Introduction & Background

Underweight refers to a body weight that is lower than what is considered healthy for a given height. For adults, a body mass index (BMI) of less than 18.5 is generally considered underweight. Weight gain for underweight individuals is crucial not just for improving physical appearance, but also for enhancing overall health. Being underweight can increase the risk of developing conditions such as weakened immune function, osteoporosis, anemia, and in severe cases, organ damage.

This guide provides a detailed overview of how to approach weight gain for underweight individuals, focusing on the causes, symptoms, treatments, prevention strategies, and other relevant factors.

Causes of Underweight

Several factors can contribute to an individual being underweight. These include:

1. High Metabolism: Some individuals naturally have a faster metabolism, meaning they burn calories more quickly than others, leading to difficulty gaining weight.
2. Genetics: Family history can play a significant role in body weight, influencing the size, shape, and metabolism of an individual.
3. Chronic Illnesses: Conditions like hyperthyroidism, diabetes, gastrointestinal disorders (e.g., Crohn’s disease), cancer, or tuberculosis can lead to weight loss or difficulty gaining weight.
4. Malnutrition: Insufficient intake of calories and nutrients can prevent weight gain. This could be due to poor diet or lack of access to nutrient-rich food.
5. Mental Health Disorders: Conditions like depression, anxiety, and eating disorders such as anorexia nervosa can lead to weight loss and a refusal to eat.
6. Medications: Certain medications, such as chemotherapy, can affect appetite or cause nausea, leading to weight loss.
7. Stress and Anxiety: Chronic stress and anxiety can lead to loss of appetite, making it hard to maintain or gain weight.
8. Active Lifestyle: Athletes or individuals with highly active jobs often burn more calories than they consume, making it challenging to gain weight.

Indications of Underweight

Some signs that an individual may be underweight include:

• BMI below 18.5: This is the most commonly used indicator of underweight.
• Fatigue: Chronic tiredness and lack of energy, as the body is not getting enough nutrients for daily functioning.
• Weakened Immune System: More frequent illnesses due to a lack of essential vitamins and minerals.
• Thin and Brittle Hair: Lack of sufficient nutrients can lead to hair loss or thinning.
• Dizziness and Fainting: Insufficient calorie intake can affect the body’s ability to function properly, causing lightheadedness.
• Cold Sensitivity: Feeling cold often, as the body may lack enough fat to keep warm.
• Low Muscle Mass: Lack of sufficient calories and protein to build and maintain muscle mass.

Symptoms of Underweight

Common symptoms of being underweight may include:

• Unintended weight loss
• Dry skin and brittle nails
• Irregular or absent menstrual periods (in women)
• Weakness and lethargy
• Difficulty concentrating or focusing
• Reduced bone density, leading to increased fracture risk
• Slower wound healing

Prevention Strategies of Underweight

Preventing being underweight is essential for maintaining long-term health. The following strategies can help prevent being underweight:

1. Eat a Balanced Diet: A balanced diet, rich in calories and nutrients, is critical for maintaining a healthy weight. Focus on nutrient-dense foods like whole grains, lean proteins, fruits, vegetables, and healthy fats.
2. Avoid Excessive Physical Activity: While exercise is important for overall health, excessive physical activity can burn too many calories, making it harder to gain weight.
3. Manage Stress: Chronic stress can lead to weight loss and a decrease in appetite. Practicing stress management techniques like yoga, meditation, and deep breathing can help.
4. Seek Medical Guidance: Regular check-ups with a healthcare provider can identify any underlying medical conditions causing weight loss or difficulty gaining weight.
5. Set Realistic Goals: Individuals should set gradual weight gain targets, ensuring the weight is gained healthily and sustainably.

Myths and Facts About Underweight

1. Myth: Being underweight is not as dangerous as being overweight.
   • Fact: Being underweight can be just as harmful as being overweight. It can lead to malnutrition, bone loss, immune system weakness, and other health complications.
2. Myth: If you’re underweight, you can eat anything to gain weight.
   • Fact: Eating unhealthy foods like junk food to gain weight is not a healthy approach. It’s crucial to consume nutrient-dense foods for balanced weight gain.
3. Myth: Only people with eating disorders are underweight.
   • Fact: There are various reasons for being underweight, including genetics, metabolism, illness, and lifestyle, not just eating disorders.
4. Myth: Weight gain is easy, just eat more calories.
   • Fact: Gaining weight, especially healthily, requires a structured approach, including balancing calorie intake, nutrients, and physical activity.

