Weight loss is a serious issue in the United States. Consumers constantly see advertisements and news reports on trendy diets, flashy products, and magic pills promising to help them lose weight.

Given that the ongoing “battle of the bulge” is front and center for so many people, being too thin may seem like a good problem to have. But the reality is that being underweight can cause health problems too.

Path to improved wellness

Fat has a bad reputation for causing people to be overweight and obese. However, not all fat is bad. In fact, breaking down and storing energy (calories) as fat is good. It’s just one of the many ways the body uses food to function, heal, and grow.

Stored energy from fat helps you get through a strenuous job or workout. It plays a key role in brain development, and in preventing inflammation (swelling) and blood clots. Fat contributes to healthy hair and skin as well.

You can determine whether you are underweight by using a Body Mass Index (BMI) calculator. This online tool considers your weight, height, age, and gender to calculate a score. If your BMI is less than 18.5, you are underweight. Your doctor also can help determine if you’re underweight based on your height, weight, what you eat, and your activity level.

Your doctor may put you on a weight gain program if you are underweight. However, this is not permission to go crazy with junk food. Healthy weight gain requires a balanced approach, just like a weight loss program.

Eating junk food may result in weight gain. However, it will not satisfy the nutrition your body needs. Even if the fat, sugar, and salt in junk food doesn’t result as extra weight, it can still harm your body. For healthy weight gain, the following tips can help:

• Add healthy calories. You don’t need to drastically change your diet. You can increase calories by adding nut or seed toppings, cheese, and healthy side dishes. Try almonds, sunflower seeds, fruit, or whole-grain, wheat toast.
• Go nutrient dense. Instead of eating empty calories and junk food, eat foods that are rich in nutrients. Consider high-protein meats, which can help you to build muscle. Also, choose nutritious carbohydrates, such as brown rice and other whole grains. This helps ensure your body is receiving as much nourishment as possible, even if you’re dealing with a reduced appetite.
• Snack away. Enjoy snacks that contain plenty of protein and healthy carbohydrates. Consider options like trail mix, protein bars or drinks, and crackers with hummus or peanut butter. Also, enjoy snacks that contain “good fats,” which are important for a healthy heart. Examples include nuts and avocados.
• Eat mini meals. If you’re struggling with a poor appetite, due to medical or emotional issues, eating large amounts of food may not seem appealing. Consider eating smaller meals throughout the day to increase your calorie intake.
• Bulk up. While too much aerobic exercise will burn calories and work against your weight goal, strength training can help. This includes weightlifting or yoga. You gain weight by building muscle.

Before beginning a weight gain program, talk to your doctor. Being underweight may be due to an underlying health problem. In that case, it won’t be corrected by diet changes. Your doctor will be able to help you track your progress. They will make sure that healthy changes are taking place.

Things to consider

People who are underweight typically are not getting enough calories to fuel their bodies. Often, they are also suffering from malnutrition. Malnutrition means you are not taking in enough vitamins and minerals from your food. If you’re underweight, you may be at risk for the following health issues:

• Delayed growth and development. This is especially true in children and teens, whose bodies need plenty of nutrients to grow and stay healthy.
• Fragile bones. A deficiency in vitamin D and calcium, along with low body weight, can lead to weak bones and osteoporosis.
• Weakened immune system. When you don’t get enough nutrients, your body cannot store energy. This makes it difficult to fight illness. It may also be difficult for your immune system to recover after being sick.
• Anemia. This condition can be caused by not having enough of the vitamins iron, folate, and B12. This can cause dizziness, fatigue, and headaches.
• Fertility issues. In women, low body weight can lead to irregular periods, lack of periods, and infertility.
• Hair loss. Low body weight can cause hair to thin and fall out easily. It also can cause dry, thin skin and health issues with teeth and gums.

