Weight Management

Have you experienced changes in weight since a diagnosis of Parkinson’s disease? It is very common for people with Parkinson’s to lose weight. Yet, for a variety of reasons, others may gain. Either way, changes in weight can affect your overall health. By being underweight, you may lose muscle mass and strength, and be more prone to osteoporosis and infection. Being overweight raises your 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 why people with PD may lose weight. Some people may lose weight even if they are eating exactly the same amount of food, while for others, certain symptoms of PD may affect appetite or the ability to eat.

For example:

  • Gradual loss of the senses of smell and taste is a nonmotor PD symptom that makes eating less enjoyable. Even before a PD diagnosis, people may eat less, and lose weight, because of this symptom. This weight loss usually levels off once PD therapy begins, and people return to normal eating habits.
  • Some PD medications can cause nausea, which in turns, causes some individuals to eat less.
  • Motor symptoms like tremor, slowness and stiffness, and complications of treatment such as dyskinesia (involuntary extra movements) can make eating difficult.
  • Swallowing difficulties (common in PD) interfere with eating.
  • People who experience depression or apathy — common nonmotor PD symptoms — may lose their appetite.
  • Some people are embarrassed that it takes them a long time to finish a meal, so they stop eating before they have had enough.
  • People with PD taking levodopa may have been advised to avoid taking medications with protein and this may make 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 signal a serious medical issue other than PD, such as cancer or depression.

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

  • Deep brain stimulation (DBS) is a surgical PD therapy that helps relieve movement symptoms in many people; however, weight gain is a potential side effect.
  • Dopamine agonists are medications that are sometimes given alone, and sometimes 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 (the Neupro® patch). Under the supervision of a doctor, adjusting medication 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 and you may wish to visit your neurologist or movement disorders specialist to see whether medication adjustment is recommended. A visit to the primary care provider to exclude other medical reasons for weight change is critical.

Tips for Achieving a Healthy Weight

Whether you wish to gain weight or lose it, diet and exercise are key. Everyone should 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 it can improve mood. Being active both 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, even if you don’t need to gain or lose any.
  • Get advice on starting an exercise routine from a physical therapist who is experienced in Parkinson’s disease.

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 (e.g., smoothies, ground meats or other soft proteins) and asking for help in cutting other foods (meat) 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.
  • Continue to eat three nutritious meals a day, but limit portion sizes. A diet that is too strict, or low in calories, may decrease your energy.
  • Be as active as possible; go for a walk every day if you can. If you eat compulsively, or are binge eating, tell your doctor—this may be a side effect of PD medications.