Treatments and Therapy

There are several treatment options for individuals who are underweight, depending on the underlying cause:

1. Medication-Based Treatments

If an underlying medical condition is causing underweight, medications may be prescribed. For example:

• Appetite Stimulants: Drugs like megestrol acetate or cyproheptadine can stimulate appetite.
• Thyroid Treatment: If hyperthyroidism is the cause, thyroid hormone-blocking medications may be prescribed.

2. Surgical Treatments

Surgical treatments are rarely required for underweight individuals unless the weight loss is due to a medical condition that requires surgery (e.g., gastrointestinal surgery for Crohn’s disease or cancer treatment).

3. Physical Therapy and Rehabilitation

For those who have lost muscle mass due to being underweight, physical therapy can help build strength and restore muscle mass. A physical therapist can provide personalized exercises to help regain muscle mass and improve overall physical health.

4. Lifestyle and Behavioral Interventions

• Caloric Supplements: High-calorie drinks or shakes can be consumed to help increase calorie intake, particularly when solid food is not an option.
• Behavioral Therapy: For individuals with eating disorders or psychological factors affecting their weight, therapy can be effective in improving eating habits and body image.

5. Alternative and Complementary Medicine

Some individuals turn to alternative therapies, such as acupuncture or herbal supplements. However, these should always be used in conjunction with conventional treatments and under medical supervision.

6. Psychotherapy and Counseling

Psychological support can be crucial, particularly if weight issues stem from mental health disorders like anorexia nervosa, depression, or anxiety. Cognitive-behavioral therapy (CBT) is often used to address negative thought patterns about food and body image.

7. Immunizations and Vaccines

While not directly related to weight gain, ensuring that individuals who are underweight receive routine vaccinations and immunizations is important to protect against illnesses that could further weaken their health.

8. Stem Cell Therapy and Gene Therapy

While these are emerging fields, stem cell and gene therapies are still largely experimental and are not typically used for weight gain. However, research is ongoing to explore their potential applications in various areas of health.

Top 20 FAQs on Underweight

1. What is the definition of underweight?
   • Underweight is defined as having a BMI of less than 18.5.
2. Can you be healthy if you’re underweight?
   • It’s possible, but the risks of being underweight, such as weakened immune function and osteoporosis, mean that it’s important to gain weight in a healthy way.
3. What should I eat to gain weight?
   • Focus on high-calorie, nutrient-dense foods like avocados, nuts, seeds, lean meats, whole grains, and dairy.
4. Can stress cause weight loss?
   • Yes, chronic stress can lead to appetite loss and weight loss.
5. How can I gain weight if I have a fast metabolism?
   • Eating more frequent meals with higher-calorie foods and strength training to build muscle mass can help.
6. Are there any medications for weight gain?
   • Yes, appetite stimulants and medications for underlying conditions can help with weight gain.
7. Is it safe to gain weight quickly?
   • No, gaining weight too quickly can lead to unhealthy fat gain and other health issues. Gradual weight gain is healthier.
8. Can being underweight affect my periods?
   • Yes, being underweight can lead to irregular or absent menstrual periods in women.
9. How do I deal with body image issues while gaining weight?
   • Psychotherapy and counseling can help address any psychological barriers to weight gain.
10. What is the role of exercise in gaining weight?

• Exercise, particularly strength training, can help build muscle mass and promote healthy weight gain.

11. Can underweight people have strong immune systems?

• Not typically. Underweight individuals often have weakened immune systems due to lack of essential nutrients.

12. Can I eat junk food to gain weight?

• While junk food may increase calorie intake, it doesn’t provide the necessary nutrients. A balanced diet is essential.

13. Can weight gain reverse bone loss?

• Gaining weight and improving nutrition can help restore some bone density, but it may require additional treatments for severe cases.

14. How do I know if my underweight is due to a medical condition?

• Consulting a healthcare provider can help determine if there is an underlying condition.

15. Is it harder for women to gain weight than men?

• Women may find it harder due to hormonal fluctuations and metabolic differences, but both genders can face challenges.

16. Can weight gain improve mental health?

• Yes, increasing body weight, especially if it improves overall health, can positively impact mood and mental well-being.

17. How long does it take to gain weight healthily?

• Healthy weight gain typically takes several months, with 0.5–1 pound gained per week being a reasonable target.

18. What role do fats play in weight gain?

• Healthy fats are essential for calorie-dense meals, and they help in the absorption of fat-soluble vitamins.

19. What is the best calorie-dense food for weight gain?

• Foods like avocados, nut butter, whole grains, and full-fat dairy are excellent for calorie-dense meals.

20. Can genetic factors affect my ability to gain weight?

• Yes, genetics can influence metabolism and fat storage, which can make it harder for some individuals to gain weight.

