Overcoming Eating Challenges - Part 2: Overweight and Underweight

Last updated: May 2021

Editor's note: This is part 2 of a 4-part series. Be sure to check out part 1, part 3, and part 4.

I know it is very hard to maintain the proper weight but if you want to breathe your best, live as normally as possible and have the strength needed to fight COPD successfully, you need the energy to do so. In order to get the energy, you must eat. If you don't eat and maintain the proper weight, your COPD can progress at a faster rate. The muscles required for breathing by a person with COPD may require as much as 10 times more calories because it takes more effort to move air through obstructed airways. When you have COPD you must strive to achieve a healthier body weight by following a healthy eating plan and an exercise program you can/will do.

Each of us with COPD has different calorie, vitamin and minerals needs. If you don't get enough of them, you may find yourself waking up tired and staying that way. COPDers that are underweight have this problem. Too many calories and you become overweight, which can cause a lot of trouble with your breathing. If you’re underweight, you need to encourage your appetite and boost your calorie intake. Calories are energy and energy is a needed friend. However, too many calories result in weight gain that can exacerbate COPD. When you’re overweight, your heart and lungs have to work harder, and also increase the demand for oxygen. Too many calories are not your friend.

What to do about being underweight

18 years ago after a bad ice storm knocked out all the electricity in our house, we were forced to use a gas oven and barbecue for heat. We lived in the country and the roads were blocked. It took the fire department two days to get us out at which time I was taken directly to the emergency room. I have had adult onset asthma since I was in my early 30s and my inhaler was no longer doing it's job. I needed a nebulizer treatment. When I arrived at the emergency room I informed the intake nurse I could not take Albuterol, I used Alupent. The respiratory therapists who came to give me the nebulizer treatment didn't look at my chart, and gave me what she gives everyone else that has breathing trouble, Albuterol. I spent the next 11 days in intensive care and left the hospital not only with Asthma, but stage 4 COPD on oxygen 24/7, heart medications, and 16 pounds lighter than the day I walked in to the hospital. I went from 126 pounds to 110 pounds, and the fact that when I got home I was immobile for another month I dropped another 10 pounds. I looked like the walking dead.

Not only was I underweight, but when you lose weight that fast your skin just hangs from the body, and you are zapped of energy. In order to gain the weight back I did most of the things listed below. Even though I couldn't eat a lot at one time, when I did eat, my food was loaded with as many calories as possible, and I became active again as soon as I could. When I was in upper stage 4 I still went camping and hiking with my grandchildren pulling my oxygen behind me. It took me about a year to put the weight back on, but I did, and so can you. Just never stop trying and eat small meals with a lot of calories. Add high calorie foods to existing dishes like, nuts, seeds, and dried fruit make a great addition to salads, rice dishes, pasta dishes. Add olive oil, peanut oil, or sunflower oil to as many foods as possible. They not only adds calories, but another depth of flavor to your food. Nut and seed butters (Peanut Butter), chocolate (Dark) and dried fruit are a good calories boost. Avocados, whole milk, eggs, cheese, oily fish (Mackerel, salmon, tuna or sardines canned in Oil) and most meat are high in calories. Add even more calories with sauces, gravies, and load that salad with your favorite dressing. Instead of drinking plain milk, have a milkshake, or add chocolate. A peanut butter and banana sandwich on whole wheat bread and a glass of milk not only taste good, it's high in calories, complex carbohydrates, protein. It is a great go-to food for putting on weight. Keep bowls of nut, dried fruit, and bite size candy around the house and snack on them all day. Grab a few when you pass by, just a hand full over time will add weight. Drinking supplement like Ensure are great as long as you drink them with your food not in place of food. Exercise is good for gaining weight also. Ask your Pulmonologist to refer you to respiratory rehab or someone who can show you some exercises you can do at home and direct you on how often they should be done. Not only will you gain weight, but breathe a lot better and be able to do more.

