How can picky eating in teenagers be improved?

Improving Picky Eating in Teenagers

Focus conversations exclusively on healthy eating behaviors rather than weight, dieting, or body image, as weight-focused discussions increase the risk of both obesity and eating disorders in adolescents. 1

Core Strategy: Regular Family Meals

Establish family meals at least 7 times per week, as this is the single most evidence-based intervention for improving adolescent eating patterns. 1

• Eating family meals together 7 or more times weekly results in consuming 1 additional serving of fruits and vegetables daily compared to families with no shared meals 1
• Family dinners most days or every day protect against purging behaviors, binge eating, and frequent dieting in both males and females 1
• These dietary improvements persist 5 years later into young adulthood 1
• Make family meals enjoyable, as perceived enjoyment provides additional protection against extreme weight-control behaviors in girls 1

What Parents Should Control vs. What Teens Control

Parents are responsible for choosing which foods are available, when meals occur, and where eating happens; teenagers decide whether to eat and how much. 1

• Provide a wide variety of nutrient-dense foods including fruits and vegetables instead of high-energy-density/nutrient-poor foods like salty snacks, ice cream, fried foods, cookies, and sweetened beverages 1
• Use nonfat or low-fat dairy products as calcium and protein sources 1
• Pay attention to portion sizes appropriate for the teenager's age and size 1

Critical Pitfall: Avoid Pressure and Restriction

Never pressure teenagers to eat or restrict access to specific foods, as both strategies backfire and lead to overeating, food dislikes, and paradoxical interest in forbidden items. 1

• Pressuring children to eat during childhood predicts problematic eating patterns in young adulthood, including reduced intuitive eating and increased disordered eating symptoms 2
• Allow self-regulation of total caloric intake when BMI is normal 1

What NOT to Discuss: Weight Talk

Completely eliminate conversations about weight, dieting, or encouraging weight loss, as these discussions are linked to higher rates of overweight, dieting, unhealthy weight-control behaviors, and binge eating 5 years later. 1

• Even well-intentioned comments about weight are perceived as hurtful and increase risk of eating disorders 1
• If conversations about eating must occur, focus exclusively on healthful eating behaviors, which decreases unhealthy weight-control behaviors in overweight adolescents 1

Eliminate Weight Teasing

Ensure zero tolerance for weight teasing by family members, as it predicts development of overweight status, binge eating, and extreme weight-control behaviors. 1

• Weight teasing is experienced by 28-40% of adolescents and significantly increases risk of disordered eating 1

Specific Dietary Recommendations

Limit sweetened beverages (including fruit juice) to 8-12 oz per day for teenagers ages 7-18 years. 1

• Sweetened beverages contribute significantly to excess caloric intake and displace essential nutrients 1
• Provide fresh foods rather than processed options 3

Introduce and repeatedly offer healthy foods even if initially refused, as repeated exposures (up to 10 times) establish taste preferences. 1, 3

Behavioral Strategies

Limit sedentary screen time to no more than 1-2 hours daily and remove television sets from bedrooms. 1

• Television watching is directly associated with unhealthy eating habits, increased requests for advertised foods, and higher fat consumption 1

Restrict snacking during sedentary behavior or in response to boredom. 1

Involve teenagers in food preparation, as this decreases the likelihood of picky eating. 4

Parental Modeling

Parents must model healthy eating behaviors themselves, particularly consuming fruits, vegetables, and unfamiliar foods, as parental role modeling is critical in establishing teenagers' food choices. 1, 3

• Create positive social experiences around mealtimes 3
• Demonstrate responsive (not authoritarian) parenting styles, as authoritarian approaches increase picky eating 4

When to Suspect a Problem Beyond Typical Picky Eating

Monitor for signs of Avoidant/Restrictive Food Intake Disorder (ARFID) if the teenager exhibits significant weight loss, failure to achieve expected weight gain, nutritional deficiency, or marked psychosocial interference. 5, 6

• ARFID differs from typical picky eating by causing clinically significant impairment 5, 6
• ARFID lacks body image distortion or fear of weight gain, distinguishing it from anorexia nervosa 5
• Early identification enables intervention and prevents poor health outcomes 6