Underweight / cachexia

Underweight / cachexia

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In modern industrialized countries, being underweight is a health issue that has received little attention, and which is paid almost exclusively to eating disorders such as anorexia or bulimia. But there are a number of other causes that can lead to weight loss and even exhaustion.


Underweight is often defined in the literature as body weight, which is 20 percent below normal weight or the target weight. From 50 percent, weight loss is classified as life-threatening; poor nutritional status leads to weakness, poor performance and other symptoms. This extreme state of underweight and exhaustion is called cachexia.

The body mass index (BMI), which is based on the formula, is usually used to determine the normal weight BMI = body weight (in kilograms): height (in meters) ² is calculated or can be read from tables. After that there is underweight with a BMI of 18.5 or less.

When calculating normal, overweight and underweight, height, gender and fat mass are taken into account, but not the individual constitution. There are vital and powerful people who are underweight according to the body mass index. The genetic and biological requirements are very individual: people of the same size can differ in terms of bone structure, muscles, urge to move and need for rest. Age and fat distribution also play an important role.

Whether a person's underweight needs treatment depends on many other factors that must be taken into account. In addition to accompanying symptoms, it is important to consider the period of weight loss, because a sudden unintentional weight loss may indicate serious illness. If, with unchanged eating behavior or an unexplained appetite loss, a weight loss of more than two kilograms occurs within four weeks, the cause should be clarified with the help of thorough diagnostics.


Underweight is caused by a negative energy balance, which means that the body uses more energy than it is supplied with.

Decreased food intake

Decreased food intake or use of food: In highly developed industrial nations like ours, this is less likely to result from reduced food intake than, for example, in developing countries. But in Germany, too, the gap between rich and poor is widening, so that child poverty and the associated hunger still occur in Germany. Neglect by parents, for example due to addiction or depression, can also lead to malnutrition or malnutrition in children.

Extreme diets and anorexia occur primarily in adolescents and adults (not children) and can result in underweight.

If there is an ongoing lack of appetite behind the unwanted weight loss, this can be a sign of an indigestion, but also of stress, mental imbalance or an existing or developing depression. Anorexia is also more common in children. Behind it are either physical causes such as infections, inflammation or malignant diseases, or psychological triggers such as power struggles, defiance or other conflicts with the parents.

Furthermore, after surviving the disease there is often an underweight, which persists even after recovery.

Difficulty swallowing (dysphagia) is another possible cause that affects all age groups equally and leads to reduced food intake. Attention: Sudden swallowing difficulties in children can indicate a swallowed foreign body; in adults, at worst, cancer of the larynx or esophagus can be behind it. Although harmless diseases can trigger these symptoms, acute swallowing disorders should always be clarified promptly by the specialist.

Even with persistent vomiting or diarrhea, the ingested food cannot be used sufficiently by the organism. In rare cases, vomiting in babies is due to a congenital narrowing of the stomach exit, the so-called pyloric stenosis.

Even with a sufficient amount of food, disturbed use of food due to poor digestion with a lack of digestive juices (dyspepsia) or disturbed absorption of nutrients from the intestine (e.g. in the case of inflammatory bowel diseases, celiac disease, small bowel shortening) can lead to underweight.

Underweight in organ diseases

Especially with rapid weight loss with general fatigue, a serious organ disease cannot be ruled out. Additional symptoms usually help to determine the causes of weight loss. For example, the high susceptibility to infections and increased fungal infections are possible indications of AIDS, liver cirrhosis shows chronic fatigue), kidney failure in the blood test is recognizable by uremia, i.e. residues of urine breakdown in the blood and bronchiectasis (pathological widening of the middle airways, i.e. bronchi) characterized by symptoms such as coughing and expectoration).

Cancer of all kinds also often leads to early, rapid weight loss without further symptoms. However, sometimes they are accompanied by general symptoms such as performance kinks, night sweats and increased body temperature (so-called subfebrile temperature, which is slightly above normal temperature but below fever, i.e. between 37.1 to 37.9 degrees Celsius).

Metabolic disorders and hormonal system

Metabolic disorders and hormonal disorders can also result in being underweight, for example in the case of derailed diabetes mellitus or an overactive thyroid (hyperthyroidism). Finally, various types of poisoning lead to weight loss, underweight and exhaustion. This chronic poisoning can be caused by alcoholism and massive drug addiction, as well as by toxins in the workplace such as lead.

Increase with naturopathic remedies

If there are serious disorders and illnesses, they must first be identified and their causes treated. Conventional medical help may be necessary. For children, adolescents and adults who are physically inclined to underweight or for people who want to regain their strength in the recovery phase after an illness, naturopathy has strengthening and tissue-building agents.

If loss of appetite and poor digestion are in the foreground, then the use of medicinal plants and spices lends itself. Cardamom and coriander stimulate appetite and digestion. Artichoke leaves can boost bile production. The means of choice is the Condurango cortex (Condurango cortex), which can be used for weaknesses, for appetite stimulation and for the increased production of digestive juices.

You can also promote weight gain by choosing certain foods. In Ayurveda's nutritional theory, all food flavors are assigned and energetic properties are attributed to them. To reduce underweight, sweet, heavy and oily foods should preferably be chosen to nourish the body. Rice, cereal dishes and legumes are of such qualities and should be eaten frequently. Figs, dates and almonds also increase weight if three to five of them are consumed daily for a longer period. Winter cherry (Ashvagandha) is also recommended as a nutritional supplement, which is said to have a tissue-building effect.

If stress, inner restlessness or the like are primarily responsible for the underweight, inner peace and balance should be strengthened, for example with exercises from yoga, self-hypnosis or autogenic training. (jvs, kh)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Magistra Artium (M.A.) Katja Helbig, Dr. med. Andreas Schilling


  • Elvira Bierbach: Naturopathy today, textbook and atlas, Elsevier GmbH, Urban & Fischer Verlag Munich, 4th edition, 2009
  • Hans Konrad Biesalski et al .: Nutritional Medicine, Thieme Verlag, 5th edition, 2017
  • Michael R. Wasserman: Involuntary Weight Loss, MSD Manual, (accessed July 9, 2019), MSD
  • John E. Morley: Overview of Malnutrition, MSD Manual, (accessed Jul 9, 2019), MSD
  • Christian Löser: Malnutrition and malnutrition, Thieme Verlag, 1st edition, 2010

ICD codes for this disease: R64ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: QD33 - Rheumatoid Cachexia (September 2022).


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