Are Skinny People Healthy?

Thinner people should not assume they are immune to health issues. When it really comes down to it, living a healthy life means that you truly take care of yourself. And staying thin may may not be helping. In fact, it could be the exact opposite.

So, what are the negative health impacts of thinness?
Is getting thin or being thin is truly health enhancing like you keep reading?

Following is a brief summary of studies examining thinness and health, with links for more information.

Health Implications of Mild Thinness

Being Underweight Puts People at Highest Risk of Dying - Underweight adults (BMI under 18.5 or less) have a 1.8 times higher risk of dying than those with a "normal" BMI of 18.5 to 24.9. This is HIGHER than for those who are "obese" and even for the severely "obese."

Overweight Who Lose Weight Have Increased Risk of Death - Weight loss of 15% or more associated with increased risk of death among overweight. (You can see how the research is NOT as clear cut as the media and our doctors report!)

Moderate Thinness Can Be Unhealthy - People who are overweight have a lower risk of death than those of normal weight. The researchers -- statisticians and epidemiologists from the National Cancer Institute and the Centers for Disease Control and Prevention -- also found that increased risk of death from obesity was seen for the most part in the extremely obese, a group constituting only 8 percent of Americans. And being very thin, even though the thinness was longstanding and unlikely to stem from disease, caused a slight increase in the risk of death. This study is considered by many independent scientists to be the most rigorous yet on the effects of weight.

Thinness and Weight Loss: Beneficial or Detrimental to Longevity? - This review examined the hypotheses that 1) low body mass index (BMI) is optimal for longevity and 2) weight loss reduces mortality rates. The preponderance of epidemiological evidence fails to support either of these hypotheses. Indeed, a number of studies show that thinness and weight loss (regardless of initial BMI) are associated with increased mortality rates.

Health Implications of Moderate Thinness Due to Anorexia Nervosa

Typically, dwelling on the negative health impacts of anorexia results in:

The person who is suffering with anorexia becomes scared and feels guilty. The result? More restricting to try to deal with the fear and guilt.
The loved ones and friends of the person suffering with anorexia become scared, and then try to “fix” the anorexic by repeating all the horrible things that will happen. The result? See #1 above.

In 35 years, I have found that scaring an anorexic individual into recover does NOT work. So I don’t do it, and I recommend you don’t either. There are times when an anorexic is ready to hear some of the negative health effects, but, in general, that should be left for the treatment team.

For these reasons, I am putting a couple of articles here, but leaving most of this information out. When and if it ever becomes helpful to recovery to learn more about these negative health effects, I’ll add it.

Impact of Low Body Weight on Brain Function - Underweight individuals with AN had significant deficits in brain grey matter volume compared to healthy controls. These deficits in grey matter volume improved with short-term weight restoration, but did not fully normalize during the year-long study. (Usually clients to not realize they are cognitively impaired until they get better and look back at their symptoms.)

Low Body Weight and Bone Loss - Being thin puts a women at increased risk of developing osteoporosis (a condition which, believe it or not, often leads to death in older women). Amenorrhea virtually guarantees it. Those with anorexia can lose as much as 2% to 6% of their bone mass each year they have AN.

Estrogen Replacement is Not Effective at Reversing Bone Loss - Unlike the positive effects among postmenopausal women, where estrogen therapy maintains or improves bone mass density, and may help reduce the incidence of fractures, the same pattern has not been seen in premenopausal women with osteoporosis. Estrogen Replacement seems to have little independent effect on correcting or preventing osteopenia in AN (Eur J Endocrinol. 2002; 146:45).

Oral Contraceptives Does Not Restore Bone Mineral Density - Restoring regular menstrual cycles with oral contraceptives will not normalize metabolic factors that impair bone formation, health and performance, it is unlikely that estrogen will fully reverse low bone density.

Oral Contraceptive Pills and Adolescent Bone Health - Some contraceptives used by teenagers can impair bone formation in teenage girls, thereby compromising peak bone mass. This is true even if the teenager is normal weight and healthy.

Exercise Is Actually Contraindicated - For those who are underweight, have anorexia nervosa, or irregular menstrual cycles due to undernutrition, exercise is a risk factor. Bone density in the spine and whole body in females with anorexia nervosa was found to be lower among those engaged in moderate levels of exercise (such as walking or pacing) compared to women who were not exercising.