Conclusion

Gaining weight in a healthy manner requires understanding the underlying causes and taking a balanced approach. While the process can take time, it’s essential to focus on nutritional, behavioral, and medical interventions. With proper guidance and support, underweight individuals can achieve a healthier weight and improve their overall well-being.

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Vermont: Obese children have lower working memory in comparison to children with normal weight, a new study has demonstrated.

The study published in JAMA Pediatrics and performed at the University of Vermont and Yale University found that obese children had a thinner prefrontal cortex than normal-weight children.

The thinner cortex could be a factor in the decreased executive function earlier studies observed among children with higher BMI.

Jennifer Laurent, an associate professor in the Department of Nursing at the University of Vermont said: “Our results show an important connection; that kids with higher BMI tend to have a thinner cerebral cortex, especially in the prefrontal area.”

The study was based on the data which followed 10,000 teens over a 10 year period. Every two years, study subjects are interviewed, given a battery of tests, gave blood samples and underwent brain scans.

The study analyzed results from 3,190 nine- and 10-year-olds recruited at 21 ABCD sites in 2017.

This rigorous research supported the conclusions of its predecessor, who appeared to have a poorer working memory for participants with higher BMI.

Laurent further mentioned that the hypothesis of the study was that the thickness of the cerebral cortex would mediate the relationship between BMI and executive function.

One of the researchers of the study said: “We found widespread thinning of the cerebral cortex. That’s significant because we know that executive function, things like memory and the ability to plan, are controlled in that area of the brain.”

More research is necessary to determine how the three variables are related.

From rodent models and adult studies, it has been shown that obesity can induce low-grade inflammatory effects, which actually do alter the cellular structure and can lead to cardiovascular disease. With prolonged exposure to obesity, it is possible that children have chronic inflammation, and that may actually be affecting their brain in the long term.

If that were the case, there would be significant public health implications, Laurent said. “We would want to proactively encourage changes in kids’ diets and exercise levels at a young age with the understanding that it’s not only the heart that is being affected by obesity, it is perhaps also the brain.”

The decrease in working memory was, however, a statistical observation.

“We did not look at behaviour. It’s very important that this work not further stigmatize people who are obese or overweight. What we’re saying is that, according to our measures, we are seeing something that bears watching. How and if it translates to behaviour is for future research to determine,” Laurent added.

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More than a fifth of primary one pupils in Scotland are at risk of being overweight or obese, new official statistics have shown.  

Figures from the NHS Information Services Division on the BMI of primary one children across Scotland reveal that 22.4 per cent are at risk of being overweight or obese, while 77.6 per cent were of a healthy weight.

Of these, 12.2 per cent were at risk of overweight, while 10.2 per cent were at risk of obesity.

While the proportion of children who are at risk of being overweight or obese has stayed quite constant since 2001-02, the gap between rich and poor areas has widened, with the proportion of primary one children at risk of obesity in the most deprived areas now more than double that of those living in the least deprived areas.

In the most deprived areas this year, 13.7 per cent of primary one children were at risk of obesity, while 6.5 per cent were at risk of obesity in the least deprived areas.

being overweight can cause a number of serious health problems over the course of life, including high blood pressure, heart disease, stroke, asthma and breathing difficulties, type 2 diabetes and some cancers.

It can also have an impact on self-esteem and lead to bullying.

Children who are obese are more likely to be obese as adults.

Lorraine Tulloch, programme lead of Obesity Action Scotland said: “It is concerning to see that the inequalities gap in obesity in primary one children in Scotland continues to grow.

“Today’s report shows that the gap between primary one children living in the most deprived and least deprived areas at risk of obesity is now the widest it has been since records began.

“We need to do more to protect our children. Ambitious action is urgently required.  

“The Scottish Government have committed to halving childhood obesity by 2030, but we need more actions to improve our food environment if we want to achieve that.”

Scottish Greens parliamentary co-leader Alison Johnstone said: “It is absolutely shocking that so many of our children are at risk of becoming overweight or obese.

“Scotland’s children have been facing a public health crisis for 18 years and we are no closer to tackling it.

“Measures such as removing sugary, high-fat foods from schools are a positive step but we need a greater focus on prevention.

“The link between poverty and obesity is well known and we must first address the root causes of health inequalities if we are to tackle the obesity epidemic.

“Access to cheap, nutritious food and free, easily-accessible sports facilities would go some way to narrowing the gap between the most and least deprived, but ensuring that everyone has a stable, sufficient income is the best means of improving health outcomes.

“This would allow families meet their basic needs, including access to proper nutrition.”

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Obesity rates have been rising in the United States for several decades, a trend that has public health officials concerned given the serious health risks associated with the condition. 

About 93.3 million people in the United States are obese – nearly 40% of the adult population – according to a 2018 study.

