Weight Changes, Malnutrition, and Cancer

Appetite loss, weight loss, and cancer

Appetite loss and weight loss are common side effects of cancer and cancer treatments. Anyone with cancer might lose their appetite and lose weight. But you are more likely to lose weight if you have head and neck, lung, pancreatic, or liver cancer or cancer in the upper digestive system. Upper digestive system cancers include cancers in the throat, esophagus, stomach, and the first part of the small intestine.

Appetite loss often leads to eating less than your body needs, which leads to weight loss. Weight loss can also occur when you burn more calories than you are taking in. Weight loss can lead to malnutrition. 

Although cachexia also causes weight loss, cachexia and weight loss are different and treated differently. Learn more at Cancer Cachexia. 

Side effects of cancer treatment that cause problems with eating include: 

• nausea and vomiting
• diarrhea
• constipation
• feeling full quickly (early satiety)
• painful swallowing
• mouth sores
• dry mouth
• taste changes

Other factors that may cause appetite loss and weight loss during cancer treatment include anxiety, pain, depression, and fatigue. Learn more about Emotions and Cancer.

Ways to manage appetite loss and weight loss in people with cancer

If you start to lose your appetite, talk with your doctor or registered dietitian. Speak with them right away if you start to lose weight. Your dietitian can help you and your family manage your weight loss. Here are some tips that may help.

Ways to Deal with Appetite Loss During Cancer Treatment

Tips about foods to eat:

• Eat foods high in protein and calories.
• Add whole milk to hot or cold cereal.
• Eat foods that smell good.
• Try new foods and recipes.

Tips on when to eat:

• Eat small meals every 2 to 3 hours, about 5 or 6 meals per day.
• If you forget it’s time to eat, set an alarm to remind yourself.
• Eat within 1 hour of waking up.
• Eat high-protein foods first in your meal when your appetite is strongest.
• Use TV shows, commercial breaks, or radio ads to remember to eat or drink.
• Eat a bedtime snack.

Tips about when and what to drink:

• Drink liquids between meals to help you stay hydrated.
• During meals, sip only small amounts of fluids so you can eat more food.
• Drink milkshakes, smoothies, juices, or soups if you do not feel like eating solid foods.
• Use whole milk or yogurt for milkshakes or smoothies to increase calories.
• Sip on nutrition supplement drinks between meals. Examples include Ensure and Boost.

Meal prep tips: 

• Make and store small amounts of your favorite foods so they are ready to eat.
• Add full-fat cheese to toast, eggs, crackers, soups, pasta, and potatoes.
• Add creamy sauces to pasta and other dishes.
• Add leftover meat to eggs, salad, pasta, and soups.
• Add beans and lentils to soup, salad, pasta, tacos, and casseroles.
• Add high-calorie foods to snacks and meals.
• Add higher calorie condiments to meals and snacks.

Other tips to help improve eating:

• Be as active as possible so that you will have a good appetite.
• Brush your teeth and rinse your mouth to relieve symptoms and aftertaste.
• Create a relaxing eating environment. Try adding candles and music and eating with your loved ones.

Medicine to manage appetite loss from cancer and cancer treatment

If you are not able to keep your appetite up, talk with your doctor about appetite stimulants. These are medicines that increase appetite and can cause weight gain. 

Increased appetite, weight gain, and cancer

Although many people with cancer have appetite loss and lose weight, you may gain weight during cancer treatment. 

Weight gain is more common if you have ovarian, breast, or prostate cancer. Each person is different, so even if you have one of these cancers, it does not mean you will gain weight. And you may gain weight if you have a different type of cancer. 

If you gain weight during your cancer treatment, let your doctor know so they can assess the cause and type of weight gain. Small weight fluctuations during cancer treatment are normal and expected. But if weight gain is sudden, such as 5 pounds in a week, or does not stop, tell your doctor right away. 

Causes of weight gain in people with cancer

Fluid retention. Some cancers may cause weight gain due to the size of the tumor or the buildup of fluid. There are different types of fluid buildup, but they all can cause you to gain weight. Learn more at Edema (Swelling) and Cancer Treatment.

Increased appetite. Increased appetite and food cravings that result in weight gain may occur from the cancer itself, cancer treatment, or medicines used with cancer treatment.

Metabolic changes. Hormone therapy may cause weight gain by lowering sex hormones. When you have lower levels of sex hormones, your metabolism slows. Our metabolism is the rate at which we burn energy. A slower metabolism means you burn less energy, which makes it easier to gain weight.

Some hormone therapies and chemotherapy may lead to early menopause in women. Early menopause may decrease your metabolism and cause weight gain. 

Medications. Steroids, which are often given during cancer treatment, increase appetite and make you want to eat more. When we eat more calories than our body burns, we gain weight. If you take steroids, try to eat foods high in fiber and protein at each meal to help you stay full. 

Steroids may also cause weight gain by causing your body to hold onto water (fluid retention). If you retain water, you may look and feel swollen. Learn more about fluid retention at Edema (Swelling) and Cancer Treatment. 

Decreased activity. Many cancer treatments can cause fatigue and pain, making it hard to be active. Being less active may in turn lead to weight gain. Talk to your doctor about how to manage problems like fatigue or pain to stay as active as possible. Learn more at Cancer Fatigue and Pain and Cancer.

Ways to manage increased appetite and weight gain in people with cancer

Here are some tips to manage increased appetite and slow or stop weight gain. Talk with your doctor or dietitian about these tips and which ones are right for you.

