Many people tend to have a relationship with food and eating characterized by a familiar problem: overconsumption. This is particularly true in the United States.  Weight gain caused by overeating can lead to a whole host of preventable diseases that can haunt people in later life—including diabetes, hypertension, and heart disease. (See The Looming Long Term Care Crisis Meets the Obesity Epidemic?)

But for many older adults, an interesting reversal seems to take place: as opposed to being a drag on health, at a certain point in the aging process, being a bit overweight starts to be beneficial. As adults age, they often suffer the consequences of common diseases, infections, and injuries much more profoundly because they lack critical physiological reserves and redundancies. Having a little extra “padding” may in fact be beneficial; as it allows them to weather the negative effects these medical events may visit upon them.

Unfortunately, many older people — particularly those over age 75 — face the distressing and medically challenging issue of serious weight loss. For them, their caregivers, and medical providers, the problem is made more complex by being hard to track. The traditional way of measuring whether a person is clinically overweight, the body mass index, often argued to be inaccurate for younger adults may be even less so for older adults, given that as people age, their lean body mass, or muscle, decreases.

Causes of Weight Loss

Underconsumption by itself is a critical issue in older adults and often becomes a serious medical problem in its own right. A number of issues may be at play when older adults stop eating, or require more calories than they consume.

Dementia. One of the consequences of Alzheimer’s disease and other types of dementia that may involve neurological impairment is that the sense of taste may degenerate as the disease progresses. For those afflicted, food simply becomes less palatable and less interesting.

Depression. In younger adults, clinical depression is often characterized by “dramatic” and “existential” symptoms such as poor self-esteem, suicidal thoughts, and crying spells. Depressed older adults, however, more often suffer from “neurovegetative” signs, such as sleep disruption, lack of energy, poor concentration–and eating problems.

Failure to Thrive. “Failure to thrive” is a catchall term used to describe a confluence of several medical issues that cause a person to become inactive, eat less, and basically waste away. In geriatric patients, it’s a descriptor often tagged to those who stop eating and stop experiencing a good quality of life when there’s no clear culprit to explain why.

Chewing and Swallowing Problems. Older adults may be missing teeth or may have to deal with denture problems. Some may have conditions that put them at risk for choking. All of these issues may require a modified diet—often one in which food must be diced or even pureed. The unappealing look and texture often affect appetite and consumption.

Digestive Problems. Some older people experience slowed digestion. This means that food stays in the stomach longer, which can lead to problems such as acid reflux, excess gas and bloating, and decreased appetite.

Increased Metabolic Rate. Several diseases common in older adults increase their metabolic rates, which also increase caloric requirements. One example is Chronic Obstructive Pulmonary Disease, or COPD, which can dramatically increase the amount of energy required to simply breathe. Cancer and some neurological disorders can also raise metabolic rates. Older adults who do not eat more to meet these increased calorie requirements can suffer serious weight loss.

Helping to Combat Weight Loss

There are a number of ways traditionally used to address poor food intake — their effectiveness is different for different individuals.

Supplements. To help combat problems of poor nutrition in older adults, medical providers frequently tout products such as Boost or Ensure — flavored liquid supplements that are typically spiked with extra protein, fat, vitamins, minerals, and calories. While these supplements are often effective, the downside is they are not particularly appetizing, and can easily become monotonous.

Dietary Liberalization. As mentioned earlier, swallowing problems may pose health risks to some older adults, which often necessitates dicing or pureeing food for safety reasons. Obviously, the problem is that pureed food is really not that appetizing. As long as the individual, caregivers, and providers are OK with the potential risks of eating a regular diet, such as choking, resuming a regular diet may be worth it, given the fact the older adult may end up eating more.

Social Eating. Research has long shown that people are more likely to eat more when in the company of others than when they eat alone. For this reason, most care facilities strongly encourage congregate dining, where residents gather in a common dining hall to eat together. Those who live alone can also be encouraged to dine regularly with friends, neighbors, and family members.

Chemical Appetite Stimulants. A frequently-prescribed appetite stimulant called Megace or Megestrol Acetate, a progesterone derivative, has been shown to stimulate appetite in cancer patients. It’s also used sometimes with older adults who have problems with appetite. However, like any number of other medications, it has side effects. Cannabis and synthetic marijuana or Marinol have also been used for this purpose — though they may also cause some dangerous side effects, such as increased confusion and risk of falling.

Avoiding “institutional food.” Many older adults stop cooking for themselves because they simply aren’t physically or cognitively able to handle the task, so opt to either have meals delivered by an organization such as Meals on Wheels, or get food prepared and served to them by staff at an assisted living or skilled nursing facility. The problem is that mass-produced, institutional food is sometimes just not that appetizing, and consumption suffers. One way family members and other caregivers may be able to get around this is to offer their loved ones more home-cooked meals, or bring them their favorite fast foods from time to time. It’s important to first find out dietary restrictions of facility rules on such practices, however.

Reconsider MSG. The food additive Monosodium Glutamate, or MSG, much like salt or sugar, is sometimes used to round out the flavor of foods and cue the palate that the food contains what the body craves: protein. But MSG has gotten some bad press over the years, with some claiming to suffer adverse reactions such as flushing, headaches, and high blood pressure from food spiked with it. However, according to the Food and Drug Administration, MSG is “generally recognized as safe.” And according to at least one study,  moderate additions of MSG to protein-laden foods may increase salivary production, increase the rate of gastric emptying—and most importantly, increase the overall food intake for older adults.

(This article has been reviewed January, 2024.)