The Overlooked Weight Problem: Americans Who Are Too Skinny

Much attention has been focused on the growing problem of being overweight in the US, but at the opposite end of the scale, two percent of Americans are seriously underweight. That means that in a country of over 340.1 million people, the seriously underweight population amounts to 6.8 million people. Men can be underweight, of course, but stats say the overwhelming majority of the “too-skinny” are women.

The fashion industry certainly shares some blame for constantly using rail-thin models to showcase stylish clothes, and Hollywood has been pushing the buxom, but at the same time thin, look for women for decades.

Physically plump women were immortalized by Flemish artist Peter Paul Rubens (1577-1640), but by World War II, the pinups painted by Alberto Vargas for Esquire and later Playboy, popularized the long-legged slim-waisted woman. Beyond trying to emulate a certain look, there are a number of very real physical reasons why a person may be underweight including (but not limited to) genes and a family history of skinny bodies, a higher metabolism that burns calories faster than normal, or frequent intense physical activity. A serious or chronic illness such as cancer, and last but hardly least a mental or emotional disorder that prioritizes being thin can also be a cause.

On the physical front, a very thin body has less insulating body fat, so it chills easily even in summer. Since bones are less cushioned by fat, it puts an underweight person at higher risk of osteoporosis breaks. Studies suggest this type of body may be more susceptible to digestive disease and infectious illness exacerbated by dizziness, headache, and fatigue linked to anemia (the lack of sufficient healthy red blood cells or hemoglobin to carry oxygen to body tissues).

For underweight women, there is also a higher risk of infertility. Once pregnant, they are more likely to give birth to more fragile, low-body-weight infants. And as they grow older, underweight women are likely to enter menopause earlier than their heavier sisters.

While thin was often equated with beauty in the media, in everyday life someone who is too skinny could have a diet that is not delivering enough nutrients to the body, creating problems including dry wrinkled skin, thinning hair, and even dental problems.

Underweight men are not exempt. Sometimes a little extra fat is better than too little fat on a body. A recent Cornell University analysis of 19 large studies showed that among 50-year-old, nonsmoking white men, those moderately underweight at age 50 were more likely to die in the following 30 years than were their moderately overweight counterparts. A similar report in the journal BMC Public Health also states being an underweight man or woman carries an increased risk for mortality. One reason, researchers theorized, may be because an underweight body might not be getting the nutrients it needs to build healthy tissues after an accident or trauma.

So how do you determine who is fit and trim versus underweight to the point of being unhealthy? Currently experts hold that the most reliable guide remains the CDC’s (Center for Disease Prevention and Control) Body Mass Index (BMI), which is calculated using the formula weight (in lbs) divided by height (in inches, squared) times 703. You can find the calculator and the chart at https://www.calculator.net/bmi-calculator.html. The CDC says a BMI less than 18.5 means underweight.

If a doctor recommends gaining weight, the authoritative website Medicalnewstoday.com suggests four ways to start.

First: Add high-protein and wholegrain snacks such as peanut butter crackers, trail mix, a protein bar, some pita chips, or a simple handful of nuts such as almonds.

Second: Forgo the three-a-day meal pattern in favor of several small meals a day, which may be easier to digest and to add calories onto your plate.

Third: Add calorie-dense foods to your regular dishes. For example, toss some sunflower or sesame seeds on your breakfast cereal or cup of yogurt or ice cream and butter your breakfast toast with nut butter rather than plain butter or a veggie alternative.

Fourth: Take a pass on empty-calorie foods high in sugar and salt such as soda and candy and fried potato chips. True, these are usually high-calorie but are likely to come with excess fat rather than useful nutrients that increase strength as well as weight.