Adolescence: Evolution From Childhood to Adulthood

Some common health issues among young females are:

1. Nutritional issues (anemia, malnutrition):

Nutrition i.e. nourishment is necessary for the adequate growth, development and a prerequisite for a healthy life. 

To ensure proper nourishment the food should fulfil the daily needs of all the nutrients (i.e. carbohydrates, proteins, fats, fiber, minerals, vitamins and water).

The nutrients are classified as:

• Macronutrients (carbohydrates, proteins, fats): Building blocks of the body.
• Micronutrients (minerals, vitamins): a crucial role in metabolism and enhancing immunity

Balanced nutrition is essential for adolescents as their nutritional requirements increase owing to the physical growth spurt, sexual maturation, scholastic performance demands and competitive needs. Both the caloric intake and micronutrients in the diet should be adequate to ensure full development.

Moreover, this is the age when the adolescents are more inclined towards junk foods, have food fads, sedentary lifestyles and eating disorders.

Poor nutrition in adolescence: will not only cause retarded growth, sexual maturity and productivity but will also lead to increased risk of chronic illnesses in adulthood. The most common issues are:

• Nutritional Anemia: Anemia develops due to deficiency of iron, vitamin B12 and folic acid in our routine diet which is required in producing RBCs (Red blood cells). There is increased demand for iron in adolescence due to the growth spurt. In females, there is a regular loss of blood during menstruation which leads to the higher rates of anemia in adolescent females. Anemia and undernutrition go hand in hand 
• Undernutrition: which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals). Poor nutritional intake increased nutritional demands due to growth and wrong eating habits lead to undernutrition. Undernutrition is rampant in adolescents and has a negative impact on their physical development, reproductive health and future performance. 
• Overweight and obesity: Overweight and obesity during adolescence have become a major concern because it is an epicentre for all other health problems. Unlike undernutrition, high caloric intake and low physical activity lead to obesity. Obesity is when a person is 20 percent or more above the ideal body weight, whereas overweight refers to persons with body weight 10-20 per cent in excess of the ideal weight. This can be calculated via “BODY MASS INDEX (BMI)”. 

BMI is expressed as:

The WHO classification based on BMI is given below:

• Sedentary lifestyle and diet-related noncommunicable diseases (hidden risks): In today’s time, physical inactivity has become a major lifestyle problem. The internet and advancement in technology have made our life more sedentary. It has a snowball impact on health with associated junk foods intake, late night sleep and stress that ultimately increase the risk of vulnerable lifestyle diseases viz. obesity, hypertension, diabetes, etc. 

• Eating disorder: adolescents are self-conscious about physical appearance and are very prone to develop eating disorders like Bulimia and anorexia nervosa. Due to peer pressure or for conforming to ideal body image they try unhealthy diets and follow unhealthy eating habits leading to eating disorders. Bulimia is caused by anxiety over one’s weight The impact of malnutrition especially in adolescence is tremendous as it causes growth delay, compromises scholastic performance and development skills and has a negative impact on the reproductive health.The parents are suggested to frequently assess the nutritional status of their child (growth monitoring) and should take corrective measures to ensure a balanced diet of the children. To know more, consulting an expert consultation and adolescent health screening is advisable

2. Sexual and Reproductive Health (menstrual irregularities, PCOD, STI, early sexual exposure, teenage pregnancy) 

The sexual development and maturation that occurs during adolescence is the result of heightened hormonal activity in the body and it adds to their vulnerability. Females start having menstruation by the end of pubertal changes and almost 50% have some menstrual irregularities. Moreover, during this phase sexual exploration and expression is common and normal. Their increased sexual interest, curiosity and ignorance may lead to risk-taking behaviors by them like unsafe sex and multiple partners causing STI, HIV, teenage pregnancies and sexual exploitation.

