I love your articles. Nevertheless, I have a criticism to make to you and to most authors who write in health magazines. There are numerous articles on metabolism, hypothyroidism and weight loss, but it’s hard to find anything about weight gain. Being too thin is just as dangerous as being overweight, but you seem to ignore it completely. Would it be possible to devote an article to this topic?

The preponderance of articles on losing weight or fat is due to two factors. First, most people are suffering from overweight or obesity - not from being too thin. Second, marketing creates the impression that "less is better" when it comes to weight. Few people will say that they need to gain weight. Being thin, or even emaciated, causes less concern than being overweight or obese. That said, there are indeed people who need to gain weight and others who would like to gain weight, who, in either case, cannot reach their goal.

In this article, I will start by addressing calorie balance and its role in weight gain. Then, in the second part (to be published in a future edition), I will examine the metabolic aspects as well as anabolism, or the formation of new tissue.

Why Gain Weight?

There are three main reasons why weight gain may be desirable. Some want to gain weight because they are well below their healthy weight - it is simply a matter of health. Others want to "fatten up" because they believe they are too thin in appearance, or perhaps others find them too thin - it's a matter of aesthetics. Finally, some want to gain weight to achieve a specific goal, such as reaching a weight class for an athletic competition – then it becomes a practical question.

Whatever the reason, there is one condition -  the weight gain must be healthy. Note that in the previous paragraph I put the words "fatten up" in quotes. This term can cause confusion - the objective should not be to "fatten up" but to gain healthy weight. Now, "fatten up" suggests an increase of body fat, not muscle. But, ideally, the end goal should be to attain a healthy weight. We will return to this later.

Do I Need to Gain Weight? 

How do we know if we need to gain weight? How much weight should we gain? If you want to gain weight for practical reasons, such as in changing weight category for a competition, you must reach a specific weight. The goal is easy enough to determine – all you need is a bathroom scale. If the aesthetic aspect is what motivates you, you can assess yourself by looking in the mirror or observing others when they look at you! Comments such as "Ah, your cheeks are not as hollow." or "You don’t look as sick." can be quite revealing. But if you want to gain weight for health reasons, certain parameters need to be evaluated. 

Types of Measurements

In my article on weight loss, I suggested some ways to determine whether it is justifiable to start a weight loss program. These same steps can also be used to assess whether it is advisable to gain weight. Two criteria that need to be measured are BMI and fat percentage. 

BMI

The Body Mass Index (BMI) is a tool that can help you determine if you are underweight. Despite its limitations, it is easy to calculate. If your BMI is less than 18.5, you are underweight.

BMI Interpretation 

Percentage of Body Fat 

The BMI does not measure the percentage of body fat. Now, it is possible that a person could be classified as thin while still having a high percentage of body fat. Recently, researchers have shown that some individuals can have the same characteristics as obese people without being overweight. Researchers describe these people who are of normal weight as being "metabolically obese". Some use the term "skinny fat". These individuals must gain weight by increasing their muscle mass and not their percentage of body fat.

We must not forget two important factors when managing our weight, whether it be for weight gain or loss. First, any weight loss must be primarily a loss of excess fat. Indeed, muscle and bone mass loss are detrimental to optimal health. But we must also remember to maintain a healthy level of fat. Indeed, fats have an important role to play in health. It is important, then, not to reduce our fat levels too much. When it comes to weight gain, we want to achieve a healthy level of fat if it is too low, while increasing muscle mass and increasing or maintaining bone mass.

There are different ways to check your body fat percentage. The most accurate method, but also the least accessible, is the DXA (formerly DEXA) or Dual-Energy X-ray Absorptiometry. This measure, used to assess bone density, also assesses the overall lean body mass. Unfortunately, since this method uses X-rays, it requires complex and expensive equipment as well as specialized professional staff. 

The skinfold measurement, one of the oldest methods, is more accurate when done by someone who is qualified. Today, we have access to other methods, such as Bioelectrical Impedance Analysis. These electronic tools measure the percentage of fat as a function of the resistance of different body tissues to an electric current. Many health centers use professional BIA devices to assess the percentage of body fat. Some BIA devices are also being sold to the public. Although they are not as accurate as professional BIA devices, they can still give a general idea of ​​the percentage of body fat.

How much fat do I need?

The table below is based on one from the American Council on Exercise, the reference on this subject. It is important to note that a table like this suggests a "general" standard and some individuals may deviate from the norm. It is, nevertheless, a useful tool to assess whether one should gain or lose weight.

Some notes

Note that the percentage of fat presented in the table above is based on individual activity level. For the purposes of this table, an Athlete is an individual with a high level of physical activity, whether at the amateur or professional level. Good Fitness Level indicates an individual who exercises or plays sports at least 1 hour a day, for a minimum of three days a week. 

