Loss of Appetite and Weight Loss – When to Act

“Loss of Appetite and Weight Loss – When to Act” was written by Daena Lamoureux, MSc, RD. Reviewed/edited by Katie Dodd, MS, RDN, CSG, LD, FAND.

Perhaps you have found yourself (or you know a loved one) in a situation where food doesn’t hold the same appeal.  Your clothes are bigger on you than they used to be.  Has this ever happened?  What did you do?  What, if anything, should you do?

Why Do Loss of Appetite and Weight Loss Matter for Seniors?

Scientific evidence continues to point to the fact that loss of appetite and weight loss (unintentional) may lead to poorer outcomes as we get older: we are at higher risk of becoming sicker, we have more difficulty in recovering, and we are more likely to die if we are ill.

Loss of Appetite

Signs of Poor Appetite

When does a poor appetite become a problem?  We aren’t talking about just being “not hungry” for one meal or being disinterested in eating when you don’t like what is being served. 

Loss of appetite that should be addressed occurs over a longer period (more than 1 – 2 days), involves a general disinterest in eating that you can’t readily explain, and may even include nausea at the sight or smell of food. 

Reasons for Loss of Appetite

Sometimes we may have an idea of why we don’t want to eat.  Sometimes the reasons may be more difficult to pinpoint.  Here are just some of the possible causes.  Do any of these ring true for you?

  • Mouth health: Having a toothache, sore gums or a dry mouth can all be reasons why we just don’t feel up to eating. 
  • Disease: Cancer, liver disease, COPD, kidney or heart failure and dementia are just a few of the conditions in which appetite decreases.
  • Illness: Some temporary sicknesses like the flu, a cold, or food poisoning definitely cause us to want to eat less. Or, if we have an infection and are taking antibiotics, we may also not feel up to eating.
  • Medications: Some medicines have a side effect of lowering the appetite: directly or indirectly by causing nausea or a dry mouth, by changing our sense of taste or smell, or by causing a sore stomach- none of which make us want to eat!
  • Factors of well-being: If we are dealing with anxiety, depression, or have recently gone through a difficult time (ex. death of a loved one), the effects on our mental health often also affect our desire to eat or to prepare meals.
  • Food textures: For those with chewing/swallowing struggles, the need for softer textures (for safety) can be off-putting, particularly if the way these softer foods are presented is unappealing.  Food is more desirable when it looks good too!
  • Natural changes in our taste and smell with aging
  • Social isolation: If we live alone, we often lose the social aspects of eating or the “cues” provided by others to remind us that it is meal time.  We may no longer need to prepare food for another and so forget to prepare food for ourselves.

Consequences of Loss of Appetite

Loss of appetite leads to other consequences. First, if we are not eating enough, then our body does not receive the nutrients it needs.  If this happens over a longer period of time, we begin to lose weight which can put us at higher risk for illness, disease, and death (1).

Perhaps less obvious, there are social consequences to losing our appetites.  Eating and sharing food with others is often a rich and important time to visit and connect.  If we are not eating, we are likely also spending less time with others. That’s a pretty important thing too!

Weight Loss

Signs of Unintended Weight Loss

There are different measures that your dietitian or doctor might use to measure weight loss: 5% of your total body weight being lost over a 6-12 month period is a place your healthcare team might start as far as “significant weight loss” (2). 

However, you or your loved ones likely have less clinical ways to know as well.  If you weigh yourself, is your weight going down a bit each week/month… even if you don’t feel you are doing anything differently with your diet or exercise?

How about your clothing?  Does it feel baggier or have you had to buy smaller clothing sizes? Have family members expressed concern about your weight going down?  Does your face seem “thinner” or are your collar bones more pronounced than they used to be?

Reasons for Weight Loss

Because prolonged loss of appetite leads to unintentional weight loss, many of the reasons for weight loss are the same as those we’ve already discussed for loss of appetite.  Re-visit the list above, but I also want to pull out a few not-yet-mentioned or that are worth highlighting:

  • Intentionally reducing your food intake or increasing your exercise: I suppose it goes without saying, but if you are trying to lose weight by eating less or exercising more, there is a good chance you may see lower numbers on the scale!
  • Disease: Cancer, dementia, undiagnosed diabetes, digestive diseases like Crohn’s, colitis, or Irritable Bowel Syndrome (IBS).  These and many more may lead to unplanned weight loss.
  • Difficulties with eating/chewing/swallowing: If eating is painful or frightening (due to fear of things going down “the wrong way”), it stands to reason that we may eat less.  Not because we aren’t hungry, but simply out of fear that we might cough or choke.
  • Struggles with drug or alcohol use: For a whole host of reasons, addictions and drug/alcohol use may lead us to lose weight without meaning to.

