No Such Thing as Too Thin? Think Again

Date: March 22, 2012      Publication: HealthyWoman from Bottom Line      Source: Gretchen E.  Robinson      Print:

Editor’s note: The other day, as I was rushing down the street, I literally ran into an old friend—and almost knocked her down. She had gotten so thin that it seemed a slight breeze could have blown her away. She’s not anorexic, she’s just…too scrawny. And that’s scary, because not weighing enough presents bigger health risks than many people realize.

Given all the current national focus on the opposite problem—that of obesity—it’s not surprising than the dangers of being underweight are underrecognized. But if you or someone you care about is overly slim, you need to know the facts and the fixes. That’s why I want to share a recent report that ran in Bottom Line/Health, another publication in the Bottom Line family (to subscribe, please visit Here’s the real skinny on being too skinny…

The obesity epidemic in the US receives so much attention these days that few people realize just how risky it can be when a person is underweight. While roughly 72 million American adults are considered to be obese, about five million don’t weigh enough.

Important finding: Underweight people—defined as having a body mass index (BMI) of less than 18.5—have a higher risk of dying from infections, postsurgical complications and other conditions than people who are a normal weight, according to an analysis of data from the National Health and Nutrition Examination Survey. According to the BMI categories, a woman who is five-foot-five-inches tall, for example, and weighs 110 pounds would be considered underweight.*


Genes play a role in an individual’s ability to gain weight, lose weight or stay thin. In some cases, however, people are too thin because of unintentional weight loss—often due to underlying health issues. Examples: Depression, chewing and swallowing disorders, or chronic conditions, such as Crohn’s disease and celiac disease, that lead to digestive and malabsorption problems. Commonly used medications, including diuretics, some painkillers, antidepressants and antibiotics, also can cause unintentional weight loss.

Important: Unintentional weight loss should always be evaluated by a doctor.


People who are underweight should try to gain weight. This is mainly achieved by consuming more calories. To gain one to two pounds a week, a person who is underweight may need an additional 500 to 1,000 calories daily beyond what his/her body needs for weight maintenance. Helpful…

Get more fat in your diet. Millions of Americans wisely limit their consumption of dietary fat. But that’s generally not as important for people who are underweight.

Recommended: To gain weight, consume more energy-dense foods, such as milk shakes made with whole milk, peanut butter, pasta and dense cereals such as granola. Foods that are high in fat have nearly twice as many calories as carbohydrates. Although it’s not healthy for most people to eat foods high in fat, it may be essential for older adults and younger individuals who are underweight. If you have a chronic condition such as heart disease or diabetes, consult a registered dietitian for advice on specific food choices.

Drink food-supplement beverages. They taste good, and most provide about 250 calories per eight-ounce serving—more if you use a powdered form and mix it with whole milk. High-quality protein beverages also contain a mix of nutrients that can improve immunity and wound healing.

Recommended: Use these products in addition to your regular diet. Aim for two to three daily servings (an hour before or after meals). Good products include Ensure Plus, Boost High Protein, Carnation Instant Breakfast and Resource Health Shake.

Add flavor whenever you can. It’s normal for people to lose some taste buds with age. Foods will often taste “flat” unless the flavors are heightened. That’s why it’s important to make every bite of food as appetizing as possible when you’re trying to gain weight.

Recommended: Season foods generously with salt-free seasonings, such as fresh or dried bay leaves, basil, celery seed, garlic powder, lemon juice or Mrs. Dash, a salt-free seasoning blend.

Snack often. It’s generally a good idea for underweight adults to have at least six meals a day—three large meals plus three high-calorie snacks.

Recommended: Snack on breakfast cereal (using whole milk or half-and-half), crackers with cheese, graham crackers and a glass of milk, or a sandwich made with two tablespoons of peanut butter and jelly, chewy granola bars, etc.

Keep plenty of healthy snacks readily available in your home—this makes it easier to take in more calories daily.

Make mealtimes an event. Research has shown that people who are involved in meal preparation—choosing foods and recipes, adding seasonings, etc.—consume more calories than those who have their meals prepared for them. Improving the ambiance of your dining area with good lighting and a pleasant table setting also will encourage you to eat more.

Dine with others. People who eat alone may consume up to 50% fewer calories than those who eat with company. When people make eating a social event, they spend more time at the table, enjoy their food more and consume more calories.

Stop smoking. Smoking suppresses the appetite and allows people to satisfy the normal “mouth function” with a cigarette rather than from eating. People who quit smoking typically gain an average of five to eight pounds within a few months.

Treat depression. It’s among the main causes of weight loss in adults of all ages. Those who are depressed lose interest in many of life’s pleasures, including eating.

Recommended: Get professional help if you experience any of the signs of depression, which include changes in eating or sleeping habits, difficulty concentrating or feelings of hopelessness or other mood changes.

Start moving. Exercise is among the most powerful strategies for weight gain. Even though exercise burns calories, you’ll make up for it with increased appetite, improvement in mood (which also increases calorie intake) and greater muscle and bone mass.

Recommended: Start slowly by throwing a ball for your dog, for example, or just flexing your muscles when you sit in a chair. Work up to walking at least 30 minutes daily and, if possible, add strength and flexibility exercises a few times a week. Quite often, people will start eating more and gaining weight within a few weeks of beginning regular exercise.

*To calculate your BMI, go to the National Heart, Lung and Blood Institute Web site, Discuss your BMI with your doctor—there are other measurements that also may be appropriate to help determine a healthy weight.

Source: Gretchen E. Robinson, RD, LD, is an adjunct professor at Ohio Northern University in Ada, Ohio, and a committee member of the American Dietetic Association work group for the development of “Unintended Weight Loss in Older Adults Evidence-Based Nutrition Practice Guidelines,” available at She also is a private-practice corporate consultant to several long-term-care facilities.