Hints For Weight Loss in HD

Hints For Weight Loss In HD-print 3 pgs

Hints For Weight Loss in HD

Preventing Weight Loss in HD Patients

Susan Sandler, M.S

Overview
Susan Sandler, M.S., is a Registered Dietitian (R.D.) of Bateman Food

and Nutrition for Healthcare at Terence Cardinal Cooke Health

Care Center in New York, NY

Maintaining weight in HD patients has been shown to reduce some symptoms and avert malnutrition. Identifying the need for more calories is critical to the patient's overall well being.

Weight loss can occur for four reasons:

-dysfunction in cell metabolism (how the cell burns energy)

-increased use of calories due to involuntary movements

-abnormal food- related behaviors which result from the

cognitive and psychological changes that occur as the disease

progresses, and

-social factors, such as inadequate access to high-quality

foods or lack of understanding of appropriate nutrition.

A diagnosis of HD dictates achieving adequate body weight as soon as is

feasible. In HD, adequate weight is a protective 10-20 pounds above ideal

weight.

Food problems may be a result of psychological manifestations, emotional

changes, depression, obsessive compulsive disorder or a shortened attention span that renders the patient unable to sit at the table long enough to eat.

Medications may address the underlying psychological causes, but may also have side effects that themselves cause loss of appetite, dysphagia or constipation and should be reviewed regularly with the doctor.

Detecting the need for more calories or more liquids involves three steps

Suggestion

Directions: What to do

Any consistent loss of weight should be met with an increase in calories.

An increase in random movements (rate, frequency or duration) also indicates a need for more calories.

In a person with HD, weight can drop so quickly that additional increments of 500 to 1,000 calories a day may be required.

Declining weight or food Intake is a red flag for a change in menu, texture or independence in eating.

Weight can be increased by adding calories to well tolerated foods and by accommodating food preferences.

Respect food requests and serve historically favorite food

Observe plate waste and order of consumption to

identify favorite foods

Watch facial expressions to Identify preferences

Serve favorite flavors, such as a sauce or seasoning,

on multiple foods

Serve food so that it is comfortably warmer or cooler

than the inside of the mouth

Alter texture of preferred foods to reduce coughing

or gagging

Serve food that holds its shape in the mouth

Form altered texture food into shapes such as croquettes,

patties or pancakes

LOOK AT THE PATIENT

Weight low is visible and measurable. Dehydration has telltale signs.

To avoid these problem:

Weigh patients weekly on the same scale in the same clothes

Note changes in the way clothing fits

Check for dry and scaly skin (dehydration)

Watch for dark or limited urine and constipation (dehydration)

LISTEN TO THE PATIENT

Watch for complaints/expressions of hunger and thirst, including:

Indications of emptiness, discomfort or hunger

despite adequate food intake

Diarrhea

Scraping an empty plate or opening mouth to be fed

Increased agitation

WATCH WHAT/HOW THE PATIENT EATS

Behavioral changes that limit food intake are among the most common reasons for weight loss.

Refusing to eat/Skipping meals

Refusing particular foods or textures

Irrational food cravings/Aversions

Preference for one or two foods only

Demand for regular texture food despite risk of choking

Self-isolation/Sleeping through meals

Staring at food/Playing with food

Taken from HDSA's "The Marker" click here August 2000