top of page
  • Barbara Hoefener NP

Am I Too Thin or Too Skinny?

Written by Barbara Hoefener, NP 8/28/2022. Make appointment at

If you have a body mass index, BMI of less than 18.5, you are considered underweight.

  • The concern for people who are underweight is not getting enough calories, vitamins and minerals to fuel their bodies and thus having malnutrition (or “starvation”). “The World Health Organization defines malnutrition as "the cellular imbalance between supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions. Malnutrition affects virtually every organ system "

  • If anyone can visualize and outline “skin and bones,” for instance a person’s collar bone, ribs or spine, that person is severely underweight. A healthy BMI individual would need to have their collar bone (rib 1), ribs, and spinous process counted by feeling them, not by visual appearance.

What is considered attractive? – an interesting research article

  • According to research by the University of Aberdeen academics, scientists have tested a theory and deemed that women with a BMI of 24 to 25 is considered the most attractive.

  • When looking at clothing women wearing size 8 to 10 is considered appealing while wearing zero to four is considered underweight or too thin.

What is healthy body fat?

  • Healthy body fat for men is 17.6 to 25.3%.

  • Healthy body fat for women is 28.8% to 35.7%

What are some of the risks/ symptoms for being underweight?

  • Weakness or lean muscle tissue

  • Tired/ Low energy/ Decreased cognitive function/ Headache/ fissured or ridged nails = Anemia – lack of iron, folate, Vit B12

  • Amenorrhea – a condition where you have stopped bleeding or severely decreased your menstrual cycle.

  • Damaged skin, thin, dull, and brittle hair and teeth

  • Vitamin/ Mineral deficiencies

  • Osteoporosis – serious condition causing brittle bones with higher risk for fracture. Bones become strong from calcium and vitamin D when your body needs these nutrients it pulls from your bones.

  • Lowered immune function – easier for you to get sick

  • Infertility/ hormone irregularities

  • Poor wound healing, slow-healing fractures = Vit C contributes.

  • Night blindness/ poor growth / thin hair/ xerophthalmia (dry eye) - Vit A deficiency.

  • Edema- increased swelling b/c of increased inflammatory markers because of increased metabolic demands from deficient calorie intake.

  • (kid) Goiter/ Developmental delay/ Mental retardation/ Thyroid instability = Iodine deficiency

  • (kid) Poor growth/rickets/ hypocalcemia = Vitamin D deficiency

  • (Kid) Neural Tube Defect from fetus, anemia, glossitis = folate deficiency

  • (Kid) anemia, dwarfism, hepatosplenomegaly, hyperpigmentation, hypogonadism, acrodermatitis enteropathica rash = zinc deficiency

  • (Kid) glossitis (swollen tongue)/ decrease cognitive function, nail changes, headache, low energy = Iron Deficiency

Chronic illness is typically associated with nutritional deficiencies

  • Cystic fibrosis, chronic renal failure, child cancer, congenital heart disease, chronic inflammatory bowel disease. Children of moms with malnutrition tend to have developmental delay and are born prematurely.

Treatment via inpatient hospitalization or outpatient?

  • The Academy of eating disorders recommends inpatient treatment for anyone at or below 75% with their ideal body weight as a general rule.

  • Outpatient is always an option, I suggest you start with meeting 1-2-3 times weekly for the first month, then tapering to weekly for at least 2 months then monthly for at least 1 year, then a few times a year possibly for life. Some things that will need to be discussed in the beginning is getting on the same page of “healthy-balanced” diet, “healthy” exercise, and “healthy” body image. As you will likely have a different thought then many others including your trusted counselor and nutritionist guide.

What is my goal for you as a health provider?

  • For you to have an accurate picture of what a “healthy-balanced” diet, “healthy” exercise, and “healthy” body image looks like.

  • For you to maintain a BMI of approximately 24.

  • For you to have no symptoms or risk factors or deficiencies mentioned above.

  • For you to be a happy person, being active and eating with family and friends, without anxiety or shame.

Common Symptoms of an Eating Disorder

**(Exact copy/paste – lots more info**

Emotional and Behavioral

  • In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns

  • Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting

  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

  • Appears uncomfortable eating around others

  • Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

  • Skipping meals or taking small portions of food at regular meals

  • Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

  • Withdrawal from usual friends and activities

  • Frequent dieting

  • Extreme concern with body size and shape

  • Frequent checking in the mirror for perceived flaws in appearance

  • Extreme mood swings


  • Noticeable fluctuations in weight, both up and down

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)

  • Difficulties concentrating

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)

  • Dizziness, especially upon standing

  • Fainting/syncope

  • Feeling cold all the time

  • Sleep problems

  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)

  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity

  • Dry skin and hair, and brittle nails

  • Swelling around area of salivary glands

  • Fine hair on body (lanugo)

  • Cavities, or discoloration of teeth, from vomiting

  • Muscle weakness

  • Yellow skin (in context of eating large amounts of carrots)

  • Cold, mottled hands and feet or swelling of feet

  • Poor wound healing

  • Impaired immune functioning




bottom of page