Being Underweight: Quite A Weighty Issue

South Africa is a unique country in the sense that it has more obese individuals than underweight ones. However the number of individuals that are underweight, is quickly increasing. In both cases, weight control often appears impossible to manage. Sometimes being underweight is a result of imposing restrictions on what one eats in fear of becoming obese or just because one wants to lose weight. Sometimes, it is due to genetics. I have many friends who have come to me, wanting to learn more about it and what they can do about it.

To determine if you are underweight, calculate your BMI (Body Mass Index), by dividing your weight (kg) by your height squared (m squared). The normal range is between 18.5 and 24.9. You are considered underweight if your BMI is below 18.5.

There are various health implications for an underweight person and these can be prevented through a sufficient diet. Implications include:

• Poor immune function - a diet which lacks essential nutrients, vitamins and minerals, which are needed for the immune system to protect against bacteria and other organisms.


• Improper wound healing - the immune system is weakened and thus wounds don't heal as quickly or efficiently as they should.


• Higher risk of infection - an underweight person is more vulnerable to infections due to a weak immune system, as the body cannot protect itself against bacteria and infections.


• Poor heart function - an underweight person's diet often lacks essential nutrients to ensure that the heart works properly. The poorer the nutritional status, the weaker the heart will be and the risk of heart complications increases.


• Other health implications include: hair loss, inelastic skin, low muscle mass, poor bone structure, low blood pressure and hormone imbalances.

Being underweight can be due to several reasons, some of which include poor absorption of food (due to wasting of the muscle surrounding the intestine); wasting disease; emotional stress; improper diet and lack of appetite; nausea and vomiting as well as habits formed in childhood, like food aversions.

The Weight Watch:

Underweight individuals should try to find out why they are underweight and address those particular issues. Monitoring your weight is important, especially if you struggle to put on weight. It is well recognised that putting on weight is often much more difficult than losing weight and this is usually aggravated by a sense of nausea and a poor appetite. Often many underweight individuals tend to eat fattening and unhealthy foods to put on weight, and this also has undesirable consequences. Despite this, many health professionals recommend high kilo-joule diets, rich in good fats, carbohydrates (starches) and protein. The main goal of underweight individuals should be to increase their energy, vitamin and mineral intakes by eating small, frequent meals rich in these nutrients. This should also prevent any further weight loss.

Reasons for Being Underweight (usually due to unplanned weight loss):

• Lung, colon or pancreatic cancer or leukemia.
• Peptic ulcers, inflammatory bowel disease, chronic pancreatitis, coeliac disease.
• Diabetes Mellitus.
• Thyroid problems (overactive thyroid).
• Infections such as HIV Aids, Tuberculosis, fungal diseases and parasites.
• Depression, schizophrenia or Alheimer's Disease.
• Certain medications cause nausea, diarrhoea or loss of appetite.

The underweight person should also determine their ideal goal weight, (a dietician will work this out for you) and aim to achieve that by eating an extra 125 kJ (30 calories) per kg of body weight per day. This is the safe recommended intake for weight gain. Elderly, ill or severely malnourished individuals should be eating an extra 168 kJ (40 calories) per kg per day and a large portion of this intake should consist of protein.

Piling on the Pounds:

To put on weight, you have to consider your diet, as this will most likely change to accommodate those extra kilojoules. Many suggest that a way to do this is to increase one’s fat intake (as the fat intake increases, so do the kilojoules increase). Some tips to do this are:

• Serve poly or mono-unsaturated fats with vegetables and use oil-based salad dressings. Butter can also be used, but be aware of the cholesterol content (too much cholesterol leads to heart problems).


• Add cheese to certain foods such as omelettes or pasta, to increase the protein and fat intake of your diet.


• Full- cream dairy products should be eaten instead of the low-fat varieties.


• Cream, evapourated milk or full cream milk can be added to soups, desserts and sauces.




• Fish, minced meat, chicken and cheese can be added to dishes to increase the protein content.


• Drink full-cream or fruit juice with meals, as this will help increase the kilo-joule content of the meals.


• Try to avoid drinking too many liquids at the beginning of the meal, as this will fill you up and you may lose your appetite.


• Also try to avoid eating fatty foods before or at the beginning of the meal, as this too will fill you up and you may not have an appetite.

• Eat at least three times per day and have snacks between those meals. Snacks can include peanut butter or cheese sandwiches, yoghurts, crackers or provita and avocado or cream cheese dips.
  
  There are also various tips to help increase your appetite:
  
• Choose different types of foods, as a variety of foods contains different nutrients. Another way to encourage this, is to eat at different restaurants.


• Have meals with family and friends and try to have a set mealtime, in a specific room, with no distractions (e.g. telephone calls). The more routine mealtimes are, the easier it is to encourage the habit.


• It is very important to eat something at every mealtime, even if you have lost your appetite.


• Different colours and textures are important as they help make food more appealing. make an effort in presenting your food and the way you set your table, so as to encourage you to eat. you've made all this effort, so why not?


• Regular exercise, such as a brisk walk also helps stimulate your appetite.

Help along the way:

Often seen as a miracle for weight gain, nutritional supplements are used to help increase the kilo joule and protein intakes of individuals. These are usually in the form of liquid drinks and come in various flavours. These supplements usually provide 100% RDA (Recommended Daily Allowance) of vitamins and minerals but as they are low in fibre and phytochemicals (found in fruit and vegetables), they shouldn’t replace meals. It should be noted that the vitamins and minerals which these supplements contain, do not cause weight gain; they merely replace any loss of essential nutrients. There are also drugs which improve your appetite and lead to weight gain.

Gaining weight has always been a tricky task and unfortunately there is no miracle cure. A high energy diet and regular exercise is the key to gaining weight. On a high energy diet alone, you will just gain fat; the exercise helps with the fat distribution. It is always important to speak to a qualified dietician or doctor about putting on weight. Broaden your mind and your body and you shall feel a lot more confident, because narrow-mindedness doesn't get you anywhere! Good luck!

Information for this blog post was obtained from these two sources:

Antia FP, Abraham P (2002). Clinical Dietetics and Nutrition. New Delhi:Oxford University Press.

Hark L, Deen D (2007). Nutrition For Life: The definitive guide to eating well for good health. London: Dorling Kindersley