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AchievingHealthyWeight Gain

IntroductionHow do we address malnutrition?Maintaining a healthy weight is important for good health. A lot ofattention is paid to problems associated with being overweight, butbeing underweight or suffering from unintentional weight loss can leadto health problems too, and it is important to identify these issues.By eating plenty of foods rich in nutrients we can prevent furtherweight loss, and gain weight if we need to. This may sound dauntingif you have lost your appetite or are unsure which foods to eat. Butdon’t worry, it’s quite easy when you know how, and there are threemain ways to achieve this:Have you experienced any of the following? A long-term loss of appetite and not feeling quite yourself Finding clothes, jewellery, or dentures have become loose Losing weight without any intention to Eating less than you used toFood fortification:Adding little extrasto the food youalready eat Currently recovering from an illnessIf you have answered YES to any of the above, you may be at risk ofbeing malnourished. Malnutrition is a lot more common than wethink, and affects over 3 million people in the UK.ritionConsequences of malnut Lack of energy Reduced strengthand Poorer immune systemincreased risk of infectioness Slower recovery from illn Low moodMalnutrition is preventable and can often beaddressed without the need for any medication2 Helping you stay wellSnacks:Having smallhigh energy snacksbetween meals-Nourishingdrinks:Packed withimportantnutrientsHow much extra do I need? If you are slightly underweight or have unintentionally lost someweight you should aim to add an extra 500 calories each day If you are very underweight or have unintentionally lost a lot ofweight, you should aim to add 500-1000 extra calories each dayAdding extra calories will help you re-gain lost weightor prevent you from losing any moreGenerally we shouldn’t have to eat or drink much more than weusually do. Instead, you can choose options with more calories, oradd little extras to foods to enrich them with additional caloriesand protein without making your portions much bigger.Achieving Healthy Weight Gain 3

Fortifying your foodFortifying means adding little extras to meals to provide morecalories, protein, and other nutrients. You should also choosemeals that are higher in energy (calories). These are marked as‘HE’ on the HILS menu. If you are preparing a meal yourself,here are a few good ideas on how to fortify the food.Breakfast Ideas Porridge– Swap semi-skimmed milk for enriched milk(see recipe on page 6)– Add an extra topping such as 1 tablespoon of:honey / chocolate spread / a few dates /chopped banana Toast or crumpets– Choose standard spread instead of low-fat– Add peanut butter / sardines / scrambledeggs / cheese / cream cheese / paté /lemon curd / chocolate spreadIdeas for Light meals Egg omelette– Add a tablespoon of skimmed-milk powder, a dash of enrichedmilk, and a generous knob of butter or full-fat spread, full-fatcream, and 2oz grated cheeseOur breakfast and tea service can provide options that havemore calories and protein. Please get in touch with the Nutrition& Wellbeing team if you are interested in finding out more.Have regular snacks You should aim to have a snack between each meal These should be packed full of calories and protein to help youget well again, but small enough so they don’t fill you upEach of the snacks below provides at least 150 calories and a fewimportant grams of protein too:Chocolate chip cookieRice puddingChocolate muffinFull-fat creamy yoghurtCheesy crackersDried fruit & nutsTop Tip – when choosing a snack, try to avoid anything labelled aslow-fat, low-calorie, or diet and choose the full-fat versions insteadNourishing DrinksTry to have 1-2 nourishing drinks each day,using enriched milk - recipe on the next page!Benefits of using enriched milk: 1 pint of enriched milk provides 580 calories,38g protein, and 52g carbohydrate Soup– Add a tablespoon of cream, a knob of butter and a few croutons– You could also serve with a buttered crumpet The nutrients in enriched milk help promote repair andrecovery from illness, as well as help maintain weight, promoteweight gain, and prevent unintentional weight lossPudding ideasWe also have a poster with recipes for nourishing drinks: pleasecall your local Support Team for a copy. If you prefer, there arealso ready to drink versions of these drinks, such as Complan andBuild-up available in your local chemist or supermarket. Fruit: Try adding honey / cream / creamy yoghurt to fresh fruit Cakes: Choose cakes with icing, or add cream or custard Yogurts, trifles & puddings: Always choose full-fat4 Helping you stay wellAchieving Healthy Weight Gain 5

Enriched milk recipeDid you know? Milk powder isreadily available in supermarketsat a very low price, usually locatednear the UHT milk or baking sectionHow do I make it? You need 4 tablespoons ofskimmed milk powder and 1pint (568ml) of whole milk (blue top)a paste, Whisk the milk powder into enough milk to makewellthen add the rest of the milk and mixwater You can make up enriched milk in your free HILSdaythetghouthroujug and keep it in your fridge to useFive ways to use your enriched milk1Use in your hot drinks, like milky coffeeor hot chocolate, throughout the day2Pour on your cereal oruse to make porridge3Use to make a nourishing cold drink suchas milkshake; please ask us for recipes4Use it to make custard orsauces, and add it to soups5Drink a glass of enriched milk with a snack6 Helping you stay wellHow can HILS help?Provide extrafood and drinkIf you have been identifiedas at risk of beingmalnourished, we canprovide you with highenergy snacks. You canselect thesnacks youwould like.Offer fun educationsessionsWe can provide informationand advice sessions foryou, your family, friends,or supportnetwork tohelp youget thebest nutritionpossible.Provide informationWe have a variety ofbooklets and postersavailable, including recipesfor nourishing drinks.Tailor your menu choicesWe can provide you withhigher energy meals. Theyare marked ‘HE’ on our menu.Higher energy means themeal contains more caloriesto prevent further weight loss,and help promote weight gainso you canachievea healthyweight.If you need further support, our registered dietitianscan visit you and give you personalised adviceAchieving Healthy Weight Gain 7