Some underweight people are physically healthy. Low body weight can be due to a variety of health conditions, including:

• Genetics. If you’ve been thin since high school and it runs in your family, it’s likely that you were born with a higher-than-usual metabolism. You also may have a naturally small appetite.
• High physical activity. If you’re an athlete, you probably know that frequent workouts can affect your body weight. However, high physical activity also can be a part of an active job or an energetic personality. If you’re on your feet a lot, you may burn more calories than people who are more sedentary (inactive).
• Illness. Being sick can affect your appetite and your body’s ability to use and store food. If you’ve recently lost a lot of weight without trying, it may be a sign of disease, such as thyroid problems, diabetes, digestive diseases, or even Talk to your doctor about sudden weight loss.
• Medicines. Certain prescription medicines can cause nausea and weight loss. Some treatments, such as chemotherapy, can reduce appetite and worsen weight loss from illness.
• Psychological issues. Our mental wellbeing affects every part of our lives. Things like stress and depression can disrupt healthy eating habits. Severe body image fears and distortions can lead to eating disorders. If you’re suffering from damaging emotional issues, talk to your doctor. He or she can help you get the care, assistance, or counseling you may need.

Questions to ask your doctor

• How do I gain weight if I’m not hungry?
• Is being underweight more serious for babies?
• What are some affordable, healthy foods to help me gain weight?
• Should I stop exercising if I am underweight?
• Should I stop taking my prescription medicine if I am underweight?

Resources

National Heart, Lung, and Blood Institute: Calculate Your Body Mass Index

National Institutes of Health, MedlinePlus: Body Weight

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Medicine can be a very expensive part of your health care treatment. Your doctor may prescribe a medicine you can’t afford to pay for. Sometimes there is a generic option, or a different, less expensive alternative. But sometimes there is not. Don’t worry. There are assistance programs available that can help you. You may be able to get the medicine for free or for a reduced cost.

Path to improved health

There are several ways you can get help paying for your prescription medicine.

Private and public health insurance

Many people have health insurance. Some plans pay for prescription medicine. Some do not. It depends on what kind of insurance you have.

• Private health insurance through your employer.Some or all of the cost of your medicine may be covered.
• Traditional Medicare plan(sometimes called fee-for-service). You’ll need Medicare Part D to make sure your medicine is covered.
• Your state’s Medicaid plan probably covers the cost of prescription medicines.

State and community programs

Some state governments offer affordable medicine programs. These are designed for seniors, people who are disabled, and people who have low incomes. Some communities offer help as well. This could be in the form of:

• Community health centers
• Area Agencies on Aging
• Free health clinics
• Other community programs

To use these services, you may need to show that you don’t qualify for private health insurance. Or you might have to show that you don’t make enough money to pay for your own medicine.

Private programs

Some social agencies offer financial help for people who can’t afford their medicines. These include the Salvation Army and some private hospitals.

Patient-assistance programs

Patient assistance programs (PAPs) are sponsored by companies that make prescription medicine. Each company has its own rules about who qualifies for its PAP. In many cases, you will need to show that you don’t qualify for private or public health insurance. (Public insurance includes Medicare or Medicaid.) You may also need to prove that your income is below a certain level.

Each PAP has its own application process. In many cases, your doctor, nurse, or social worker will need to apply for you. For some programs, your doctor or nurse can submit an application online. For others, the application must be mailed in. Remember that applying for a PAP does not guarantee you will get your medicine for free or at a lower price.

Pharmaceutical coupons

Some pharmaceutical companies offer coupons to reduce the cost of a prescription. Ask your doctor if they have coupons or can direct you to online coupons.

For more information

The following websites can help you and your doctor see which assistance programs you might qualify for:

Medical Assistance Tool

The Medicine Assistance Tool was created by Pharmaceutical Research and Manufacturers of America (PhRMA) as a clearinghouse for more than 475 public and private assistance programs. These programs are provided by:

• Pharmaceutical companies
• Doctors
• Other health care providers
• Patient advocacy organizations
• Community groups

The tool helps patients get the medicines they need. It helps them find the assistance program that’s right for them. Many people who qualify for these programs will get their medicines free or for a reduced cost. Organizations that support this program include:

• American Academy of Family Physicians
• American Autoimmune Related Diseases Association
• Lupus Foundation of America
• NAACP
• National Alliance for Hispanic Health
• National Medical Association

Together Rx Access Program

The Together Rx Access Program can help people save on their medicines. It offers a discount card for those who qualify. Most cardholders save 25% to 40% on brand-name prescription medicines and products. Savings on generic medicines are also available. The card can be used at the majority of pharmacies.

