Achieving Healthy Weight Gain Introduction How do we address malnutrition?

Maintaining a healthy weight is important for good health. A lot of By eating plenty of foods rich in nutrients we can prevent further attention is paid to problems associated with being overweight, but weight loss, and gain weight if we need to. This may sound daunting being underweight or suffering from unintentional weight loss can lead if you have lost your appetite or are unsure which foods to eat. But to health problems too, and it is important to identify these issues. don’t worry, it’s quite easy when you know how, and there are three

main ways to achieve this: Have you experienced any of the following? • A long-term loss of appetite and not feeling quite yourself Food fortification: • Finding clothes, jewellery, or dentures have become loose Adding little extras

• Losing weight without any intention to to the food you • Eating less than you used to already eat • Currently recovering from an illness

If you have answered YES to any of the above, you may be at risk of being malnourished. Malnutrition is a lot more common than we Snacks: Nourishing think, and affects over 3 million people in the UK. Having small drinks: high energy snacks Packed with between - important Consequences of malnutrition meals - nutrients • Lack of energy • Reduced strength How much extra do I need? • If you are slightly underweight or have unintentionally lost some Poorer immune system and • weight you should aim to add an extra 500 calories each day increased risk of infection • If you are very underweight or have unintentionally lost a lot of • Slower recovery from illness weight, you should aim to add 500-1000 extra calories each day

• Low mood Adding extra calories will help you re-gain lost weight or prevent you from losing any more

Generally we shouldn’t have to eat or drink much more than we Malnutrition is preventable and can often be usually do. Instead, you can choose options with more calories, or add little extras to foods to enrich them with additional calories addressed without the need for any medication and protein without making your portions much bigger.

2 Helping you stay well Achieving Healthy Weight Gain 3 Fortifying your food Our breakfast and tea service can provide options that have more calories and protein. Please get in touch with the Nutrition Fortifying means adding little extras to meals to provide more & Wellbeing team if you are interested in finding out more. calories, protein, and other nutrients. You should also choose meals that are higher in energy (calories). These are marked as ‘HE’ on the HILS menu. If you are preparing a meal yourself, Have regular snacks here are a few good ideas on how to fortify the food. • You should aim to have a snack between each meal

• These should be packed full of calories and protein to help you Breakfast Ideas get well again, but small enough so they don’t fill you up • Porridge – Swap semi-skimmed milk for enriched milk Each of the snacks below provides at least 150 calories and a few (see recipe on page 6) important grams of protein too: – Add an extra topping such as 1 tablespoon of: Chocolate chip cookie Full-fat creamy yoghurt honey / chocolate spread / a few dates / Rice pudding Cheesy crackers chopped banana Chocolate muffin Dried fruit & nuts

• Toast or crumpets Top Tip – when choosing a snack, try to avoid anything labelled as – Choose standard spread instead of low-fat low-fat, low-calorie, or diet and choose the full-fat versions instead – Add peanut butter / sardines / scrambled

eggs / cheese / cream cheese / paté / lemon curd / chocolate spread Nourishing Drinks

Ideas for Light meals Try to have 1-2 nourishing drinks each day, using enriched milk - recipe on the next page! • Egg omelette – Add a tablespoon of skimmed-milk powder, a dash of enriched Benefits of using enriched milk: milk, and a generous knob of butter or full-fat spread, full-fat • 1 pint of enriched milk provides 580 calories, cream, and 2oz grated cheese 38g protein, and 52g carbohydrate • Soup • The nutrients in enriched milk help promote repair and – Add a tablespoon of cream, a knob of butter and a few croutons recovery from illness, as well as help maintain weight, promote – You could also serve with a buttered crumpet weight gain, and prevent unintentional weight loss

Pudding ideas We also have a poster with recipes for nourishing drinks: please • Fruit: Try adding honey / cream / creamy yoghurt to fresh fruit call your local Support Team for a copy. If you prefer, there are • Cakes: Choose cakes with icing, or add cream or custard also ready to drink versions of these drinks, such as Complan and • Yogurts, trifles & puddings: Always choose full-fat Build-up available in your local chemist or supermarket.

4 Helping you stay well Achieving Healthy Weight Gain 5 Enriched milk recipe Did you know? Milk powder is How can HILS help? readily available in supermarkets at a very low price, usually located How do I make it? near the UHT milk or baking section • You need 4 tablespoons of Provide extra Offer fun education

skimmed milk powder and 1 food and drink sessions pint (568ml) of whole milk (blue top) If you have been identified We can provide information

• Whisk the milk powder into enough milk to make a paste, as at risk of being and advice sessions for then add the rest of the milk and mix well malnourished, we can you, your family, friends, • You can make up enriched milk in your free HILS water provide you with high or support jug and keep it in your fridge to use throughout the day energy snacks. You can network to select the help you snacks you get the Five ways to use your enriched milk would like. best nutrition possible. Use in your hot drinks, like milky coffee 1 or hot chocolate, throughout the day

Pour on your cereal or Provide information Tailor your menu choices 2 use to make porridge We have a variety of We can provide you with booklets and posters higher energy meals. They available, including recipes are marked ‘HE’ on our menu. for nourishing drinks. Higher energy means the Use to make a nourishing cold drink such meal contains more calories as milkshake; please ask us for recipes 3 to prevent further weight loss, and help promote weight gain so you can Use it to make custard or achieve 4 sauces, and add it to soups a healthy weight.

