Starting a new medication is rarely seamless, even when the potential benefits are significant. I recently experienced this firsthand when my doctor and I decided to begin a trial of medication for Attention-Deficit/Hyperactivity Disorder (ADHD). One of the most common side effects, it turns out, is a decreased appetite – and I’m among the approximately 80% of people taking stimulant ADHD medications who experience this.
It’s easy to assume appetite changes are solely a response to medication, but registered dietitian Avery Zenker explains that’s not always the case. “Ideally, the body is properly communicating hunger signals and we’re accurately hearing them,” she says. “However, We find many situations where appetite isn’t aligned with what the body needs.” This can be due to stress, sleep deprivation, underlying medical conditions, or even simply being too busy to prioritize eating.
I was curious about how a dietitian approaches this issue with clients. Zenker emphasizes a personalized approach. “What works best is different for different people,” she says. “You may need to play around with different strategies to find what works best for you. Try having small, frequent meals. Try different textures and flavors. Go shopping and look for some new snacks or foods that interest you, or try something new at a restaurant that you think you would like.” Her overarching goal is to maximize intake of calories, protein, vitamins, and minerals – getting the most nutritional “bang for your buck” with the food you *do* manage to eat.
Should I be making myself eat when I don’t want to?
For me, the challenge isn’t just a general lack of hunger; it’s a disinterest in food itself. Even foods I typically enjoy can feel unappetizing. This raises the question: when does a reduced appetite warrant intervention? Zenker offers reassurance, but also a cautionary note. “In the short-term, it’s usually fine to eat less when you don’t feel like it, assuming that your appetite will return,” she says. “However, chronic low appetite often requires an intervention to help you eat even if you don’t feel like it.”
The primary concern with prolonged low appetite is the risk of unintentional weight loss or, more subtly, nutrient deficiencies. “The malnutrition risks of some short-term low appetite are small, but the risk increases with higher duration and severity of reduced appetite,” Zenker explains. It’s not simply about the number on the scale; even maintaining a healthy weight doesn’t guarantee adequate nutrient intake.
How can I increase my appetite?
Zenker stresses the importance of addressing the root cause of appetite loss whenever possible. However, when that’s not feasible – as in my case, where the medication’s benefits outweigh the side effects – strategies to optimize food intake become crucial. “Addressing the root cause of low appetite is ideal, if possible. If not, then there are a number of strategies that can help optimize food and nutrient intake when appetite is low.”
In my situation, I’ve chosen to prioritize effectively managed ADHD symptoms. So, what can I do to make the most of my meals? Zenker’s advice begins with self-compassion. “Be gentle with yourself,” she says. “Don’t let perfect be the enemy of good. If it feels like too much energy to decide what the perfectly nourishing food would be for you at the moment, it’s okay to choose what sounds appetizing.”
“Try to choose foods that you know will make you feel good.”
Avery Zenker, registered dietitian
Whenever possible, Zenker advises opting for foods rich in the nutrients the body needs, but acknowledges that simply eating *something* is better than nothing. Focusing on appealing foods is key to maximizing intake when appetite is low.
Beyond that, Zenker shared eight practical tips for increasing the nutritional value of meals, even when eating less:
1. Aim for variety
Consuming a range of macronutrients (proteins, carbohydrates, and fats) as well as a wide variety of vitamins and minerals is particularly important when eating less than usual. This is best achieved through a varied diet, incorporating fruits, vegetables, whole grains, and legumes where possible. “Aim to eat a variety of foods to get a wide array of different nutrients. If you have a condition that requires particular eating patterns or increases your need for a certain nutrient, that should be a key focus,” says Zenker.
2. Strike a balance between calorie density and nutrient density
“Nutrient-dense means a food is higher in nutrients like vitamins and minerals. Calorie-dense means that a food is high in calories,” explains Zenker. Overemphasizing low-calorie, nutrient-dense foods can leave you feeling full without providing sufficient energy. Conversely, relying solely on high-calorie, low-nutrient foods can lead to deficiencies. Finding a balance is crucial. “Malnutrition isn’t just about calories or weight loss. You can be eating enough calories, but still be malnourished.” She suggests prioritizing foods that are both calorie- and nutrient-dense, such as protein shakes, avocados, nuts, seeds, and yogurt.
3. Build your meals around protein
“Protein is especially important to help prevent muscle loss,” says Zenker. However, protein is also very filling, so moderation is key. “You want to make sure you’re getting enough, but not so much that it limits total food intake,” she says. “It can be helpful to structure meals by starting with a protein source, then adding in carbohydrates and fats.”
4. Choose your fiber sources carefully
While fiber is important for overall health, high-volume, low-calorie fiber-rich foods can be overly filling when appetite is already reduced. Zenker recommends opting for higher-calorie fiber sources like avocados, nuts, seeds, and beans. “Make food swaps for foods with more calories, but that aren’t as filling,” she says. “For example, instead of oatmeal, have granola, which fills you up less for more calories.”
5. Try liquid meals
“Often, drinks are better tolerated than foods and they’re also a great way to pack in a lot of nutrients and calories,” says Zenker. Smoothies are a particularly good option, allowing for a concentrated dose of nutrients in an easily digestible form.
6. Stick to set mealtimes
“Try mechanical eating,” says Zenker. “This is when you plan specific times to eat, and eat because it’s time to eat. Make note of when your appetite is best and try to eat more at those times.” She also suggests reframing your view of food, treating it as medicine rather than simply fuel. “Take a spoonful of olive oil or a shot of protein shake if it helps,” she says. Creating a relaxed mealtime environment can also be beneficial.
7. Supplement energy-dense foods
Zenker suggests adding calorie-rich ingredients to meals to boost their nutritional value. For example, adding peanut butter to oatmeal or coconut milk to soup. “Find sauces and spices that you enjoy adding to foods,” she says. “This will not only make foods tastier and more appetizing, but sauces can also be a good source of calories and nutrients.”
8. Prioritize some micronutrients
A reduced appetite raises concerns about potential nutrient deficiencies. While all vitamins and minerals are important, Zenker highlights the need to prioritize iron, calcium, magnesium, vitamin A, vitamin C, and B vitamins. “Vitamin and mineral supplements can help improve micronutrient intake in individuals with a suppressed appetite,” she says.
