There are many reasons people go “off their food”. Pain is one, depression is another. Certain treatments and medications can deaden the appetite, as can ill-fitting dentures or poor dental health. Favourite meals, even with their appealing aromas, fail to stimulate interest and unwanted weight loss is worrisome, especially for close family.
Eating little and often, instead of three larger meals a day, is the first and most important tactic to practise. This means using the clock rather than hunger as a guide. Don’t wait for hunger, but try nibbling at something every few hours during the day.
Serving appealing-looking portions on a small plate also helps; large plates of food are very unappetising when you have little interest in food.
Have a selection of ready-prepared meals and snacks on hand for when you’re not up to cooking; for example, soup, rice pudding, cheese, figs and crackers. Use full-fat milk to make warm drinks such as cocoa. You could add regular yogurt, milled seeds and nuts or extra protein powder to smoothies to boost the protein and calorie content. Sometimes it is easier to drink calories than to eat them.
Hospital visits
“Some hospitals will have guidelines in relation to whether or not they permit food to be brought in to patients,” says Dara Morgan, a consultant dietitian at Morgan Nutrition. “However, when someone is really struggling to tolerate hospital food, it might be just the thing to have a bowl of homemade chicken noodle soup, exactly the way they like it, brought in by a relative, or a sandwich made with care on your favourite wheaten bread.”
She adds: “Nutrient-dense granola-style bars or protein bars, or fruit and nut mixes, are all safe bets and handy to store in the bedside locker. While a small individual portion of fruit such as grapes or a delicious single serving of fruit salad topped with Greek yogurt might be appetising, bear in mind that fruit baskets or large pieces of fruit may be awkward to store in a hospital ward and are less appealing if lying there for a few days.”
Poor appetite in older people
Dara Morgan
, dietitian
Many older adults report that they just don’t have an appetite. There may be an underlying medical cause or it may be due to
loneliness, depression or anxiety. Regardless of the cause, not eating adequately increases their chance of poor nutrition and its consequences.
I have found that older people who have been bereaved often struggle with poor appetite as they lose their interest in food when they are cooking only for themselves. In some cases, their partner may have done all the shopping and cooking and they are left not really knowing how to cook. In these situations, it is not unusual to see someone relying primarily on tea, bread and jam for their nutrition.
For an older person who has never cooked, and feels overwhelmed by it, looking into availability of local meals-on-wheels can be helpful. In particular, if loneliness is contributing to poor appetite, looking forward to a volunteer arriving to the door with home-cooked meals can make an enormous difference. I have seen cases where older people have a local café that serves delicious homemade soups and half-portion dinners at a reasonable price. Using this option a few times a week can be as economical for someone living alone as cooking for one.
It also gets them out of the house and into a social situation, which can help to make them feel less isolated. I encourage older people struggling with appetite to keep custards and rice puddings in their store cupboard or refrigerated versions of these foods in their fridge.
Similarly, tinned fish such as salmon, tinned beans and cereals such as porridge are all winners and mean there is always something in the larder to fall back on. I advise them to avoid reduced-fat or low-calorie products, and to opt for full-fat milk to make up their morning porridge or to add to mashed potatoes.
To increase the nutrient density of foods, dried milk powder can be added to many foods and drinks such as hot milky drinks, soups, rice puddings or mashed potatoes.
Often a dessert such as jelly and ice cream can go down a treat with an older person who is struggling with poor appetite and is losing weight. If they feel up to making something like chicken soup, I encourage them to freeze some for another time when they don’t feel up to cooking.
Often older people who struggle with eating large dinners find that a small meal such as a boiled egg with toast and butter or poached eggs on toast is more tolerable. Eggs are so nutritious, a great source of protein and represent great value for money.
Cancer patients
Maeve O’Shaughnessy, dietitian
Surely the answer must lie in providing a healthy diet based on the well-circulated principles of low-fat meals padded out with lots of vegetables, fruits and high-fibre foods. After all, given how gruelling cancer treatments such as surgery, chemotherapy and radiotherapy can be, is this not the very time when “healthy eating” should be to the fore? Not necessarily.
A healthy, balanced diet is applicable to people who are well and maintaining their weight on treatment. However, for certain groups of people, the reality can be very different.
Many patients with a cancer diagnosis can suffer enormously from nutritional problems. Certain cancers are notorious for causing weight loss, in particularly cancers of the head and neck, gastrointestinal system, lung and pancreas. People with advanced cancers can also experience weight loss, which is a visible side effect that has physical and psychological impacts.
The side effects of treatment also have the potential to cause a striking loss of appetite, taste changes, nausea, vomiting and a constant feeling of fullness. Fatigue can also limit a person’s capacity to do daily chores such as food shopping and cooking.
Unfortunately, even as much as 5 per cent weight loss in three months before and during treatment can have a negative influence on a person’s tolerance of treatment. Also, simply not being able to enjoy or taste one’s food throughout the cancer journey impinges on quality of life in what is already a challenging time.
The best person to assess and advise on individual dietary needs for people subjected to these side effects is a qualified dietitian, who will discuss strategies for tacking these challenges. Do not be surprised if very high-calorie foods are recommended. A “little-and-often” policy, as well as specific nourishing drinks, might also be appropriate.
In this highly emotive time, the inherent desire to care for family and friends via food can be very strong. Unfortunately, this sometimes can cause a strain on dynamics if expectations are not met. Recognising, empathising and staying with where people are at in terms of their symptoms can be a fantastic starting point in supporting and nurturing loved ones who have cancer. If you are struggling with the side effects described, ask your consultant oncologist or GP for a referral to a hospital or community dietitian.
A recipe booklet, Good Nutrition for Cancer Recovery, written by dietitians from UCC and produced in co-operation with Breakthrough Cancer Research, Cork Institute of Technology and the Mercy Hospital, is an excellent resource for people who experience unintentional cancer-induced weight loss.
Paula Mee is an INDI dietitian working at Medfit Proactive Healthcare. pmee@medfit.ie Twitter: @paula_mee
The following organisations also have useful factsheets and resources: Irish Nutrition & Dietetic Institute indi.ie Irish Cancer Society, cancer.ie Macmillan Cancer Support (UK) macmillan.org.uk
