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Chapter: Nutrition and Diet Therapy: Diet and Weight Control


Underweight can cause complications in pregnancy and cause various nutritional deficiencies.





Underweight can cause complications in pregnancy and cause various nutri-tional deficiencies. It may lower one’s resistance to infections and, if carried to the extreme, can cause death.



Underweight can be caused by inadequate consumption of nutritious food because of depression, disease, anorexia nervosa, bulimia, or poverty, or it can be geneti-cally determined. It also can be caused by excessive activity, the tissue wasting of certain diseases, poor absorption of nutrients, infection, or hyperthyroidism. For further discussion of anorexia nervosa and bulimia.




Underweight is treated by a high-calorie diet or by a high-calorie diet combined with psychological counseling if the condition is psychological in origin as, for example, in depression or anorexia nervosa. In many cases, a high-calorie diet will be met with resistance. It can be as difficult for an underweight person to gain weight as it is for an overweight person to lose it.


The diet should be based on MyPyramid so that it can be easily adapted from the regular, family menus or to a soft-textured diet. The total number of calories prescribed per day will vary from person to person, depending on the person’s activity, age, size, gender, and physical condition.


If the individual is to gain 1 pound a week, 3,500 calories in addition to the individual’s basic normal weekly calorie requirement are prescribed. This means an extra 500 calories must be taken in each day. If a weight gain of 2 pounds per week is required, an additional 7,000 calories each week, or an additional 1,000 calories per day, are necessary. This diet cannot be immediately accepted at full-calorie value. Time will be needed to gradually increase the daily calorie value. In this diet, there is an increased intake of foods rich in carbohydrates, some fats, and protein. Vitamins and minerals are supplied in adequate amounts. If there are deficiencies of some vitamins and minerals, supplements are prescribed.


Nearly all nutritious foods are allowed in the high-calorie diet, but easily digested foods (carbohydrates) are recommended. Because an excess of fat can be distasteful and spoil the appetite, fatty foods must be used with discretion. Fried foods are not recommended. Bulky foods should be used sparingly. Bulk takes up stomach space that could be better used for more concentrated, high-calorie foods. See Table 16-6 for high-calorie and high-protein shakes and spread that could be used to increase caloric intake.


Persons requiring this diet frequently have poor appetites, so meals need to be especially appetizing. Favorite foods should be served, and portions of all foods should be small to avoid discouraging the clients. Many of the extra calo-ries needed may be gotten as snacks between meals, unless these snacks reduce the client’s appetite for meals and consequently reduce daily calorie total. Some clients do better if the number of meals is reduced, thereby increasing the appetite for each meal served. When the causes of underweight are psychological, therapy is required before the diet is begun, and the dietitian and therapist may well needto consult one another before and during treatment. Foods to be avoided in a high-calorie diet are foods the client dislikes, fatty foods, and bulky, low-calorie foods.


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