Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that causes breathing difficulties. According to the Centers for Disease Control and Prevention (CDC), it ranks as the fourth most common cause of death in the United States. While treatment and healthy lifestyle habits are crucial for improving the outlook for individuals with COPD, the disease can also lead to significant weight loss in many individuals. It's essential to learn how to maintain your weight and meet your nutritional needs to promote a good quality of life and overall health with COPD.
The Link Between COPD and Weight Loss
According to a literature review published in the Journal of Translational Internal Medicine, 25-40% of people with COPD experience low body weight. Unintentional weight loss is a sign of a serious issue, especially if you lose many pounds in a short time. Eating enough calories and nutrients is essential to supporting your breathing, immune system, and energy levels.
How COPD Develops and Affects the Body
COPD develops as a result of lung damage, primarily from smoking. There are two primary forms of this disease:
Chronic Bronchitis: This causes severe inflammation (swelling) in the airways of your lungs, leading to mucus buildup that blocks your airways and makes it difficult to breathe correctly.
Emphysema: This develops when air sacs in your lungs are damaged, hindering their ability to properly take in oxygen and release carbon dioxide.
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Breathing issues and a constant cough (or “smoker’s cough”) are often the first signs of the disease, along with symptoms like tightness in your chest, sputum production with cough, shortness of breath after moderate physical exertion, wheezing, muscle aches, and headaches. COPD develops slowly, and many people with COPD receive an advanced-stage diagnosis because they seek medical attention late.
At this stage, damage to your lungs becomes so severe that your lung volume expands in size, which flattens your diaphragm, reducing the amount of space between your lungs and stomach. When this happens, your respiratory muscles expend more energy due to the lack of space and the diaphragm’s inability to expand. A flattened diaphragm also makes breathing more difficult, and the resulting lack of oxygen and excess carbon dioxide in the blood forces the body to expend more energy, contributing to unhealthy weight loss.
Factors Contributing to Weight Loss in COPD Patients
Weight loss in COPD patients can be attributed to a combination of factors:
Increased Energy Expenditure: People with COPD often burn up to ten times the amount of calories as regular people just by breathing alone. Breathing requires more energy if you have COPD, and if you are living with COPD and are experiencing weight loss or are already underweight, you will need more calories to replace the energy used. According to the COPD Foundation, people with COPD need an extra 430 to 720 calories per day. When you do not consume enough calories to meet your body’s energy needs, your body breaks down stored fat and muscle, causing both muscle loss and weight loss. It makes the muscles in your lungs work harder, which can further cause shortness of breath.
Reduced Appetite: Loss of appetite is the most common cause of weight loss for people with COPD. This can be due to difficulty breathing, food not tasting as good as it used to, COPD medications leading to a lack of hunger, or preparing meals being too tiring. Eating too fast or some foods may trigger bloating or indigestion, which can also make it harder to breathe, discouraging you from eating regular, healthy meals. These foods may include salty foods, spicy foods, fried foods, high fiber foods, carbonated drinks, and caffeine.
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Muscle Weakness: When you do not eat enough calories, it makes the muscles in your lungs work harder. This can further cause shortness of breath.
Mental Health Issues: COPD can contribute to mental health issues, which can affect your appetite and eating habits. When you’re managing the effects of COPD, it’s not uncommon to experience depression or anxiety. Such mental health challenges affect everyone differently. Some people eat more and gain weight, while others eat less and lose weight.
Difficulty Preparing Meals: Sometimes, preparing food can be physically exhausting for people with COPD. You might feel tired or out of breath when cooking, which might discourage you from making snacks and meals.
The Consequences of Being Underweight with COPD
Being underweight is often associated with poor nutrition, and in people with COPD, the effects can be severe.
Weakened Immune System: Not getting enough nutrients weakens your immune system and increases your infection risk. This is why many people with COPD are hospitalized with chest infections.
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Chronic Fatigue: Being underweight and malnourished can also make you feel extremely tired, making it difficult to complete everyday tasks.
Strategies to Increase Body Weight and Nutrient Intake
To increase your body weight while ensuring you get enough nutrients, it may help to:
- Avoid smoking.
- Eat small but frequent meals throughout the day; eating frequent, small and nutritious (high energy, high protein) meals is best.
- Find ways to eat higher calorie foods.
- Reduce your intake of fluid during meals to allow more space in your stomach for food.
- Drink more fluids in between meals; hydration helps to thin out mucus.
- Avoid foods and drinks that trigger bloating.
- Eat while using oxygen treatments.
- Rest before you eat.
Dietary Recommendations
Focus on Nutrient-Dense Foods: Choosing nutrient-dense food is important. It is easier to eat smaller meals, so choose meals such as peanut butter, eggs, cheese, etc. These items are high in protein and also high in calories.
