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We all know that a plethora of health problems become more problematic with overweight. But did you know that many health problems are also a greater risk to those who are underweight?

"You can never be too rich or too thin" seems to be an adage adopted by American medicine. While there is no doubt that you can never have too much money to pay for American healthcare, it is in fact possible to weigh too little for good health. Here are some examples:

  • Len had been a stand-out (American football) quarterback in high school, and had won a full athletic scholarship at a Big Twelve school. He was ripped, proud of his six-pack, and proud of his six percent  body fat. Just three weeks before he was to report to summer training before his freshman year, he suffered a freak accident. He tripped over his girlfriend's cat at the head of a staircase, fell to the bottom, broke his jaw, and fractured his neck. For a week in the hospital, Len only received intravenous fluids to stop dehydration. In just a week his body started to cannibalize muscle tissue, and in three weeks the gastrocnemius muscles of both legs were so badly deteriorated he could only walk with braces. His college football career never materialized.

  • Susan also ate perfectly balanced, organic, wholesome meals. She was as thin at age 50 as she was at age 15, in fact, a little thinner. When she developed breast cancer and was given chemo, it was only three months before she developed cachexia, the wasting disorder. She survived cancer, but died of wasting because her body did not have the fat reserves she needed to survive weeks of not being able to eat.
  • Throughout human history, periods of famine have been followed by periods of "pestilence and plague." Hungry people's immune systems become highly susceptible to infections, and when masses of people have survived starvation, infections tend to become epidemics.

When scientists reviewed 230 studies involving over 30,300,000 people that looked at the relationship between body mass index (BMI, a measure of weight taking height into account), they found a "U shaped" relationship between BMI and risk of death. It wasn't surprising that the risk of death of all causes in the morbidly obese (people who have a BMI greater than 45, which generally corresponds to weighing approximately 300 pounds or 140 kilos or more) was four and one-half times greater than the risk of death for people who had a BMI between 25 and 27, which corresponds to "normal" weight for height. It was surprising that the risk of death was 50 to 100 percent greater for people who had a BMI of 15 to 20, which corresponds to being 10 to 20 percent underweight or maybe a little more.

Underweight was particularly predictive of mortality in people who had ever smoked cigarettes. However, in people who had been underweight for 20 years or more, there was almost no additional risk of death. The combined data of the 230 studies suggested that losing weight may be an early sign of a slow disease process, which causes weight loss years, perhaps 10 to 15 years, before it causes other symptoms.

Continue reading after recommendations

  • Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016 May 4. 353:i2156. doi: 10.1136/bmj.i2156. PMID: 27146380.
  • Tan XF, Shi JX, Chen AM. Prolonged and intensive medication use are associated with the obesity paradox after percutaneous coronary intervention: a systematic review and meta-analysis of 12 studies. BMC Cardiovasc Disord. 2016 Jun 6.16:125. doi: 10.1186/s12872-016-0310-7. PMID: 27267233.
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