FAQ ASK THE DIETITIANMichelle, our team leader and registereddietitian, has answered some of yourfrequently asked questions I have heard that gettingthinner is a normal part ofageing – is this true?Getting thin is NOT a normalpart of ageing. Lots of factorsaffect our appetite, foodchoices, and the way we eat.It’s always important to have ahealthy weight for your heightno matter what age you are.If you have particular issuesthat you feel are affectingyour eating habits, please getin touch with our Nutrition &Wellbeing team, or speak toyour GP.8 Helping you stay wellHow do we achieve ahealthy diet, whilst puttingon weight?Foods that are high in fat arealso full of calories, so theyare great options if you wantto gain weight. However,you may feel this goesagainst conventional advicesurrounding healthy eating.If you have heart disease oryou are concerned about yourcholesterol levels, choosingunsaturated fats, like oliveoil and rapeseed oil, nuts orpeanut butter would be ahealthier option. Full-fat dairyfoods are packed with calciumand protein so they are greatoptions too. It is still importantto have plenty of fruit andvegetables, but remember tofortify these by serving fruitwith full-fat custard or addingunsaturated oils or spreads tovegetables. If you have furtherconcerns, please discuss thiswith your GP before startingan enriched diet.Enriching your diet if you have diabetesCan I follow an enriched dietif I have diabetes?If your diabetes is well controlledthen you should be able tofollow an enriched diet.Should I contact my GP if Ihave diabetes?We would recommend that youcontact your GP or diabetesnurse for a medication reviewif you are prescribed insulin orsulphonylureas such as gliclazideand glipizide. Your medicationdose may need adjusting andyour blood sugars may need tobe monitored so that you areable to meet your nutritionalneeds safely. If your blood sugarlevels are unstable or if you haveany concerns we recommendthat you contact your GP beforestarting an enriched diet.When to contact your GPYou should contact your GP if:þ You have been eating anddrinking well but seem to belosing weightþ Changes to your weight havebeen quite sudden with noapparent causeþ If you have questions aboutmedication and whether youneed to be cautious with anyparticular foodsTops tips for an enrichingdiet with diabetesþ Space out nourishing drinksthroughout the day andchoose smaller volumes (suchas 4 drinks of 100ml instead of2 drinks of 200ml) so that theextra carbohydrate does nothave such a significant effect onyour blood sugar levels.þ Enrich your meals with fatand protein-rich products(such as fortified milk, cheese,cream, peanut butter) ratherthan products that are high insugar, although you do not haveto exclude sugar altogether.þ You may also wish to chooseheart healthy unsaturated fatssuch as olive or rapeseed oilwhen enriching foods.þ You are concerned aboutyour health and changesyou have noticedþ If you have any other healthconcerns, you are on arestricted diet, or on a fluidrestriction for any reason,please speak directly withyour GP prior to startingfood fortification orchanging fluid intakeAchieving Healthy Weight Gain 9

Instead of.HILS swaps for weight gainInstead of.Tea time choose this.ExtraBreakfast Porridge madewith milk (200ml)Cheese sandwichPorridge made with raisins, honeyand enriched milk (200ml)Ham sandwichNo addedsugar jelly potLunch ExtraExtraExtraChicken breastwith cheese and baconExtraCauliflower andbroccoli bakeApple andblackberry crumble118 calories2g protein*Available products and manufacturer recipes are subject to change.By making small changes throughout the day, you could eatan extra 1000 calories, and nearly 30g of protein!10 Helping you stay well121 calories4g proteinRicepudding potLow sugarjuice drink110 calories6g proteinFlavouredmilk drink*Available products and manufacturer recipes are subject to change.98 calories2g proteinStewed appleand custardExtraHam andcheese sandwichExtra96 calories7g proteinVegetariancottage pie136 calories10g proteinCheese andonion sandwich(with mayo)Steak and kidney pie210 calories4g proteinChicken breastwith roast potatoes254 calories2g proteinExtraExtra227 calories6g proteinBeef with roast potatoeschoose this.HILS HANDY HINTSIf you get full easily, or have lost your appetite:þ Eat little and oftenþ It’s important to drinkregularly throughout the day,þ Get some fresh air and trybut don’t drink too much atto move around as muchthe same time as eating, asas you can, as this canthis can fill you up and affectimprove your appetiteyour appetiteþ Eat with others once a week ifþ Give yourself time to eatyou can to increase appetite;and avoid distractionsif you would like to find outmore about lunch clubs inþ Don’t forget your oral health:your area, just ask your localbrush your teeth at leastHILS’ Support Teamtwice daily and use a fluoridetoothpasteAchieving Healthy Weight Gain 11