By Erin Dummert RD, CD

Appetite loss is often the first side effect of cancer treatment. It is characterized by a general feeling of not being hungry, getting full faster than normal, or feeling overwhelmed by a normal portion of food. While a reduced appetite may seem harmless, it can lead to severe weight loss, dehydration, fatigue, poor immune function, and malnutrition. Although it may continue at some level throughout your treatment, there are ways to manage appetite loss and ensure you are still meeting your nutritional needs.

Food: Fuel for recovery

Dealing with appetite loss during cancer treatment can be extremely frustrating for you and your family. It is one of the most common side effects of cancer treatment, and can have serious consequences. Try to think of food as fuel for your recovery. Make every effort to eat as much as possible, and be sure to discuss the problem with your health care team.

Three appetite loss myths

Appetite loss is surrounded by many myths that make people think it is really not a problem. Here are some common myths and facts about appetite loss:

• Myth #1: I am not hungry because my stomach has shrunk.
  Fact: Stomachs do not shrink. During cancer treatment, the signals that trigger appetite can become disrupted, leading you to think you are not hungry even though your nutritional needs are higher than ever.

• Myth #2: I have never been a big eater, so my body does not need many calories.
  Fact: Calorie, protein, and nutrient needs are much higher during cancer treatment. Therefore, the amount you ate before diagnosis has no bearing on what you need during treatment.
• Myth #3: Since I am not exercising during treatment, I do not need to eat as much.
  Fact: Cancer greatly increases the number of calories needed on a daily basis. The body needs 1000 or more extra calories daily to build new healthy cells and fight cancer to the best of its ability.

Tips for eating when you do not want to

Anyone who has faced appetite loss from cancer treatment will tell you that eating when you are not hungry can feel like climbing a mountain blindfolded. When you are looking at a plate full of food, even a single bite feels like a major accomplishment.

Here are some tips for when you are overwhelmed by food:

• Trick yourself into thinking you are eating small portions. Use a large plate to eat a very small amount of food. This tactic convinces your body and mind that you really are not eating much. Never fill a whole plate with food.

• Nibble and graze all day. Do not worry about eating regular meals; just try to eat small bites throughout the day.
• Set a timer to remind yourself to eat. When you are not hungry, it is easy to allow 6 or 8 hours to pass without eating or drinking anything. Set a kitchen timer for 60 minutes and eat a few bites when it goes off. Reset the timer and repeat this pattern during your waking hours.
• Keep food out where you can see it. Place bowls of peanuts, M&Ms, or dried fruit around the house; eat 1 to 2 pieces every time you walk by.
• Sip on a beverage with calories. Hot chocolate, cider, milk, Gatorade, and juice are great ways to consume calories throughout the day. Keep juice boxes and drink mixes handy and be sure to sip often.
• Sip on nutritional supplements. Supplements such as Ensure, Boost, or Carnation Instant Breakfast are good sources of calories, protein, and nutrients.
• Eat your favorite foods. This is no time to worry about fat or cholesterol. If it sounds good to you, eat it.

Medications for appetite loss

Your oncologist may prescribe an appetite stimulant to perk up your hunger. Appetite stimulants are usually reserved for people who have lost more than 10 percent of their usual body weight or are at-risk for malnutrition. As with all medications, there can be some side effects ranging from increased risk of blood clotting to dizziness, depending on the medication. Some medications may take a few weeks to reach their full potential, and may not work for every patient, so you should work with your oncologist to find the medication that is right for you.

Caregiver support

As a caregiver, you know how important it is that your loved one eats properly. However, the appetite loss he or she is experiencing is real. Try to be supportive without pushing. You cannot force someone to eat. Despite the best intentions, pushing too hard can backfire, leaving your loved one resentful and angry, often refusing to eat in order to regain control.

As a support person, your role is to provide whatever your loved one thinks he or she may want to eat at any time, and to encourage him or her to eat as often as possible. Try to make the eating experience as pleasant and as stress-free as possible. Discuss any eating problems with a registered dietitian, nurse, or oncologist at a cancer treatment center.

For more ideas about diet during cancer treatment see the following articles from TheDietChannel: Guidelines for Effective Weight Loss and Weight Gain during Cancer Treatment and Increase Your Calories and Protein during Cancer Treatment.