Changes in appetite and eating

You may experience a decrease in appetite and dietary intake that may be due to medical problems, changes in mood, poor appetite, difficulty chewing and swallowing, and taste changes. Inadequate nutrient intake and a decrease in mobility can lead to weight and muscle loss. Weight and muscle loss can result in weakness, feeling tired, and an inability to participate in daily activities.

Maintaining energy and muscle mass

It is important to consume adequate calories and protein to help maintain energy and muscle mass. The right amounts of calories and protein help your body fight infection, maintain muscle mass, and help prevent skin breakdown. If you are underweight, the goal for healthy weight gain is a gain of one-half to two pounds per week. This can usually be accomplished by eating at least 250 to 500 more calories per day than you normally do. If your doctor or dietitian has told you that weight gain is appropriate for you, the following tips may help you achieve a healthy weight.

Increasing calories

Consult with your doctor before trying to increase calories, as there may be dietary restrictions related to general health, level of arousal, and/or ability to swallow.

• Start by eating 3 meals and 2 to 3 snacks per day.
• Set an alarm to remind you to eat if you are not experiencing regular hunger cues or have a hard time remembering to eat.
• Try to include more nutritious, energy-dense foods such as nuts and nut butters, dried fruits, cheese, granola bars, and avocados.
• Try nutrition supplement drinks like Ensure Plus, Boost Plus, Carnation Instant Breakfast, or regular milkshakes.
• Make sure to eat protein with each meal and snack. Foods high in protein include eggs, milk, yogurt, cheese, meat, poultry, fish, dried peas and beans, nuts, and nut butters.
• Add gravy, cream sauces, or cheese sauces to meats or vegetables.
• Add oils or butter to cooked vegetables, grains, or protein.
• Use whole or 2% milk in place of water or skim milk in drinks, snacks, and cooking.
• Use regular, full-fat condiments like mayonnaise, sour cream, and salad dressings in foods.

Finishing food

• Play soft music or watch TV while eating.
• Eat in a calm environment.
• Eat small frequent meals and snacks every 2 to 3 hours.
• Eat energy-dense foods like meats and starches before lower-calorie foods like fruits and vegetables.
• Drink liquids one hour before or after meals, and not with meals.

Coping with changes in taste

• Experiment with different seasonings to increase your preference for foods. For example, if foods are too sweet, try adding a little bit of salt or vinegar. If foods taste too salty, try adding some sugar.
• Eat foods cold or at room temperature.
• If you have problems consuming meats, add chopped meat to casseroles or salads or try eating meats in a sandwich.
• Cook with spices, herbs, and sauces that you like.
• If foods taste metallic, try eating with plastic silverware instead of metal silverware.

Coping with nausea and vomiting

• Eat dry food in the morning, such as toast or crackers.
• Avoid taking medications on an empty stomach unless instructed to by your doctor, pharmacist, or nurse.
• Avoid hot foods or foods with significant smells and odors if you are sensitive to the smell of foods.
• Eat smaller, frequent meals and snacks every 2 to 3 hours.
• Sit up for at least 30 minutes after eating.
• Eat slowly.
• Take sips of cold clear drinks like water, fruit juice, or sports drinks throughout the day.
• Stay on top of your bowel program to avoid constipation, which can worsen nausea.
• Avoid gas-forming foods like onions, cabbage, broccoli, or dried beans.

Changes in activity

You may experience decreased physical activity and decreased muscle mass, so your body may require fewer calories than you did before your injury. If you continue to eat the same as prior to your injury, you will likely gain weight over time, so it is important to adjust what and how much you eat. Pills, shots, or crash diets will not help with healthy, lasting weight loss.

Adjusting eating and exercise habits

Adjusting eating and exercise habits is necessary to achieve permanent weight control. If you need diet education or help controlling dietary intake, ask your doctor to refer you to a registered dietitian. It is important to consider how much you eat and what types of foods you eat to control your body weight.

