Underweight or Malnourishment

OVERVIEW

Being underweight or malnourished is referred to deficiencies in nutrient

intake, imbalance of essential nutrients or impaired nutrient utilization and is
also defined as having a BMI of less than 18.5. You may be underweight for a
variety of reasons:

 Stressful life event or mental illness

 Recovering or battling an illness
 Underlying disease
 Lack of interest in food
 Family history

If you are losing weight without any obvious reason and suspect that you are
at risk, it is a good idea to check in with a GP to have your bloods taken and
ensure that there is no underlying disease or nutritional deficiencies. A
Dietitian can help you to optimize your diet and lifestyle to gain weight in a
healthy and realistic way for you.

The main symptoms of being underweight or malnourished are: 

 Lack of energy
 Fatigue
 Poor appetite
 Reduced immunity
 Slow healing cuts and bruises

However, not everyone has the same symptoms and some people may not
have any symptoms. If you are underweight, it is advisable to see a Dietitian as
long-term consequences:

 Nutritional deficiency - lacking essential nutrients which may result in

skin, hair or teeth problems
  Reduced immunity - causing susceptibility to illness – getting sick
frequently
 Anemia – have low blood counts – causes dizziness, headaches and
fatigue
 Irregular menstrual cycle – stops earlier, first cycle might delay and may
also cause infertility
 Premature births – higher risk of preterm delivery – having a baby
before 37 weeks
 May affect mental health - the individual may be more likely to
experience low moods
 Disease - e.g. osteoporosis in the long-term – increases woman’s risk –
bones are brittle and more prone to breaking.

Causes

Underweight can be caused by a variety of factors, some of which are

psychological, while others are physical.

a. Physical causes of underweight

Many illnesses can cause temporary weight loss. If you have had a bad dose of
flu, accompanied by a high temperature, you may lose a few kilos, but you will
probably gain back those kilos once you are well again.

There are five major medical reasons for pronounced weight loss and
underweight:

1. Hyperthyroidism

The thyroid gland, which produces the hormone thyroxine, is often regarded
as the 'conductor' of the 'orchestra of the body'. If your thyroid hormone
production is normal, all will be well with your health, metabolism and
weight.

If, however, the function of your thyroid gland is disturbed so that it produces
too much thyroid hormone, your metabolism and many body functions such a
heartbeat, body temperature, etc., will be deranged and you will experience
pronounced weight loss.
This condition, which is called hyperthyroidism, thyrotoxicosis, or overactive
thyroid, is associated with symptoms such as: enlarged thyroid gland causing
a 'goitre' or bulging at the base of the neck, nervousness, tiredness, loss of
weight despite adequate intakes of food, increased body temperature with
excessive sweating, increased heart rate, and in some patients, exophthalmos
(bulging eyeballs).

If you experience sudden weight loss accompanied by any of the above-

mentioned symptoms such as goitre, excessive sweating and tiredness, you
need to have a medical examination and thyroid function tests.

2. Cancer

Malignancy or cancer can also be associated with rapid weight loss, tiredness,

lack of appetite, nausea, and inability to gain weight.

Because malignancies are so serious, it is important to have your doctor give

you a thorough examination and have blood and other tests done to
determine if you could be suffering from conditions such as leukemia, or other
types of cancer.

3. Tuberculosis

Tuberculosis, or TB, is very common in South Africa. This is a wasting disease

that is accompanied by rapid weight loss, coughing, night sweats and
tiredness.

Once again, you urgently need to find out if the weight loss you experience is
due to TB, so that you can receive the appropriate treatment.

4. Diabetes

Although many patients with insulin resistance and diabetes tend to suffer

from overweight, excessive weight loss, tiredness, excessive thirst and
urination, are also symptoms of diabetes.

