When the weight is really low
The guideline is body mass index: weight in kilograms divided by the square of height in meters. A value below 18.5 is regarded as underweight, below 16 as severe wasting. In children and adolescents, age scales are used, but in the elderly, it is not the number itself that is more important, but the dynamics: loss of weight and muscle mass with a normal BMI is already unfavorable. Athletes with developed muscles and people of small build are individual cases where the formula requires interpretation by a doctor.
- BMI below 18.5 – underweight
- BMI below 16 – severe wasting
- In children, assessment according to age scales
- For older people, dynamics are important, not just numbers
- Constitutional thinness without weight loss is a normal option
Why do you lose weight?
There are three mechanisms: a person eats less, loses nutrients or uses more energy. Insufficient intake occurs with depression, dental problems, nausea, poor diet, and in the elderly due to decreased appetite and loneliness. Losses are typical for intestinal diseases with malabsorption. Increased consumption is observed in thyrotoxicosis, uncompensated diabetes, chronic infections and tumors. Often the reasons are combined, so the examination should be systematic and not reduced to one analysis.
- Depression and anxiety with decreased appetite
- Thyrotoxicosis and uncompensated diabetes
- Celiac disease, Crohn's disease, chronic pancreatitis
- Chronic infections, including tuberculosis
- Oncological diseases
- Parasitoses
- Eating disorders
- Problems with teeth and swallowing in the elderly
What are the dangers of being underweight?
With a lack of nutrition, the body saves on everything: muscle mass and strength decrease, wound healing worsens, and infections occur more often. Over time, bone density decreases and the risk of fractures increases. In women, the menstrual cycle is disrupted until it stops and fertility decreases; in adolescents, growth and sexual development slow down. Chilliness, hair loss, dry skin, weakness, and sleep disturbances appear. In older adults, muscle loss is directly related to falls, fractures, and loss of independence.
- Decreased muscle mass and strength
- Frequent infections and slow healing
- Decreased bone density
- Menstrual and fertility disorders
- Delayed growth and development in adolescents
- Chilliness, hair loss, dry skin
- Falls and fractures in the elderly
What examinations are needed
They start with a conversation and examination: weight dynamics, appetite, stool character, temperature, cough, mood, and medications taken are important. The basic kit includes a complete blood count, inflammatory parameters, glucose, TSH, liver and kidney tests, total protein and albumin, and stool analysis. If there are complaints from the abdomen, celiac disease is checked and referred for gastroscopy or colonoscopy. Be sure to exclude HIV and tuberculosis if the corresponding symptoms occur. In young women, attitudes towards food and body are assessed separately.
- Complete blood count and ESR
- Glucose and glycated hemoglobin
- TSH
- Total protein, albumin, liver and kidney tests
- Stool analysis and parasite screening
- Tests for celiac disease
- Chest X-ray for cough and fever
- Gastroscopy and colonoscopy according to indications
How to Gain Weight Safely
If the cause is found, treatment begins with it; Without this, you won't be able to gain weight. At the same time, they increase the calorie content of the diet through whole foods, rather than sweets and fast food: they add additional meals, nuts, vegetable oils, dairy products, meat and fish, and cereals. It is better to eat often and in small portions, especially if you have poor appetite. In order for the increase to come from muscles, and not just fat, strength loads are needed. For eating disorders, working with a psychotherapist is mandatory.
- Treatment of the underlying disease
- Small meals 5–6 times a day
- Calorie-dense foods: nuts, oils, cheese, meat, fish
- Adding protein to every meal
- Strength training for muscle growth
- Refusal of fast food and sweets as a way to gain
- Special nutritional mixtures prescribed by a doctor
- Help from a psychotherapist for eating disorders
