Unintended Weight Loss

Kathrynne Holden, M.S., R.D.

All too often, people with PD lose weight, sometimes a critical amount of weight, unintentionally.There are many possible reasons for this.

• Depression can cause lack of appetite and desire to eat.

• Chewing or swallowing difficulties may make it hard to eat at a normal rate; it may take hours to finish a meal

• Some have difficulty manipulating a fork and knife

• Tremor and dyskinesia burn up many extra calories

• In other instances, people with PD report their appetites are good, they enjoy eating, and yet still mysteriously lose weight.

Often this weight loss is gradual, taking place over a period of several years. In other cases, weight loss can be sudden, occurring over a period of months or even weeks.

Weight loss --why is it a problem?

Unplanned weight loss should never be taken lightly. Studies report that the loss of just ten percent of a person’s maximum lifetime weight within the past ten years raises the risk for illness, bone fracture, and even death.

When we lose weight, precious muscle mass is depleted, too. Muscle wasting makes it difficult to walk, maintain proper balance, and perform the usual activities of daily living. Furthermore, the body becomes depleted of nutrients, ike vitamins and minerals. This depletion can lead to behavior change, altered mental function, depressed immune system, weakened bones, and other undesirable conditions.

Besides these concerns, we need regular meals to maintain our energy. People with PD often experience fatigue due to the disease or medications used to treat PD; lack of glucose can make this fatigue even worse. Food supplies a steady stream of blood glucose, which our body’s cells use for nourishment, energy, and work. Without this glucose, we may feel tired, listless, apathetic.

If you have lost weight without meaning to.....

If you or someone you know has lost weight within the past few weeks, you must notify your physician and ask for a referral to a registered dietitian.Why? Your medications, laboratory reports, food preferences, and any diagnoses must be taken into consideration when planning a weight gain program. A dietitian can help you solve these problems and design a safe, personal eating plan for regaining weight.

What if I don’t feel like eating?

Medications can cause a loss of appetite. Also, people with PD often lose the sense of smell, and this affects the ability to taste, and sometimes affects appetite as well.

When your appetite is poor, a big plate of food can seem discouraging. Don’t try to force yourself to eat large meals.You’ll need to eat a bit more than you have been, but not all at one time. Instead, plan for three small meals and three or more nutritious snacks each day. Meals should range from 300 to 600 calories each, and snacks from 50 to 300 calories, totaling enough calories to prevent weight loss. If weight loss has already occurred, calories should be adequate to allow you to regain weight.

Aim for a gradual weight gain of about one or two pounds per month. A number of my clients who have experienced gradual weight loss over as muchas ten years, have regained weight in this way.

What if I can’t finish meals on time?

Several conditions may make it hard to finish a meal. Sometimes bradykinesia (slowed movement) makes it difficult to handle utensils, or cut meat.

It may help to choose softer foods, like meatloaf, soups and stews, where the meat has been ground or cooked to tenderness, and doesn’t have to be cut. Avoid raw vegetables and lettuce salads – these are difficult to spear on a fork and convey to the mouth. Cooked vegetables, vegetable juices, and vegetable soups may be better choices. Pureed soups can be sipped from a mug, avoiding the need for a spoon. This can also help if chewing becomes difficult.

Sometimes it’s hard for me to swallow, or I feel like I might choke.

If it’s hard to swallow, or if choking occurs, your physician should order a visit to a speech pathologist. This is very important because there could be a danger of inhaling food. Food particles, liquids, or even saliva in the lungs can cause a form of pneumonia called “aspiration pneumonia.” Aspiration pneumoniais a very frequent cause of hospitalization among people with PD. The speech pathologist can perform a swallowing evaluation to determine whether you are at risk for aspiration pneumonia, and if so can show you safe swallowing techniques.You may be advised to eat soft, well-cooked foods or to avoid such foods as nut butters and raw vegetables until danger of choking is past.

When depression causes weight loss

Lack of appetite may be due to depression, a condition of sadness or hopelessness.This is often a temporary condition, but if it persists, your doctor may refer you to a counselor, or prescribe a medication to help. It’s especially important to eat at this time, because lack of nutrients can make depression much worse.

Follow the guidelines under “What if I don’t feel like eating?” Aim for small meals with frequent snacks. Meals and snacks should be as nutritious as possible, in order to provide all the vitamins and minerals needed to help overcome depression. A multivitamin-mineral pill is a good idea, too; ask your physician or pharmacist to recommend one.

Keep on hand the foods you like best. It’s easier to eat foods you like than those you don’t much care about.

Keep small snacks sitting out, where you can reach them easily. If you take levodopa, low-protein snacks are especially important. A dish of ice cream, a cup of hot chocolate (make with fortified soy or rice milk substitute if necessary),a few fig cookies, may be appealing. It’s better to eat sweets than not to eat at all!

Attractive, colorful meals are usually more appealing, so make the most of garnishes, textures, and flavors. A bright, cheerful setting, and soft music, may help, too.