Management of weight loss and failure to thrive
Most of the time the topic of conversation, when it comes to nutrition and weight, is how to lose weight. However what if you want to gain weight? What if you or someone you love is severely underweight? Being underweight is just as unhealthy as being overweight. The frail elderly population is especially at risk for nutritional deficiencies, decreased immunity and even has a higher risk of death. Malnutrition and low body measurement index (BMI) may occur in the elderly due to dental issues, depression, malignancies, cardiac disorders and benign gastrointestinal diseases such as GERD or gastritis. Medications frequently have side effects that may cause nausea and vomiting and anorexia as well. Unfortunately, a specific cause is not identified in approximately one quarter of elderly patients with unintentional weight loss. Regardless of the cause, underweight seniors should gain weight to improve their both their physical and emotional health.
In neonatal and geriatric medicine this type of weight loss is sometimes called failure to thrive or FTT. The National Institute of Aging describes failure to thrive as a "syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol." In the geriatric population failure to thrive describes a syndrome of general decline that occurs in older adults that is frequently compounded by cognitive (thinking) impairment and/or functional disability. This can become a vicious cycle and may snowball out of control.
Okay, enough of all the negativity, as all is not lost. The first step is to have a thorough medical exam that rules out causes for weight loss such as cancer, renal disease, liver disorders and other possible physical causes. A battery of lab tests should include a lipid profile to look for low cholesterol and low albumin (protein) levels. Both are common in individuals that are malnourished. A psychological evaluation, such as the “mini mental exam” can evaluate for changes in cognitive abilities. Often the elderly are diagnosed as demented when in reality they are clinically depressed. No matter what the outcome the priority remains calories, calories, calories. The earlier the better once there has been a weight loss of over 5 percent. The consequences of sustained malnutrition are dire.
Consequences of weight loss
Involuntary weight loss can lead to general muscle wasting, decreased immunity, depression and an increased rate of disease complications. Infections, pneumonia and injuries from falls can occur. Various studies have demonstrated a strong correlation between weight loss and death. One study showed that nursing home patients had a much higher mortality rate within six months after losing as little as10 percent of their body weight. In another study, elderly patients who lost only 5 percent of their body weight in one month’s time were found to be four times more likely to die within one year. Statistics like that are a wakeup call for early detection and intervention.
Several drugs have been used to promote weight gain. However, the Food and Drug Administration have not labeled any of these drugs for use in the elderly population with weight loss. Doctors still however may still prescribe them in hopes of an improvement.
Mirtazapine (Remeron) has been shown to increase appetite and promote weight gain while also treating underlying depression.
Dronabinol (Marinol) is a cannabinoid medication indicated for the treatment of anorexia with weight loss in patients with AIDS. This drug has also been studied in patients with Alzheimer's disease with some success. It contains elements found in marijuana which is known to spark the appetite.
Megestrol (Megace) has been used successfully to treat anorexia in patients with AIDS or cancer. Lower dosages may be effective for stimulating weight gain in frail elderly patients as well. It is hormone derived and sometimes effective.
Although medications may help promote appetite and weight gain in an elderly patient, drugs should not be considered first-line treatment. Even if drugs are successful in inducing weight gain, long-term effects are unknown. Nothing beats good old fashion nutrition.
The main goal is to increase the overall intake of calories every day. Several small meals or snacks throughout the day may be preferred. Often having a lot of food presented at one time is intimidating and unpalatable. Supplemental drinks such as ensure or boost should be drank between meals and not with meals in order to not dampen the appetite. Find out what are the person’s favorite foods and work with that. It is all good and fine to develop a creative and highly balanced nutritional plan, however if it is not eaten it will do no good. But be careful, some weight loss products can kill you.
Here are a few basic tips:
• Have an extra slice of whole grain toast at breakfast,
• Add some nut butter to that toast,
• Add extra olive oil to pasta. Good for the heart too!
• Use whole milk to prepare soups and hot cereals like oatmeal.
• Add extra cheese or a piece of turkey bacon to an omelet.
• Stir chopped nuts or wheat germ into plain yogurt and top with honey.
• Add calories with nutritious beverages such as milk, 100-percent fruit juices, or vegetable juices. Water is always a good choice but devoid of calories.
• Add a few more calories to potatoes with gravy or cheese.
• Add dry milk powder to instant mashed potatoes.
• Top your vegetables and starches with butter, olive oil or cheese.
• Drink smoothies made with frozen fruit, whole milk or yogurt and honey between meals.
• Creamed soups are generally higher in calories, and you can add even calories to by adding a spoonful or two of dry milk powder.
• Choose puddings, sweetened yogurt, custards and muffins made with whole grains and dried fruit.
Supplements such as Ensure and Boost can be expensive, and after time they can become boring. Here is an idea that is easy and has vast variety ability. Combine the following in a blender:
• A cup of milk, almond or soy milk
• A scoop of vanilla ice cream or frozen yogurt
• A packet of Carnation Instant breakfast
• Add fruit, extracts or flavorings to taste.
Blend well in a blender and you will have a well balanced and nutritious smoothie that is superior to anything on the market. Vanilla, banana, caramel, strawberry, butterscotch and orange extracts are excellent choices. You can use different flavors of ice cream as well or even orange sherbet. The variety is endless. Make sure to serve this between meals and not with a meal. It is okay to occasionally substitute a smoothie for a meal however, don’t make it a habit. It is an excellent choice however as a midmorning and mid afternoon snack.
Other ideas to stimulate the appetite
There is something to be said about socialization and eating with others. After all who really likes to eat alone? Arrange to attend family meals or senior potlucks at your senior center or YMCA. Having company may inspire the person to eat more and add variety to their meals. Potlucks can allow for variety and the ability to experiment with new tastes and textures.
Add light exercise to stimulate the appetite. Seek out special seniors classes at the gym or simply allow for a walk with a friend, neighbor or spouse. Getting out is good for the mind, body and spirit.
Take away message: Gaining weight is easy for the majority of us but a struggle for some. Just as in a typical weight loss program, it is achievable if the right diet and exercise are combined. By increasing the food intake and frequency of meals, you can achieve the goals one day at a time. As always consult your healthcare professional before making any changes especially if there is a metabolic disorder such as diabetes.
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