NeedyMeds

This website gives information about drug company PAPs. It lists medicines that are available through PAPs. It gives contact information for the companies that make them. In many cases, you can download a copy of a drug company’s PAP application. NeedyMeds also offers a free discount card. Just download and print the card, then take it to your pharmacy. Many pharmacies accept the discount card. It can help you receive up to 80% off the price of your prescription. The NeedyMeds site also links to state Medicaid websites.

RxHope

This site is supported by the Pharmaceutical Research and Manufacturers of America (also called PhRMA). Your doctor can use the tools on the RxHope website. They can apply for you to receive free or low-cost medicines from the companies that make them.

RxAssist

This website is sponsored by an organization called Volunteers in Health Care. Your doctor, nurse, or social worker can search the database on the site. They can find out which PAPs you might qualify for. The site also gives information about other resources, such as prescription discount programs.

GoodRx

This website will direct you to the pharmacy that has the lowest price for the medicine you need. You can search medicines by active ingredient or by brand name. It also shows you any discounts available for your medicine. It offers free coupons to use at the pharmacy.

Things to consider

There are many different PAPs out there. Each one has its own rules and requirements. Some are easier to join than others. Some of the differences between programs include:

Applications. Some program applications are only available from your doctor. Some are online. Others you can get by calling a toll-free number.

Application process. Most programs require the application to be sent in by mail or fax. Some may accept enrollment over the phone. You may have to include documentation showing your financial information. This could include W-2 forms, tax returns, or paycheck stubs.

Eligibility. Factors that make you eligible for different programs can vary. Some programs have income limits. Some require that you don’t have any health insurance. Others may require that you not be eligible for any state or local assistance programs.

Response time. Some programs process and approve applications quickly. You may be able to get your medicine in just a week. Other programs could take up to six weeks.

Delivery of medicine. Many programs deliver the medicine to your doctor. Some will deliver it to your home. Others may give you a card or voucher that you can take to the pharmacy to exchange for your medicine.

Amount of medicine. You may only be able to get a 30-day supply of medicine from some programs. Others may allow you to get up to 180 days (6 months).

Refills. Programs may require you to submit a new application every time you need to get a refill of your medicine.

Questions to ask your doctor

• Do I have insurance or prescription coverage that will pay for my medicine?
• How do I find out about assistance programs? Can you help me?
• What is the best assistance program for me?
• Do you fill out the application for the assistance program or do I?
• When will I find out if I am approved for prescription assistance?
• Will my medicine be delivered to you or to my home?
• Do I have to fill out a new application every time I need a refill of my medicine?

Resources

American Cancer Society: Help Paying for Prescription Drugs

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Your body depends on water to survive. Every cell, tissue, and organ in your body needs water to work properly. For example, your body uses water to maintain its temperature, remove waste, and lubricate your joints. Good hydration is important for overall good health.

Making sure you get enough water every day is an important step in maintaining your health.

Path to improved health

Most people have been told they should drink 6 to 8, 8-ounce glasses of water each day. That’s a reasonable goal. However, different people need different amounts of water to stay hydrated. Most healthy people can stay well hydrated by drinking water and other fluids whenever they feel thirsty. For some people, fewer than 8 glasses may be enough. Other people may need more.

While plain water is best for staying hydrated, other drinks and foods can help, too. Water can be found in fruits and vegetables (for example, watermelon, tomatoes, and lettuce), and in soup broths. Fruit and vegetable juices, milk, and herbal teas add to the amount of water you get each day. Just make sure to limit sugary drinks that are high in calories.