Tips about foods to eat:

• Eat foods high in fiber, such as fruits, vegetables, and whole-grain breads, cereals, and pasta.
• Eat fish, lean meats, such as lean beef, pork trimmed of fat, and poultry (chicken or turkey) without skin.
• Eat plant-based proteins, such as beans, nuts, seeds, and tofu.
• Eat low-fat dairy products, such as 1% and skim.
• Eat foods that you enjoy so you feel satisfied.

Tips about foods to limit:

• Eat less fat. 
• Cook with and use less salt to reduce fluid retention. 
• Reduce sugary drinks like fruit juices and soda. Try diluting fruit juice with water. 
• Limit or do not drink alcohol.

Grocery shopping tips:

• Buy ground meat that is 93% lean or higher.
• Buy leaner cuts of meat, such as “loin,” “sirloin,” or “round.”
• To help control portions, buy food in single-serving containers, such as single-serve yogurts.

Meal prep tips:

• Limit cooking oils. As a general guideline, use 1 teaspoon if cooking for yourself. Use 1 to 2 tablespoons if cooking for more than just yourself.
• Use cooking methods that reduce fat, like baking, broiling, air frying, roasting, and boiling. 

Other ways to help with weight gain:

• Plan meals and snacks ahead of time.
• Keep your pantry and refrigerator stocked with healthy snacks.
• Eat only when hungry. 
• Find activities you enjoy, if you eat out of boredom. 
• Eat more slowly. It takes about 15 minutes for the stomach and brain to know if you are full. Slowing down when you are eating can help you know if you are full or not.
• Eat smaller amounts of food at meals. Use smaller plates.
• Exercise daily.
• Keep a food diary. This can help you see what foods and drinks you eat that help you to manage your weight.

If you have swelling from steroids, try limiting or avoiding foods that are high in sodium, such as:

• breads that have a long shelf life 
• sauces
• dressings
• cheese
• deli and canned meats
• olives
• certain frozen foods, such as pizza and frozen dinners
• canned foods (look for low-sodium options)
• table salt
• seasonings with salt

If you don’t want to cut out these foods, look for lower sodium options. You can look at the front of a product to see if it says, “low sodium,” “very low sodium,” or “sodium free.” 

Instead of using the saltshaker, use dried or fresh spices like garlic and onion powder or fresh basil and oregano.

Talk with your doctor and dietitian before going on a diet to lose weight. If you eat because of stress, fear, or depression, think about talking with a counselor. Your doctor might also prescribe medicine to help with these feelings. Learn more about Emotions and Cancer.

Malnutrition and cancer

Malnutrition is when your body doesn’t get enough energy, protein, vitamins, and minerals.

Causes of malnutrition in cancer

Malnutrition can be caused by the cancer itself, the side effects of cancer treatment, or both. 

Cancer and its treatment can cause malnutrition in many ways. They can decrease your appetite, make you feel full quickly, and change your sense of taste and smell. These changes may cause you to eat less. In fact, decreased appetite or appetite loss is a main cause of malnutrition in people with cancer. Cancer may also lead to malnutrition by causing problems with swallowing, digestion, and absorption of your food.

Common treatment side effects that increase the risk of malnutrition are:

• appetite loss
• dry mouth
• mouth sores
• feeling full quickly
• taste changes
• problems swallowing

Cancer and cancer treatments may also cause fatigue, pain, anxiety, distress, and depression, all of which can make eating a challenge, both physically and emotionally. Talk to your doctor and registered dietitian about any of your side effects and concerns. Your team is there to support you and help you manage these challenges.

Problems caused by malnutrition

Malnutrition can cause you to be weak, tired, and not able to fight infection or even finish cancer treatment. Studies show that malnutrition can decrease your quality of life and become life-threatening. 

Screening for malnutrition

Your health care team may use nutrition screenings and assessments to catch eating problems early and measure your risk of malnutrition. Ask your doctor about a nutrition screening before treatment starts and when you should be screened again during treatment.

Ways to prevent malnutrition

Here are tips to prevent malnutrition.

Tips on what to eat:

• Eat foods high in calories and protein.
• Use nutrition supplement drinks, such as Ensure or Boost. 

Tips on when to eat:

• Eat small meals spaced throughout the day. Aim for five to six small meals each day.
• Eat every 2 to 3 hours.

Tips on talking with your doctor or dietitian:

• Report loss of appetite and other eating problems to your doctor right away. 
• Ask your doctor about a referral to a registered dietitian. A registered dietitian can do a nutrition assessment and provide a nutrition care plan.
• Ask your dietitian about high-calorie and high-protein nutrition supplement drinks.
• Report weight loss of more than 3 to 5 pounds in one week to your doctor. 

If you continue to have trouble eating and are losing weight, your doctor or dietitian might suggest tube feeding (enteral nutrition) or IV nutrition (parenteral nutrition). Learn more about tube feeding and IV nutrition at Nutrition During Cancer Treatment.

Getting support for weight changes and malnutrition

Support from family and friends. Ask your family and friends to help with meal planning, grocery shopping, cooking, and cleaning. Provide them with a list of your favorite foods and meals they can prepare for you. 

Support from your health care providers. If you’re having trouble with eating and drinking, your doctor and dietitian can help. Your doctor can help you find medicines to manage certain problems and refer you to a registered dietitian. Your registered dietitian is your nutrition expert. They can help you with eating and drinking habits before, during, and after treatment.

Support for caregivers. Do not be surprised or upset if your loved one’s food preferences change from day to day. There may be days when they do not want a favorite food or say it now tastes bad. Offer gentle support rather than pushing your loved one to eat. Talk with your loved one about ways to manage eating problems. Ask the doctor for a referral to a dietitian and meet with them together. Talk through problems and seek other advice that can help you both feel more in control. Learn more about getting support when your loved one is being treated for cancer at Support for Caregivers of Cancer Patients.