No woman is ever too slim or too rich," the late Babe (Mrs. William S.) Paley has been credited with saying. So far no one has argued with the latter part of her philosophy, but there are millions of Americans who might contest the former. They are part of an often overlooked minority for whom gaining weight is a constant, and losing, battle.
Their problem is compounded by living in a fat-obsessed society where the chances for sympathy are, ah, slim indeed. "It's frustrating," says Boston secretary Glenda Brown, 34, who at 5'2½" and 102 pounds would like to weigh more. "I get very little understanding. When people call me skinny, it's as offensive to me as it is for me to call them fat."
Although underweight people may tire or chill easily, and sometimes feel weak, depressed or nervous, they are generally healthy and less affected by obesity-related ailments like heart disease and diabetes. "This kind of excessive thinness is not a disease," explains Dr. Johanna Dwyer, 43, director of the Frances Stern Nutrition Center at Boston's New England Medical Center Hospital, where Glenda Brown works. "It's a problem of self-image."
As a result, the scope of the problem is hard to define. Some studies say up to 20 percent of the population is affected, but Dwyer thinks that figure is high. Statistically, the underweight person is one who is more than 10 percent below his or her ideal body weight. Such people should not be confused with those suffering from anorexia nervosa, who are 25 or more percent below proper body weight from self-starvation.
The causes of being too thin are varied. In some cases, says noted nutritionist Dr. Jean Mayer (Dwyer's mentor and president of Tufts University), they are genetic and are related to appetite regulation, body type and the ability to store fat. "The excessively thin have fewer fat cells and an extremely sharp sense of satiety," Mayer explains. "All of a sudden they gag and can't eat one more mouthful." There are also emotional factors. The very thin, says Dwyer, are often "high-strung people who don't sleep well and simply forget to eat." Other habits that impede weight gain are smoking, a lack or an excess of exercise, and too little rest.
Unlike victims of anorexia or bulimia (an eating disorder involving bingeing and purging), who tend to be females in their teens and 20s, the underweight don't fall into any one age or sex group. "Teenagers are the most sensitive," reports Dwyer. "Body image is critical to their social and psychological self-image." Also affected are the elderly, who often suffer with problems, ranging from loneliness to ill-fitting dentures, which affect their diet.
Regardless of the cause, the psychological toll of being underweight can be considerable. "Being too thin has strong connotations in terms of sexual attractiveness," says Mayer. "Very thin boys see themselves as 90-pound weaklings and girls are concerned about being flat-chested."
Dwyer has a special empathy for her underweight patients. The daughter of a lawyer father and a psychologist mother, she grew up in Syracuse, N.Y. and was "very thin," a problem that bothered her throughout her college years at Cornell, where she majored in nutrition. In 1969 she earned her doctorate in science from Harvard. Unmarried, Dwyer lives in a Boston condo and admits that at almost 5'8", 138 pounds, the skinniness of her girlhood is "not a problem I have now."
An associate professor at Tufts Medical School, Dwyer has been director of the Stern clinic since 1974. There she and her staff of seven nutritionists first advise underweight patients to consult a doctor in order to rule out any medical problems. A diet is then tailored to the individual's needs and can incorporate up to 1,000 extra calories a day. The diet includes such form-fillers as the Mae West sandwich: cream cheese, walnuts and turkey on rye bread. Patients are advised not to weigh themselves every day ("weight gain takes time"), to eat as many as six or seven small meals a day, exercise regularly and get adequate rest.
As important as diet, believes Dr. Mayer, are fashion tricks that can make women look plumper, such as wearing horizontal stripes and layers of clothing, choosing full skirts and light colors, and avoiding long, straight hairdos. "If it will make them happy to gain 10 pounds, fine," he adds, "but that's not what's important. They need to develop physical fitness and self-confidence. Instead of feeding them a lot of nonsense about modifying the bodies God gave them with high-cholesterol foods, I'd rather teach them to wear a padded bra."
Rx for the underweight: snacks, stripes and self-esteem