Hydration and caffeine

Even some caffeinated drinks (for example, coffee, tea, and soda) can contribute a little to your daily water intake. A moderate amount of caffeine (400 milligrams) isn’t harmful for most people. Here are the caffeine amounts found in popular drinks:

• 12 ounces of soda: 30 to 50 milligrams
• 8 ounces of green or black tea: 30 to 50 milligrams
• 8 ounces black coffee: 80 to 100 milligrams
• 8-ounce energy drink: 45 to 80 milligrams

However, it’s best to limit caffeinated drinks. Caffeine will cause you to urinate more frequently. This can make it difficult to stay hydrated. It can also make you feel anxious or jittery.

Sports drinks can be helpful if you’re planning on exercising at higher-than-normal levels for more than an hour. They contain carbohydrates and electrolytes that can increase your energy. They help your body absorb water. However, some sports drinks are high in calories from added sugar. They also may contain high levels of sodium (salt). Check the serving size on the label. One bottle usually contains more than one serving. Some sports drinks contain caffeine, too. Remember that a safe amount of caffeine to consume each day is no more than 400 milligrams.

Energy drinks are not the same as sports drinks. Energy drinks usually contain large amounts of caffeine. Also, they contain ingredients that overstimulate you (guarana, ginseng, or taurine). These are things your body doesn’t need. Most of these drinks are also high in added sugar. According to doctors, children and teens should not have energy drinks. Because these drinks have high amounts of caffeine, they do not offer good hydration.

If staying hydrated is difficult for you, here are some tips that can help:

• Keep a bottle of water with you during the day. To reduce your costs, carry a reusable water bottle and fill it with tap water.
• If you don’t like the taste of plain water, try adding a slice of lemon or lime to your drink.
• Drink water before, during, and after a workout.
• When you’re feeling hungry, drink water. Thirst is often confused with hunger. True hunger will not be satisfied by drinking water. Drinking water may also contribute to a healthy weight-loss plan. Some research suggests that drinking water can help you feel full.
• If you have trouble remembering to drink water, drink on a schedule. For example, drink water when you wake up, at breakfast, lunch, and dinner, and when you go to bed. Or drink a small glass of water at the beginning of each hour.
• Drink water when you go to a restaurant. It will keep you hydrated, and it’s free.

Things to consider

If you don’t drink enough water, you may become dehydrated. This means your body doesn’t have enough fluid to operate properly.

Your urine can be an indicator if you’re dehydrated. If it’s colorless or light yellow, you’re well hydrated. If your urine is a dark yellow or amber color, you may be dehydrated.

There are other signs that can signal you may be dehydrated. They include:

• Little or no urine
• Urine that is darker than usual
• Dry mouth
• Sleepiness or fatigue
• Extreme thirst
• Headache
• Confusion
• Dizziness or lightheadedness
• No tears when crying

Some people are at higher risk of dehydration. They include people who:

Exercise at a high intensity (or in hot weather) for too long

Have certain medical conditions (kidney stones, bladder infection)

Are sick (fever, vomiting, diarrhea)

Are pregnant or breastfeeding

Are trying to lose weight

Can’t get enough fluids during the day

Are on medications that contribute to dehydration

Older adults are also at higher risk. As you get older, your brain may not be able to sense dehydration. It doesn’t send signals for thirst.

Note that water makes up more than half of your body weight. You lose water each day when you go to the bathroom, sweat, and even when you breathe. You lose water even faster when the weather is hot, when you’re physically active, or if you have a fever. Vomiting and diarrhea can also lead to rapid water loss. Be sure to actively drink plenty of water to avoid becoming dehydrated.

Questions to ask your doctor

• I don’t like water. What’s the next best thing to keep me hydrated?
• What can I add to water to make it taste better?
• What if I can’t consume as many fluids as doctors recommend?
• What does it mean if I drink a lot of fluids but don’t urinate often?
• How does drinking alcohol affect hydration?
• Am I on any medications that contribute to dehydration?

