Much like losing weight, gaining weight can be a real challenge – and being too thin has serious health risks.

  • 18 November 2016

Much like losing weight, gaining weight can be a real challenge – and being too thin has serious health risks.

Gaining weight can be a real challenge – and being too thin has serious health risks.

Question: Because of his low body weight, my son is close to failing his next annual medical check, essential for his profession. Like his father’s male family members, he is a natural beanpole but otherwise healthy. We eat a healthy Mediterraneanstyle diet and I’ve added more lean meat and legumes to his diet, but so far there’s been no weight gain. He eats lots of yoghurt and some cheese, but I’m loath to add more dairy. Can you offer some weight-gain tips and explain the dangers of being underweight?


Being underweight may not make headlines like the obesity epidemic, but it also carries real health risks. What’s more, dietitians are far more likely to see people looking to maintain or increase body weight, rather than lose weight, says registered Auckland dietitian Anna Sloan. In the 2014/15 New Zealand Health Survey, about 47,000 adults (1.3%) and 35,000 children (4.4%) were classified as underweight or thin, with a body mass index (BMI) of 18.5 or lower. Older adults, young children, teenagers and anyone who is particularly active are potentially at risk of becoming underweight, says Sloan.

Typically, underweight people are not eating enough fuel for their body, so they may have nutrient deficiencies. Older adults in particular are at risk of developing malnutrition, which can lead to longer hospital stays and wound healing times and reduce daily functioning after a hospital stay – in other words, the ability to look after yourself and live independently.

For active, growing underweight children, one of the key risks is longterm stunting – or not reaching their full height potential, Sloan says. Being underweight also increases the risk of osteoporosis and can affect hormone regulation and lead to reduced blood pressure. It can also affect muscle function and strength, which may be a problem for people in jobs that involve critical elements of danger or risk, she says.

“Basically, if you’re not consuming enough to maintain body weight, your body will start breaking down its muscle mass to create its own glucose [fuel] to feed the brain.

“If your son is in a complex or risk-based job and his body is having to break down its own muscle mass to create carbohydrate, there will be times when his brain is possibly starved of fuel, so his critical thinking could be affected.” That could be disastrous.

Of course, we need to be realistic about our body type, because genetics plays a significant role in our physical build. If your

son has the same physique as his father and other paternal relatives, it’s highly likely he is genetically programmed to be tall and lean. However, as he’s on the borderline of failing his medical check, it’s possible all he needs is a relatively modest weight gain.

Other people may need to gain or regain weight if they have had a serious illness or been hospitalised, are older and have unintentionally lost weight, are athletes who want to build muscle and strength for their performance or are simply too thin.

Much like losing weight, gaining kilos can be a real challenge. But as with all things diet related, the key is to choose nutrient-rich foods. Consuming sugar-rich, nutrient-poor snacks such as chips and soft drinks may be a quick and easy way to add weight, but it won’t build muscle, strengthen bones or repair the body after surgery. Instead, foods that are both energy- and nutrient-dense are better.

Sloan recommends continuing with your Mediterranean-style diet and making sure your son gets a good ratio of vegetables, along with carbohydrates such as wholegrain breads, cereals and pasta at each meal. If he is physically active, she recommends he have 6-8 daily carbohydrate servings – one serving is equivalent to two breakfast wheat biscuits, a slice of bread, half a cup of muesli or a cup of cooked pasta or rice.

If he still needs to gain weight, she suggests adding high-energy snacks and foods such as nuts, olives, avocado and peanut butter to his diet. For example, he could have peanut or almond butter on a savoury muffin or scone. Adding an extra 2-4 teaspoons of oil directly to plated meals will also increase energy and essential fatty-acid intake, says Sloan. If he is aged 20-25, he should eat 2-3 daily servings of low-fat dairy products; three servings if he’s under 20. One dairy serving is equivalent to a glass of milk, a small pottle of yoghurt or two slices (40g) of cheese.

Make sure he is eating when hungry and having regular meals and snacks throughout the day. If he works long shifts with little opportunity for meal breaks, consider nutrient-dense snacks that can be eaten quickly.

Underweight people should focus on eating when hungry, and if they’re trying to gain weight, having an extra snack or slightly larger portion size at meal-time may help. Certainly those with a small appetite will benefit from eating five to six times a day. It’s also a good idea to drink fluids before or after meals, but not with a meal, so that there’s more room left for food.

Ultimately, being underweight can make it difficult to stay healthy, says Sloan. So if you’re affected this way, it is important to take that as seriously as if you were overweight.

For active, growing underweight children, one of the key risks is longterm growth stunting.

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