Drink a glass of enriched milk with a snack 5 If you need further support, our registered dietitians can visit you and give you personalised advice

6 Helping you stay well Achieving Healthy Weight Gain 7 Enriching your diet if you have diabetes FAQ ASK THE DIETITIAN Can I follow an enriched diet Tops tips for an enriching if I have diabetes? diet with diabetes Michelle, our team leader and registered If your diabetes is well controlled þ Space out nourishing drinks dietitian, has answered some of your then you should be able to throughout the day and frequently asked questions… follow an enriched diet. choose smaller volumes (such Should I contact my GP if I as 4 drinks of 100ml instead of 2 drinks of 200ml) so that the I have heard that getting How do we achieve a have diabetes? extra carbohydrate does not thinner is a normal part of healthy diet, whilst putting We would recommend that you have such a significant effect on ageing – is this true? on weight? contact your GP or diabetes your blood sugar levels. Getting thin is NOT a normal Foods that are high in fat are nurse for a medication review part of ageing. Lots of factors also full of calories, so they if you are prescribed insulin or þ Enrich your meals with fat affect our appetite, food are great options if you want sulphonylureas such as gliclazide and protein-rich products choices, and the way we eat. to gain weight. However, and glipizide. Your medication (such as fortified milk, cheese, It’s always important to have a you may feel this goes dose may need adjusting and cream, peanut butter) rather healthy weight for your height against conventional advice your blood sugars may need to than products that are high in no matter what age you are. surrounding healthy eating. be monitored so that you are sugar, although you do not have If you have particular issues If you have heart disease or able to meet your nutritional to exclude sugar altogether. that you feel are affecting you are concerned about your needs safely. If your blood sugar þ You may also wish to choose your eating habits, please get cholesterol levels, choosing levels are unstable or if you have heart healthy unsaturated fats in touch with our Nutrition & unsaturated fats, like olive any concerns we recommend such as olive or rapeseed oil Wellbeing team, or speak to oil and rapeseed oil, nuts or that you contact your GP before when enriching foods. your GP. peanut butter would be a starting an enriched diet. healthier option. Full-fat dairy foods are packed with calcium When to contact your GP þ You are concerned about and protein so they are great You should contact your GP if: your health and changes options too. It is still important þ You have been eating and you have noticed to have plenty of fruit and drinking well but seem to be þ If you have any other health vegetables, but remember to losing weight concerns, you are on a fortify these by serving fruit þ Changes to your weight have restricted diet, or on a fluid with full-fat custard or adding been quite sudden with no restriction for any reason, unsaturated oils or spreads to apparent cause please speak directly with vegetables. If you have further þ If you have questions about your GP prior to starting concerns, please discuss this medication and whether you food fortification or with your GP before starting need to be cautious with any changing fluid intake an enriched diet. particular foods

8 Helping you stay well Achieving Healthy Weight Gain 9 HILS swaps for weight gain Instead of... choose this... Tea time… Instead of... choose this... Extra Breakfast… Cheese sandwich 254 calories Cheese and 2g protein onion sandwich Porridge made Porridge made with raisins, honey (with mayo) with milk (200ml) and enriched milk (200ml) Extra Extra Ham sandwich 136 calories Ham and 227 calories 10g protein cheese sandwich 6g protein Extra No added Rice sugar jelly pot 121 calories pudding pot Lunch… 4g protein

Beef with roast potatoes Extra Steak and kidney pie

210 calories Extra 4g protein Low sugar 110 calories Flavoured juice drink 6g protein milk drink Chicken breast Chicken breast with roast potatoes Extra with cheese and bacon *Available products and manufacturer recipes are subject to change. 96 calories 7g protein HILS HANDY HINTS

Vegetarian Extra Cauliflower and cottage pie broccoli bake If you get full easily, or have lost your appetite: 98 calories þ Eat little and often þ It’s important to drink 2g protein þ Get some fresh air and try regularly throughout the day, to move around as much but don’t drink too much at Stewed apple Extra Apple and as you can, as this can the same time as eating, as and custard blackberry crumble improve your appetite this can fill you up and affect 118 calories your appetite 2g protein þ Eat with others once a week if you can to increase appetite; þ Give yourself time to eat if you would like to find out and avoid distractions *Available products and manufacturer recipes are subject to change. more about lunch clubs in þ Don’t forget your oral health: your area, just ask your local brush your teeth at least By making small changes throughout the day, you could eat HILS’ Support Team twice daily and use a fluoride an extra 1000 calories, and nearly 30g of protein! toothpaste

10 Helping you stay well Achieving Healthy Weight Gain 11 Your goals

Write down your person goals to help you prevent unwanted weight loss or gain some weight. Even small goals can make a huge difference. Make sure they are realistic and achievable for you.

For example 1. I will use enriched milk in all my drinks and on my breakfast cereal 2. I will choose the Higher Energy (HE) meals from the HILS menu 3. I will have a rice pudding or a muffin with my tea in the afternoon

Your personal goals

1.

2.

3.

We also have a selection of additional booklets and leaflets for the following health conditions: Diabetes, feeling forgetful, caring for someone with dementia, healthy heart, good bowel health, coeliac disease, kidney problems, chewing and eating difficulties, IBS, COPD, food labelling This resource has been compiled using available current evidence and has been approved by a team of dietitians and nutritionists. The information is for general use and should not replace individual tailored advice given by a healthcare professional. For further information, please contact your local Support Team or visit our website on www.hertsindependentliving.org or contact us directly through [email protected] Alternatively, please call Hertfordshire Independent Living Service on 0330 2000 103 (all calls charged at local rate) Photographs of meals are for reference purposes only and may differ slightly due to recipe changes. Hertfordshire Independent Living Service is the operating name of Hertfordshire Community Meals Limited, a community benefit society, society number IP30206R and registered as a charity with HMRC registration number XT37228

HILS September 2015