"You can never be too rich or too thin.” This quote is attributed to the Duchess of Windsor, Wallis Simpson. It was enough perhaps to cause King Edward VIII to abdicate his throne for her, but studies are showing that while you may never be “too rich,” being too thin can be hazardous to your health.
Well known are the adverse consequences of obesity. The higher incidences of heart disease, cancer, stroke, hypertension, diabetes and countless other co-morbidities have doctors always encouraging patients to lose weight. But there is a point at which being chronically or significantly underweight can also pose risks. Putting aside the category of eating disorders such as anorexia and bulimia, which are well recognized causes of mortality, what risks could be the result of being too thin?
The good news with underweight is that most people up until middle age have no problems with a slighter than normal build, especially if it is lifelong and not associated with a chronic disease. The protective value appears to wear off over time until, at age 65, chronic problems may set in. Underweight is associated with fertility issues in both men and women. There appears to be a “critical mass” necessary for proper ovulation and sperm production. Thinner also means less dense and more brittle bone structure, an increased risk of type 2 diabetes, higher fats in the blood (perhaps from more rapid metabolism) and a higher risk (according to the Journal of Public Health) of accidents and depression. This also assumes that underweight does not occur because of poor or improper nutrition which also carries its own set of risk factors for the body.
Those who are chronically underweight also have problems with low blood count (anemia), particularly if nutritional. As the body ages, there is an increased risk of fall and fracture, since supporting tissue for the bones is limited. A rapid metabolism may have other primary causes, such as hyperthyroidism or diseases with increased bone turnover. An increased susceptibility to infection and a compromised immune system have also been reported.
Underweight is measured according to universally available BMI (body mass index) charts calculated through height and weight measures. Underweight is generally associated with BMI between 18.5 and 19 (normal BMIs are between 19 and 25). In more recognizable terms, a woman 5’9” or more is considered underweight if she is under 112 pounds; 5’2”, under 90 pounds. These are extrapolated to use for men (6’1”, 126 pounds might be considered pathologic in a male, extremely slim but acceptable in a female), and in those under the age of 20. Low mortality is actually found between the normal to 10 percent underweight until older ages, when illness or loss of musculature makes it more of a risk factor.
Most concerning is a loss of weight from normal to underweight. Poor nutrition and eating disorders are more common in the young, but cancer is a particularly dreaded cause as age increases. Intestinal malabsorption, endocrine disorders such as diabetes or hyperthyroidism, depression and even alcohol abuse are common causes of decreasing weight in adults. Someone’s weight-loss diet which is going too well or perhaps even too easily may also have a less desirable cause associated with it.
Insurers look for a current height and weight, documentation of any changes in the last year and reasons for that change, and any complications that may be associated with the loss of weight, such as chronic infections, loss of appetite or falls. An unintended weight loss must have all causes investigated before insurance consideration is given. Those who are underweight but active and fit without any concurrent disorders may be given better than standard issue.
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1991. Goldstone can be reached by telephone at 949-943-2310. Email: firstname.lastname@example.org.