Last updated: August 2020
Next review: August 2022
URN: 0074

Dietary advice if you are having problems eating enough: A guide for adult service users and their carers/relatives

This leaflet gives Food First advice for service users who:

• Have been unintentionally losing weight
• Have an ongoing poor appetite
• Are only able to eat small amounts
• Want to gain some weight gradually
• Have been identified at risk of developing a pressure injury

Some of the information contained in this leaflet may be unsuitable if you have diabetes or end-stage renal disease. If you are worried about your diabetes, please contact your healthcare professional.

Improving nutrition

Many people who are unwell can have problems with eating. This can be upsetting or stressful. Medical treatment, surgery, and some medications can lead to side-effects that often reduce appetite, which can lead to someone eating less than usual.

Maintaining good nutrition can:

• Help prevent weight loss
• Improve your strength and maintain mobility levels
• Maximise your energy levels and keep you feeling good
• Help maintain your skin in good condition
• Support preparation prior to surgery
• Support recovery after illness or an operation
• Support your immune system to fight infections

Top tips

• Aim to eat ‘little and often’ throughout the day e.g. have 3 small meals and 3 snacks or nourishing drinks every day (something every 2-3 hours). Smaller amounts are easier to eat and regularly eating can maintain/improve your appetite.
• Feeling hungry? Make the most of it, and eat more when you are feeling hungry e.g. if you are hungry most in the morning, try having a cooked breakfast, or have a nourishing snack if you are hungry between meals.
• Eat first, drink later. Drinking with meals can make you feel fuller sooner.
• Can’t be bothered with cooking? Choose readymade oven/microwave meals or tinned foods such as chilli, bolognaise, curry.
• Try having a pudding, snack, creamy soup, or a nourishing drink if you do not feel like eating a meal.
• If you are feeling tired choose soft, moist foods which are easier to eat.
• Take your time and rest during eating if you need to, have the best bits first!
• Include something from each food group at meals to make sure you get a range of nutrients – Beans, pulses, fish, eggs, meat and other proteins – Potatoes, bread, rice, pasta and other starchy carbohydrates – Fruit and vegetables – Dairy and alternatives (e.g. cheese, yoghurt)
• Avoid foods and drinks labelled ‘low fat’/’low sugar’/ ’no added sugar’/‘diet’/‘light’ – full fat and sugar products are more nourishing
• A small glass of alcohol may stimulate your appetite – try having one 30 minutes before your meal (ask your doctor first to ensure it is suitable with any medication that you take).
• Get out – fresh air can often help stimulate your appetite. Try going for a brief stroll or simply step or sit outside for a while before meals. Try to eat in a well ventilated room.
• If possible, make meal times sociable by sharing the experience with others. Eating with relatives, friends, informal carers, attending local cafés, pub lunches or visiting voluntary, community or faith organisations with luncheon clubs or events can all help improve your eating experience.
• If food shopping is difficult or too tiring, consider alternatives such as supermarket online delivery, community meal delivery services, or private delivery services (such as Wiltshire Farm Foods, Parsley Box, Oakhouse Foods or others).
• Smoking can reduce your appetite. If you do smoke, try not to smoke in the half an hour before your meal. If you wish to give up, ask your GP or nurse for information on local support services.

How to fortify/enrich your food

It is important to choose food that is energy dense which provides lots of calories (energy) in each mouthful. Adding fats and sugars to your diet will mainly increase the calories, and adding dairy foods (especially full-fat options) will increase both protein and calories. This is called fortifying or enriching your food intake.

• Milk: Add 2-4 tablespoons of dried milk powder to 1 pint of full fat milk (this is called “fortified milk”)
• Breakfast cereals and puddings: Fortified milk, evaporated milk, nuts or dried fruit, full fat yoghurt or cream
• Sauces and soups: Fortified milk, evaporated milk, grated or cream cheese, full fat yoghurt or cream, dried milk powder
• Potatoes (boiled, mashed, or fried): Fortified milk, butter or margarine, grated or cream cheese, mayonnaise or salad cream, olive oil
• Cooked vegetables: Grated or cream cheese, mayonnaise, butter or margarine, olive oil, creamy sauces
• Salads: Grated or cream cheese, olive oil or dressing, mayonnaise or salad cream, coleslaw, avocado

Top tip: Aim to have at least one pint of fortified milk per day either by itself or in drinks/puddings (see above for recipe)

Nourishing snack ideas

Aim for 2-3 snacks in between meals.

Savoury

• Crackers/oatcakes with butter and/or cheese and chutney
• Tinned fish or scrambled egg on toast with added mayonnaise or cheese
• Pate or meat paste on toast
• Small bowl breakfast cereal with fortified milk
• Omelette made with cream and cheese
• Handful of nuts and seeds
• Bread sticks with houmous
• Slice of quiche/pizza
• Teacake/crumpet with butter
• Mini sized cocktail sausages, sausage rolls, scotch egg, pork pie
• Tortilla chips or crisps and with creamy or avocado based dips
• Bagel or pitta bread with peanut butter

Sweet

• Chocolate coated biscuits or shortbread
• Malt loaf, fruit loaf or gingerbread with butter or margarine
• Cereal bar
• Chocolate
• Scone with jam and cream
• Slice of cake/muffin/ doughnut/pastry
• A handful of mini-sized chocolate bars
• Creamy yoghurts with oats or cereal
• Tinned fruit with cream, evaporated milk or ice cream
• Custard or rice pudding
• Jelly and ice-cream
• Fruit segments (such as orange) dipped in melted chocolate
• Porridge made with fortified milk with honey, sugar or jam

Nourishing drinks

Milky drinks are the most nourishing types of drinks, and can be made with fortified milk. Try having:

• Malted milk drinks like Ovaltine or Horlicks
• Hot chocolate with cream and marshmallows
• Ready-made or homemade milkshakes, try adding ice cream, yoghurt and fruit
• Soup (creamy varieties are best) with extra cream or cheese
• Supplements bought from the pharmacy or supermarket (milkshake or soup style) such as Meritene, Complan, Aymes Retail, Nurishment or others

Store cupboard ideas

If you can’t get to the shops regularly, it’s useful to have a store of some basic foods. Choose foods and drinks that are full fat/sugar.

• Whole milk/full cream milk (blue label) – long-life/UHT/ evaporated
• Desserts, mousses, yoghurts, fromage frais, and puddings – long-life/UHT tinned or fresh
• Oils, margarine, butter, spread
• Cheese (hard, soft and spreadable)
• Mayonnaise, salad dressing, houmous, coleslaw, dips
• Nuts and seeds, dried fruit
• Cakes, chocolate, crisps, biscuits – cream, chocolate, cheese
• Drinks – lemonade, cola, cordial, cocoa, hot chocolate, long-life fruit juice • Jams, marmalade, lemon curd
• Soups – “cream of” varieties
• Tinned lentils and other pulses
• Tinned meat, fish
• Tinned fruit, vegetables (including baked beans)
• Breakfast cereals
• Crackers, crispbreads, pasta, rice
• Ready meals – fresh or frozen
• Instant mash

What to do if you continue to experience problems

If you continue to experience problems such as ongoing weight loss despite following the above dietary advice, start to keep a food diary and contact your GP for advice. Your GP will consider if further medical tests are appropriate, and can also refer you onto a specialist dietitian. If you are vegan or do not tolerate dairy contact your health care professional for further advice.