Many people with cancer struggle to maintain a healthy weight. People may put on weight during cancer treatment due to being less physically active than normal or due to the effects of steroids, or they may find they struggle to eat for a range of reasons including nausea and vomiting, loss of appetite, changes to smell/taste, anxiety/depression, physical swallowing impairment (e.g. head & neck cancer) or sore mouth.

It is recommended that all health and care professionals at a supportive, assistive and registered level can take a role in nutritionally screening for malnutrition and provide advice or refer to a specialist as indicated.

The dietitian can:

• Carry out in depth assessment of nutritional need
• Establish case history, current extent of disease and proposed form of treatment
• Undertake detailed dietary assessment to include anthropometric (e.g. height, weight) and biochemistry measurements (blood test results)
• Assess for body image alteration/adjustment
• Assess functional ability relating to activity stamina, food preparation and eating
• Consider/manage oral nutritional supplements both non-prescribable and prescribable

Prescribing members of the multi-disciplinary team may consider pharmaceutical agents e.g. appetite stimulants, steroids, pancreatic enzymes and prokinetics.

A physiotherapist or specialist exercise professional, e.g. clinical exercise physiologist at a registered and enhanced level, can provide exercise advice and treatment to maintain muscle bulk, improve stamina and functional ability and advise on exercise regime and activity tolerance.

Occupational therapists may be able help with body image adjustment and psychological concerns, relaxation and visualisation techniques and assess and address issues around meals, timings and preparation, weakness and pressure care and equipment provision.

It is important to recognise signs of anxiety/depression which may be impacting on appetite and nutritional status and provide anxiety management as appropriate.

Anorexia nervosa (often called anorexia) is deliberately losing a lot of weight or keeping body weight much lower than is healthy for a persons age and height.

Signs and symptoms include:

• missing meals, eating very little or avoiding eating any foods you see as fattening
• lying about what and when you’ve eaten, and avoiding eating with others
• wearing baggy clothes to hide your body shape and lying about how much you weigh
• taking medicines to reduce your hunger (appetite suppressants), or to help you poo (laxatives) or to make you pee (diuretics)
• exercising excessively or making yourself sick to try to avoid putting on weight
• an overwhelming fear of gaining weight
• strict rituals around eating and thinking about food a lot
• weighing yourself frequently and seeing losing a lot of weight as a positive thing
• believing you’re fat when you’re a healthy weight or underweight
• not admitting your weight loss is serious

Other physical signs and symptoms include:

• for a person under 18, weight and height may be lower than the minimum expected for the persons age
• for an adult, having an unusually low body mass index (BMI)
• periods stopping (in women who have not reached menopause) or not starting (in younger women and girls)
• bloating, constipation and abdominal pain Headaches or problems sleeping
• feeling cold, dizzy or very tired
• poor circulation in hands and feet
• dry skin, hair loss from the scalp, or fine downy hair growing on the body
• reduced sex drive

These signs and symptoms may mirror those that occur with cancer and its treatments.

People with anorexia often have other mental health problems, such as depression or anxiety.

Rehabilitation Assessment for Anorexia

Subjective Global Assessment (SGA) – Assessment (SGA) – CMTF – Canadian Malnutrition Task Force (nutritioncareincanada.ca)

Patient Generated Subjective Global Assessment (PG-SGA) – Patient Generated Subjective Global Assessment questionnaire

Bioelectrical impedance analysis for sarcopenia