Turn on the television, open the newspaper, pick up a magazine and one is inundated with information on the latest weight-loss fad. Glossy images of waif-like celebrities and headlines announce the global obesity pandemic. With all the attention on the problems of overweight and obesity, it is easy to forget that there are many people whose main concern is how to gain weight in order to improve their health.

Who are these lucky individuals, you ask? Most of them are not so lucky, and gaining weight can be just as difficult — physically and psychologically — as trying to lose it.

Who is at risk of being underweight?

People suffering from chronic illnesses, such as cancer and HIV/AIDS, as well as those fighting or recovering from acute infections (like pneumonia, tuberculosis, malaria) or from trauma (e.g. accident victims with large wounds or burns), are among those with increased calorie and nutrient needs.

Many elderly people also fall into this category due to their increased frailty, caused by loss of muscle mass, weight loss and poor health. The causes of low food intake in the elderly are multifactorial, but may include social isolation, physical limitations, and a reduced sense of taste. Studies have shown that elderly people with a little extra weight have improved health outcomes, as they are better able to survive illnesses and infections when they do occur.

Others at risk include those who may not have the financial resources to adequately nourish themselves and their families. It is not uncommon for food insecurity in some parts of the world to result in starvation and malnutrition. Elsewhere, malnutrition does exist even though starvation may be rare. Whether suffering from starvation or malnutrition, those affected may have sporadic eating patterns — eating larger volumes when finances allow — but managing with minimal food, if there isn’t enough money to purchase what is needed.

How can you avoid weight loss?

For those who need to gain weight, getting the biggest nutrient “bang for your buck” should be the guiding principle. This means that when a person is able to eat, they should focus on consuming foods and beverages that are both higher in calories and nutrients.

Calories will supply the body with adequate energy — enabling the individual to carry out activities of daily living — while nutrients such as protein, vitamins and minerals can help fight an infection and support immune function. These nutrients are vital to the body’s ability to function at an optimal level, which is particularly important for someone in poor health.

Below are some examples of foods and beverages that are rich in both calories and various other nutrients:

• Meats and proteins: fatty fish (tuna, salmon, sardines, mackerel), chicken (with the skin), ground meat, eggs, whole milk, cheese and yogurt, pulses (beans, lentils, chickpeas), nuts and seeds;
• Whole grains: breads, chapatti, granola cereals, muesli, rice, corn meal (ugali), quinoa, buckwheat;
• Fruits and vegetables: avocados, coconut/coconut milk, bananas, corn, potatoes, dried fruit (e.g. dried apricots, raisins, dates, prunes);
• Fats and oils: butter, ghee, olive oil, canola/rapeseed oil, coconut oil.

Unfortunately, common side effects of many medications and treatment regimens may make the task of consuming adequate amounts of food that much more difficult. Some medications cause dry mouth, or induce a metallic flavor in the mouth, while others cause nausea, or other gastric problems such as constipation or diarrhea.

Your doctor or healthcare provider may also suggest trying supplemental meal replacement beverages, which contain easier to digest nutrients and calories. To maximise intake from whole food sources, try to consume these beverages as a snack in between meals, rather than with them. For recipe ideas, check out some high calorie, nutrient rich recipes from The Ismaili Nutrition Centre, such as Seero, Kheer, Kuku-paka, and Hondwo.

Eating strategies for poor appetite

In addition to consuming calorie and nutrient-dense foods, several eating strategies may be particularly helpful for individuals suffering from poor appetite.

• It is often easier to drink beverages than to eat food. Try incorporating high-calorie, nutrient-rich smoothies and milk shakes into your diet.
• Consider eating smaller meals more frequently. This may help cut down the volume of your meals so you don’t feel so full all the time. Your body will adjust to the amount of foods overtime.
• Avoid drinking before meals, as this can affect your appetite. Consider limiting your drinking to at least 30 minutes after eating.
• Add extra nutrients to your food. Add a tablespoon of coconut oil to morning porridge, extra protein or milk powder to beverages, extra beans or raw eggs into soups, or ground up seeds/nuts into meals so you are increasing calories and nutrients, but not the volume of the food on your plate.
• Get active! Physical activity can help to increase your appetite. Discuss the type and amount of physical activity that's right for you, with your healthcare provider.

Preparing your eating environment

Some people are particularly sensitive to their eating environment, so avoid smells or noises that may be offensive, and ensure that room temperature, lighting and ventilation are comfortable. Try playing music, use decorative table settings and whenever possible, include the company of friends and family at mealtimes.

It is also important not to overwhelm yourself, or the person you are caring for, with an overfilled plate of food. Large portions can be psychologically off-putting and physically impossible for many people to handle.

Focus on eating small amounts of food frequently throughout the day. For example, set a goal of six mini-meals, rather than three large ones. For those who are able, a short bout of physical activity , such as walking or getting fresh air, prior to mealtimes can actually help to boost hunger levels and improve food intake.

Other considerations

The challenges involved in eating enough of the right kinds of foods for the sick, the elderly, and the food-insecure, are substantial. There may be financial barriers to purchasing food, a lack of family or social support to shop and cook, and medical side effects (nausea, diarrhea, difficulty swallowing, physical disabilities) that make eating physically difficult.

There are many resources and services that are available in the community, so if help is needed with meal times, try to get assistance. However, for those with support, the food choices and strategies presented here will provide the knowledge to begin the process of nourishing yourself or your loved ones back to health.