Undernutrition (how to gain weight)

The Community Dietetics Team promote the use of food and drink as treatment for people who are identified as moderate and high risk of undernutrition. However, sometimes despite best efforts it is not always possible to meet nutritional requirements from food alone and prescribed nutritional supplements may need to be considered.

If there are any concerns about weight loss or poor appetite it is important that advice is sought from a healthcare professional, such as a GP or a dietitian.

Every mouthful counts if someone has a poor appetite. It is therefore very important that food and drinks are packed full of nourishment. This means that even though only small portion sizes are eaten, nutritional requirements may still be met, preventing further weight loss prevented and promoting weight gain.

1. Nourishing snacks

Nourishing snacks are recommended at least twice a day to provide an extra source of nutrition, to try to prevent weight loss or help you gain weight. It is important to have a small nourishing snack, because you do not want to negatively impact your appetite at your next main meal. 

Nourishing snack ideas (containing around 150kcal) are slice of malt loaf, cheese and biscuits, half a scone or teacake, handful of nuts, piece of cake. A plain biscuit e.g. rich tea (40kcal), morning coffee, is not a nourishing snack as it is low in calories. One slice of malt loaf is the same amount calories as four plain biscuits. Your dietitian can provide further guidance on examples of nourishing snacks suitable for your dietary requirements (e.g. for Diabetes, Cardio protective diets and for those needing soft or pureed textures). 

2. Nourishing drinks

Nourishing drinks are encouraged throughout the day. Replace at least two cups of tea or other lower calorie drinks with nourishing drinks to provide more nutrition. Nourishing drinks ideas are milky coffee (115kcal), milky hot chocolate (155kcal), fruit juice (45kcal) or fortified milkshake (285kcal). Did you know a cup of milky coffee made with full cream milk is the same amount of calories as eight cup of teas?

3. Fortified diet (high calorie protein diet)

A fortified diet is where meal dishes are adapted by adding small quantities of everyday foods which increases the calorie and nutrient content without increasing the portion size. This means every mouthful is full of nourishment.

Tip: Try adding 1 heaped tablespoon of skimmed milk powder to a glass of milk, milky coffee or hot chocolate, to increase the energy and protein. 

4. Multivitamin and mineral tablets

A doctor or dietitian may recommend you take a general A-Z multivitamin and mineral supplement if you are struggling to meet your requirements through your diet alone.

Seek advice from a pharmacist or GP to determine an appropriate product.

5. Homemade fortified drinks

Two homemade fortified drinks are recommended each day

• Each 200mls drink contains at least 300 calories which is similar to prescribed nutritional supplement drinks for example Complan Shake, Fortisip, Fortijuce and Ensure Plus
• Homemade fortified drinks are made with full cream milk, skimmed milk powder and other ingredients which are readily available within the home. The drinks can be prepared by the individual, family member or carer
• Fortified drink recipes include: fortified milkshake, fortified soup, fortified smoothies, fortified hot chocolate, fortified malted drinks

If identified as moderate risk of undernutrition using 'MUST' the following can be recommended:

• two nourishing snacks a day between meals
• nourishing drinks throughout the day
• use fortified milk in drinks and on cereal
• fortified (high calorie, high protein) diet
• consider a multi vitamin and mineral tablet daily

If there are any concerns about weight loss or poor appetite it is important that advice is sought from a healthcare professional, such as a GP or a dietitian.

If identified as high risk of undernutrition using 'MUST' the following can be recommended:

• two homemade fortified drinks each day
• two nourishing snacks a day between meals
• use fortified milk in drinks and on cereal
• nourishing drinks throughout the day
• fortified (high calorie, high protein) diet
• consider a multi vitamin and mineral tablet daily

If there are any concerns about weight loss or poor appetite it is important that advice is sought from a healthcare professional, such as a GP or a dietitian.

Sometimes despite best efforts it is not always possible to meet nutritional requirements from food alone and prescribed nutritional supplements may need to be considered.

Prescribed nutritional supplements have a valuable role in the management of undernutrition when used appropriately.

It is recommended before any nutritional supplement is prescribed:

• the individual is identified as high risk of undernutrition using 'MUST'
• high risk dietary interventions have been trialled for a month but further weight loss has been identified
• prescribe a powdered nutritional supplements as the initial supplement, refer to the nutritional supplement care pathway.

Examples of first line prescribed nutritional supplements include Foodlink Complete, Complan Shake, Aymes Shake, Ensure Shake.

Once prescribed nutritional supplements, a regular review should be completed by a dietitian or an appropriately trained healthcare professional.

A dietitian may recommended adding Polycal Powder or Maxijul Powder to the drinks and semi solid food dishes. These powders are virtually tasteless and can be used in a variety of dishes and drinks. These are available on prescription and known as ‘calorie powders’, because they only provide calories and no other nutrients. 

Each heaped teaspoon or scoop of Polycal or Maxijul powder provides 20 calories. This can be added to a drink or a semi solid dish such as custard, yoghurt, soup. Start with 1 heaped teaspoon, and gradually increase if tolerated, up to a maximum of 4 teaspoons. Mix well and wait for the powder to dissolve.  

• BAPEN - Self Screening Tool
• BDA Malnutrition 
• The Malnutrition Pathway