Patients displaying these symptoms need to have their blood glucose and
insulin levels tested to see if they suffer from diabetes. This is particularly
significant in families with a hereditary tendency to diabetes.
5. HIV/Aids

Probably the main cause of wasting or excessive weight loss in South African
patients is HIV/Aids. This condition, also initially called 'slim disease', causes
pronounced weight loss and hampers weight gain.

If you suspect that you may be living with HIV/Aids and your weight keeps on
dropping even when you eat large quantities of food, you should have an HIV
test as soon as possible.

With the correct medication and diet, you will be able to halt the progression
of this disease and improve your survival rate and quality of life.

b. Psychological causes of underweight

Besides anorexia and/or bulimia (which are not the subjects of our discussion
today), one of the most important causes of underweight is depression.

Patients suffering from depression not only often have a reduced appetite, but
they may actively lose weight at an alarming rate. If you have any reason to
believe that you may be suffering from depression, it is essential to get help as
fast as possible from clinical psychologists or psychiatrists to stop your weight
loss.

Other symptoms that may point towards depression are moodiness, tiredness,
an overpowering urge to sleep all day, inability to do simple daily tasks, a
feeling that 'life is not worth living' and ideas of suicide.

c. Other factors

There are also a number of other factors that could be causing weight loss or
hampering weight gain, namely:

 Medication – many medicines either suppress appetite or actually cause

weight loss. Check with your pharmacist if you have recently started a
new medication and now are losing weight without wanting to.

 Excessive exercise – you may well be overdoing your exercise sessions

to such an extent that your diet cannot keep up with the increased
demands.
  Excessive stress – individuals who are very stressed may stop eating
due to a lack of appetite, nausea or being preoccupied with their
worries.

 Enzyme deficiencies – deficiencies of digestive enzymes and/or stomach

acid may also hamper digestion and absorption of food thus causing
weight loss.

 Other medical conditions such as coeliac disease (gluten allergy), or

cystic fibrosis are associated with inability to gain weight.

Various forms of malnutrition

Undernutrition manifests in four broad forms: wasting, stunting, underweight,

and micronutrient deficiencies. Undernutrition makes children in particular
much more vulnerable to disease and death.

Wasting is defined as low weight-for-height. It usually indicates recent and

severe weight loss, although it can also persist for a long time. It usually
occurs when a person has not had food of adequate quality and quantity
and/or they have had frequent infectious disease, such as diarrhoea, which
has caused them to lose weight or any other prolonged illnesses. Wasting in
children is associated with a higher risk of death if not treated properly.

Stunting is defined as low height-for-age. It is the result of chronic or

recurrent undernutrition, usually associated with poverty, poor maternal
health and nutrition, frequent illness and/or inappropriate infant and young
child feeding and care in early life. Stunting prevents children from reaching
their physical and cognitive potential.

Underweight is defined as low weight-for-age. A child who is underweight

may be stunted, wasted or both.

Micronutrient deficiencies are a lack of vitamins and minerals that are

essential for body functions such as producing enzymes, hormones and other
substances needed for growth and development. Iodine, vitamin A, and iron
are the most important in global public health terms; their deficiency
represents a major threat to the health and development of populations
worldwide, particularly children and pregnant women in low-income
countries.

Overweight and obesity

Overweight and obesity is when a person is too heavy for his or her height.
Abnormal or excessive fat accumulation can impair health.

Body mass index (BMI) is an index of weight-for-height commonly used to

classify overweight and obesity. It is defined as a person’s weight in kilograms
divided by the square of his/her height in meters (kg/m²). In adults,
overweight is defined as a BMI of 25 or more, whereas obesity is a BMI of 30
or more.

Overweight and obesity result from an imbalance between energy consumed

(too much) and energy expended (too little). Globally, people are consuming
foods and drinks that are more energy-dense (high in sugars and fats), and
engaging in less physical activity.

Diet-related noncommunicable diseases

Diet-related noncommunicable diseases (NCDs) include cardiovascular

diseases (such as heart attacks and stroke, and often linked with high blood
pressure), certain cancers, and diabetes. Unhealthy diets and poor nutrition
are among the top risk factors for these diseases globally.

IMPACT

In 2018,

- stunting affected an estimated 21.9% or 149 million children under the age
of 5 years, while

-wasting affected 7.3% or 49 million children under the age of 5 years.

-1.9 billion adults are overweight or obese, while 462 million are
underweight.
Around 45% of deaths among children under the age of 5 years are linked to
undernutrition. These mostly occur in low- and middle-income countries.

At the same time, in these same countries, rates of childhood overweight and
obesity are rising. Every country in the world is affected by one or more forms
of malnutrition. Combating malnutrition in all its forms is one of the greatest
global health challenges.

Malnutrition vs Obesity

The double burden of malnutrition consists of both undernutrition and

overweight and obesity, as well as diet-related noncommunicable diseases.

Americans are overfed and undernourished. That’s right, the most obese
children and adults in the country are also the most nutritionally deficient!(1)

How can those two things possibly co-exist?

The mistake is to think that if you eat an abundance of calories, your diet
automatically delivers all the nutrients your body needs. But the opposite is
true. The more processed food you eat, the more vitamins you need.

That’s because vitamins and minerals lubricate the wheels of our metabolism,
helping the chemical reactions in our bodies run properly. Too many “empty
calories” confuse the metabolism and pack on the pounds.

Who is at risk? (jut xplain)

Every country in the world is affected by one or more forms of malnutrition.

Combating malnutrition in all its forms is one of the greatest global health
challenges.

Women, infants, children, and adolescents are at particular risk of

malnutrition. Optimizing nutrition early in life—including the 1000 days from
conception to a child’s second birthday—ensures the best possible start in life,
with long-term benefits.

Poverty amplifies the risk of, and risks from, malnutrition. People who are
poor are more likely to be affected by different forms of malnutrition. Also,
malnutrition increases health care costs, reduces productivity, and slows
economic growth, which can perpetuate a cycle of poverty and ill-health.

What are malnutrition and starvation ?

Malnutrition comes in many forms. Simply put, it means poor nutrition. It

includes: undernutrition, micronutrient deficiencies, overweight and obesity.

Starvation is a severe lack of food which can result in death.

Who is most vulnerable to undernutrition and starvation during

emergencies ?

Young children and women who are pregnant or breastfeeding are most
vulnerable to undernutrition. Their bodies have a greater need for nutrients,
such as vitamins and minerals, and are more susceptible to the harmful
consequences of deficiencies.

Children are at the highest risk of dying from starvation. They become
undernourished faster than adults. Severely wasted children are 11 times
more likely to die than those with a healthy weight. Undernourished children
catch infections more easily and have a harder time recovering because their
immune systems are impaired. Globally, undernutrition is an underlying
factor in more than half of child deaths from pneumonia and malaria, and
more than 40% of measles deaths.

How should severe acute malnutrition be treated in an emergency ?

(xplain content)

Severe acute malnutrition is when a person is extremely thin and at risk of

dying. They need immediate treatment. The response to acute malnutrition is
broad and includes several elements such as medical, food, water and hygiene,
and social services.
Children who still have an appetite can stay at home and receive outpatient
care. They need treatment with specially-formulated foods, and their recovery
must be monitored regularly by a trained health worker.

Children who have medical problems and do not have an appetite need
inpatient care in a clinic or hospital. They need specially-formulated milks and
treatment for infections or other potential complications.

What are the challenges to breastfeeding in emergency situations ?

(xplain content)

Often the poor physical and mental health of mothers in emergencies leads to
poor breastfeeding outcomes. Displaced mothers may struggle to find
comfortable, private places to breastfeed and their support network of family
and friends is often not accessible in emergencies. Health workers who would
usually offer support may be redeployed to cope with other aspects of the
emergency response.

Well-meaning donors may distribute breast-milk substitutes (such as infant

formula) in emergencies. This can undermine breastfeeding and, if there is a
lack of clean water to make formula or clean bottles and teats, put children at
increased risk of infections which can be deadly.

Governments and humanitarian organizations have a key role to play in

protecting, promoting and supporting breastfeeding in emergencies.

DIET PLAN

To deal with underweight, maintaining a proper nutritious diet is important.

We create a weight gain meal plan for underweight, easily followed by both
males and females. We try to add food with high-calorie foods for
underweight adults. This diet meal plan is used to provide the right
nutrients, vitamins, and minerals required by the body. You can easily buy
food items listed in the underweight diet meal plan in your local markets.

These are quick health tips for the person suffering from underweight should
include this in your diet plan:
1. Heavy food items that are more in calories.
2. Frequent consumption of food items which are rich in nutrients, it could be
snacks, shakes or juices, or proper meals.
3. Adding extra ingredients that are high in calories to regular diet, for
example, including eggs and bananas in morning breakfast, etc., can help in
increasing the weight.
4. Consume protein supplements along with adequate amount of vegetables
and fruits.
5. Eating calorie dense food and maintaining a balanced diet will help in
gaining the weight.
6. However, the diet shouldn’t be started drastically and instead, should be
implemented gradually so that the body is accustomed with it.

Some key components of a diet for weight gain may include: (jus xplain)

 Adding snacks. High-protein and whole-grain carbohydrate snacks can

help a person gain weight. Examples include peanut butter crackers,
protein bars, handful of almonds.
 Eating several small meals a day. Sometimes a person may be
underweight because they cannot tolerate eating large meals. Instead, a
person can eat several small meals throughout the day.
 Incorporating calorie - dense foods. A person can add calorie-dense
food sources to their existing diet, such as putting almonds on top of
cereal or yogurt, chia seeds on a salad or soup, or nut butter on whole-
grain toast.
 Avoiding empty calories. Eating high-calorie foods may cause a person
to gain weight, but they also have excess fats that could affect a person’s
heart and blood vessels. A person should avoid foods that are high in
sugar and salt.
The United Nations Decade of Action on Nutrition (jus xplain)

On 1 April 2016, the United Nations (UN) General Assembly proclaimed 2016–
2025 the United Nations Decade of Action on Nutrition. The Decade is an
unprecedented opportunity for addressing all forms of malnutrition. It sets a
concrete timeline for implementation of the commitments made at the Second
International Conference on Nutrition (ICN2) to meet a set of global nutrition
targets and diet-related NCD targets by 2025, as well as relevant targets in
the Agenda for Sustainable Development by 2030—in particular, Sustainable
Development Goal (SDG) 2 (end hunger, achieve food security and improved
nutrition and promote sustainable agriculture) and SDG 3 (ensure healthy
lives and promote wellbeing for all at all ages).

Led by WHO and the Food and Agriculture Organization of the United Nations
(FAO), the UN Decade of Action on Nutrition calls for policy action across 6
key areas:

 creating sustainable, resilient food systems for healthy diets;

 providing social protection and nutrition-related education for all;
 aligning health systems to nutrition needs, and providing universal
coverage of essential nutrition interventions;
 ensuring that trade and investment policies improve nutrition;
 building safe and supportive environments for nutrition at all ages; and
 strengthening and promoting nutrition governance and accountability,
everywhere.

WHO response (jus xplain)

WHO aims for a world free of all forms of malnutrition, where all people
achieve health and wellbeing. According to the 2016–2025 nutrition strategy,
WHO works with Member States and partners towards universal access to
effective nutrition interventions and to healthy diets from sustainable and
resilient food systems. WHO uses its convening power to help set, align and
advocate for priorities and policies that move nutrition forward globally;
develops evidence-informed guidance based on robust scientific and ethical
frameworks; supports the adoption of guidance and implementation of
effective nutrition actions; and monitors and evaluates policy and programme
implementation and nutrition outcomes.