Answer:

Thanks for reaching out John. Glad that you are on top of her nutrition and have sought medical attention first. Certainly, there are very high calorie foods to incorporate I’ll address below. However, I must say in my experience with geriatric nutrition and long-term care residents, the body’s ability to process and assimilate the calories consumed is often the limiting factor. There may be impairments anywhere from gut digestion and absorption to cellular uptake and utilization. 

You’re right to focus on solid foods as weight gain supplements should be given between meals not as a replacement. Nutrament by the way, is marketed as an energy drink for active persons and it’s half sugar1! [360 Cals, 10 g Fat, 47 g Sugar, 16 g Protein] If you’re trying to stay away from medical weight gain supplements, then a comparable 12 fl. oz. of Carnation Instant Breakfast High Protein2 would be more suitable (330 Cals, 9 g Fat, 18 g Sugar, 22 g Protein).  

Cheese, avocado, fatty fish (salmon, trout, sardines, herring), full-fat yogurt, nut butters, olives and coconut (meat and milk, not the water) are the richest in calories. Incorporating eggs, beans, olive oil, potatoes and whole-grain starches will provide additional protein and energy. Meal and snack suggestions include: eggs benedict, pudding, nachos with guacamole, mashed potatoes, potatoes au gratin, pumpkin mousse, yogurt + fruit smoothies, shepherd’s pie, avocado on toast, peanut butter on crackers, bisques and chowders, olive tapenade with crostini, granola, and trail mix. 

Several condiments can be used to supplement additional calories and protein, such as: syrups, gravies, cheese sauces, creams, spreads, butter, icing/frosting, honey, jelly/jam, pesto, tahini, hummus, and tamari. Use these to coat, cover, top and soak into the main foods (e.g. whipped cream and maple syrup on French toast).  Additional food preparation tips are available from the Institute on Aging, the Dietitians of Canada, and the Cleveland Clinic.  

Regarding medications2–4: Dronabinol has been available for three decades and is effective for stimulating appetite in the majority of elderly HIV and cancer patients who take it, although some don’t respond to it. The liquid solution form is showing promise over the capsule form for a quicker onset of action. For people experiencing loss of weight and lack of appetite in the absence of conditions like HIV or cancer, Megace is the drug typically prescribed, though it has limited effectiveness. 

References: 

1. “Nutrament Home Page.” Nutrament Home Page, Harvest Hill Beverage Company, 2019, www.nutrament.com/. Accessed 10.21.2019

2. “Carnation Breakfast Essentials® High Protein Ready-to-Drink.” Carnation Breakfast Essentials®, Société Des Produits Nestlé S.A., 2019, www.carnationbreakfastessentials.com/products/carnation-breakfast-essentials-high-protein-ready-drink. Accessed 10.21.2019

3. Wilson MM, Philpot C, Morley JE. Anorexia of aging in long term care: is dronabinol an effective appetite stimulant?–a pilot study. The Journal of Nutrition Health and Aging. 2007 Mar-Apr;11(2):195-8. 

4. Badowski ME, Yanful PK. Dronabinol oral solution in the management of anorexia and weight loss in AIDS and cancer. Therapeutics and Clinical Risk Management. 2018;14:643–651. Published 2018 Apr 6.

5. Persons RK, Nichols W. Should we use appetite stimulants for malnourished elderly patients? The Journal of Family Practice. 2007 September;56(9):761-762 doi:10.2147/TCRM.S126849 

– Debbie J., MS, RD