DIET IN UNDERWEIGHT

Half the Indian rural population is underweight with up to three- quarters being so classified in deprived community.

A very large proportion of rural Indian households have inadequate food supplies. Chronic energy  deficiency is due to chronic food deficiency.

People who BMI is less than 18.5 are considered as underweight.

Children who are subjected to socioeconomic and dietary constraints during the critical years of growth and development end up with small body size. Such adults may be apparently healthy but there is evidence that their productivity and earning capacity may be impaired.

LIMITATIONS OF UNDERWEIGHT –

1. Adults with BMI< 18.5 have reduced VO2 max, reduced capacity for sustained heavy work and a lower productivity.
2. Pregnant women show a proportional increase in the risk in that kind of body born in relation to post partum BMIs and BMIs range from 25 to 16 or less.
3. Progressively greater proportions of time are spent off work or in bed ill when BMI levels are below 17 in men and women.
4. This is a progressive curvilinear increase in mortality in group of men with BMIs ranging from 18.5 to below 16.0.
5. Immunological deficits are seen particularly in men with low BMIs concomitant micronutrients deficiencies are present
6. Undernourished  children have lower heights and weights.
7. The age of menarche is delayed in undernourished girls by about 1-2 years.

CAUSES OF UNDERWEIGHT

1. Starvation occurs either due to famine conditions or an adequate diet in proteins or an attempt at reducing weight.
2. This weight condition also result from debilitating diseases like tuberculosis, diabetes, malabsorption, syndrome or cancer.
3. Psychological factors may contribute to eating very little food. Some mental patients reject food leading to serve weight loss. For example in anorexia nervosa.
4. This condition occurs in people who are active, tense, nervous and who never takes rest .
5. It occurs in pathological condition such as fever, gastrointestinal disturbance , where the digestion and absorption capacity are decreased and in hyperthyroidism.

NUTRITION AND FOOD REQUIREMENTS FOR UNDERWEIGHTS

A high calorie, high protein, high fat diet with liberal vitamin intake is recommended . but before going into the diet the first step is to determine and eliminate the cause for under-eating. Then a balanced diet should be planned based on the requirement.

1. The energy intake

The calorie requirement vary depending upon the activities. For increasing weight the total calorie intake should be in excess of the energy requirement. In addition 500 kcal pr day is recommended. The increase should be gradual over one or two weeks otherwise digestion disturbance can occur.

• The protein intake

Instead of 1g of protein, over 1.2g per kg is recommended for tissue building.

Good quality protein is completely  utilized by the body and as far as possible best protein sources must be liberally included at the initial stage.

• The fat intake

Even through fat content is increased, easily digestible fats are to be included. Fried and fatty foods are not recommended as they may cause diarrhea.

Fatty food should not be taken at the begging of meals as they reduce appetite.

High calorie fatty food such as cream, butter, margarine and oils helps to increase the weight.

• The Carbohydrate intake

High carbohydrate sources must from the basis of the diet. Leafy vegetables should be restricted and preference to be given to potato and yam.

Dried fruits, sweets, nuts desserts, jam, jelly, cereals, cereal products and non- vegetarian foods are rich sources of energy and can be liberally included to diet.

The number of meal should be increased.

• The vitamin and mineral intakes

With a liberal dirt there is no need for extra vitamin and mineral supplement.

• The fluid intake

Fluids should not be taken before or with a meal but only after a meal so that food intake is not reduced. Enough fluids must be taken so as to avoid constipation.

DIETARY GUIDELINES FOR UNDERWEIGHT

1. Underweight person has to be on positive energy balance. Calories intake should be more than the energy expended.
2. Energy dense foods hold key to weight gain.
3. Under weight person should have regular meals.
4. He should make meals a priority and take the time to plan, prepare and eat each meal.
5. They should at least eat three major meals a day and snacks in between.
6. Underweight person should learn to eat more food at each meal. Serving size can be increased, for example, drinking milk from a larger glass.
7. Dietary supplements can be given.
8. Food should be appetizing.
9. Diet can be varied and new foods and recipes can be tried.
10. Eating can be made in different location and ambience and with friends and family members.
11. A walk before taking meals can make an individual more hungry.

EXERCISE AND BOWEL

Regular outdoor exercise helps to stimulate appetite. Emotional well-being is essential to have a good appetite. Constipation may reduce the appetite so the bowel movements should be regulated with adequate fluids, exercise and fruits. Synthetic drinks, soft drinks, alcohol, aerated drinks, too much of tea and coffee reduce appetite and should be avoided.