In a couple of my blog posts, I’ve talked about how inadequate or imbalanced nutrition affects bone health, putting thin persons — particularly thin women — at greater risk for bone fractures. The most recent post, Beauty is Bone Deep, focused on women who try to force a thin physique on their (usually unwilling) bodies for the sake of an unrealistic beauty ideal. But there are those women, and men too, who try and try togain weight rather than lose it, often to no avail. These aren’t people who have an eating disorder or anorexia — they’re otherwise healthy-seeming people who simply can’t gain a single pound.
Now, many folks out there will read this and think, “Gee, that’s a problem I wish I had.” But as people who do have this problem will tell them, the struggle to gain weight is actually harder than the struggle to lose it.
Think about it: there are dozens, if not hundreds, of weight loss solutions out there (some better than others), but there aren’t many workable solutions to gain weight in a healthy manner. If you search the internet, you’ll find most information on weight gain is for bodybuilders and focuses on building bulky muscle, but that’s not something most women (and many men, too) really want. And contrary to the suggestions some of my underweight clients hear, eating cheeseburgers, ice cream and cookies 24/7 does not help, and it’s a highly acidifying, bone-damaging way of life as well.
So what should an underweight woman or man do to gain weight in a healthy manner?
Just as with any health issue, solving underweight requires examining root causes. I’ve noticed that people who are underweight fall into several camps:
For people who stay thin despite eating well, I look at three factors. First, are theyreally eating enough food on a regular basis, or is that simply their perception? Is a meal something they sit down to at a table, with 2 or 3 different dishes, and spend time enjoying — or do they consider an apple and a small tub of yogurt consumed between meetings at work to be “lunch”? While the average adult needs 2000-2500 calories, that’s an average; some people require more, but may not realize it — and gaining weight might simply be a matter of eating more nutrient-dense foods. Moreover, if you’re underweight because of a nutritional deficit, you may need to supplement with the 20 key nutrients required for bone health because if your muscles, skin, organs and tissues aren’t getting what they need, they’ll take it from your bones!
Second, I consider whether a metabolic or endocrine issue could be at work. Hyperthyroidism, latent autoimmune diabetes in adults, and various other chronic disorders can prevent people from gaining weight, even when they eat well — and sometimes, these disorders are “silent,” meaning they have no clear-cut symptoms. I often recommend a medical workup for osteoporosis for this very reason. Simple blood tests can generally uncover the presence of autoantibodies or hormone imbalances, however. Such disorders represent significant health issues that need to be addressed by a specialist.
Finally, I’d look at the possibility that they might not be absorbing the food they eat. A great many malabsorption syndromes and digestive issues can prevent a person who eats reasonably well from reaping the benefits of the food they take in. Some of these, like IBS or Crohn’s disease, have obvious symptoms attached — diarrhea, gas, bloating, pain — but others, such as celiac disease, can damage the GI tract and impair nutrient absorption capabilities, sometimes without causing any distinct symptoms related to the digestion. Poor nutrient absorption frequently occurs in older people simply as a byproduct of aging. So if I saw indications of poor nutrient absorption (dry, brittle hair and nails, for instance), I might suggest that a client ask her physician for testing for celiac or other GI issues, and we’d look very closely at how to boost the nutritional and caloric content of her food so she gets more of what she needs. And I’d offer them suggestions for how to strengthen their digestion.
Those who don’t feel hungry or who don’t feel like eating usually have one of two problems. Either they have an imbalance in the “hunger hormones” that stimulate appetite (often associated with zinc inadequacy), or they simply don’t prioritize meals sufficiently. The second problem is likely more common than the first — many folks are so rushed or busy that they habitually ignore their body’s signals that it needs food, to the point that they genuinely believe they’re not hungry even when they are! These folks benefit by taking time to acknowledge and understand their physiologic needs. I would do the following:
For those who stop eating or eat less due to anxiety or stress, part of the problem is their response to anxiety and worry. For clients whose thinness is related to an anxious mind, I’d help them to learn stress-reduction techniques, and also have them focus on their intentions around eating — that is, to find ways to celebrate their meals as an affirmation of their worth. It doesn’t need to be complicated — simply saying grace before each meal, for example, can send a strong signal from the mind and spirit to the body that the food in front of you is a blessing meant to nourish you. The power of the mind should not be underestimated, and focusing it on nourishment (instead of on anxieties and worries) may be an important component of promoting healthy weight gain.
If you’re underweight, taking steps to build strong muscles, eat a nutritious diet, and reduce stress and anxiety can help you gain weight, meanwhile reducing your fracture risk. Even if the tips outlined above don’t help you to add a single pound of weight, the bone-strengthening benefits of my Better Bones approach may make the difference in staying healthy and avoiding fractures — and isn’t that what matters in the long run?