How to Gain Weight for Elderly Adults
Losing weight in later life is not a normal part of getting older. The NHS says people aged 65 and over are particularly at risk of malnutrition and that "weight loss is not an inevitable result of old age." This guide, for older adults and the people who cook for them, covers why weight slips, how to check whether a loss needs a doctor, and food steps that add calories and protein without huge meals.
- See a doctor first if the weight loss was not planned, and promptly if it reaches 5% or more of body weight within 6 to 12 months.
- Eat smaller meals more often and add calories to foods that are already on the plate.
- Lean on healthy fats and protein: peanut butter, avocado, nuts, cheese, eggs, yogurt and fish.
- Fix what gets in the way of eating: dentures, taste changes, medicines that dull appetite, and eating alone.
Why older adults lose weight
The National Institute on Aging (NIA) lists everyday reasons first: a smaller appetite, trouble getting out to buy food, pain when chewing or swallowing, and simply forgetting to eat. A review of unintentional weight loss in older adults published in American Family Physician (AAFP) adds that taking many medicines can change the sense of taste or cause nausea, and that isolation and money problems can also play a part.
Illness is the reason to take weight loss seriously. NIA warns that sudden, unintended weight loss can be a sign of a serious medical problem such as cancer, digestive disorders or some neurological diseases. In the AAFP review, conditions other than cancer were the more common causes, but cancer still accounted for up to one third of cases.
Being underweight carries its own risks. According to NIA, a low BMI makes problems such as osteoporosis and anemia more likely and can make it harder to recover from an illness or infection. The AAFP review links weight loss with frailty, repeated falls and worse health overall.
Weight loss check
Enter the usual weight from before the loss (a number from a doctor's visit is best), today's weight, and the months in between. Age and height are optional and add a BMI check. With no old weight on record, the AAFP review notes that a change in clothing size or a relative's estimate can stand in.
Result
A screening aid built on the AAFP definition of unintentional weight loss and the GLIM malnutrition criteria. It does not diagnose anything.
When weight loss needs a doctor
Doctors use a simple yardstick. In the AAFP review, unintentional weight loss in adults older than 65 is generally defined as losing 5% or more of body weight within 6 to 12 months, and a loss that size should prompt a medical evaluation. For someone who usually weighs 150 pounds, 5% is 7.5 pounds.
The NHS gives the same advice in plain terms: see a doctor if weight has dropped suddenly, or if it has dropped without any change in diet or exercise. NIA adds that anyone losing weight rapidly without meaning to should see a health care professional to find out whether there is a medical cause.
The GLIM criteria for diagnosing malnutrition, a consensus from clinical nutrition societies worldwide, use similar numbers: weight loss of more than 5% within six months, or more than 10% over a longer period. GLIM also lists a low BMI of under 20 before age 70 and under 22 after 70, though it notes low BMI is seldom used as a marker in North America. The CDC adult cutoff for underweight is 18.5, and NIA says healthy weight ranges for older adults differ from other age groups, so ask the doctor what range fits.
A food-first plan to add calories
NIA puts the basic rule simply: to gain weight, eat more calories while keeping up a moderate level of activity. Its tips for older adults who are trying to gain weight:
- Choose foods with healthy fats, such as avocados and peanut butter.
- Eat smaller meals more often if you get full quickly.
- Add nutrient-dense snacks such as nuts, cheese and dried fruit.
- Share meals with friends and family to make eating more enjoyable.
- Stay active to boost appetite.
The NHS suggests gaining weight gradually; for adults in general it mentions around 300 to 500 extra calories a day, but for an older adult with health conditions, let the doctor or a dietitian set the number. It also advises high-calorie drinks such as milkshakes between meals rather than before them, and not relying on chocolate, cakes and sugary drinks.
Add calories to food that is already on the plate
For people at risk of malnutrition, the NHS says the first dietary advice is usually fortified foods that are high in calories and protein, plus drinks that contain plenty of calories. Ideas drawn from the NHS and from the food lists in the National Cancer Institute's Eating Hints booklet include:
- Adding olive oil to vegetables, soups and mashed potatoes.
- Melting cheese onto eggs, potatoes and vegetables, or grating it into soups and sauces.
- Using whole milk instead of water in hot cereal and soups.
- Spreading peanut butter on toast, crackers or fruit slices.
- Adding protein at meals with beans, fish, eggs and lean meat, as the NHS suggests.
Soft, calorie-dense foods
These foods are easy to chew and pack a lot of energy into a small portion. Values are from USDA FoodData Central.
| Food | Portion | Calories | Protein |
|---|---|---|---|
| Scrambled eggs | 2 large | 182 | 12.2 g |
| Peanut butter, smooth | 2 tbsp | 191 | 7.1 g |
| Ricotta, whole milk | 1/2 cup | 186 | 9.3 g |
| Greek yogurt, plain, whole milk | 6 oz | 165 | 15.3 g |
| Avocado | 1/2 fruit | 161 | 2.0 g |
| Whole milk | 1 cup | 149 | 7.7 g |
| Hummus | 1/4 cup | 146 | 4.8 g |
| Olive oil, stirred into food | 1 tbsp | 119 | 0 g |
| Cottage cheese, 4% fat | 4 oz | 111 | 12.6 g |
| Pink salmon, canned | 3 oz | 110 | 16.7 g |
| Banana | 1 medium | 105 | 1.3 g |
Source: USDA FoodData Central, SR Legacy. If swallowing is difficult, ask the doctor about texture first; care teams can include speech therapists and dietitians.
