Question
QUESTION: im 19yrs old. my weight is 36 and my height is 60 inches ( or 146 cm )..im female.im also suffering from scoliosis 30 degree spinal curve . i want to gain some weight. please help me. im severely underweight =( and everyone says me that ur too thin. please help me

ANSWER: Dear Maham Majid,

I'm very sorry to have taken so long to answer your question. I have been very unwell recently with a bad respiratory infection, and spent most of last week resting in bed. I have therefore been very slow in responding to all my e-mails (even ones from family!). Not a good start!

Anyway, I understand that you are concerned about your weight, and you are worried about being severely underweight. The information you give me is that you are female, aged 19 years, that you weigh 36 (kilos, I assume) or 5st 9.4lb, and you are 146cm /60ins or about 4ft 9.4ins to 5ft in height. (I am a little uncertain as to your true height, as the measurements you have given me in centimetres do not match those in inches.)I have given both metric and imperial measures to aid understanding - living in the UK, and aged 41 years, I am used to using imperial measurements. Just goes to show my age!

You are indeed very petite. However, I note that you have also mentioned a 30 degree spinal curve due to scoliosis. I do recall in the past having answered questions from you regarding this, and therefore I am assuming that it does have some effect upon both your posture, and your full height.

There is a measure that is generally used in order to calculate whether a person is underweight, or overweight, or a healthy weight for their height. This is known as the "BODY MASS INDEX". Body Mass Index is defined as an individual's body mass divided by the square of his or her height. It describes a range of weights and heights, that are grouped into different categories. The Body Mass Index is a measure of body fat based upon height and weight that applies to both adult men and women. The different categories of Body Mass Index are as follows:
UNDERWEIGHT is a BMI (body mass index) of less than 18.5% fat
NORMAL WEIGHT is between 18.5% and 24.9%
OVERWEIGHT is between 25% and 29.9%
OBESITY is more than 30%

The Body Mass Index (BMI) is widely used by Health Professionals in order to work out whether an adult is a healthy weight. However, it does have some problems. The calculation used can overestimate fat in athletes and other people who have a very muscular build, because the BMI does not differentiate between weight due to body fat and weight due to muscle. For the same reason, it can underestimate body fat in people who have lost muscle due to being elderly, or perhaps due to excessive dieting.

According to the BMI, you would be classed as underweight. However, I wish to tell you not to worry yourself too much. You are not massively underweight, perhaps you need to gain about three or four kilos in weight. This would make you an acceptable weight. Don't get too anxious.

Instead, I would much rather that you sought advice from your G.P. (doctor), in order to ensure that if you do go about gaining weight, you do it in a sensible and healthy way. Yes, you could gain weight by eating more - especially sweets, chocolates and fatty foods - but this is definitely NOT a healthy way to do it! All you wold gain is unhealthy fat, and not healthy muscle.

You need to get good advice about healthy eating and also exercise that is safe to do with your pre-existing scoliosis. Your doctor might be able to refer you to a Dietician/Nutritionalist who can advise about healthy eating. It would also be useful to find out if there are any exercises that it may be safe for you to do, that would help you to build up a little more muscle.

Right now, you could begin to think carefully about your eating. Do you eat a balanced diet? Do you eat regular meals? Are you finding it hard to eat, or to enjoy eating?

A balanced diet is important. You need to ensure that you are getting the right mix of foods to meet all your body's needs for energy and nutrition. Foods are grouped into 5 main categories:
1. Fruits and vegetables. A good source of vitamins and minerals. You should try to eat five portions a day.
2. Meat, fish, eggs and beans. These give energy via proteins, as well as minerals and vitamins. Fish is very good for you, and oily fish such as Tuna can be very helpful. White meat such as chicken is better for you than red, and lean meat is better that fatty meat. Two to four portions a week of meat is fine, but you should aim to eat lots of fish if you can. Two portions of fish a week is good.
3. Milk and dairy food (such as yoghurt, ghee, cheese). These contain calcium which can help to keep your bones healthy.
4. Foods containing fat and sugar (such as sweets, crisps, cake). Eat least of these as they are the least healthy foods.
4. Starchy foods such as rice, bread and pasta. You should choose wholegrain if possible. These add fibre to your diet to aid digestion and also energy via carbohydrates. They should make up a third of all we eat. Base your meals on such foods.

If you eat healthily you should gain weight, but it is always best to do so in a sensible way. Try to eat at regular times (i.e. three meals a day), however, if you find this difficult, then it is better to eat small amounts throughout the day ("grazing").  I do suggest that you seek advice from your G.P. especially if you are having trouble with eating. I would hate to think that you have an Eating Disorder that you have not disclosed to me, as this is very distressing. Eating Disorders can make a person very unwell, and lead to feelings of misery and despair. If this IS you, please talk to your G.P. about it, or get support. However, I suspect it is not the case. I suspect that you need good nutritional advice, and advice about exercise.

I hope that this has been a start. Please do discuss matters with your G.P. as well, just to be on the safe side.

Good luck with everything. Perhaps with a little better nutritional knowledge, you will also discover that you are an excellent cook. It is always good to learn about how to cook well, and to feed oneself and keep oneself happy. You may even find you enjoy it, and develop an extra skill.

Hope everything goes well.
Regards,
Elaine Ellis.

---------- FOLLOW-UP ----------

QUESTION: thanks Elaine . no doubt you have always been so helpful. it will take some time to visit my GP. as you said .. eat portions of fruits etc.. can you please help me to understand what do mean by portions?? and i want to know one more thing..whether scoliosis has affected my growth or not?? and please tell me the age at which a human height can grow.