Consequences of Weight Loss

Unintentional weight loss, as mentioned already, can lead to an increased risk of illness, disease and death (1,2).  When our bodies are not well nourished, our immune systems are less equipped to fight off infections or to heal wounds.

Weight loss also usually includes loss of muscle, meaning that we are likely to become weaker. Doing daily tasks may become more difficult, we may have reduced stamina, and we are more likely to fall.  

This ultimately means that our independence may be affected.  Whether it be moving around, taking care of the household, or attending to our hygiene and care: when we lose weight, all of these day-to-day tasks become more challenging and we are at higher risk for injury.

You can learn more about unintended weight loss here.

How Do I Know When it’s Time to Act?

So, we’ve gone through what can cause loss of appetite and weight loss and why there are some big problems that can arise when we have either of these issues. 

WHEN IS IT TIME TO DO SOMETHING ABOUT IT?

  • When there are other concerning symptoms.  Are you nauseous or vomiting? Do you have a fever, diarrhea, constipation, ongoing fatigue?  These symptoms can lead to dehydration, malnutrition and other serious issues if not addressed promptly.
  • When you can’t identify a straightforward reason for loss of appetite or weight loss.  Let your healthcare team work with you to figure out the cause(s).  Getting to the root of the issue is critical.
  • When you can identify a reason for loss of appetite or weight loss and it’s not going to go away…. or go away anytime soon.  Maybe you have figured out you have a sore in your mouth or abdominal cramping that keeps you from eating.  Has it been around for more than a day or two?  Time to seek some help to get the situation under control.

Please note: you may think you have figured out the reason behind your appetite or weight loss.  You may even be right.  EVEN SO, if you have been struggling with the loss of appetite or unplanned weight loss for a while now….. seek help anyways! 

Not only will your healthcare team be able to properly test and diagnose things, but they will be able to work with you to effectively and safely address the problem. 

Who Do I Go To For Help?

If you are dealing with other urgent symptoms (eg. vomiting, diarrhea, fever, or nausea), it may be appropriate to visit an Emergency Department or Urgent Care facility for immediate assistance.

In the absence of urgent symptoms, your physician is your go-to for diagnostic testing to get to the bottom of the problem.  You will also want to be referred to a dietitian. Depending on where you live, this may be through your doctor or you may be able to self-refer.

Your dietitian should be able to help pinpoint issues contributing to your loss of appetite or weight loss. And they are a key team member to develop strategies and plans to get your appetite and weight back on track!

Finally, if you are in contact with other health care professionals, don’t hesitate to tell them about your weight and appetite concerns too.  Health care professionals want to have a clear picture of your overall health, and they should direct you to the professional you need.

What Should I Tell My Healthcare Team?

  • Share your symptoms – all of them- as clearly as possible.  The more detail you can share, the more information your team will have to be able to discern the issues and make correct diagnoses.  Don’t be shy to write things down so you remember!
  • Let the team know when these symptoms began.  Do you have dates or approximate timelines for when each symptom began?  Did you notice a lower weight four months ago?  Has your appetite been poor for one week?  These details matter and are helpful.
  • Help the team to understand your “baseline”.  If you have numbers or quantities, the team will thank you!  If you were 175 lbs three months ago and are now 130 lbs…that’s useful information.  If you normally eat 3x/day and now eat once, please tell us!

Can Anything Be Done About My Appetite or Weight Loss?

There are MANY ways that loss of appetite and weight loss can be addressed.

The very best strategy is to determine the root of the problem.  Sometimes if the root can be addressed (ex. healing a sore gum, changing a medication, altering a food texture), one’s appetite can return and weight can be restored.

Sometimes, we find the root of the problem and realize that loss of appetite and weight loss are going to continue (ex. diagnosis of cancer or dementia).  However, knowing the root issue can help the care team (especially the dietitian!) determine the best way forward.

Knowing diagnoses and root causes helps the team to be able to offer YOU as many safe and reasonable options as possible.  Maybe it means having foods with more calories, maybe it means eating smaller meals more often each day, maybe it means a nutrition supplement. 

Regardless, you will be at the center of all these conversations with your dietitian to decide which strategies will work best for you.  Let’s talk about it!

References

  1. Park, S.I. et al (2018) Weight change in older adults and mortality: the Multiethnic Cohort Study.  International Journal of Obesity 42(2), 205-212. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803382/
  2. Gaddey, H.L and Holder, K.K. (2021) Unintentional Weight Loss in Older Adults. American Family Physician 104(1), 34-40. https://www.aafp.org/afp/2021/0700/p34.html#afp20210700p34-sort1

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