Keeping your weight stable in older age

How to gain weight safely when you're down a few pounds.

You've spent your whole life trying to keep extra pounds off. Now your doctor says you actually need to gain a few pounds to stay healthy. But healthy weight gain isn't so simple. "Some people find it difficult to add enough calories to their usual diet. It takes a lot of effort," says registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.

Where to begin

A dietitian can help you come up with an eating plan based on your specific calorie needs. It starts with understanding how quickly you've lost weight and why (see "Why are you underweight?"). Your age, size, activity, amount of weight lost, and overall health will be key to designing a diet that's right for you.

Meal structure is also important. McManus says eating mini-meals throughout the day is better than relying on large feasts. "If you've lost weight, you're used to eating a lower volume of food, and you get fuller faster. It's better to spread several 300-calorie meals throughout the day than dump 900 calories at dinner," she explains.

What if you're not up to eating a mini-meal at some point during the day? "Have a protein drink. It could be something you make at home or something ready-made that you buy," McManus says.

If it's ready-made, you'll want a drink with about 10 to 20 grams of protein per 8-ounce serving, and as little added sugar as possible. (If sugar is the first or second ingredient, there's probably a healthier option.)

Why are you underweight?

There are many reasons for weight loss in our older years. "Unless it's because someone is dieting, weight loss is a cause for concern, especially if the person has lost 10% of their prior body weight," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Sometimes weight loss results from a lifestyle change, like the loss of a loved one or a loss of independence. You may be depressed and lose interest in eating. Or you may have to cut back on food because of a tight budget. "Usually weight loss suggests an underlying health condition, such as an overactive thyroid, depression, cancer, or dementia that causes people to forget to eat or shop for food," Salamon points out.

Other possible causes of weight loss:

  • a recent hospitalization

  • a loss of taste or smell due to Parkinson's disease or another condition

  • medication side effects such as nausea, diarrhea, or decreased appetite

  • dental problems that cause difficulty chewing

  • infections such as pneumonia or skin infections

  • disability or pain that makes it hard to prepare food for yourself.

Whatever the reason, weight loss increases the risk for malnutrition: insufficient calories, protein, vitamins, and minerals you need to function properly.

The best foods to eat

McManus steers people toward nutrient-dense foods with the most nutrition bang for the buck: they have lots of vitamins, minerals, fiber, lean protein, or unsaturated fat.

For example, a slice of white bread has about 70 calories, but very few vitamins and minerals. However, one slice of whole-wheat bread has about 70 calories, plus four times the amount of potassium and magnesium and three times the zinc.

Other examples of nutrient-dense foods: green, leafy vegetables (kale, spinach); fruits (berries, apples); whole grains (oatmeal, quinoa); beans and lentils; lean protein (fish, poultry, lean meat); dairy foods (low-fat milk, cheese, or yogurt); and unsaturated fats (nuts, seeds, avocado).

Making it work

Don't worry about counting grams of nutrients. "Just aim for a balance of healthy carbohydrates, unsaturated fats, and protein," McManus says. She advises power-packing each mini-meal with as many nutrient-dense foods as possible. Examples include oatmeal with berries and walnuts; a salad with spinach, tomatoes, cheese, black beans, shelled sunflower seeds, and avocado dressing; or brown rice with raisins, almonds, chicken chunks, and asparagus pieces. For something simple, try scrambled eggs with cheese or whole-wheat crackers with peanut butter.

Eating this way throughout the day will help you regain the weight you've lost. "I look to see 2 to 3 pounds per month if they're going in the right direction. It won't be faster than that," McManus says. "You have to hang in there and be consistent over time. Slow and steady wins the race."

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