Obesity is considered a major risk factor for various conditions, including type 2 diabetes, cardiovascular disease, high blood pressure and cancer. Almost 365,000 deaths each year can be attributed to obesity, according to Harvard Health. 

To calculate it, you can simply input your height and weight into an online BMI calculator like this one. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 and over is considered obese. Anything beneath 18.5 is viewed as underweight. 

Waist circumference is another way to determine your risk for obesity and its related health issues. For women, a waist size larger than 35 inches is of concern. For men, it’s a waist larger than 40 inches. 

Even losing few pounds can improve cardiovascular health, according to the American Heart Association. Not only can the body circulate blood in a more efficient manner, but it can also manage fluid levels better.

Additionally, losing weight can help people who are obese better manage high blood pressure as well as high cholesterol and triglyceride levels. Obesity also increases the risk of heart disease and stroke. 

Still, BMI only can tell us so much about our health. According to the National Heart, Lung, and Blood Institute, it “may overestimate body fat in athletes and others who have a muscular build” or it “may underestimate body fat in older persons and others who have lost muscle.”

Dr. Robert H. Shmerling, of Harvard Health, cautions that BMI is not a measure of patient’s total health. There are people with a high BMI who are healthy and people with a normal BMI who are not, he says. Still, Shmerling finds it a useful tool because a high BMI is linked to increased risk for various health conditions.  

The Centers for Disease Control and Prevention also does not consider BMI a diagnostic tool for disease risk. It recommends making time for regular health evaluations from a trained healthcare provider.

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A number of medical experts are calling for obesity to be classed as a disease in order to encourage people to seek treatment.

John Wilding, professor of medicine at the institute of ageing and chronic disease at the University of Liverpool, and Vicki Mooney, executive director of the European Coalition for People living with Obesity (EASO), argue that the view obesity is “self-inflicted and that it is the individual’s responsibility to do something about it, is “inaccurate” and reinforces stigma around being overweight.

Instead, the pair believe that the role played by genetics combined with the illnesses created by obesity, such as Type 2 diabetes, high blood pressure and some cancers, means it should be defined as a disease.

According to the NHS, obesity is thought to affect around one in every four adults in the UK, and roughly one in five children aged 10 to 11.

Body mass index (BMI) is widely used as a simple and reliable way of finding out whether a person is a healthy weight for their height.

For most adults, the NHS states that having a BMI of 18.5 to 24.9 means you’re considered to be a healthy weight. A person with a BMI of 25 to 29.9 is considered to be overweight, and someone with a BMI over 30 is considered to be obese.

Wilding and Mooney add that the Oxford Dictionary supports their argument with its definition of disease as “a disorder of structure or function … especially one that produces specific symptoms … and is not simply a direct result of physical injury”.

They also state that obesity, in which excess body fat has accumulated to such an extent that health may be adversely affected, has been considered a disease by the World Health Organisation since 1936.

“Studies in twins show that 40-70 per cent of the variability in weight is inherited,” Wilding and Mooney write in the British Medical Journal (BMJ) to bolster the theory that obesity is influenced by genetics.

“Body weight, fat distribution, and risk of complications are strongly influenced by biology – it is not an individual’s fault if they develop obesity.”

The pair add that recognising obesity as a chronic disease with severe complications rather than a lifestyle choice could help “reduce the stigma and discrimination experienced by many people with obesity”.

They write: “Instead of discouraging them from seeking treatment it should give them permission to do so.

“The stigmatisation of obesity leaves patients fearful of discussing their weight, and they turn to fad diets or non-prescription medication because they assume that their obesity is solely their responsibility.”

However, not all medical professionals agree with Wilding and Mooney’s stance on the issue.

In contrast, Dr Richard Pile, a GP from St Albans, said the Oxford Dictionary definition of disease “is so vague that we can classify almost anything as a disease”.

Also writing in the BMJ, Pile argues that recommending a change implies that current NHS and public health strategies are “doomed to failure without classifying obesity as a disease“.

”Labelling obesity as a disease risks reducing autonomy, disempowering and robbing people of the intrinsic motivation that is such an important enabler of change,” Pile adds.

“It encourages fatalism, promoting the fallacy that genetics are destiny.”

The debate in the BMJ follows calls from the Royal College of Physicians(RCP) in January for the Government and the NHS to urgently recognise obesity as a disease.

The RCP said it wanted to see obesity recognised as an ongoing chronic disease to allow the creation of formal healthcare policies to improve care both in doctors’ surgeries and hospitals.

It argued that obesity is not a lifestyle choice caused by individual greed “but a disease caused by health inequalities, genetic influences and social factors”.

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