Underweight

Sex and Gender-based Analysis of this topic

Definition
According to Health Canada’s classification of body weight, underweight is defined as a body mass index (BMI) of <18.50. Specifically, the categories are: Severe thinness (<16.00), Moderate thinness (16.00-16.99), and Mild thinness (17.00-18.49). Based on data from the 2007/2008 Canadian Community Health Survey (CCHS), approximately 4% of women in Canada are considered underweight [1]. Underweight has been associated with ulcers, depression, and poorer prognosis for hypertension, diabetes, and hyperlipidemia [2].
 
 
Sex Issues
Underweight is much more common among females than males both among young adults (5.5% versus 3.5%), and seniors (2.5% versus 1.2%) [3]. Research suggests that approximately 4% of women in Canada have a serious eating disorder and 10% of those women are expected to die from that disorder [4].
 
 
Gender Issues
Women often face social and cultural pressures to achieve particular ideals of body shape and size [5], often emphasizing thinness in Western societies such as Canada. Very thin women are often presented as socially desirable which has important implications for women’s psychological and physical health. There are also expectations that men should be thin and toned, but there tends to be a much greater tolerance for a “big” man than a “big” woman in Western society [6]. Women who fail to achieve the ideal body are much more likely than men to suffer negative consequences, including poor self-esteem, depression, social exclusion, stigma, and discrimination [7]. Women are also more likely than men to engage in injurious patterns of diet and exercise in order to achieve the thin, toned ideal and the social and economic benefits associated with a thin body [6]. 
 
 
Diversity
Underweight disproportionately affects young and older women. Young women have the highest underweight rates in Canada and results from the 2007/2008 CCHS show that women between 18 and 24 years have underweight BMI rates that are more than twice the national average for women [1]. High rates of underweight among younger women can be attributed, at least in part, to poor body image, dieting, and eating disorders. Results from the CCHS 2007/2008 suggest that 50% of women classified as underweight consider themselves at a normal weight or too heavy [1].

Women who have lived in Canada for less than 10 years are often underweight [1]. Researchers propose this may be due to a “healthy immigrant effect” whereby new immigrants have not adopted the unhealthy lifestyles prevalent in Western society [8]. Others suggest that female immigrants may be over-represented in underweight classifications due to being unemployed and living in poverty and suffering the effects of food insecurity (i.e., nutrient insufficiency, poor overall health) [9,10]. 
 
Equity
Underweight can be linked to low income and food insecurity as a lack of economic resources may lead to food insufficiency that can result in malnutrition and underweight [6].
 
 
Critique
The preoccupation with overweight and obesity in the healthy living discourse means that limited attention has been paid to underweight [6]. In particular, little is known about underweight rates among younger people in Canada (under the age of 18). For example, the CCHS does not measure underweight rates for women under the age of 18 years, even though underweight rates are often highest in this age group. Instead, the CCHS focus on categories of “neither overweight nor obese,” “obese,” or “overweight” in the age group 12-17 years [11]. This is concerning because  underweight rates are demonstrably higher for young women and pose high fatality risks. Additionally, these classifications encourage practitioners and program managers to focus on overweight and obesity and ignore risks posed by being underweight [6]. Recognition of the importance of a healthy body weight may help identify and prevent problematic weight control practices when young women first adopt them.
 
 
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