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Weight Management

Have you experienced changes in weight since being diagnosed with Parkinson’s disease (PD)? It is common for people with PD to lose weight, yet others may gain. Changes in weight can affect overall health. Being underweight means you can lose muscle mass and strength, cause you to be prone to osteoporosis and infection. Being overweight raises risk of heart disease and high blood pressure and puts stress on your joints. Maintaining a healthy weight is key to living well with PD.

Common Causes of Weight Changes

Weight Loss
There are many reasons people with PD lose weight. Some people lose weight even if they are eating exactly the same meals. Others find certain PD symptoms affect appetite or the ability to eat.

  • Gradual loss of the sense of smell and taste is a non-motor PD symptom that makes eating less enjoyable.
  • Weight loss usually levels off once PD therapy begins and people return to normal eating habits.
  • Some PD medications cause nausea, which suppresses appetite.
  • Motor symptoms like tremor Involuntary shaking of the hands, arms, legs, jaw or tongue. The typical Parkinson’s tremor is “pill-rolling” – it looks like holding a pill between thumb and forefinger and continuously rolling it around. Some people report an internal tremor, a shaking sensation inside the chest, abdomen or limbs that cannot be seen. Most Parkinson’s tremor is “resting tremor,” which lessens during sleep and when the body part is actively in use., slowness and stiffness and complications of treatment such as dyskinesiaAbnormal, involuntary body movements that can appear as jerking, fidgeting, twisting and turning movements; frequently caused by dopaminergic medications to treat Parkinson’s. (involuntary extra movements) can make eating difficult.
  • Swallowing difficulties are common in PD and can interfere with eating.
  • People who experience depression A mood disorder whose symptoms can include a persistent sad or empty mood, feelings of hopelessness or pessimism, irritability and loss of interest or pleasure in previously enjoyable activities. or apathy — common non-motor PD symptoms — may lose their appetite.
  • Embarrassed by their slow eating, some people stop eating before they have had enough.
  • People taking levodopaThe medication most commonly given to control the movement symptoms of Parkinson’s, usually with carbidopa. It is converted in the brain into dopamine. may have been advised to avoid taking medications with protein, making it difficult to get adequate nutrition throughout the day.

PD does not cause ongoing, unexplained weight loss. Tell your doctor if you experience this symptom — it may be a sign of a serious medical issue unrelated to PD.

Weight Gain
Weight gain is sometimes a side effect of PD therapies.

  • Deep brain stimulation (DBS) A surgical treatment for Parkinson's disease. A special wire (lead) is inserted into a specific area of the brain responsible for movement. The lead is connected to a pacemaker-like device implanted in the chest region. This device creates electrical pulses, sent through the lead, which “stimulate” the brain and control abnormal brain cell activity. is a surgical therapy that helps relieve movement symptoms in many people. Weight gain is a potential side effect.
  • Dopamine A chemical messenger (neurotransmitter) that regulates movement and emotions. agonists are medications occasionally given alone or in combination with formulations of levodopa to manage PD motor symptoms. They have been linked with compulsive behaviors, including binge eating, which leads to weight gain. Commonly prescribed dopamine agonists are Pramipexole (Mirapex®), Ropinirole (Requip®) and rotigotine transdermal system (Neupro® patch). Under the supervision of a doctor, adjusting medications can stop a person’s compulsive eating.
  • Other medications, especially those used to treat psychiatric complications of the disease or its treatment, can contribute to weight gain.

Therapies

It is important that PD motor symptoms be optimally controlled. See your neurologist or movement disorders specialist to see whether he or she recommends a medication adjustment. Also, visit your primary care provider to exclude other medical reasons for weight change.

Tips for Achieving a Healthy Weight

  • Whether you wish to gain weight or lose it, diet and exercise are key.
  • Eat a balanced diet, with a variety of foods from all the food groups: whole grains, vegetables, fruits, dairy products and sources of protein like meat, fish and beans.
  • Exercise helps keep people mobile and strong and can improve mood. Being active stimulates appetite and burns calories.

Talk to your doctor:

  • Do you need to gain or lose weight?
  • Get a referral for nutritional counseling — learning about nutrition and PD can help you maintain a healthy weight.
  • Get advice on starting an exercise routine from a physical therapist who is experienced in PD.

To gain weight:

  • Eat small, frequent meals, every two to three hours or eat a nutritious snack between meals.
  • Eat foods you enjoy.
  • Save your energy for eating by keeping easy-to-prepare foods on hand.
  • Stimulate your appetite by seasoning food with herbs, spices and sauces.
  • Include some high-calorie foods like cream and butter (if recommended by your primary care provider) in your diet.
  • Consider drinking a nutritional supplement, such as Ensure® or Carnation® Breakfast Essentials™.
  • Avoid filling up on coffee, tea and clear soups.
  • Limit fatigue by choosing foods that are easy to chew (like smoothies, ground meats or other soft proteins)
  • Ask for help cutting proteins into smaller pieces.
  • Increase consumption of whole grains (whole grain rice, breads).

To lose weight:

  • Consult a nutritionist or registered dietitian to plan a healthy, gradual weight loss program.
  • Eat three nutritious meals a day, but limit portion sizes.
  • Be mindful that a diet too strict or low in calories may decrease your energy.
  • Be as active as possible. Go for a walk every day if you can.
  • Enroll in an individual/group exercise program near your home.

Tell your doctor if you eat compulsively or binge eat —this may be a side effect of PD medications.

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.

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