Resources

Centers for Disease Control and Prevention: Water & Nutrition

National Institutes of Health, MedlinePlus: Dehydration

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The hardest part of working out is getting started. We all know we need to do it. Often, we’re glad we did. We feel energized and better for having done it. Finding the right motivation may be the secret to working out and staying with it.

Path to Improved Wellness

Everyone has a different reason for working out. Some might exercise for their physical health, while others work out for their mental health. Some do it to look good. And some just enjoy being active. If you want or need to work out and are having trouble getting started, one of these reasons might be the motivation for you:

• Health and wellness. If living longer and living well is important to you, working out is a priority. Endless studies have shown that working out on a regular basis can reduce, delay, and maybe even prevent the onset of certain diseases. Diabetes, cancer, and dementia are some of the most common medical conditions positively affected by exercise.
• Mental health. Regular exercise helps your body release endorphins (hormone). This hormone helps reduce stress and can improve your mental outlook. Exercise has proved to be an important contribution to the treatment of depression and anxiety.
• Weight management. If you’re struggling to lose weight or maintain your weight loss, exercise is crucial. The combination of aerobic (running, dancing, walking) and weight-bearing exercise is especially helpful in building your muscles. This helps your body burn calories and fat.
• Working out is a great opportunity to spend time with friends and family. And depending on the weather, it’s free. Activities such as walking, jogging, biking, tennis, basketball, and soccer are great group work outs. These activities also can get you laughing, which is important for your mental health.

The American Academy of Family Physicians (AAFP) promotes safe and healthy fitness. This includes exercise as an essential part of health throughout life (and in preventing disease) and participation in recreational and competitive athletics.

Tips for getting started with a workout and staying with it include:

• Set reasonable goals. If you’re just starting, plan to exercise for 20 minutes 3 times a week and work up from there.
• Record your progress. Whether you’re checking your BMI, your weight, your clothing size, or your mood, track it to see if you are making progress.
• Give yourself a break. Try to work out on a regular basis, but don’t feel guilty if a day of personal and work obligations causes you to skip a workout.
• Make it all about you. Plan this time for you. You work hard for your employer and your family. You deserve to treat your mind and body.
• Seek support from friends and family. Ask your friends to encourage you or to be understanding when you choose to work out.
• Make it fun. If you don’t like to jog, don’t do it. Do you like to dance? Do you like yoga? Do what makes exercise fun.
• Mix it up. The same old routine can get boring. Consider doing different kinds of exercise. Alternate by the day, by the week, or by the month. Do what works for you.
• Work it into your daily life. Consider skipping that heavy lunch and working out instead. Take the steps instead of the elevator. Try waking up 30 minutes earlier once or twice a week to get your workout in and over with.
• Focus on the future. Don’t worry about past failures with weight and exercise. Stay focused on what you want to accomplish in the future.
• Pat yourself on the back. Don’t forget to celebrate your exercise success. While it’s okay to splurge on your diet once in a while, focus on other kinds of rewards. Consider a movie, downloading a new song, or a hot bath. Choose something that makes you feel good about your accomplishment.

Things to Consider

While exercise is a good thing, most people should talk to their doctor before starting an aggressive routine. This is true for people with existing health conditions, such as heart disease or other chronic illnesses. Other things to consider when motivating yourself to exercise include:

• Choose public areas or gym facilities that are safe.
• If you can’t afford a gym membership, look for less expensive alternatives. This might include community recreation centers (less expensive than most commercial gyms), a safe park, or dusting off your old bike.
• Age/ability. Talk to your doctor for recommendations on the type and level of exercise you should aim for at your age and ability.
• Type of activity. Consider what activities may be too much for your age and ability. For example, playing team sports, such as basketball, might be harder on your body as you age. It is also important to have variety in your exercise. If you are a runner and are injured, for example, you’ll have another exercise to fall back on. Plus, doing different exercises helps ensure you aren’t overworking the same muscle group.