Fiber: Fiber has many benefits, including keeping your bowel movements regular. High-fiber foods include whole-wheat pasta, whole-wheat bread, whole-grain cereals, vegetables, fruit, nuts, beans, and rice.
Protein: Protein can help you build muscle mass and ultimately gain weight. Meat, poultry, fish, nuts and seeds, tofu, milk, cheese, and eggs are higher in protein. Mixed nuts and nut butter, like peanut or almond, are delicious, versatile, and easy to use. Spread peanut butter on cut-up apples, sandwiches, whole grain crackers, and toast. Add mixed nuts or seeds to yogurt, cottage cheese, and cereal. Try added protein powder to fruit smoothies and milkshakes.
Fat: Fats help you digest your foods and make vitamins. Foods like meat, dairy, eggs, nuts, and oils contain fat. Choose whole or full-fat dairy options rather than low or reduced-fat. Add cheese, cream, olive oil, butter, and dressings to meals when possible. You may find that eating too much dairy causes your mucus to thicken, so listen to your body.
Simplifying Meal Preparation
Finding ways to prepare snacks and meals more easily might also help you meet your nutritional needs. For example, you can reduce some of the physical work cooking involves by buying precut produce, microwaveable meals, or other packaged products.
Reducing Sodium Intake
Look for low sodium options when shopping for preprepared or packaged food products. Overeating sodium causes your body to retain water, which puts more pressure on your lungs. Cut back on sodium.
Addressing Mental Health
If you notice that you’ve lost weight around the same time that you’ve been experiencing feelings of depression, anxiety, or stress, consider asking your doctor about ways to improve your mental health. Antidepressants and other treatments may help you manage your weight while improving your mood and outlook on life.
Seeking Professional Guidance
In some cases, your doctor or a dietitian may encourage you to add a nutritional supplement to your diet. Your doctor may refer you to a registered dietitian or other specialist for more tips and support. A registered dietitian can help you develop ways to adjust your diet while coping with COPD. Referral to a dietitian is recommended to establish an appropriate diet for a person with COPD who is malnourished.
Pulmonary Rehabilitation
Pulmonary Rehabilitation is the most important non-medication treatment for COPD. This program provides education and support, as well as supervised exercise. This program improves your quality of life and reduces exacerbations (flare-ups) of your COPD symptoms which reduces hospital admissions. During this program, you will learn how to stay healthy with COPD, different breathing techniques, more about your medications, nutrition to help your lungs, how to stay relaxed and manage stress, and about oxygen therapy.
Cachexia and COPD
Cachexia is a complex syndrome that encompasses multiple manifestations of COPD. Cachexia is an important extra‐pulmonary manifestation of chronic obstructive pulmonary disease (COPD) presenting as unintentional weight loss and altered body composition. The prominent and dynamic feature of cachexia is unintentional weight loss, driven by a variable combination of reduced food intake and metabolic disturbance. A consensus definition from the Cachexia Consensus Working Group requires the presence of ≥5% weight loss in the previous year or a BMI <20 kg/m2 plus ≥3 of five markers of metabolic disturbance [decreased muscle strength, fatigue, anorexia, low fat‐free mas index (FFMI), or abnormal biochemistry] to diagnose cachexia. Similarly, diagnosis of a pre‐cachexia state defined by the European Society of Clinical Nutrition and Metabolism Special Interest Group on cachexia-anorexia requires assessment of weight loss (≤5% in the previous 6 months) plus markers of anorexia and metabolic disturbance.
A study enrolled 1755 consecutive outpatients with stable COPD from two London centres between 2012 and 2017, stratified according to European Respiratory Society Task Force defined cachexia [unintentional weight loss >5% and low fat‐free mass index (FFMI)], pre‐cachexia (weight loss >5% but preserved FFMI), or no cachexia. The primary outcome was all‐cause mortality. The prevalence of cachexia was 4.6% [95% confidence interval (CI): 3.6-5.6] and pre‐cachexia 1.6% (95% CI: 1.0-2.2). Both cachexia [HR 1.98 (95% CI: 1.31-2.99), P = 0.002] and pre‐cachexia [HR 2.79 (95% CI: 1.48-5.29), P = 0.001] were associated with increased mortality. In multivariable analysis, the unintentional weight loss feature of cachexia was independently associated with mortality [HR 2.16 (95% CI: 1.31-3.08), P < 0.001], whereas low FFMI was not [HR 0.88 (95% CI: 0.64-1.20), P = 0.402]. Weight loss should be regularly monitored in practice and may represent an important target in COPD management.