Help if you have lost weight - the building-up diet

Many people with cancer have weight loss at some time. Weight loss can be caused by cancer or be a side effect of cancer treatments. Losing weight can be distressing, especially when a person is already dealing with a cancer diagnosis and treatment.

The following cancer treatment side effects can lead to weight loss:

• Some types of surgery can affect someone’s ability to eat.
• Radiotherapy to the head and neck area can cause a sore mouth.
• Some chemotherapy drugs can cause a person nausea (feeling sick), a sore mouth or loss of appetite.

Some types of cancer can cause a person to lose weight. But this improves once the cancer has been treated.

Sometimes a cancer can cause someone to lose a lot of weight. The cancer may produce chemicals that make their body use calories more quickly than normal, and break down fat and protein more quickly. This can lead to a person losing weight, even if they are eating well and not doing very much. This condition is called cachexia. It usually only happens in people who have an advanced cancer.

If you lose a lot of weight, it is important to talk to a dietitian. They can suggest changes to your diet. They may suggest you take nutritional supplements to help prevent further weight loss and help you gain weight.

If you have a good appetite, you should be able to eat the extra calories and protein you may need if you are ill. But if you do not have a good appetite, there are ways to add extra energy and protein to your diet without needing to eat more food.

If you do not eat meat, poultry or fish, there are plenty of other foods that help add energy and protein. These include:

• cream and cheese
• nuts and nut butters
• avocados
• lentils, beans and chickpeas
• quinoa
• seeds and seed products such as tahini
• dried fruits
• sweet potatoes
• rice
• vegan cheese, spread and cream.

Talk to your cancer doctor, specialist nurse or a dietitian if you find it difficult to eat enough. They may recommend or prescribe food (nutritional) supplements, such as milkshakes or juices.

You may need to follow a special diet, for example if you have a lactose intolerance or diabetes. It is important to talk to a dietitian, GP or specialist doctor at the hospital for advice.

You can add extra energy and protein to your diet without having to eat more. This is called fortifying your food. You can fortify milk by adding 2 to 4 tablespoons of dried milk powder to 570ml (1 pint) of full-fat milk and mixing it together. Keep it in the fridge and use it in drinks or on cereals. You can also use fortified milk or milk-based supplements to make soups, sauces, jellies, custards and puddings.

Apart from soya milk, most plant-based milks contain less protein than cow’s milk. They may also contain fewer vitamins and minerals. Many plant-based milks have added supplements such as iodine or vitamin B12. You can check the label to see what has been added.

You can fortify plant-based milks, such as oat or coconut milk, by adding ground nuts or peanut butter powder. But you may also need to take a supplement to make sure you are getting enough nutrients. And you may need to get more protein from other sources.

The following tips can help you increase the protein and energy of different foods. When we talk about milk, cheese or cream, this can be a dairy product or a plant-based product.

• When shopping, choose full-fat foods instead of foods labelled ‘diet’ or ‘light’.
• Fry foods in oil, ghee or butter.
• Add extra butter, cream or oil to bread, potatoes, pasta and cooked vegetables. Add cheese to cooked vegetables or soup. Add cream or drizzle oil over soup.
• Use fortified milk to make sauces. Add cream, plain yoghurt, sour cream, crème fraiche or cream cheese to sauces, soups and casseroles.
• Use fortified milk on cereals or to make porridge. Add golden syrup, honey or sugar to breakfast cereals or porridge. You can also add dried fruit or nuts, or fresh or stewed fruit.
• Add extra paneer to curries.
• Add whole or blended beans, lentils or peas to soups, curries, tagines, and stews and casseroles.
• Choose vegetables that are rich in protein and energy, such as spinach, sweetcorn, beans and lentils.
• Add evaporated milk, condensed milk or cream to desserts and hot drinks.
• Have cream, custard, or ice cream with desserts.

Quick meals and snacks

• Add peanut butter or other nut spreads, chocolate spread, tahini, honey or jam to bread, toast, crackers and biscuits.
• Add nut butters, avocado, Greek yoghurt or plant-based alternatives to smoothies.
• Use plenty of butter or spread in sandwiches. Add mayonnaise or salad cream to sandwich fillings or toppings such as tuna, chicken, avocado, egg or cheese.
• Add cream to canned soups, or make packet soups with fortified milk.