Questions to Ask Your Doctor

• What type of exercise is good for seniors?
• How long after a heart attack or surgery should a person wait to exercise?
• What does it mean if I feel sick after working out?
• Can I exercise while pregnant?

Resources

National Institute on Aging: 5 Tips to Help You Stay Motivated to Exercise

National Institute of Diabetes and Digestive and Kidney Diseases: Tips for Starting Physical Activity

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A dog may be man’s best friend. However, household pets of all types can carry diseases or parasites (organisms living inside or on another organism) that make people sick. This includes dogs, cats, birds, and reptiles. It also includes animals that people turn into pets, such as farm animals (pigs, chickens). Symptoms might include fever, muscle aches, and diarrhea. The good news is that this rarely happens. Most pet-to-people diseases can be avoided by following a few common-sense rules.

Path to improved wellness

The most important rule is to avoid touching animal waste (urine or stool). This includes objects contaminated by the waste products. For example, wash your hands after cleaning a soiled carpet (including cleaning under your fingernails) or picking up stool.

Don’t let small children play in uncovered sandboxes that might be used as litter boxes by neighborhood cats. Keep your children out of the dirt in parks that may be used by local dogs.

Another important tip is to avoid oral contact with your pet. Don’t share food or kiss your pet on the mouth. Pregnant women and people who have weakened immune systems should never clean out cat litter boxes or handle cat feces. They can be exposed to a disease called toxoplasmosis. Toxoplasmosis can cause severe birth defects in an unborn child if the mother is infected during pregnancy. Anyone cleaning out a litter box should wash his or her hands thoroughly afterward.

Have your pet dewormed and vaccinated exactly the way your vet recommends. This keeps your pet healthy and decreases your risk of getting parasites and diseases from your pet. Control fleas and ticks on your pets and in your house. Fleas and ticks can make both you and your pet miserable. It can make you sick.

Don’t feed raw meat to your pets. And don’t let your cat or dog hunt and eat wild animals. This is how cats get the toxoplasmosis parasite. Keep your pets away from wild animals or stray pets (which may be unvaccinated or sick).

Things to consider

Disease exposure from reptiles is serious. Reptiles include lizards, snakes, and turtles. They carry bacteria (germs) that can make people sick. They also transmit salmonella, a bacterial infection. If you have a pet reptile, you should wash your hands after handling the pet or anything in its cage. Frequently wash the cage, the area around the cage, and any items used to clean the cage. Children younger than age 5 and people who have weakened immune systems should not handle reptiles or items from the cage.

It’s a good idea to watch toddlers while they play with pets. Small children are more likely to get infections from pets. That’s because children crawl around on the floor with the animals, kiss them, put their fingers in the pets’ mouths, and then put their dirty fingers in their own mouths.

Small children are also more likely to be bitten or scratched by pets. Teach your children how to treat family pets and to avoid strange pets. It may be best to wait until children are past the toddler stage to get a pet.

Children younger than 5 years of age should also avoid contact with:

• Animals at petting zoos and farms.
• Baby chicks.
• Baby ducks.
• Amphibians (such as frogs, toads, and salamanders).
• Reptiles (such as turtles, lizards, and snakes).

If you enjoy the outdoors, don’t treat wildlife like pets. Deer and some wild animals may seem cute, but they carry germs, viruses, and parasites. Deer and deer mice carry ticks that cause Lyme disease. Some wild animals carry rabies.

If you’re planning to get a pet, you might consider adopting an older cat or dog. This way, you can avoid the housebreaking stage and its problems. Older pets that have been well cared for are less likely to spread disease or become ill themselves. Do not take in sick pets or strays. They carry even more risk of making you or your children sick.

Questions to ask your doctor

• Can a parasite cause death in people and pets?
• Can human disease from a parasite be treated with medicine?
• Do some pet diseases and parasites result in life-long health issues for humans?

Resources

Centers for Disease Control and Prevention: Animals (Zoonotic)

National Institutes of Health, MedlinePlus: Animal Diseases and Your Health

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