Doc: Find cause as underweight hits malnourished

Keith Roach
To Your Health

Dear Dr. Roach: I have a problem that is opposite many other peoples.’ I lost 10 pounds, going from 130 to 120. I am 5-foot-7-inches tall.

I would appreciate receiving any information about what foods that I can eat to, hopefully, help me gain some weight.


Dear H.E.: I hear this question occasionally, and it makes me very nervous. Unexplained weight loss has many possible causes, and since they are potentially very serious, it always is worth an evaluation by your doctor.

Weight change in anyone is an issue of calories in against calories out; however, that simple equation hides several important truths.

Calories taken in as food are expended as energy. We require a certain number of calories a day to maintain our body functions, perhaps 1,200 or so calories a day, but we may expend many more in activities.

Moreover, individuals can lose calories, both through the intestines (malabsorption, such as sprue) and through the kidney (sometimes protein, but most often sugar, in uncontrolled diabetes).

The metabolism also may be increased, especially through an overactive thyroid, but also through active cancer. (Cancer causes weight loss via several different mechanisms, an important one being suppressing appetite).

Depression is a frequent cause of weight loss, and it is sometimes not recognized by patient or physician.

Eating disorders, especially anorexia nervosa, can cause life-threatening weight loss, and may go unrecognized. Although they occur most commonly in adolescents, they can occur in older adults, as well.

I had one patient with unexplained weight loss that, despite extensive testing, I just could not find a cause for. It wasn’t until I visited her home that I found out she had literally no food to eat at home, and she was too embarrassed to tell me she couldn’t afford it.

So, although I certainly could give you a list of high-calorie foods to eat, I’d urge you to get it from your doctor, after a thorough evaluation.

I am very concerned by your current weight and your body mass index of 18.8, which puts you into the borderline malnourished zone.

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