-5
4. Reel J, Voelker D, Greenleaf C. Weight status and body image perceptions in adolescents: current perspectives. Adolesc Health Med Ther. Published online August 2015:149. doi:10.2147/AHMT.S68344
5. Tribole E, Resch E. Intuitive Eating: An Revolutionary Anti-Diet Approach. 4th Edition.; 2020. Accessed February 5, 2022. https://www.overdrive.com/search?q=FF22AEFE-3400-44FE-AF91-A844023C9AFB
6. Erhardt GA. Intuitive eating as a counter-cultural process towards self-actualisation: An interpretative phenomenological analysis of experiences of learning to eat intuitively. Health Psychol Open. 2021;8(1):205510292110009. doi:10.1177/20551029211000957
7. Tylka TL. Development and psychometric evaluation of a measure of intuitive eating. J Couns Psychol. 2006;53(2):226-240. doi:10.1037/0022-0167.53.2.226
8. Denny KN, Loth K, Eisenberg ME, Neumark-Sztainer D. Intuitive eating in young adults. Who is doing it, and how is it related to disordered eating behaviors? Appetite. 2013;60:13-19. doi:10.1016/j.appet.2012.09.029
9. Hawks S, Madanat H, Hawks J, Harris A. The relationship between intuitive eating and health indicators among college women. Am J Health Educ. 2005;36(6):331-336. doi:10.1080/19325037.2005.10608206
10. Tylka TL, Kroon Van Diest AM. The Intuitive Eating Scale–2: Item refinement and psychometric evaluation with college women and men. J Couns Psychol. 2013;60(1):137-153. doi:10.1037/a0030893
11. Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005;105(6):929-936. doi:10.1016/j.jada.2005.03.011
12. Carroll S, Borkoles E, Polman R. Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological well-being in obese premenopausal females with the metabolic syndrome. Appl Physiol Nutr Metab. 2007;32(1):125-142. doi:10.1139/h06-093
13. Ingraham N, Harbatkin D, Lorvick J, Plumb M, Minnis AM. Women’s health and mindfulness (WHAM): A randomized intervention among older lesbian/bisexual women. Health Promot Pract. 2017;18(3):348-357. doi:10.1177/1524839916670874
14. Mensinger JL, Calogero RM, Stranges S, Tylka TL. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite. 2016;105:364-374. doi:10.1016/j.appet.2016.06.006
15. Miller CK, Kristeller JL, Headings A, Nagaraja H. Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A randomized controlled trial. Health Educ Behav Off Publ Soc Public Health Educ. 2014;41(2):145-154. doi:10.1177/1090198113493092
16. Miller CK, Kristeller JL, Headings A, Nagaraja H, Miser WF. Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A pilot study. J Acad Nutr Diet. 2012;112(11):1835-1842. doi:10.1016/j.jand.2012.07.036
17. Nelson JD, Trojanowski PJ, Aarnio-Peterson CM, Fischer S, Adams L, Matthews A. Caregiver and adolescent intuitive eating behavior: associations with weight change during family-based treatment for anorexia nervosa. Eat Weight Disord – Stud Anorex Bulim Obes. 2023;28(1):32. doi:10.1007/s40519-023-01557-0
18. Hazzard VM, Telke SE, Simone M, Anderson LM, Larson NI, Neumark-Sztainer D. Intuitive eating longitudinally predicts better psychological health and lower use of disordered eating behaviors: findings from EAT 2010–2018. Eat Weight Disord – Stud Anorex Bulim Obes. 2021;26(1):287-294. doi:10.1007/s40519-020-00852-4