• Menstrual irregularities: Within the first 2 years of menarche, irregular menstruation usually occurs due to the immaturity of the reproductive axis and does not require any intervention. The adolescent should be reassured regarding their reproductive health. But expert advice should be sought if the problem persists after that and hampers the normal daily activity of the person.
• PCOS: Polycystic ovary syndrome (PCOS) is the most common hormonal problem that affects adolescent females. It occurs due to the imbalance of reproductive hormones. The normal menstrual pattern is not established or is irregular and the female has signs of androgen (male hormone excess). It is commonly associated with obesity, insulin resistance and metabolic syndrome. Expert opinion is essential along with lifestyle modification.
• Early sexual exposure, STI, teenage pregnancy: lack of appropriate reproductive health information, curiosity, sexual exploration and peer pressure may lead to inappropriate and health risk behaviours by the adolescent. This makes them vulnerable and at risk of developing sexually transmitted infections (STI), HIV and may lead to teenage unwanted pregnancy. Proper reproductive health counselling, parental guidance and easy access to contraceptives may be beneficial. 

3. Mental Health

Every adolescent undergoes a series of physical, social and emotional changes during this transition phase. That’s why there are mood or behaviour fluctuations that need to be managed carefully. The common issues are:

• Emotional problems: sadness, anxiety, anger, stress, episodes of panic attacks,
• Behavioural problems: aggressive or disruptive behaviour, high-risk behaviour, self-harm, school drop-out,
• Scholastic issues: the stress of academic achievement causes psychosomatic symptoms like headache, eyestrain, sleep problems,
• Body image issues: body image is how a person evaluates her physical appearance and her cognitive abilities. Peer pressure and media influence a person’s self-image and may lead to loss of self-esteem and feelings of inferiority. It may also hamper the day to day functioning and relationships.
• Depression and suicidal attempts: if the above mental health issues are not timely addressed then it may lead to grave psychological problems like depression and suicidal attempts.

Here are a few tips that every adolescent should include in lifestyle to stay comfortable in the new phase:

• Exercising/Sporting regularly plays a positive role in your body and mind. It reduces stress and anxiety and elevates mood by the release of positive chemical from the brain called endorphins. Moreover, aids in weight loss and helps in correcting the hormonal imbalance.
• Develop healthy sleep habits.
• Discuss your problem with an elder confidant

Parents should be aware of these behavioural changes in their adolescent and if the change is significantly affecting their routine lifestyle, expert consultation should be taken, and the child should undergo a health screening.

4. Addiction (drugs, smoking, alcohol) 

Adolescents usually get engaged in substance abuse due to their peer pressure, curiosity, experimentation, risk taking behaviour or imitate an adult. 

Moreover, substance abuse is frequently associated with behaviours like rebelliousness, poor school performance, delinquency and personality traits like low self-esteem, anxiety and lack of self-control. These can have short-term and long-term physical and psychological effects. 

This condition requires immediately expert consultation and adolescent with the above risky behaviour and personality traits should be screened beforehand.

Adolescent Health Assessment

There are loads of changes occurring in the body and mind of adolescents and are exposed to numerous health issues. Hence, it can be a time of confusion, but it doesn't have to be.

Adolescents are often considered as the healthiest age group and even the parents are ignorant of their health issues. Thus, they have the lowest rate of healthcare access. During this period there is rapid physical, mental and sexual development makes them vulnerable to develop a wide range of health problems. 

Therefore, a regular adolescent health screening is essential to detect the hidden health issues and address them timely for a healthier future.

The adolescent health screening should ensure annual check-up on the following parameters:

• Measurements: Growth monitoring, BMI calculation, BP measurement.
• Sensory screening: Vision and hearing assessment.
• Developmental assessment 
• Psychological/behavioural assessment
• Immunization assessment 
• Diagnostic tests: haemoglobin, TB assessment, lipid profile, STI screening
• Oral health assessment
• Physical examination by a paediatrician 
• Counselling 

Moreover, it is important for all of us to encourage healthy lifestyles in our daily regime:

Ensure half an hour walk every day: Walk more, whether that means taking a 10-minute walking break while doing any work or preferring stairs instead of elevators can be beneficial for you. These little changes in your physical activities can surely increase and enhance the blood flow while releasing hormones that assist in controlling stress, burn calories, and high alertness.

Practice YOGA and aerobics: Do regular meditation and keep yourself organized to eliminate unnecessary and preventable stress.

Balanced diet: Do not ever skip your meals as it may lead to excessive hunger and eventually over-eating. Just make sure to have at least two balanced meals and healthy snacking in between. 

References:

National youth policy 2014

https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions