Module Id- F14TN49 -Why underweight? Remedial measures - Problems, causes, health. By going through this module you will be able to

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1 Paper14-Therapeutic Nutrition Module Id- F14TN49 -Why underweight? Remedial measures - Problems, causes, health 1. Objectives By going through this module you will be able to Understand the possible factors contributing to under weight Understand the problems and risks of being under weight and Gain ideas to explore nutritional requirements 2.Introduction Globally malnutrition is a serious health issue in which more than 30 per cent of under five children are affected. Nutritional deficiencies are more common in under nutrition population in developing countries where nutritional deficit is common. Those who are undernourished may be found to be underweight. It is observed that predominantly under nutrition is higher among the low socio economic population both in rural, urban and also among tribes residing in remote areas. When the body weight is less than per cent of the average expected for height, age and sex the person is under weight. If the individual s body weight is less by 20 per cent or more than Ideal Body Weight, that person is grossly underweight. When the person is underweight, his body weight will be very low and he is considered as unhealthy. It is usually related with Body Mass Index (BMI).If the Body Mass Index(BMI) is less than 18.5 or a body weight below per cent for their age and height they are under weight( Krause,2000). This indicates that woman aged years with the average height of 160 cm, the weight should be 59 kg,if it is below this weight the person is considered as underweight. Recent studies have shown that even as India fares better than many developing regions of the world on several indicators of growth and development such as GDP, per capita, Purchasing Power Parity (PPP), literacy, life expectancy, etc., the number of malnourished children in India is significantly high. If an individual lose weight extremely he may require medical examination. Underweight might be secondary to or symptomatic of any underlying disease. Weight loss may a primary cause for certain health condition. If the person is severely underweight, he may have poor physical strength and lack immune system, which may lead to infection. In order to ascertain whether a person is in proper healthy normal weight it is necessary to understand Ideal Body Weight(IBM) and Body Mass Index (BMI).

2 2.1. What is an Ideal Body Weight? An ideal body weight that is believed to be maximally healthful for a person, based chiefly on height but modified by factors such as gender, age, build, and degree of muscular development What is Body Mass Index, or BMI? According to the Centers for Disease Control and Prevention Body mass index, or BMI, determines the body composition and the amount of body fat versus lean tissue, based on the measurement derived from the body weight and height. BMI measurements are helpful to understand whether an individual is underweight, normal weight, overweight or obese. If BMI is below 18.5 it indicates underweight, if BMI is between 18.5 and 24.9 it denotes the person is normal weight, if BMI falls between 25.0 and 29.9is an indication of overweight, and if BMI is 30.0 or higher it refers to obese. Normally metric measurement system is used in the calculation of BMI, measuring weight in kilograms and height in meters. The formula used to find out the BMI = weight in kilograms / height in meters squared. For eg. if the height of a person is 160cm, then divide 160cm, it is equivalent to 1.6 meters. Suppose the body weight is 65 kg and the height is 1.6 m, BMI can be calculated by using the above formula 65/1.6 2 which equals 25.0 rounded off. An adult s BMI is calculated by this method. But children and teenagers from ages 2 to 20 are still growing, their BMI scores are compared to others of the same age and gender on gender-specific BMI-for-age percentile charts, according to the Centers for Disease Control and Prevention. But in order to categorize the children as either underweight, a healthy weight, overweight or obese percentile values are used. The most appropriate and useful indicator to measure the size and growth pattern of children and teen age children is the BMI-for age percentile growth charts. BMI-for-age weight status categories are given below: Weight Status Category Underweight Normal or Healthy Weight Overweight Obese Percentile Range Less than the 5th percentile 5th percentile to less than the 85th percentile 85th percentile to less than the 95th percentile Equal to or greater than the95th percentile

3 The following is an example of how sample BMI numbers would be interpreted for a 10- year-old boy. Source: Centers for Disease Control website 3.Factors contributing to underweight Socio-economic status and cultural factors The persons who are poor and low socioeconomic status are at health risk. Contrast to this those who have high socio-economic status are relatively more likely to be over-nourished.

4 As far as child malnutrition is concerned, children belonging to low-income families are more malnourished than those in high-income families. Besides socio economic status poor cultural beliefs and religion are factors leading to malnutrition.the vegetarians are devoid of including meat. The pure vegans, strictly avoid dairy products and eggs which are rich in protein. This may result in a serious problem of inadequate protein. But unfortunately, the type of protein that cereal contains does not parallel to the proteins that animal product contain (Gulati, 2012). Child nutrition is also different from family to family depending on the mother's characteristics, household ethnicity and place of residence. It is expected that with improvements in socio-economic welfare, child nutrition will also improve Region Under-nutrition is more prevalent in rural areas. Since low socio-economic status is prevailed in rural areas under nutrition is more prevalent. The rate of incidence of anaemia among adult male and female is slightly higher in rural areas than in urban areas. For example, in 2005, 40per cent of women in rural areas, and 36% of women in urban areas were found to have mild anaemia. 3.2.Underweight can be caused by variety of factors Physical causes of underweight Many health problems like fever such as flu or malaria or typhoid, may occur temporarily which causes weight loss accompanied by a high temperature. However weight gain will be noticed once the person is normal. The weight loss and underweight are mainly caused by medical reasons, which are given below: Hyperthyroidism: The thyroxin hormone produced by thyroid gland, is often regarded as the 'conductor' of the 'orchestra of the body'. When there is normal production of thyroid hormone the individual will be strong, healthy, and will have normal metabolism and maintain normal weight. If the function of thyroid gland is disturbed and produce too much of thyroid hormone weight loss also will be noticeable and many body functions like heartbeat, body temperature, will be deranged Cancer: Rapid weight loss, tiredness, lack of appetite, nausea, and inability to gain weight may be commonly observed when the person is affected by malignancy or cancer

5 Tuberculosis: The symptoms in Tuberculosis, or TB, a wasting disease, are rapid loss of weight, coughing, night sweats, tiredness and malaise Diabetes: The problems experienced by diabetic patients or patients with insulin resistance are tiredness, excessive weight loss, overweight, excessive thirst and urination. If the patients have, the symptoms mentioned above they need to assess blood glucose and insulin levels to confirm whether they suffer from diabetes. It is especially common for families with a hereditary tendency to diabetes HIV/Aids: Wasting or excessive weight loss is the main symptoms in patients with HIV/Aids. Earlier HIV/Aids is called 'slim disease'. It causes pronounced weight loss and prevents weight gain Psychological causes of underweight: Depression is the major important causes of underweight other than anorexia and/or bulimia. When the patients are suffering from depression, they have low appetite, and their food intake will be very less results in weight loss at an alarming rate. The depressed persons may have the symptoms like lack of mood, physical tiredness, feeling tendency to sleep all through day, loss of stamina to carry out simple daily tasks, a feeling that 'life is not worth living' and ideas to commit suicide are example of depression Other factors causing underweight: Medication Some medication may suppress appetite or actually cause weight loss Excessive exercise Unlimited exercise without not meeting the increased dietary demands lead to loss of weight Excessive stress Person suffering from stress or too many worries may have lack of appetite and nausea, thereby very less intake Enzyme deficiencies Deficiency of digestive enzymes or stomach acid may also prevent or reduce digestion and absorption of food which causes weight loss Imbalanced food consumption It indicates that when the quantity as well as quality of foods lesser are than the nutritional requirements a person may end up with underweight Malabsorption-In malasorption syndrome there may be vomiting and diarrhoea and poor nutrient absorption which in turn lead to under nutrition and cause under weight Other medical conditions Gain in weight is not possible if the person is affected by Coeliac disease (gluten allergy), or cystic fibrosis. Whenever a person is unable to gain weight or suddenly experience unexplained weight loss, there is a need for consultation of medical physician for a health check-up. The physician will recommend the test for certain problems like overactive thyroid, malignancies, TB, diabetes mellitus, HIV/AIDS, enzyme

6 deficiencies, Coeliac disease, cystic fibrosis and any other physical condition that may also hampering weight gain. 4. Health Hazards of Underweight: Normally underweight individuals will have poor health. Growth retardation and failure to thrive in growing children may be due to underweight Infections and diseases may be increased with inadequate intake of antioxidant foods and other healthy nutrients. Underweight individuals are more susceptible to certain infections like tuberculosis. They may feel fatigue easily, reduce working efficiency and listless. Complications like preterm delivery and smaller babies are more common during pregnancy if they are underweight If the person is underweight the risk during surgery is more. The preschool children with underweight are most often associated with nutritional deficiency diseases like marasmus and kwashiorkor Eating disorders or underweight are more prone to osteoporosis due to a lack of certain nutrients, mainly calcium. Deficiency of potassium may be observed in underweight individuals. Potassium is needed for healthy heart. Besides this potassium deficiency may interfere with lung function, mental health, and digestion. Underweight woman may find it much harder to conceive, irregular periods, lack of periods compared to woman within the normal weight. Under weight caused by iron deficiency, folate deficiency and vitamin B12 deficiency, resulting in dizziness, fatigue and headaches. Low body weight can lead to infertility in females. Low body weight can cause hair to thin and fall out easily. It can also cause dry, thin skin and teeth health issues. Underweight persons may feel cold even when outside air is warm. If a person is normal weight his body is insulated with a layer of fat, which regulates the body temperature keeps the person warm. 4. Objectives of dietary management are to restore body weight to normal rebuild body tissues and nutrient stores and restore health and maintain desirable body weight and good nutritional status Many factors determine the weight of the human body. The diet and the type and amount of exercise performed by an individual are the main two factors that can be controlled effectively. Since diet is the source of all nutrition received by the body it is an essential part of determining an individual s weight. These nutrients need to be present in the food in the desirable level that is being consumed by an individual.

7 Currently, the Indian government is working to solve malnutrition problem by making more organic foods and prevent health problems by strictly adhering to sanitation measures. 4.1.Dietay requirements Energy In order to improve the status of underweight person an increase of about 500 kcal per day results in a weight gain of 0.5 kg per week. For every increase in 1000kcal of energy, there will be a weight gain of approximately one kilogram. If any interference with the absorption due to fever or gastrointestinal disturbances, higher levels of energy need to be given. Add healthy calories by the inclusion fruit juices, fruit salad topped with nuts and cream, whole grain cereals and butter Protein Since the energy need is increased, protein requirement should be liberal to build up the muscle tissue. Preferably, the intake of protein can be 1.5 to 2g per kg bodyweight per day. Easily digestible and high biological protein foods like milk, eggs, and a combination of cereals and pulses should be included in the daily diet. Full cream milk drinks in between meals, use of grated cheese in cooked foods and more skim milk instead of regular milk may help to gain weight Carbohydrates The energy needs as well as a protein sparing action can be possible by a high carbohydrate intake. In order to meet the carbohydrate requirement sugar, honey, cereals, starchy vegetables and fruits must be included in plenty in the diet. The bulk of the diet should, however, not be increased as it cuts down on food intake. Sufficient amount of fibre intake should be included to regulate bowel movement Fats Fat being a energy dense food reduces the bulk of the diet. The intake of fat should be only in moderate quantity so as to meet partly energy needs without exceeding the tolerance limits. Better tolerated fats are butter, cream and whole milk Minerals and Vitamins The diet must be liberal in minerals and vitamins to help regain health. The nutritional deficiencies can be counteracted by giving supplements. Including plenty of vegetables, fruits, whole grain cereals and pulses, particularly in sprouted form help in ensuring an adequate intake of minerals and vitamins. All of a sudden, the amount of food intake cannot be substantially increased. Gradually

8 increase the amount of food at each meal and the frequency of meals. Without increasing the bulk of food, increase the calorie density of the foods, by using more sugar, jam, butter, cream, oil, and nuts. The protein content of the diet can be increased by using, milk powder, cheese, cottage cheese, and protein concentrates can be added to liquid milk, and other beverages and soups. 5. How would you manage a child who is underweight? In case a child is underweight in the health facility or in the community, following steps should be taken to manage him or her: (i) Look for the primary cause of the child s under nutrition. (ii) Advise the mother or caretaker proper feeding of the child. (iii) Immunize the child if he/she has not completed the immunization schedule. (iv) Follow up such children and observe the growth line. If there is no catch up, or if the weight stays the same or is lost, then refer the child for further examination and treatment. 5.1.Exercise Exercising is one way of gaining weight for underweight persons. Since the body mass is increased by muscle hypertrophy. Weight lifting exercises are effective in helping to improve muscle tone as well as helping with weight gain. The catabolism of exercise results in the reduction of body mass. The gain in weight is possible from the anabolic over compensation when the body recovers and overcompensates via muscle hypertrophy. This can happen by an increase in the muscle proteins, or through enhanced storage of glycogen in muscles. Exercise can help stimulate a person's appetite if they are not inclined to eat. While too much aerobic exercise will burn calories and ultimately work against weight goal, strength training such as weight lifting or yoga can help you gain weight by building muscle. Before beginning any major weight gain programme, be sure to consult the family doctor. The physician also will be able to help to track the progress and make sure that healthy changes are taking place. 6.Conclusion Underweight can be easily controlled by following simple measures: Increase food intake gradually. Eat small frequent meals throughout the day. Avoid eating empty calories and junk foods; instead focus on nutrient dense foods. Avoid forceful feeding; Consider high-protein foods to build up muscle by adding skim milk powder to soups, stews and drinks. Have snacks containing protein and carbohydrates. Practice exercise to stimulate appetite, improve muscle tone and weight gain. By adhering to these guidelines, it is possible to maintain healthy normal weight.

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