Build Yourself Up Nutrition and Dietetics Department Patient Information
This leaflet provides advice on how to increase the protein and energy content of your diet if you have a poor appetite and need to gain weight. It may not be suitable if you have diabetes or renal disease. If you have either of these conditions speak to you doctor before using this information. For specific individual advice ask your doctor to refer you to a Dietitian. Page 2
The best way to achieve weight gain is to: Eat LITTLE AND OFTEN - take small nourishing meals together with nourishing snacks and drinks between meals ENRICH your food and drink WHY SHOULD I EAT WHEN I DO NOT FEEL HUNGRY? Eating regular meals is important. If you go for longer than a couple of days without adequate food you will begin to lose weight. This is because your body will use its own muscle and fat stores for energy, leaving you feeling tired and weak. When you eat adequate amounts of nutritious food to maintain your weight, you should be able to fight infection and illness better, and healing will be quicker. This is especially important if you need surgery, have recently undergone surgery or are recovering from an infection. Avoid buying diet or low fat products as these are generally intended for people trying to lose weight. Page 3
Top tips for improving your appetite Eating regular meals helps your body to regulate your appetite: Try eating three small meals and three snacks each day. For example: Breakfast Lunch Evening meal Midmorning snack Mid-afternoon snack Bedtime snack Avoid missing or skipping meals! If you don t feel like eating have a nourishing drink instead. Use a smaller plate to avoid being overwhelmed by large quantities and present your food in an attractive way to tempt your appetite Where possible take a little exercise and get some fresh air as these may help to improve appetite and general feeling of well-being A small glass of alcohol 30 minutes before your meal can help to stimulate your appetite. Follow your doctor s advice and check with your pharmacist to ensure it is safe for you to have alcohol first If the smell of food is off-putting, make sure the room is well ventilated whilst cooking or avoid hot meals for a while. Cold meals can be just as nutritious as hot meals. Page 4
Avoid drinking too much fluid with your meals as this will make you feel fuller. Water and diet fizzy drinks are very low in energy and protein and can reduce your appetite. You may find you eat better with company and in a pleasant social environment. If isolation is a problem, perhaps you can join a lunch club or day care centre. Oral hygiene is very important make sure you keep your mouth clean and healthy with regular tooth brushing 2-3 times a day. Mouthwashes can help to keep the mouth fresh. Your GP may be able to prescribe mouth care preparations, e.g. artificial saliva (Prescribed by GP), if required. Page 5
WHAT SHOULD I EAT? It is important to try and have as varied a diet as possible, to provide all the essential nutrients. Try to include the following: Three portions of starchy food per day: approximately a 1/3 of your plate at each meal e.g. bread, breakfast cereals, potatoes, rice, pasta, chapattis, and other cereal foods Two portions of protein per day (One portion 100g/4oz): meat, fish, beans, cheese, nuts and eggs Try to have a small portion of fruit or vegetables with a knob of butter/margarine/cream with each meal every day. You could include fruit in a pudding e.g. apple crumble and ice cream, fresh fruit with cream, bananas and custard Try to have one glass of fruit juice per day Aim for three portions of dairy food per day: o 1/3 pint/ 200ml fortified full cream milk (see page7), o 125g/ small pot of thick and creamy yoghurt o 30g/1 matchbox size piece of cheese Oily Fish: try to have oily fish at least 1-2 times per week. Oily fish such as herring, salmon, mackerel, sardines and pilchards are good sources of healthy oils and often can make an appetising smaller meal, e.g. pilchards on toast 6-8 cups of fluid per day (1500-2000ml/ 3-4pints). Try to use nourishing drinks such as milky coffee, milky tea, fruit juice, smoothies, fortified milk (see page 6), or squash with added vitamin C as your main sources of fluids. Water and diet fizzy drinks count as fluid but are very low in energy and protein. Page 6
HOW TO INCREASE CALORIES AND PROTEIN Milk Use full cream milk instead of semiskimmed or skimmed milk. Milk can be fortified to increase the energy and protein content by adding milk powder to it. To make fortified milk, mix 3-4 tablespoons of milk powder into a pint of milk, e.g. Marvel, supermarket own brand. Use this within 24 hours. Aim to have 1 pint of fortified milk per day. This can be used in drinks, soups, sauces, even in desserts such as custards, jellies or rice pudding. Cheese Grated cheese kept in an airtight box in the fridge is handy for use in soups and sauces. Use also on cooked vegetables, mashed potatoes, meat and fish to add extra calories. Grated cheese can also be kept in the freezer and used as required. Page 7
