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When You Need to Gain Weight, and Your Friends Can’t Relate

Whether it’s metabolism, illness or another cause, being medically underweight can put your body at risk. Here’s how to manage it, one meal at a time.

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Chiara Ghigliazza
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I can’t remember a time when I didn’t want to lose an extra five or 10 pounds — until now. When a major digestive surgery left me weighing in at less than 100 pounds this summer, I found myself on the opposite end of the scale.

Because of my drastic weight loss from about 145 pounds to 99 pounds, I was severely malnourished. At 5 foot 5, I needed to reach 111 pounds in order to be considered a “healthy weight” again. 

Turns out gaining weight can be a lot more challenging than some people think. While well-meaning loved ones suggested that I simply gorge myself on high-calorie foods like pizza and ice cream, it’s important to eat foods dense in nutrients, says Jerlyn Jones, a registered dietitian nutritionist in Atlanta.

Being underweight can also be harmful to the body. It can lead to malnutrition, which is a condition in which your body doesn’t receive the vitamins and minerals needed to function properly. That in turn can lead to other conditions such as a weakened immune system and anemia. Osteoporosis — a condition in which your bones are brittle and break easily — and depression are also more common among women who are underweight. In addition, being underweight may increase your risk of dementia.

A body mass index calculator can let you know whether you are underweight based on your height and weight. If your score is less than 18.5, you are considered underweight. A score of 18.5 to 24.9 is considered healthy. A score of 25.0 to 29.9 is considered overweight. A score of 30.0 or above is considered obese.

An overactive thyroid or diabetes could impair your metabolism. Parkinson’s disease, cancer or Crohn’s disease could spark unintended weight loss. Stress, depression, some medications and dental problems can also lead to a loss of appetite.

There is also a body of research that suggests that being underweight becomes even more harmful as we age. For example, a landmark study published in 2014 by The American Journal of Clinical Nutrition showed that older adults are more likely to die from a number of different conditions once their BMI goes below 23. That study and others like it have prompted some in the medical field to recommend that we carry a little extra weight as we age. In fact, the National Institutes of Health says that it is often better for older adults to aim for a BMI of between 25 and 27.

There are a lot of reasons why you or a loved one might start to lose too much weight. An overactive thyroid or a condition like diabetes could impair your metabolism. Chronic illnesses such as Parkinson’s disease, cancer or Crohn’s disease could spark unintended weight loss. Stress, depression, some medications and dental problems can also lead to a loss of appetite, which can result in significant weight loss.

So far, I’ve gained 11 pounds by developing a new relationship with food. If you or a loved one needs to gain weight for your health, these nine strategies may help.

First, do no harm. In your bid to gain weight, make sure you don’t make other health conditions worse. For example, if you’re diabetic, foods with a lot of carbohydrates might help you gain weight but could cause your blood sugar to rise dangerously high. Think about any other conditions you have when coming up with meal plans that are conducive to gaining weight.

Choose nutrient-rich foods. If you’re not eating enough, you’re likely not getting enough nutrition. Try to get foods from all five food groups, Jones suggests. That means adding fruits, vegetables, grains, protein and dairy to your diet. Then look for ways to add calories and nutrients to your meals. For example, if you prepare oatmeal, use milk instead of water and add honey, dried fruit or nuts, Jones suggests. If you’re making chili, maybe add a little cheese on top. Whole grain breads, pastas and lean proteins can also help you bulk up.

Think heart-healthy fats. Peanut butter and avocados — two foods high in healthy unsaturated fats — can be great to add to foods, which can help you gain weight. For example, spread peanut butter on an apple or add avocados to your smoothie. “Foods that are higher in those heart-healthy fats can give you extra calories without causing health issues later on,” Jones says.

Avoid “miraculous” cures. If any product purports to help you gain substantial weight in a short period of time, ignore it, Jones says. “It's never a quick fix when it comes to gaining weight.” 

Assess your limitations. Many factors can influence how much you eat. For example, if you can only stand for a short period of time, then meals should be quick to prepare, Jones says. If you don’t have the strength to open packages and containers, can you realistically cook your meals? Consider asking a family member or loved one for help. In the days after my surgery, if I’d had to cook for myself, I probably wouldn’t have eaten at all. 

Eat smaller amounts more often. If you are underweight, you might feel full a lot faster, Jones says. If that’s the case, get more calories in by eating five or six smaller meals a day rather than three large meals.

Don’t drink when you eat. Drinking liquids can make you feel full. For that reason, drink your beverages after you eat so you have more room for food, Jones says.

Use shakes and smoothies to supplement. Oral supplements like Ensure and Boost can help you add pounds and protein to your body. They may also be easier to take in than food. However, try to use them in addition to your meals, not as a replacement for them, Jones says.

Exercise. It might seem like exercise will cause you to lose weight, but in fact, it can stimulate your appetite and help you increase muscle, which will result in additional weight.

The bottom line: Gaining weight can be as long and difficult a road as losing it. If you’re up for the challenge, “take it one meal at a time,” Jones says.

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