The best way to get more energy and protein is by eating a healthy, balanced diet if you can. If you have eating problems or are losing weight, talk to your cancer doctor, specialist nurse, dietitian or GP. They can give you more advice.

There are many nutritional supplements that can add extra energy or protein (or both) to your diet. You can add them to your everyday foods or have them in addition to your normal diet. In some situations, supplements can be used to replace meals.

We have more information about the different kinds of supplements and how they can help.

You may not always feel well enough to shop or cook food for yourself or others. This may be frustrating. If you usually prepare the meals for your family, it may feel hard to let someone else do this. Try not to feel guilty about letting someone else do the things you usually do. When you feel better, you can go back to your routine.

You may find it easier to use ready meals or pre-prepared meals on days when you do not feel like cooking. This is fine to do sometimes. You can always add some fresh vegetables, salad or fruit to the meal.

If you live on your own and need help with cooking or shopping, talk to your healthcare team at the hospital or your GP. They may be able to arrange for help at home, meals on wheels or a local organisation to help you with cooking or shopping.

If you are the main carer for someone with cancer, it can be difficult to know how to deal with eating problems, such as lack of appetite or weight loss. Mealtimes are usually an enjoyable and important part of life. It can be upsetting and worrying when you have prepared a meal and the person is not interested in food or cannot eat very much.

Cancer, cancer treatments and other medicines can all affect someone’s appetite. The person you are caring for may feel sick or have diarrhoea or constipation. This can stop them eating. They may:

• feel too tired to eat
• have a sore or dry throat or mouth
• find chewing and swallowing difficult.

The amount someone can eat may change each day, and their likes and dislikes may also change. Try not to put pressure on someone to eat. This can be stressful for both of you. If you know when their appetite is at its best, you can make the most of it. For example, you could treat them to their favourite foods.

If the person you are caring for continues to struggle with food and is losing weight, speak to their doctor or nurse. They can refer them to a dietitian. The dietitian can advise them about what they eat. They may suggest using nutritional supplement drinks if needed.

• Ask the person what they would like to eat.
• Try to talk openly about their weight loss and what both of you think will help. This can help you both feel more in control.
• The person you are caring for may find cooking smells make them feel sick. Prepare food in a different room if possible and open the windows when cooking.
• Give them smaller meals and snacks, whenever they feel like eating. If they never feel like eating, try to make sure they have regular small meals and snacks.
• Try not to offer drinks before a meal. This can make the person feel too full to eat.
• Offer them their favourite foods at the times when you know their appetite is good.
• Make batches of their favourite meals and freeze portions to use at another time.
• Keep snacks in easy reach so they are ready whenever the person feels hungry.
• Stock up on items you know they like. You can then prepare meals and snacks easily.
• Avoid low-fat or diet products. For example, choose whole milk rather than skimmed or semi-skimmed milk.
• If the person would like it, try offering a small amount of alcohol just before, or with, food. Some people find this helps their appetite. Check with the healthcare team that the person can have alcohol.
• Add extra energy to everyday meals and drinks. For example, try adding fortified milk to tea or coffee.
• Encourage the person to do some physical activity, if possible. This can help increase their appetite. Ask the person’s healthcare team for advice about what they can do.

The person you are caring for may have problems such as:

• nausea (feeling sick)
• vomiting (being sick),
• a sore mouth
• changes to their taste.

If they have any of these symptoms, ask their healthcare team for advice.

Make sure you have support. It is important to look after yourself and make sure you are eating well yourself. We have more information about looking after someone with cancer.

You can also visit our carers forum to share any worries and find emotional support.

• Serve food in a well-ventilated room with the window open.
• Try to create a comfortable eating environment. Make sure the person is in a comfortable position.
• Present meals so they look appetising.
• Keep servings small. Too much food can be overwhelming and off-putting. The person can always have more if they want to.
• The person you are caring for may want to go out to a cafe or restaurant for food. You can call ahead and ask if they can prepare softer, easier-to-eat foods, or smaller portions.
• Try not to worry if the person you are caring for cannot eat what you have cooked. Gently encourage them to eat but try not to push them too much.