More ideas for adding calories without big meals are in our guides to gaining weight with a small appetite and calorie-dense snacks.
Fixing the roadblocks that stop eating
NIA's advice on common roadblocks for older adults:
Teeth, dentures and swallowing
People with problems with their teeth or dentures often avoid meat, fruits and vegetables. NIA suggests seeing the dentist to check for problems or the fit of dentures. If food seems to stick in the throat or is hard to swallow, talk to the doctor, because the cause can range from a dry mouth to problems with the muscles or nerves of the throat, the esophagus, or reflux.
Food that tastes flat
Taste and smell can change with age, dental problems and medicine side effects. NIA suggests herbs, spices, lemon juice or vinegar to lift flavor without extra salt, and varying the color, shape and texture of foods.
Medicines that dull appetite
Some medicines change how food tastes, dry the mouth or reduce appetite. Ask the doctor about side effects, since NIA notes the doctor may be able to suggest a different drug. Never stop a prescribed medicine on your own.
Eating alone, or feeling low
NIA suggests potluck meals, cooking with a friend, or meals at a senior center, community center or religious facility. Being unhappy can also take away appetite; if low feelings last a few weeks or months, talk with the doctor, because help and treatment are available.
Getting food into the house
The US Senior Nutrition Program, run through the Administration for Community Living, offers group meals and home-delivered meals to people aged 60 and over and their spouses. To find programs near you, use the Eldercare Locator at eldercare.acl.gov or call 1-800-677-1116.
Keeping muscles working
Aim to rebuild muscle, not just weight. NIA notes that aging is linked with muscle loss at every body weight, and that staying active helps older adults keep muscle, stay independent and avoid falls. Its general target is at least 150 minutes of moderate activity a week, and if that is too much at first, to be as active as possible. The NHS adds that strength training or yoga can build muscle and can also improve appetite. Talk with the doctor before starting a new or harder exercise program.
Supplement drinks and appetite medicines
Food comes first. If changes to meals are not enough, the NHS says a doctor, nurse or dietitian may suggest extra nutrients in the form of nutritional drinks or supplements. The AAFP review adds a useful rule: supplement drinks, if used, should add calories on top of scheduled meals and snacks, not replace them.
The same review cites the American Geriatrics Society's Choosing Wisely advice to avoid prescription appetite stimulants and high-calorie supplements for poor appetite or wasting in older adults, and to focus on feeding help, a review of medicines that may interfere with eating, appealing food and social support. On mirtazapine (Remeron) and megestrol, it notes that evidence of benefit is lacking and that mirtazapine's side effects, such as dizziness and sleepiness, can raise the risk of falls.
Frequently asked questions
- What is the best way for an elderly person to gain weight?
- Start with a doctor's check if the weight loss was not planned. Then eat smaller meals more often, add healthy fats such as avocado and peanut butter, snack on nuts and cheese, add calories to familiar foods, and stay as active as is safe.
- How much weight loss is too much for an older adult?
- A widely used definition in a review in American Family Physician is a loss of 5% or more of body weight within 6 to 12 months, and a loss that size should prompt a medical evaluation. The NHS also advises seeing a doctor for any sudden weight loss or loss without a change in diet or exercise.
- What foods help elderly people gain weight?
- Soft, calorie-dense foods with protein work well: eggs, Greek yogurt, cottage cheese, ricotta, peanut butter, avocado, hummus, whole milk and canned fish. Adding olive oil or cheese to vegetables, soups and potatoes raises calories without bigger portions.
- Should older adults drink nutrition shakes to gain weight?
- Only as an add-on and ideally on a clinician's advice. The NHS says a doctor, nurse or dietitian may suggest nutritional drinks if food changes are not enough, and the AAFP review says supplements should add calories without replacing scheduled meals and snacks.
- Is mirtazapine (Remeron) used for weight gain in elderly people?
- It is sometimes prescribed for appetite, but the AAFP review notes that evidence of benefit is lacking and that side effects such as dizziness and sleepiness can raise the risk of falls. Guidance cited in the review favors feeding help, a medicine review and appealing food first.
- What BMI is underweight for an older adult?
- The CDC adult cutoff is a BMI under 18.5. The GLIM malnutrition criteria use a higher low-BMI cutoff for older adults, under 22 after age 70, and NIA notes that healthy weight ranges for older adults differ from other age groups. Ask the doctor what range is right for the person.
Keep reading
References
Sources: NIA: Maintaining a Healthy Weight · NIA: Overcoming Roadblocks to Healthy Eating · NHS: Malnutrition · NHS: Healthy ways to gain weight · Unintentional Weight Loss in Older Adults, Am Fam Physician 2021 · GLIM criteria for the diagnosis of malnutrition (Cederholm et al., 2019) · CDC: Adult BMI Categories · ACL: Nutrition Services · Eldercare Locator · USDA FoodData Central.