Medical Health Encyclopedia

Goals for Weight Gain and Good Nutrition. One approach to weight gain involves the following steps:

• The weight-gain goal, usually one to two pounds a week, is strictly set by the doctor or health professional. This goal is absolute, no matter how convincingly the patient (or even family members) may argue for a lower-weight goal.
• Patients who are severely malnourished may need to begin with a calorie count as low as 1,500 calories a day, however, in order to reduce the chances for stomach pain and bloating, fluid retention, and heart failure.
• Eventually, the patient is given foods containing as many as 3,500 calories or more a day.
• More calories than normal may be required to put on weight. In some cases, severe dieting has caused the metabolism to adapt to malnutrition and resist the effects of overfeeding. Some anorexic patients also may naturally have a higher metabolism than other individuals.
• Dietary supplements may be needed. Zinc supplementation has been shown to help increase body mass. Patients should receive calcium plus a multivitamin. Oral phosphates are also useful.
• Although eating is the problem, discussions of the disorder are never held during meals, which are times for relaxed social interaction.

Some doctors recommend cyproheptadine (Periactin), an antihistamine, which may stimulate appetite. (It is not useful for patients with bulimia and may even slow recovery.) One interesting study suggested that eating yogurt with active cultures of so-called good bacteria may boost immune factors that may help prevent infections.

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Tubal Feedings. Feeding tubes that pass through the nose to the stomach are not commonly used, since many experts believe they discourage a return to normal eating habits and because many patients interpret their use as punishing forced feeding. A 2002 study reported, however, that when patients were given such tube feedings at night with oral feedings during the day, they gained twice as much weight as patients who were being fed orally only. More research is needed to see if benefits persist when patients return home.