Make your weight goals realistic and achievable. Do not expect to lose a lot of weight quickly and then to keep it off. A good rate of weight loss is no more than one-half to two pounds a week. Quicker weight loss often leads to water loss and muscle wasting. Losing fat takes patience and changes to eating and exercise habits. Enlist friends, family, and your healthcare team to provide support and help you meet your goals.

Achieving your weight goals

After achieving your weight goals, it is important to continue your healthy diet and lifestyle modifications. A person cannot go back to old eating habits without gaining pounds back. Incorporate sustainable habits and healthy eating into your daily routine to help achieve lasting results.

Reducing calories

Cutting back on serving sizes, seconds, sugary drinks, and unhealthy snacks can help you lose weight gradually.

• Tune in to your hunger and fullness cues. Ask yourself if you are actually hungry or if you are eating out of boredom or emotional reasons. Stop eating when you feel full.
• Eat smaller, more frequent, balanced meals throughout the day.
• Eat off of a smaller plate. This may help you with portion control.
• When eating out, ask for half of your meal to be boxed up before you start to eat.

Foods that are high in unhealthy fat and sugar tend to be high in calories and low in healthy nutrients. Regularly including these foods can lead to unhealthy weight gain. Often people find that they can lose weight just by decreasing or eliminating the amount of high-fat and high-sugar substances they are eating, such as desserts, soft drinks, and juices. Instead, choose balanced, healthy meals so that your body gets the nutrients it needs from all the necessary food groups.

Tips for modifying calories

Here are a few tips for modifying calories without compromising nutrition.

• Dairy: Choose low-fat or fat-free dairy products to cut down on the calories and unhealthy fat. Switch to skim or 1 percent milk rather than whole milk. Choose low fat or part skim cheeses instead of regular, full fat cheese. Switch to low-fat or fat-free yogurts.
• Fats and oils: Limit the amount of saturated and trans fats in your diet by limiting fried food, packaged food, and high-fat meats. Include heart-healthy fats like oils and nuts and nut butters in your diet. It is important to monitor your portion sizes, even with healthy fats, because they are high in calories. Choose fat-free or reduced-fat salad dressing and mayonnaise.
• Fluids: Staying well hydrated is important for general health. Good hydration is also important because sometimes we confuse thirst with hunger. Choose diet or sugar free drinks such as water, crystal light, sparkling water, and diet drinks flavored with artificial sweeteners instead of juice, regular soda, or sweet tea.
• Fruits and vegetables: Most vegetables are low in calories and make up nutritious parts of meals and snacks. Avoid adding butter, margarine, sauces, and dressings to vegetables because those will increase the fat and caloric content. Choose fresh fruit instead of drinking fruit juice. If consuming canned fruit, choose fruit packed in its own juice instead of syrup. Try to have fruits and vegetables make up one half of your plate at lunch and dinner.
• Grains: Do not avoid grains because they are needed for a healthy diet, but do monitor portion sizes. They should typically take up approximately one quarter of your plate. Consume whole grains instead of processed or refined grains. Whole grain options include whole wheat, oats, barley, rye, quinoa, couscous, brown rice, and whole wheat pasta. Limit refined grains and grain products made with fat, such as biscuits, croissants, pancakes, waffles, and prepackaged desserts, as they contain more calories than other bread products. Avoid adding butter or margarine to breads.
• Protein: Choose lean protein such as fish, poultry, eggs, or beans. Trim away all fat on meat. Prepare meals by broiling, baking, roasting or grilling instead of frying. Protein foods should typically take up approximately one quarter of your plate.
• Snacks: Snacks can be part of a healthy diet, but it is important to choose healthy snacks that will promote satiety and energy. Combine a grain, fruit, or vegetable with a healthy fat or protein to help you stay full. For example, eat a fruit with peanut butter or some whole grain crackers with low-fat cheese. Avoid snacking on junk foods such as chips and cookies because these are high in calories and won’t keep you feeling full.
• Sweets: Typical desserts tend to be high in calories, sugar, and unhealthy fats. Try fruit, sugar-free pudding, or low-fat yogurt instead of typical desserts as a healthy option. Limit high-fat desserts like cakes, pies, candy, and cookies to special occasions and monitor your portion size.