Too Thin to Be Healthy?

News and entertainment outlets recently buzzed with controversy over whether the latest winner of NBC’s reality show The Biggest Loser had lost too much weight during the course of the season.

Rachel Frederickson, 24, dropped nearly 60 percent of her body weight – going from 260 to 105 pounds – enduring physical challenges documented on the show’s 15th season.  She won the competition and the coveted title “The Biggest Loser,” but critics say the 5’5” voiceover artist from Los Angeles is too thin.

While Ms. Frederickson’s weight loss was deliberate to win cash prizes, endorsements and fame, some people live on the opposite end of the weight spectrum.  They, like the contestant, are deemed “too thin” and try to gain weight to achieve a healthier body.

“The key to gaining weight healthily is to be sure you get your caloric intake from foods rich with nutrients, proteins and complex carbohydrates found in fruits and vegetables,” said Elise McCormack-Granja, M.D., a Baptist Health Medical Group doctor who specializes in internal medicine.

Dr. McCormack-Granja also recommends weight-bearing exercise to build up muscle mass, which will increase a person’s weight.  But, she warns, exercise may not be enough in the long run to change a person’s body composition – key to a person’s overall health.

“It’s difficult to determine whether someone who has a low Body Mass Index (BMI) is healthy  based solely on the number, which is just a calculation,” she said.  “If that person has always been thin and other measurements, such as their red blood cell count and nutrients in the blood, are normal, we  tend not to worry.”

But, she says, when she sees signs of malnutrition, loss of bone density, anemia, heart problems, hormonal imbalances or women who stop menstruating, that are unrelated to some other cause, Dr. McCormack-Granja recommends  a comprehensive evaluation, including a referral to a dietitian to help patients learn how to eat to reach caloric and nutritional goals.

“We start by asking patients to tell us what all they’ve eaten over the last 24 hours,” said Kelly LaRocco, a registered dietitian and licensed nutritionist at Homestead Hospital.  “That  24-hour dietary recall helps us see where the patient can add larger portions of healthy calories to their diets. We then tailor their meal plans to include foods that are nutritious and that they are willing to eat, because we want them to adhere to these plans.”

Both Dr. McCormack-Granja and Ms. LaRocco say it’s best to talk with your doctor first, in case other health problems, such as high cholesterol and allergies are affected by your diet.

Barring any other health conditions, Ms. LaRocco recommends the following as part of a healthy weight-gain diet:

• Small, frequent meals throughout the day
• Healthy fats found in avocado and peanut butter
• Nuts and seeds, which are high in calories and nutrients
• At least five servings of fruits and vegetables a day, complex carbohydrates and healthy fats, as  recommended by the Academy of Dietetics and Nutrition
• Higher- fat milk and low-sodium cheeses

While Hollywood focuses its attention on the devastating health effects of eating disorders that have threatened the lives of so many young stars forced by the entertainment business to fit the “ideal” weight, Dr. McCormack-Granja assures parents that not all underweight children have eating disorders.  “As long as children and teens maintain their regular growth projectile in height and weight, a low BMI isn’t a definitive sign of an eating disorder,” she said.  She recommends, though, paying close attention to any changes that veer off track from their regular weight , since being underweight can have health consequences and deserves a complete medical evaluation.

Dr. McCormack-Granja also advises adult children to pay close attention to their elderly parents, who typically lose their appetites and body composition as they age.

“Recent studies have found an association between increased mortality and low BMI in the elderly. However, an individual’s health is determined by many factors outside of their BMI alone. Again, if they’ve always been thin, and they’re getting the nutrients they need, it’s less concerning, but if they start to lose weight, it may signal a problem that needs attention,” she said. “The key is not the weight or the BMI alone, but a person’s overall health and attention to healthy lifestyle habits.”

That advice can make us all winners when it comes to our weight.