Many aspects of cancer care can affect appetite resulting in weight loss that can be stressful for those being treated for cancer and their families.  Less interest or ability to eat can be related to a variety of things: 

• A side effect of treatment and other medications 

• Emotional stress  

• Fatigue 

• The disease itself 

• A combination of all of these 

While eating is something we usually anticipate and enjoy, when going through cancer treatment you may find yourself turned off by the sight, smell and taste of some – or many – foods.  These food aversions maybe related to the cancer itself or a side effect of treatment and can make it difficult to decide what to eat – or even remember to eat at all.  If food is unappealing, smells are bothersome, taste is off, or it’s painful to chew and swallow, it’s not surprising that portions of foods may shrink, or meals skipped all together.    

During treatment, the goal is to maintain a stable weight as much as possible to enhance quality of life and tolerance to treatment.  This may require a change in eating strategy than what is typical for you and may be particularly challenging for those whose usual habit is to eat infrequently during the day. 

Calories First 

It’s true that our body needs more protein during cancer treatment, but first and foremost we need calories. Protein provides the “building blocks” for all the cells of our body, including muscles, which are important to hold onto through treatment for overall health and quality of life.  But above all else our body needs calories to fuel our vital functions (cardiac function, breathing, digestion), maintain our muscles, restore blood counts between treatments and support our immune system.  Including carbohydrates and fats in your meals and snacks can help prevent the protein you’re eating from being burned as calories to support these life-sustaining functions. Think of this as surrounding the protein you’re eating with calories from carbohydrates and fats. 

Tips for Meeting Nutrition Needs with Loss of Appetite 

Mini-meals – If you’re unable to eat much at once without feeling sick, shift to a pattern of smaller“ mini-meal” amounts more frequently over the day.  With consistent attention to more frequent eating, it may be possible to accrue enough calories to stabilize your weight.  Start in with your mini meal plan as soon as possible after waking with a goal of eating every two or three hours over the day. 

Small plates – When food is unappealing large plates of food can feel overwhelming.  Try serving mini-meals and snacks on small plates, and smoothies in smaller cups.  This may feel more achievable and be less likely to trigger aversions. 

Cold, odorless foods – When appetite is lacking, odors from foods can sometimes be a turn-off.  As a rule, cold or room temperature foods don’t smell so may be better tolerated.  If odors are an issue for you, try cold cut sandwiches instead of cooked meat or poultry, sliced raw vegetables or vegetable salads in place of cooked vegetables, or cold pasta salads instead of cooked pasta dishes.    

Add something to soups – Soup can be a common go-to comfort food when we are not feeling well.  While pea and bean soups, chowders and cream soups can be good sources of calories and protein, broth-based soups tend to be low in both calories and protein.   To increase the nutritional value of a soup meal, add half a grilled cheese or other protein-containing sandwich (like sliced turkey or roast beef, tuna or egg salad, or peanut butter and jelly), a few crackers with cheese or nut butter, or a Greek yogurt to boost overall nutrition.   

Drink more between meals – Our stomach distends with eating and drinking, which contributes to the feeling of fullness.  To preserve space in your stomach for calorie and protein-dense foods at meals and snacks, try drinking most of your fluids between rather than with meals.  It is fine to sip fluids when eating but avoid drinking large amounts that may feel you up easily. 

Supplementing with small protein shakes– Many people find protein shakes helpful for boosting their calorie and protein intake and many homemade and store-bought options are available.  Protein shakes may be better tolerated in smaller portions, so if needed serve them in 4 to 8-ounce portions, storing any remaining shake in the refrigerator to be consumed later in the day.  Ideally, protein shakes would be taken between meals but not within the two-hour window before a meal to prevent them from affecting your mealtime appetite. 

Enrich foods with calories– The most efficient way to increase the calories in meals, snacks and shakes is to add fats.  Try the following to optimize calories in every bite of food:   

• Cook eggs and other pan-fried foods in oil.  Drizzle oil into soups, pastas, and vegetable and rice dishes. Neutral tasting oils like avocado and canola oil can also be added to smoothies. All oils add 40 calories per teaspoon (120 calories per Tbsp.).   

• Spread tub spreads or butter on toast, muffins, pancakes, French toast, potatoes, vegetables and anywhere else it may be appealing.  Adds 30 – 40 calories per teaspoon. 

• Add nut butters (peanut, almond, cashew, sunflower butter) to crackers, toast, muffins, sandwiches, smoothies, and fruit (like bananas or apples). Adds 95 – 100 calories per Tbsp. 

• Sprinkle nuts on cereals, salads, fruit cups, ice cream, puddings, and yogurts, or snack on them between meals. On average adds 200 calories per ¼ cup.  

• Use sliced or mashed avocado to add calories and creaminess to toast, eggs, sandwiches and salads, or with tortilla chips as guacamole. Adds 100 calories per 1/3 avocado, or 30 calories per 2 Tbsp. guacamole. 

• Top bagels or toast with cream cheese (50 calories/Tbsp.), and sour cream (30 calories/Tbsp.) to potatoes, chili or eggs. 

Aim to Be Consistent 

Trying to gain weight, or at least remain stable, often requires changing your mindset from food as enjoyment to eating as part of your treatment plan. Developing an eating plan you can follow as consistently as possible is key to keeping your calorie intake up.  

Although some days may be more challenging than others, starting as soon as possible in the morning, have your first mini-meal or small shake, then aim to eat something small every 2-3 hours throughout the day. As a reminder to eat, write out your plan and leave it somewhere you will see. You can also set alarms on your smart phone or use a kitchen timer. The goal is to eat 5-6 times per day as often as possible. 

Additional Points to Consider 

Maintain some activity.  Physical activity may increase your appetite and interest in eating.  Whether it is indoors or outside, aim to move around as much as possible, even if it is just for a few minutes. 

Manage side effects that may be affecting your interest in eating.  This is critical to being able to take advantage of the suggestions above.  Nausea, constipation, diarrhea, taste changes and mouth sores can all affect your ability to eat so it’s important to follow your clinical team’s advice to proactively manage them.   

Medications and other Therapies to Improve Appetite 

Appetite stimulating medications exist that may help increase your interest in eating.  Whether these medications are safe and appropriate for you must be decided on a case-by-case basis. Speak to your clinical team to determine if they are an option for you. 

Use of medical cannabis as an appetite stimulant, or for managing nausea, is also of interest to some patients undergoing cancer treatment.  Laws around the availability of medical cannabis vary from state to state. Speak to your clinical team to learn more about this option.   

Sample Calorie-Enriched Mini-Meal Plan 

For additional mini meal ideas check out Impactful Snack and Mini Meals.