By Pam Stuppy
Concerns about the growing number of individuals who are overweight or obese are well-founded. There are many people, however, who are struggling with the opposite weight issue unwanted weight loss. Reversing the trend of weight loss can be just as much of a challenge for them as losing weight is for overweight persons.
Numerous factors can contribute to unwanted weight loss. It could be due to certain medical conditions (such as intestinal problems, an over-active thyroid, etc.), chronic disease (like COPD, rheumatoid arthritis, etc.), symptoms from some medications (loss of appetite, taste changes, etc.), side effects from treatments for medical problems (such as cancer), emotional or mental health issues (anxiety, depression, dementia, etc.), extended illness, aging, alcohol abuse, or limited access to sufficient food (financial issues, transportation limitations, etc.).
More specifically, physical eating problems can be caused by poor appetite, nausea or vomiting, diarrhea or constipation issues, changes in taste or smell, problems with swallowing and/or chewing, chronic pain, or reduced thirst cues.
Lack of sufficient calories and nutrients can lead to a variety of health problems. Low intake can result in fatigue, which can prompt more sedentary habits, social isolation and reduced motivation for self-care. Inadequate food intake also compromises the immune system. This means a greater risk of illness and/or slower recovery from illness.
Poor dietary intake generally leads to reduced muscle mass and bone density. This can contribute to an increased risk of falling and fractures, difficulty accomplishing activities of daily living, reduced independence and a higher risk of acquiring some chronic diseases.
Addressing inadequate intake depends on the conditions creating the problem. In some cases, adjustments can be made to remove or reduce the cause of the eating issues. In others, it means making purposeful changes specific to the pattern of eating, the types of foods available, and access to enough food.
For healthy weight gain, some general guidelines are to increase the frequency of eating, increase the portion sizes of foods as possible, and to choose more nutrient/calorie-dense foods (more nutrients/calories for the volume of food consumed).
Rather than depending on feelings of hunger or thirst, it might be advantageous to consume foods and beverages on a schedule. A good plan might be to eat within about an hour of waking and then every two to three hours throughout the day. This spreads the food out to reduce the need for larger amounts fewer times a day. Being presented with large amounts all at once can seem overwhelming and can actually counter the desire to eat.
Many high-calorie foods provide empty calories meaning calories with minimal nutrients. Ideally, the foods consumed should provide nutrients as well as calories. There are numerous ways to slip healthy ingredients into foods to boost their nutrient content.
Some good choices for more calories might be dense grain foods like granola, dense breads like bagels, dried fruit, nuts, seeds, nut and seed butters, avocado, oils used in cooking or added to foods, fruit and vegetable purees added to foods like quick breads, cooked cereals made with milk, smoothies made with yogurt, cheese and veggie omelets, cooked whole-grain products, thick soups/stews rather than those with more broth, etc. Powdered milk or evaporated whole milk can be added to many foods to boost protein and calcium.
Having food always available is important. If grocery shopping is limited, one idea is to store larger amounts of less perishable and frozen foods. The individual or caregiver may also want to make bulk amounts of one-dish meals that can be used over several days and/or frozen in portion-sized amounts. These can easily be reheated as needed.
For nausea, foods that have a limited scent are often better tolerated. This might mean foods at refrigerator temperature or frozen items (like a yogurt and fruit smoothie, frozen fruit, frozen peas, etc.). Another tip is to have others do the cooking and avoid being near where foods are prepared.
For addressing disinterest in foods because of reduced taste or smell, try enhancing the flavors. Add more seasonings, serve foods warm, and try some new recipes. Eating with others in the home or out of the home in social environments can often encourage greater food intake.
For swallowing issues, modify foods so they are the appropriate texture for maximal swallowing ability. If chewing is an issue, focus on foods that require less chewing or again modify the consistency as needed. Softer foods might include eggs, yogurt, milk, fish, beans/hummus, melted cheese, pudding topped with soft or pureed fruit, oatmeal or other cooked whole grain (made with milk to add calories/protein/fiber), pureed fruit/vegetables, avocado, 100 percent fruit or vegetable juices, etc.
Beverages can be used not only to provide fluids, but also to add nutrients and calories. By consuming them toward the latter part of a meal or snack, they are then not replacing the nutrients and calories provided by adequate amounts of solid foods.
Unwanted weight loss can definitely be challenge to reverse, but the benefits of weight gain or stabilization are worth the effort when it comes to short- and long-term health and quality of life.
Pam Stuppy, MS, RD, CSSD, LD, is a registered, licensed dietitian with nutrition counseling offices in York, Maine, and Portsmouth. She is also the nutritionist for Phillips Exeter Academy, presents workshops nationally, and is board-certified as a specialist in sports dietetics. Visit http://www.pamstuppynutrition.com for nutrition information, healthy cooking tips and recipe ideas.
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