I have a problem that is so unusual, I can't seem to find *any* help for it on-line. For years I have struggled with *not* being able to gain weight -- that's right, I'm too thin! (Just to give you the particulars, I am 5'2" and my weight hovers between 98-100 lbs.). I thought after having my son that things would improve (gained 45 lbs. during pregnancy with nary a problem!) but I can't seem to get up to my "best" weight of around 107-110. (I'd like to be at least 110 so I can donate blood).

My appetite waxes and wanes throughout the month; I try to eat healthy but find myself eating high-fat items because I'm so worried about my weight. I have been tested for hyperthyroid but nothing definitive. I know eating a lot of fat isn't good for one, anyway (cancer runs in my family), but I don't know what else to do! Are there any supplements I should be taking to help balance my appetite? And is there actually a solution on the books about this (besides drinking malteds)?

Thanks a lot,
Wendy

Dear Wendy,

You are in a minority, thats for sure, but that doesn't make your problem any easier than it is for those trying to lose weight. One good place for you to look for advise and food ideas is in a sports nutrition book targeted towards athletes, particularly endurance athletes, such as marathon runners. The good books in that field stress the importance of healthy food choices in trying to put on or maintain weight. You are very right in being concerned about fat intake. The best way to add weight is to increase your intake of complex carbohydrates, particularly whole grain ones. Foods like whole wheat bread, muffins, pasta, crackers, and bagels are good to include. Also, legumes and fruits would be wise choices.

In order to gain weight, you will have to eat more calories. In order to prevent gaining too much weight as fat, you will need to include regular exercise and strength training into your lifestyle. And, as I mentioned, those extra calories should come mainly from additional carbohydrate. Keep your fat intake to 30% of calories, or preferably, less.

To start, set up a realistic goal weight for yourself. You may need to resign yourself to a less than (what you may consider) an ideal weight. Make good nutrition your priority, and weight gain the second. It is most important that you get the necessary nutrients to be optimally healthy. For example, if your choice is between getting the calcium you need from a glass of milk, or the calories you are trying to consume for weight gain, go for the milk. For health reasons you will want to choose low fat milk, which doesn't come close to the calorie count of a candy bar. Therefore, you may want to choose a fruited low fat yogurt. Many of them are high in calories because of the added sweeteners, yet they still provide you with the calcium you need from the yogurt.

It is best to gain weight slowly and steadily. This will help to ensure that your weight gain is in the form of lean body mass and not excessive fat. Don't try to gain more than 1/2 pound a week.

Because you have a small appetite, I suggest that you try and eat several small meals throughout the day as opposed to trying to get all your calories in three meals. Try for 5 or six meals a day. Increase portion size when you can. Eat a large snack just before going to bed.

It may be that it is just to hard for you to eat the extra calories that you need in which case a liquid supplement may be helpful on occasion. During those times that you find your appetite has waned, use some powdered breakfast drink that is mixed with low fat milk. Also, the energy bars eaten by athletes can also provide concentrated nutrition. Their main drawback is their expense.

More concentrated foods will allow you to eat more with less bulk. However, the more concentrated foods tend to contain lots of fat. That is because fat has more calories per gram than does carbohydrate or protein. Be careful when choosing from amongst these concentrated foods as some fats are more healthful than others. The foods containing saturated fats should be avoided, such as full fat cheese, beef, butter or bacon. Focus on healthy fats, the monounsaturates, found in walnuts, olive oil, natural peanut butter, and oily fish like sardines and salmon.

Some other strategies that may help: drink 100% juices for thirst instead of water. Make hot cereals and soups with milk instead of water. Choose dense cereals, like low fat granola, Grape-Nuts, or Mueslix instead of puffed or flaked cereals. Use lots of dried fruits like raisins, apricots or dates for snacking and adding to baked goods like muffins. Beef up a salad with plenty of olive oil based dressing, adding legumes, or cottage cheese. Increase the power of your milk by mixing in powdered chocolate, or instant powdered milk. Choose from the more caloric fruits like banana and pineapple instead of lower calorie, watery ones such as melons or grapefruit.

Some people that may be able to help are a registered dietitian and an athletic trainer. The dietitian will be able to help you decide how many extra calories a day you will need, and how to best get those calories based on your food preferences. An athletic trainer will be able to help design an exercise and strength training program for you that will help you to gain the weight as lean body mass, without 'bulking up'. Contact your physician for a recommendation of a registered dietitian in your area or visit the American Dietetics Association on the internet at http://www.eatright.org. Your local YMCA or health club should be able to recommend a trainer, or offer a complimentary visit to help you get started.

Lots of luck in gaining those extra pounds!