A Centers for Disease Control & Prevention Health and Nutrition Examination Survey found that 16% of Americans over the age of 65 who live in retirement communities consume less than 1,000 calories a day. That is roughly half the federal government’s recommended daily allowance for this age group. Two studies have shown that low body weight accelerated bone loss and hip fractures in 6,785 older women and 1,342 older men.
Unintentional weight loss can begin as a physical problem, such as cancer, that can develop into a mental health problem such as depression as the disease progresses. It can also begin as a mental health problem that turns into a physical problem. Evidence is mounting that not eating can affect the mental well-being of people who are depressed, who may also become depressed after they stop eating.
A recent study of older people found their average rate of weight loss doubled in the year before Alzheimer’s became apparent. The study followed 449 older people, many in their 70s and 80s but some as young as 65, for an average of six years. All the participants initially had healthy minds, but 125 were eventually diagnosed with mild dementia. Among this latter group, the rate of weight loss doubled, from 0.6 pounds per year to 1.2 pounds per year shortly before their diagnosis.
Feed the problem?
To determine why someone is not eating enough or eating the right kinds of foods, a health professional may do a nutritional assessment and order various blood tests. When an eating disorder or depression is suspected of causing the weight loss, the doctor may suggest counseling and prescribe various medications to improve appetite.
Cindy Underwood, an Erickson HealthSM dietitian at Greenspring, an Erickson built and managed community in Virginia, cautions against a one-size-fits-all treatment approach to a medical problem with many underlying causes. “It matters why the person is losing weight so you need to confer with a doctor to find out what is going on,” she says.
Evans does just that when she begins her nutritional assessment, along with an inspection of her client’s surroundings. “You need to look at how they are eating and preparing their meals. If they can’t shop, who is shopping for them, if anyone?” she asks.
Are supplements the answer?
When someone is not eating, it may help to indulge the person’s culinary preferences before trying a supplement. “If we find foods that are wellaccepted, we look at how we can fortify and offer them to the person. This is frequently a better approach than giving them a supplement,” says Doris Henning, Erickson HealthSM director of dining in Maryland.
If that doesn’t work, nutritional supplements are often the next step. “When specific treatments are not identified, a comprehensive nutritional strategy is the best approach,” says William Russell, M.D., vice president and regional medical director at Erickson Communities in Maryland. He insists that routine tube feeding to maintain nutrition and prevent muscle wasting does not generally keep people alive.
Others share his concerns about the value of tube feeding. “For years, the idea has been to feed people and think that will make them better but every species quits eating when they are sick,” says David R. Thomas, M.D., a professor of geriatric medicine at the St. Louis University Health Sciences Center in Missouri.
As an alternative, Thomas prescribes appetite stimulants, including megestrol, to improve appetite, produce weight gain, and help people feel better. Does it make them live longer? “We don’t know,” he says. Does it make them live better? “Yes, I think it is compassionate care,” he says.
He also favors antidepressants because of evidence that they boost appetite and weight gain while treating the underlying depression, stress, and anxiety that contribute to the weight loss problem.
Several studies are exploring the potential benefit of various drugs to improve appetite and help control sickness in people with unintentional weight loss. For now, could being pleasantly plump provide an edge when the chips are down? At least one physician thinks so. “If I got sick, I would much rather have a little reserve than be underweight,” Lewko says.