“She only takes two spoons and pushes the plate away.” Caregivers say some version of this all the time. A person recovering from a wound, an operation or a long illness often loses interest in food, and it happens at the worst moment, because healing tissue needs more protein and energy than the body uses at rest.
Nobody can force someone to be hungry. You can, though, make every spoonful carry more, change how and when food is offered, and notice when a poor appetite has turned into a medical problem.
Why do people lose their appetite during recovery?
Knowing the cause helps, because some causes can be fixed. The common ones are:
- The illness or injury itself sends inflammatory signals through the body that dull hunger.
- Pain makes it hard to want food at all.
- Antibiotics, painkillers and iron tablets can cause nausea, constipation or a metallic taste.
- Constipation, very common in people who lie in bed, leaves the stomach full and uncomfortable.
- Mouth ulcers, a dry mouth, sore gums, or dentures that loosened after weight loss make every bite unpleasant.
- Being ill, stuck indoors or eating alone takes the pleasure out of meals.
- Someone who lies in bed all day burns less energy and feels less hungry, even though the wound still needs fuel.
Pain, nausea, constipation and mouth problems can often be treated. Mention them to the doctor or nurse, because fixing them can bring appetite back faster than any recipe.
How little is too little?
Everyone has an off day. These signs suggest that poor eating has become a real problem:
- eating half a normal meal or less for more than a week
- losing weight without trying, especially about 5 percent of body weight over a few months (roughly 3 kg for a 60 kg adult)
- clothes, rings, a watch strap or dentures becoming loose
- growing weakness, tiring quickly, or struggling to get up
- a wound that has stopped getting better
If you see any of these, tell the doctor. Weighing the person once a week on the same scale, at the same time of day, gives you a simple record to show them.
Offer small meals more often
A full thali can look like a mountain to someone with no appetite. Five or six small meals a day are easier to face and usually add up to more food than three large ones. A day might look like this:
- Early morning: a cup of milk or tea made with milk, with a spoon of milk powder stirred in
- Breakfast: a small portion of upma, poha or a chilla, with an egg or some curd
- Mid-morning: a banana with a few peanuts, or a small bowl of curd
- Lunch: a smaller plate than usual, with the dal or protein food served first
- Afternoon: a glass of lassi, a sattu drink or a boiled egg
- Dinner: soft khichdi with extra moong dal and a spoon of ghee
- Bedtime, if they are awake: a cup of warm milk
Many people are hungriest in the morning, so make breakfast the biggest meal if that suits them. Serve protein first on the plate, while appetite is strongest. Offer water and tea after food, not before, so drinks do not fill the stomach. Use a smaller plate. Half a plate looks manageable, while the same food on a big plate can look like a task.
Make every spoonful count
This is the most useful technique for a poor eater. Instead of asking the person to eat more, add protein to the food they already accept. Nothing about the dish changes much, but each bite carries more.
| Add this | To this | Extra protein (approx.) |
|---|---|---|
| 2 tablespoons milk powder | milk, dalia, kheer, custard | 5 g |
| 1 egg | khichdi, upma, poha, paratha filling | 6 g |
| 50 g grated paneer | paratha, khichdi, sabzi, rice | 9 g |
| 2 tablespoons sattu | buttermilk or lemon water | 4 g |
| 2 tablespoons besan | kadhi, chilla batter, sabzi gravy | 4 g |
| 1 tablespoon peanut powder | poha, chutney, sabzi | 4 g |
| a small katori of curd (100 g) | rice, paratha, as raita | 3 to 4 g |
If the person is losing weight, extra energy matters too. A spoon of ghee on dal or khichdi, full-fat milk in place of toned milk, and a little oil in the sabzi all add calories without adding much volume. The exception is someone whose doctor has limited fat for another condition. In that case, ask first.
Soft foods for people who find chewing hard
Many older people eat less simply because chewing is tiring or painful. Soft, moist food can make a big difference:
- moong dal khichdi with ghee, with an egg or paneer mixed in
- curd rice, or soft rice with dal and ghee
- dalia or suji upma cooked soft with milk
- idli with sambar, or soft dosa
- scrambled egg or soft paneer bhurji
- thick dal soup, or besan kadhi
- mashed potato mixed with grated paneer
- ripe banana, papaya or mashed chikoo
If dentures have become loose, a visit to the dentist can help, since loose dentures make chewing sore and embarrassing. Rinsing the mouth or brushing before meals can also freshen a dry or bad-tasting mouth.
Coughing, choking or a wet, gurgly voice during meals is different. These can be signs that food or drink is going the wrong way, which can cause chest infections. Tell the doctor and ask for a swallowing assessment. Do not start thinning or thickening food on your own.
Drinks that are easy to finish
Some people will drink when they will not eat. A nourishing drink between meals can supply as much as a small meal:
- milk blended with a banana and a spoon of milk powder
- sweet or salted lassi
- sattu drink with lemon, salt and roasted jeera
- badam milk or haldi milk with added milk powder
- thin dal or vegetable soup
- chaas with a spoon of sattu stirred in, which adds a few grams of protein
For someone with diabetes, skip added sugar and keep portions moderate. Their doctor can say which drinks fit their plan.
Make mealtimes easier
How food is offered matters almost as much as what is offered.
Help the person sit up as straight as they comfortably can, and keep them upright for about half an hour after eating. Eat with them if you can, since people tend to eat more in company. Let them choose between two options, which gives back a little control. Allow favourite foods, even at odd times of day. If they want parathas at 4 pm, a paratha at 4 pm beats nothing. Keep the room calm and the portions small, and do not scold or bargain. Pressure tends to shut appetite down further.
When food alone is not enough
Sometimes all of this still does not get the person eating enough. That is when to ask the doctor or a dietitian about an oral nutrition supplement. These are ready-made powders or drinks that add protein, energy, vitamins and minerals, and some are made for people recovering from wounds. They are taken between meals, in addition to food, not in place of it.
For people with diabetes or kidney disease the choice of supplement matters, so check with the doctor before buying one. If intake stays very low for a long time, the doctor may suggest other ways of giving nutrition, and that is a medical decision.
When should you call a doctor?
Get medical advice promptly if the person:
- has eaten almost nothing for two days, or is barely drinking
- is losing weight week after week
- is vomiting, or has diarrhoea that does not settle
- becomes drowsy, confused or unusually weak
- coughs or chokes when eating or drinking
- has a wound that is getting larger, smells bad, or is red and hot around the edges
The bottom line
A person who will not eat much still needs protein and energy to heal. Offer small meals often, add protein to the foods they already accept, and use nourishing drinks between meals. Treat the fixable causes, such as pain, nausea, constipation and mouth problems, and tell the doctor about weight loss early instead of waiting.
For more ideas, see what to feed someone with a bedsore, what to eat after surgery, and the common food myths that often cut protein by mistake.