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Dear Dr. Roach: Our 19-year-old son, who is 6 feet, 2 1/2 inches tall and weighs 130 pounds, wants to know if there’s anything that can decrease his metabolism. He’s always been thin and very active, loves outdoor sports, running, hiking, surfing. He’s will be graduating high school next month, but lately he is so self-conscious about his thin build that he doesn’t want to do water activities or wear short sleeves or go shirtless in public. He does not like most breakfast foods and therefore is not a breakfast eater. He is starting to eat pizza only because he’s embarrassed to keep pulling all the cheese off in front of his friends. He loves all fruits and vegetables, even the green ones that most teens dislike, but there’s not a lot of calories in those. He doesn’t do drugs, drink or smoke. He’s an honors student with a 4.0 grade point average. We persuaded him to at least try chocolate milk, and he’s drinking a lot of it. Can you suggest a healthy way he can gain weight, or are we good with the chocolate milk?

S.S.

Dear S.S.: If your question is about a healthy diet, I would tell him not to worry too much. He is making choices far healthier than those of most teens. I might recommend some good protein sources (peanut butter, granola, nuts, legumes), unless he eats those already. If your question is about his appearance, I would recommend his adding weightlifting, which is the most reliable way to gain muscle mass. The weightlifting also strengthens bones, improves balance and, for many young men (and women), improves self-confidence.

As far as eating certain foods to gain weight, I wouldn’t worry about it too much, as long as there is not a medical problem, such as an eating disorder or a chronic illness. Based on what you are telling me, that sounds pretty unlikely, but I hope his doctor has done a careful history and physical exam, and has considered thyroid disease, Marfan’s syndrome, malabsorption and many others.

Most very thin young men like him stay thin and healthy, and very gradually gain weight over the years. Gaining fat isn’t healthy; gaining muscle is. I found helpful links at the USDA website: 1.usa.gov/1TOG5zn. A registered dietitian nutritionist is an invaluable colleague if his issue is in food and nutrition.

Dr. Roach Writes: Several women wrote in to tell me about treatments for urinary incontinence in women I didn’t mention in a recent column. I heard about vaginal sling procedures, a heat-based vaginal tightening device, Botox injections into the bladder and an electric bladder-stimulation device. The women who wrote me all were happy with their results, but I must caution that all have greater and lesser potential for harm, and I do not consider any of them first-line treatment options.

However, they may be options for some who had poor results with other therapies.

Email questions to ToYourGoodHealth@med.cornell.edu.

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