Note also that this table is only valid for adults. Children and adolescents normally have a higher percentage of body fat.

What Should I do Now?

Evaluate your BMI and make sure you also know your fat percentage. If your BMI is less than 18.5, you should gain weight. 

Have your percentage of body fat evaluated by a professional. If it falls below the recommended standard, you should gain weight.

If both your BMI and body fat percentage are too low, gaining weight is imperative.

What Causes Thinness?

Extreme thinness can be caused by a variety of factors. In many cases, the problem is simple - lean people consume as much or fewer calories than they burn. In addition, an overly fast metabolism can cause a disproportionate loss of calories as energy. Hyperthyroidism can also cause difficulties with weight gain. In some cases, anabolism, the formation of new tissue, is inadequate. The body produces too little tissue and can’t compensate for tissue loss. Finally, there may be problems with digestion and / or absorption. 

Calorie Intake VS Expenditure

One of the first factors to evaluate is whether I burn as many or more calories as I consume. Indeed, if we do not consume a sufficient number of calories our weight will be affected. It is interesting to note that many persons who are underweight overestimate their calorie intake.

Average Calories Burned Per Day

Examples: Louis and Brigitte

Brigitte

Let us now take a 48-year-old female with a medium level of activity. We will call her Brigitte. She works 5 days a week at a desk job. Brigitte walks to the subway and takes the stairs instead of the elevator whenever possible. She also practices 1 hour of light yoga (Hatha Yoga) per week. On weekends, Brigitte does 1½ to 2 hours of cycling at a relaxed pace. Brigitte burns about 2,461 calories per day on average.

In terms of food, her intake is not excessive, and it is fairly well balanced. You will find below an example of a typical menu.

This averages to 2105 calories per day. On weekends, Brigitte generally drinks three glasses of wine or the equivalent, about 357 calories, or an extra 51 calories a day on average. Her consumption of food over the weekend is substantially similar to that of the week except that she can eat an additional 600 calories, increasing her average daily intake by 86 calories. So, Brigitte consumes about 2199 calories a day on average.

Do the math ...

2461 calories are used up and 2199 calories taken in. So, we have a deficit of 262 calories per day or 1,834 per week.

Louis

Louis is 50 years old. At 5’ 6” (167.6 cm), he weighs 140 pounds (63.5 kilos). Although his BMI is excellent, he feels better at 160 pounds (72.5 kilos). Unfortunately, Louis has difficulty gaining weight. Being an active person, he burns about 2200 calories per day.

Louis consumes about 1,925 calories a day, but he burns about 2200! This amounts to a deficit of 275 calories a day, or 1,925 calories per week. Therefore, he cannot gain weight. 

WHEN IT’S A QUESTION OF GAINING WEIGHT, THE FIRST THING IS TO CHECK IS CALORIE INTAKE VERSUS CALORIE EXPENDITURE. 

Here is a reminder of the Harris Benedict Equation I mentioned in my article on weight loss. According to this researcher, 3,500 excess calories equals one extra pound (450 grams) in body weight. According to this calculation method, an individual consuming an extra 250 calories per day will gain 26 pounds or 11.79 kg over the course of a year.

Brigitte would like to gain 10 pounds (4.5 kilograms) in three months. With a deficit of 219 calories a day, Brigitte will need to consume an additional 607 calories per day during this period. As long as she does not resort to eating "junk food", she will make huge strides to reach her goal.

As for Louis, his other half would like him to gain 10 pounds over a short period, 3 months. However, since he already has a deficit of 275 calories, he will have to consume 664 more calories per day, or about 33% more calories.

How to evaluate calorie consumption

As with Brigitte and Louis, it is important that we evaluate our calorie intake and compare it to our calorie expenditure. There are different ways to assess our calorie intake to determine whether there is a deficit. The simplest method is to use a phone or online app. To get started, I suggest MyFitnessPal, a free online and smartphone app. Visit: http://www.myfitnesspal.com/food/calorie-chart-nutrition-facts

If your calculations show that you burn more calories than you consume, then you have three options.

• Reduce your activity level.
• Increase your calorie intake.
• Do both.

It is unusual for people to burn too many calories when they suffer from emaciation, and the first option is rarely the option chosen. In most cases, it is better to increase the number of calories consumed to provide a calorie intake that matches the weight you wish to gain. 

Give yourself a few days to determine the average number of calories you consume in a day.

