Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

While most of the U.S. population and an increasing percentage of the world’s population is overweight, there are some people who are underweight and need to gain a few pounds. I can feel some of my overweight readers groaning right now, but being underweight for some people is just as important to resolve as being overweight, and can be equally challenging.

People become underweight for a variety of reasons, which include hyperthyroidism, long-term illness, stress, and significant increases in activity. Many elderly people lose weight because their lives lack the structure that used to lead to regular meals, their appetites are sometimes smaller, and they do not like shopping and cooking for themselves. And then there are those who just don’t love eating like some of the rest of us. These are the people who say things like “Sometimes I just forget to eat.” I personally do not understand this. During my almost 60 years of life, I have forgotten where I put my car keys, I have forgotten my mother’s maiden name, but I cannot remember ever forgetting to eat.

Underweight people are often told that immediate weight gain is imperative, and calorie-loading, sometimes with terrible foods like cheeseburgers and milkshakes, is encouraged. Some people are dangerously underweight, for example, people who have eating disorders like anorexia or bulimia, but this does not mean that they have to gorge on high-fat and unhealthy foods in order to resolve their problems. In fact, there is considerable evidence that being forced to do so may exacerbate their eating disorder.  I’ll restrict this article to helping those who do not have an eating disorder, are not dangerously thin, and who can take the time to gain weight more slowly while eating an optimal diet.

While this may sound ridiculously simple, the key to gaining weight while eating an optimal diet is to slightly increase calorie intake every day. There are two ways to do this, adding meals or adding calories to meals. Many underweight people eat three meals per day, and they do not like the idea of eating more food at each meal. So adding 2-3 smaller meals is a better option for them. Examples would be adding a vegetable wrap or a serving of leftover lunch at 3:00PM and a bowl of cereal and fruit at 9:00PM. This would add a few hundred healthful calories per day, which would stop the weight loss and usually will result in weight gain of a pound every 7-10 days.

The other option is to add calories to the meals already consumed. For example, a person who eats an apple at 3:00 can add a bowl of soup or a black bean wrap. A person who eats a salad with steamed vegetables at lunch can add a cup of brown rice or a baked potato. This strategy will also add enough calories to result in weight gain of one pound or so every 7-10 days.

For elderly people, assistance with shopping and food preparation can be very helpful, as is inviting older people, particularly those who live alone, to share meals.

Even elite athletes burning several thousand calories per day can increase calorie intake without resorting to eating high-fat junk. Just increasing the portion sizes of healthy foods and eating more often will result in higher calorie intake. For example, a person my size would eat a small bowl of multi-grain cereal with raisins and almond milk. An athlete would have a larger serving of cereal and raisins with a sliced banana and one half of a melon. The meals are comprised of healthy foods, just more of them.


The pressure to gain weight for underweight people can be intense. It seems that family and friends, and even some health professionals, panic when people lose weight. It’s unfortunate that weight gain does not result in the same level of concern. People can gain 100 pounds or more and no one says anything, but a person who is 10 pounds underweight is often told that he or she must gain that weight back immediately or terrible health consequences are imminent.

While I agree that a person who is underweight should work at gaining a few pounds, in most cases being slightly underweight is not life-threatening.  The extreme reactions from family and friends may be due to the fact that there are so few normal weight people left that the underweight person is perceived as having a more serious problem than he/she really has.