The appetite deception: why some older people eat less than they need

Appetite’s simple, isn’t it? You eat when you are hungry, and you don’t when you’re not.

But if it were that simple and we only ever ate exactly what we needed, then we would all be the ‘ideal’ weight all our lives.

The reality is that appetite is an extremely complex function, and science has a long way to go in unravelling all its secrets. One thing we do know for sure is that our appetites frequently mislead us about what food intake we actually need.

And eating the wrong amount of food – whether it’s too much or too little – as we age is a particularly serious issue.

Hungry? Or not hungry?

Anyone who has struggled to keep their weight down will recognise this scenario: if I look at food –particularly something I consider delicious, like a creamy dessert – my brain will tell me I’m ‘hungry, hungry, hungry … must eat creamy dessert!’ Even if I’ve just eaten what I know is a perfectly adequate meal, I’ll still think I want that dessert.

Of course, I’m not really hungry – I just like the look of the treat before me. My appetite is misleading me. I have to consciously decide whether to eat the dessert or not.

As we age, the converse often happens: our appetites decrease and tell us we’re ‘not hungry, not hungry’. As a dietitian, I frequently hear older people – who are, often, already thin and losing more weight – say, ‘But I can’t eat more, I’m just not hungry’ or ‘I just have two spoonfuls, I don’t need any more than that’.

This is another appetite deception, and one that can lead to weight loss and devastating malnutrition if it’s not recognised quickly.

Did you know?

• There are many reasons for the natural decline of appetite as we age, including ageing itself, the impacts of medications, psychosocial impacts, and changes in senses.

• The senses of taste and smell tend to diminish with age but can also be affected by illness, accidents, medications and some types of surgery. As a result, food intake can falter. Studies have shown that people in their 80s often need much higher concentrations of salt or sugar and other flavour enhancers for foods to taste the same as when they were in their 30s or 40s.

• Younger people often won’t feel satisfied by a meal unless they have experienced quite a wide variety of tastes, smells and textures. But as people age, they need less variety to achieve the same level of satisfaction. That can make food preparation a bit easier, but it’s still important to eat many different foods each day to cover a range of nutritional needs.

Deception dangers for older people

Over- or under-eating isn’t good for us at any age. However, the nutritional needs of older people are quite particular, and if those needs aren’t met it can affect not only the person’s health, but also their independence and quality of life.

If appetite mistakes result in an older person overeating, their increasing weight can add unnecessary strain on joints and aggravate (or cause) other health issues, like diabetes and heart conditions.

But what is far more common and potentially more dangerous is appetite mistakes leading to under-eating, which causes weight loss and deficiencies in vital nutrients. So even if your appetite has always kept you oversupplied, it’s very likely a day will come when the opposite becomes true. I see this problem all too frequently.

The end results of these two mistakes might look completely different, but in both cases the cause is the same: your appetite is deceiving you!

Avoiding the weight-loss trap

The simple truth is that if you are losing weight without intending to, you are not eating enough. And if your appetite is ‘telling you’ otherwise, it’s misleading you.

So how can you stop it? If your appetite is not helping you maintain your weight, you need to recognise that, ignore its misleading messages, and find ways to eat more. In the same way that I must choose not to eat that dessert despite being ‘assured’ by my appetite that I need it, you must choose to get the nutrition you need despite being ‘assured’ that you don’t need to eat.

That could mean making sure you eat at least three meals each day. It could mean sometimes having at least one more mouthful, even though you feel full after only a few. It might mean having a milkshake instead of nothing if you just can’t face a meal. The important thing is not to let yourself fall into the trap of believing the mistakes your appetite makes.

A good thing to know is that eating, in itself, somehow ‘reminds’ our bodies that food is necessary. So eating small amounts frequently, even when you don’t really feel like it, could be part of the trigger needed to bring that appetite back.

Both quality and quantity are important

The other issue if you are struggling with a poor appetite is making sure the food you do eat gives you what you need. Your appetite doesn’t distinguish between different types of food – it’s focused on quantity, not quality. You will feel just as full on tea and toast as you would on a poached egg or cheese on toast, but the cheese and eggs will give you better nutrition.

It is vitally important to eat to get the nutrients you need, even if your appetite has slowed down. If you’re less active in your later years, you may need fewer calories (kilojoules) – but you still need comparatively more protein and more of some micronutrients. So if you are only eating small amounts, every mouthful needs to deliver what your body needs.

We all hope to enjoy our later years in good health, independence and comfort, and one of the best steps we can take towards this is to look after our nutritional needs as we age. Understanding how our appetites deceive us can help us to choose not only the right things to eat, but the right amounts.

What about people living in aged care homes?

Poor appetite is especially challenging in aged care situations, for both clients and care providers.

In these settings, all sorts of things can be playing a part in creating false appetite messages and impeding good nutrition. For clients, the contributing factors can include physical and cognitive concerns; medical issues and medications; feelings of grief, sadness or loneliness created by changes in life circumstances and/or bereavement; clinical depression; and more.

If their families, carers and support organisations then fail to provide meals and snacks that are appealing, appetising and appropriate as well as nourishing, what’s already a precarious situation can rapidly escalate.

Providers of care must do more than simply support the work of cooks, chefs and food service staff to produce appetising and nutritious food and drink. They must also have systems in place to ensure every person in their care receives dignified and encouraging support at meal and snack times.

It is only with both these functions in place, supported as required by the professional input of an aged care dietitian, that issues with appetite can be adequately addressed in aged care. Anything else could amount to neglect in the duty of care.

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Disclaimer: The information provided on this website is not a substitute for individual health advice from a doctor or dietitian.

by Ngaire Hobbins APD

Ngaire Hobbins is an Australian dietitian specialising in ageing and brain health. This article is based on her book, Brain Body Food, which presents in everyday language the science of eating well for healthy ageing. Brain Body Food is available through Ngaire’s website, or your favourite book retailer.