Calculate 3500 calories for every pound you want to gain. For example, if you want to gain 10 pounds, it will be 10 x 3500 = 35000 calories. Divide those calories by the number of days in which you want to achieve your weight goal. For example, if you want to gain 10 pounds in six months, it will be 35,000 divided by 180 days or 194.44 calories per day. From this number, you must either add or subtract the number of missing or excess calories. Thus, if you calculated that you consume 150 calories more than what is required, subtract 150 from 194.44. So, you just need to consume 44.55 fewer calories every day for six months. On the other hand, if you have a deficit, as is the case with Louis, you must add the number of calories required to gain those 10 pounds. If you do not consume enough calories, 150 for example, you must add this number to 194.44 for a total of 344.44 extra calories per day.

Once the required number of daily calories has been established, it is quite simple to add more foods or increase portion size to achieve your goal.

Which foods?

Obviously, consuming junk food or simple sugars is not the solution when you want to gain weight. That said, there are some strategies that can help facilitate an increase in calories. 

1. Make sure you have a snack after meals in the morning and after lunch.

2. Add quality oils such as olive oil or hemp oil to your breakfast cereal, salads or smoothies. For example, 1 tsp. hemp oil table provides about 110 calories. A tablespoon of coconut oil provides about 130 calories.

3. Eat dense snacks such as an "energy" bar or quality protein for extra calories.  A good-quality energy bar has more protein than sugar and can provide 150 to 300 calories while 1/3 cup (80 mL) of dried fruits and nuts can provide up to 200.

4. Eat avocados. One medium avocado provides about 225 calories.

5. Increase portion size. This option is often the most neglected when it comes to gaining weight. It may seem insignificant, but the effect is unmistakable. If you consume 2000 calories a day and you can increase your servings by 10%, you will consume 200 more calories. You can then consume those 3500 calories in 17.5 days. Just be disciplined and keep a food diary to control your portions.

6. Eat breakfast! The most important meal of the day is breakfast. However, this breakfast must be balanced and must provide carbohydrates, proteins and high-quality fats. Below, you will find an example of a high-calorie smoothie.

* Based on the "Mass Gainer Shake" by Jim Stoppani

N.B. for a "Nutella"-type flavor, use chocolate-flavored rice milk, rice protein and hazelnut butter!

Yes, but I'm not hungry!

This is a problem for many people who want to gain weight. Even if they know they should eat more, they are simply not hungry. This lack of appetite may be due to several factors such as a nutritional deficiency, abnormal metabolism or a non-pathological disorder of the pituitary gland.

For now, I would like to address the impact of nutritional deficiencies and how they can reduce appetite. I will discuss metabolic problems and the pituitary gland in the second part of this article. 

The effect a zinc deficiency has on appetite and weight control is well documented. Indeed, zinc plays an important role in both appetite control - through its regulatory effect on the pituitary gland - as well as growth due to its effect on growth hormone. A paradoxical effect of increased zinc intake in deficient people is that it can help overweight people lose weight as well as help those who are underweight to gain weight. Taking a 15-25 mg supplement of zinc is not a problem for most adults and may, if they are deficient in zinc, improve both appetite and weight gain.

Vitamin B1 or thiamin is also involved in appetite control. Some studies have also shown that a lack of thiamin is probably one of the biochemical causes of anorexia. This is not to say that anorexia is only biochemical, but nutritional deficiency does play an important role in worsening the symptoms of anorexia. The significant effect vitamin B1 has in controlling the appetite may explain why some individuals feel that taking a B complex supplement helps increase their appetite. Taking a B complex supplement may be helpful in increasing one’s appetite.

Helpful Plants

A plant mixture known as Relora® has been proven effective in increasing appetite in those who suffer from lack of appetite due to stress. These people, who are easily "wound up" often produce a high level of cortisol, the stress hormone. However, since the production of cortisol increases blood sugar levels, they have no or little appetite. By reducing the excessive production of cortisol, blood sugar levels drop and the body realizes it needs to eat. 

The plant most often used to increase appetite is fenugreek. Commission E, the German government commission, recognizes only one therapeutic application for fenugreek - appetite stimulation. For its part, the monograph approved by Health Canada notes that fenugreek is “(Traditionally) used in Herbal Medicine to help stimulate the appetite.”  Although fenugreek has other therapeutic uses 

(see: http://webprod.hc-sc.gc.ca/nhpidbdipsn/monoReq.do?id=84&lang=eng), its effect on the appetite is better documented. The dosage of fenugreek is about 1500 mg per day. 

A note of warning, breastfeeding women should know that fenugreek can act as galactagogue and thus increase the production and secretion of milk. 

Conclusion

The balance between calorie expenditure and intake must be in favor of the intake if you want to gain weight. However, for some people weight gain is difficult even when they consume enough calories. Two factors appear to be involved in this scenario: basic metabolism including NEAT (non-exercise activity thermogenesis), and a lack of anabolic stimulation. These two factors will be the subject of the second part of this article.