Answer
Dear Maham Majid,

I am so very sorry to have taken so long in responding to this second part of your question. I have been very ill over the last couple of weeks with a really bad respiratory infection, and have had to spend most of my time resting in bed. This has meant that I haven't kept up to date with my e-mails. Still, I'm recovering now, so I'll try to answer the rest of your query. I hope I can still be of assistance...

Your question appears to have two parts to it. Firstly, you should like to know more about PORTIONS and portion sizes, when it comes to meals. Secondly, you have asked until what age a human can continue growing (including whether scoliosis may have affected your growth).

I will actually answer the question about GROWTH first, as the response is shorter! Human beings generally begin to have a "growth spurt" at the commencement of puberty. For boys and girls, this may be a slightly different age, as girls sometimes enter puberty slightly earlier than boys. However, it is understood that for both sexes, this growth tends to stop with the ending of puberty, which is generally about age 20 years. ALL the bones in the body grow and develop from birth onwards. Babies and infants (toddlers) grow very rapidly, almost like a "first growth spurt". As I have stated, humans have a "second growth spurt" that is associated with puberty.

Some bones continue to grow and change throughout ALL of our lives. These are the skull and the pelvis. In a 2011 study, researchers at the University of North Carolina (U.S.A.) found that the pelvis continues to grow wider between the ages of 20 and 79 years. This can cause a human's waist size to increase by anything up to 3 inches. A study in 2008, carried out by Duke University, showed that the skull continues to grow and change througout a person's lifetime. However, as mentioned above, on average humans tend to stop growing in height at about age 20 years.

With regard to whether your scoliosis has affected your growth, I cannot truly say. As a general rule, mild scoliosis ought not to affect a person's final height. However, if a spinal curve is very severe, and is left untreated, then it could possibly result in some height loss.  It is always prudent to seek treatment under such circumstances, as scoliosis can have other unpleasant effects on the body. More serious complications of untreated severe scoliosis can include arthritis of the spine, chronic pain, heart, and lung problems. This is why I have advised you to try to visit your G.P. and to discuss your concerns with him/her. Your G.P. should be aware of your worries, and may be able to measure your height accurately, and talk with you about whether this has been affected by your scoliosis. Your G.P. may also be able to refer you to specialist services designed to assist people who have scoliosis and spinal problems.

Now to PORTION SIZES!

I hope you can recall that I divided food into different groups. Recommended portion sizes differ from group to group.

STARCHY FOODS:
These are our main source of energy, and should form the basis of every meal. They include -
Cereal - three tablespoons of cereal (breakfast cereal) is a portion. Try to eat three portions a day.
Bread - two slices make a portion. Try to eat two portions a day.
Potato - one medium sized potato is a portion. Try to eat two portions a day. If you only have very small potatoes, then you can eat up to six as a portion.
Rice - six tablespoons is a portion. Try to eat 3 portions a day.
Pitta/Naan bread - one filled bread is a portion. Try to eat 2 portions a day.
Noodles - one block of dried noodles is a portion. Try to eat one portion a day.

MEAT, FISH AND OTHER PROTEINS:
You should aim to eat about three portions a day, and at least one portion of oily fish (such as tuna)per week. These include -
Meat - about 75g of cooked meat is a portion. This is about the same size as a pack of cards, or a box of cigarettes, or a small pocket book.
Fish - about 75g of oily fish, or 100g of white fish is a portion. This is about the size of a cheque book.
Pulses (e.g. lentils or chickpeas) - four tablespoons or a heaped handful is a portion.
Nuts - two tablespoons or a small handful is a portion.
Eggs - two medium sized eggs is a portion.

DAIRY:
Try to eat three portions a day, as this provides calcium for your bones. Portions include -
Milk - a portion is 200ml or a small glass.
Yoghurt - a portion is 150ml or a small pot.
Cheese - a portion is 30g, or the size of a small matchbox.
Cottage cheese - a portion is 90g, or about two tablespoons.

FRUIT AND VEGETABLES:
One portion is about 80g of any fruit or vegetable. Examples include -
Large fruit - one or two slices of fruit such as mango, papaya or pineapple.
Medium fruit - one medium fruit such as an apple, orange, peach or banana.
Small fruit - two small fruits such as kiwis, plums, satsumas or clementines.
Berries/grapes - one or two handfuls of berries or grapes.
Beans - three heaped tablespoons is a portion.
Vegetables - three heaped tablespoons of thigs such as peas, carrots or sweetcorn is a portion.
Salad leaves - one small bowl is a portion.
PLEASE NOTE: you could also drink one small glass of fruit juice to count as a portion.

FAT AND SUGAR:
You do not really need to think about these in terms of portion sizes, as they are not healthy foods and should only be eaten sparingly. Try to have sweets, cakes, chocolates and crisps only as treats. You do not need to feel guilty or bad for eating them, but remember instead that your main meals should consist of healthy foods.

I understand that you have access to a computer, so you might be able to get even more advice about portion sizes and healthy meals online. Try typing into a search engine such as "Google" or "Yahoo" the words PORTION SIZES or HEALTHY EATING, and see what this brings up. There are probably lots of websites available that could provide you with advice and assistance. Some might even suggest meals that you could try making.

Good luck with everything. I hope that you find the assisntace you require.
Regards,
Elaine Ellis.