What to do about being overweight

After I almost died the first time 18 years ago I became severely underweight. After I almost died the second time 13 years ago, 29 days in hospital, most of it in intensive care on life-support, I was sent home loaded down with steroids. Both my Pulmonologist and cardiologist gave me less than a year to live. This time instead of being underweight I couldn't stop eating and became 20 pounds overweight. When I stopped smoking 5 yrs later, I put on another 20 lbs. Carrying around all that extra weight was not only bad for my COPD but put a tremendous strain on my already bad heart. After putting on the extra weight my doctors cut my chances of living down to six months and put me on hospice. That's when I decided to take control of my body again and make some change. The first thing I did was ween myself off of Prednisone, and put myself on a diet. I didn't count calories I just eliminated food I knew contained a lot of calories like sweets, chips, salad dressings and gravies. It took me over two years but I lost the weight. I now eat what I want whenever I want I just limit my portion size and for the last six years I have maintained a weight that does not interfere with my breathing, and allows me to be as active as possible. If you apply the diet tips I used you too may be successful in reaching your ideal weight and maintaining it. One other thing to remember: what is the ideal weight for me or someone else may not be ideal for you. You may do better with a few extra pounds so don't set your goal by others, but what makes you feel the best.

If you're overweight you not only need to learn to measure portions, but you need to learn to eat the right food and start a good exercise program. You have to educate yourself on ways to achieve your goal naturally. Just make sure you consume the right type calories and not the empty ones. By empty calories I mean ones that serve no useful purpose other than to put fat on your body such as refined sugars and soft drinks. And don't think by drinking diet soda you're helping yourself out. Many diet drinks and other diet foods are appetite stimulants, not suppressors. You may not get the calories from the drink, but within 15 to 30 minutes of consuming that drink you will become hungry and crave food. So try to stick to water, coffee, tea, unsweetened juice and regular (not diet), foods as much as you can. Foods like eggs (If you are not on a low cholesterol diet) which are one of the few foods that are a complete protein, meaning they contain all nine essential amino acids that your body can’t make itself. Once digested, they trigger the release of hormones that suppress appetite. A study from Saint Louis University found that folks who ate eggs for breakfast consumed 330 fewer calories throughout the day than those who had a bagel or cereal. Adding vegetables to a scramble egg make them more filling for only a few extra calories.

If you don't like eggs try Oatmeal - it's high fiber content give it a filling force. When cooked with water or skim milk, the oats thicken and take more time to pass through your digestive system, meaning you’ll go longer between hunger pangs. You could try eating baked and boiled potatoes with skin-on to get more fiber and feel full longer. Instead of crackers or bread, have a bigger bowl of soup or salad helping.  For snacks try apple, mangos, or popcorn. Apples are one of the few fruits that contain pectin, which naturally slows digestion and promotes a feeling of fullness, according to a study in Gastroenterology. Mangos helps the body feel fuller and boosts the digestive function of the body helping in weight loss. Popcorn is a snack that's only 90 calories for 3 cups of air-popped corn. For great smoothies put fat-free milk or yogurt in a blender, add strawberries which are 92 percent water or bananas. Just don't add sugary ingredients like fruit juices or flavored syrups. Try some cottage cheese mixed with honey or berries for another low-calorie and satisfying snack.

I want you all to remember when you eat, eat a healthy well-balanced diet. You may have to try different foods to pick the ones that work best for you. There are few things I restrict in my own diet, I just eat in moderation. The restrictions I do have are mostly due to interference with the medicine I take, or has caused a major problem with my digestive system or CHF. Nothing I suggest is steadfast, you may need to adjust them to fit your own needs, and always talk with your physician before starting any big diet change. It may take a lot of hits and misses, but don't give up. Like me you will come up with a plan that works for you. When you do you might feel much better and be able to do some of the things you thought you would never do again. I hope these ideas work for you, Bon Appetit. Breathe deep & easy.

Editor’s Note: We are extremely saddened to say that on March 2, 2018, Mary Ultes passed away. Mary was an engaged advocate for the COPD community who strived to help people live fulfilling lives. She is deeply missed.

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