Butter/Margarine/Oils/Mayonnaise Use full fat margarines or butter generously Avoid low fat or reduced fat margarines. Full fat margarines are higher in healthier oils and calories Spread thickly on bread, toast, crumpets, scones or chapattis Add to cooked vegetables, potatoes, rice, pasta, sauces and on meat, fish and eggs Add oil based margarines or butter to sandwiches, salads or baked/mashed potatoes Sauces White or cheese sauce can be added to meat, fish, pasta and vegetables. Make the sauce with fortified milk and add 1tbsp of cream or 1oz of grated cheese or full fat soft cheese. When making gravy, add 1 tbsp of cream to add extra calories. Soups Soup is often not very high in calories or protein. Choose creamy soups and add cooked meat, 1oz cheese, 1tbsp of cream or 1tbsp milk powder (mix to a paste with milk) to increase the protein and calorie content. You could also add dumplings which can be pre made and stored in the freezer. Alternatively use Build Up or Complan soups (available from most chemists and supermarkets). Page 8
Desserts Try to have 1-2 desserts per day. A dessert provides a nutritious end to a meal. If you feel full after your first course you could have dessert a little later. Use yoghurt, ice cream, cream, or evaporated or condensed milk to add extra calories Milk puddings and custards can be made with fortified milk Chocolate or fruit flavour mouse are light and tasty Try creamy yoghurts or full fat fruit yoghurt with fruit Jellies or instant puddings made with fortified milk, evaporated or condensed milk Fresh, tinned or stewed fruit with ice cream, cream, custard or evaporated milk Crumble or sponge with custard or cream Rice or ground rice pudding with a spoonful of jam, golden syrup, honey or dried fruit Slice of cheesecake Sticky toffee pudding with clotted cream Trifle Crème Caramel or egg custard Lemon meringue pie Bread and butter pudding Chocolate sponge cake Page 9
SNACKS Keep snacks within easy reach so that you can eat them whenever you like. Some nourishing snack ideas include: Savoury snacks Mini Quiche Scotch eggs Cocktail Sausages Breadsticks with full fat humous or soft cheese Toast with full fat margarine, butter, marmite, peanut butter, baked beans, cheese, fried or scrambled egg Nourishing creamy soup Cheese scone with full fat margarine Savoury biscuits e.g. oat cakes or crackers with full fat margarine and a topping such as ham, peanut butter, soft or hard cheese or pâté. Sandwiches with tempting fillings such as ham, cheese, boiled egg, egg mayonnaise or sardines Crumpets toasted with butter or cheese Page 10
Sweet snacks Cereal with fortified milk Stewed fruit with cream Full fat yoghurt (can be fruity or add tinned fruit) Glass of fortified full cream milk Fruit scone with clotted cream and jam Fruit bread toasted with full fat margarine or butter Fruit smoothie Cake Biscuits Jelly with cream or ice cream Mini trifle Mousse Crumpets toasted or toast with butter jam or honey Dried fruit and nuts Milky puddings e.g. rice pudding, ground rice pudding, tapioca with a teaspoon of jam, honey or syrup Malt loaf toasted with margarine Page 11
NOURISHING DRINKS Milky drinks are an excellent source of protein and calories. Use fortified milk for milky coffee and tea, cocoa or have a glass of milk between meals or at bedtime. Add hot milk instead of hot water to chocolate drinks. Fruit juice, smoothies and squash with added vitamin C are also a good source of nutrients. Build Up or Complan drinks made up with milk are a good source of protein and energy and can be used as snacks between meals. Only use these in place of a meal if you are struggling to eat your main meals. (They can be bought from most chemists and supermarkets). Keep drinks within reach and where you can see them to act as prompt. Use a flask for hot drinks and put it by your chair or bed. Page 12
SUGGESTED MEAL PLAN Breakfast: Mid morning snack: Lunch: And/or Or Mid afternoon snack: Evening Meal: Bedtime Snack: Or Porridge or cereal with milk, sugar or honey and chopped fruit e.g. banana Toast with margarine and jam Small glass of fruit juice Milky drink with a snack from snack list Fish, meat or chicken in a creamy sauce with mashed potato and vegetables with added olive oil or margarine Rice pudding or ice cream and jelly Build Up, Complan soup or drink if unable to manage food Milky drink with a snack from snack list Soup with added milk, cream, meat or cheese Sandwiches with egg, tuna, meat or cheese Tinned beans or sardines or cheese or eggs on toast Milk pudding or tinned fruit with custard or ice cream and jelly Hot chocolate, cocoa or Horlicks Page 13
USEFUL WEBSITES The British Dietetic Association http://www.bda.uk.com/ Mind the Hunger Gap http://www.mindthehungergap.com/ Page 14
Patient Name:... Date:.. Dietitian:... Contact details:... Further Information We endeavour to provide an excellent service at all times, but should you have any concerns please, in the first instance, raise these with the Matron, Senior Nurse or Manager on duty. If they cannot resolve your concern, please contact our Patient Advice and Liaison Service (PALS) on 01932 723553 or email pals@asph.nhs.uk. If you remain concerned, PALS can also advise upon how to make a formal complaint. Author: Dietetics Department: Dietetics Department Version: 3 Published: March 2014 Review: March 2016 Page 15
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