Weight Loss in Parkinson's Disease

Causes, Impact, and Management of Parkinson's Disease Weight Loss

standing on a scale
What are the causes and impact of weight loss with Parkinson's disease, and how can it be managed?. Laura Nubuck/HAAP Media

If you have Parkinson's disease (PD), you may feel that one of the few benefits of PD is weight loss, but that's not necessarily true. Let's take a look at weight loss in Parkinson's disease, the impact it may have on your life, and what you can do to maintain a healthy weight while coping with the disease.

Weight Loss in Parkinson's Disease

Weight loss in in people with Parkinson's disease isn't universal, but approximately four times as many people with Parkinson's disease lose weight when compared to people of a similar age and background who do not have the disease.

Most of the time, the weight loss is only mild to moderate, but some people have lost upwards of 40 or 50 pounds after their diagnosis. In addition to lessening quality of life, we've learned that weight loss may be a "red flag" indicating more severe disease, since those who experience weight loss also have faster worsening of their disease statistically. Who is at risk? Why does this happen? And what can you do if you're facing weight loss yourself?

Risk Factors for Weight Loss with Parkinson's Disease

Weight loss appears to be common in women with Parkinson's disease than with men. It also increases with age and with the use of higher doses of levodopa. It does not seem to be linked with several other factors, and it appears anyone with the disease may be at risk.

Causes for Weight Loss

There are many theories about the origin of weight loss for people with Parkinson's disease, but at the present time, the precise cause remains a mystery.

Theories have included the loss of smell (since loss of the sense of smell can affect appetite,) increased energy expenditure and fat burning due to tremors and dyskinesias  Other theories point at the mood disorders in Parkinson's disease such as depression. Yet, none of these factors have been found to play a big role upon rigorous testing.

Weight loss is thought to be more common in those who are treated with levodopa/carbidopa infusion gel (LCIG) with poor control of dykinesias, calling into question a drug role.

At the present time, weight loss is thought to most likely to be part of the gastrointestinal dysfunction seen in people with Parkinson's disease along with gastoparesis and decreased bowel peristalsis—terms that simply mean that food moves through the digestive more slowly than it ordinarily would without the disease. This decreased motion of smooth muscles in the digestive tract and elsewhere with the disease is often referred to as "autonomic dysfunction."

Malnutrition in Parkinson's Disease

As noted earlier, weight loss is common with Parkinson's disease, with roughly four times as many people experiencing this symptom than those of similar age who do not have the disease. Different than weight loss alone, malnutrition is the condition of not getting enough nutrients for good health. Studies have found malnutrition to be present for between zero and 24 percent of people with PD, with another 3 to 60 percent being at risk for malnutrition.

The true numbers are likely much higher than this, and it's only been relatively recently that the role of nutrition in disease has been given the respect it deserves.

The Impact of Weight Loss with Parkinson's Disease

No matter the real incidence of weight loss, it clearly has detrimental effects for people living with Parkinson's disease. Researchers have found that weight loss (defined as the loss of an average of one pound per month) is linked with a significantly lower quality of life. Though weight loss was not found to lower survival, the small sample size of some of these studies makes a true judgment of the effect of weight loss on survival difficult to assess.

One concern is that people with Parkinson's disease appear to be at a higher risk of osteoporosis, and osteoporosis is a significant cause of both illness (morbidity) and death (mortality) in this age group. Weight loss has been found to increase the risk of osteoporosis in people with PD—people who already have an elevated risk of developing osteoporosis. Weight loss also increases the risk of pressure ulcers (bed sores), another condition which is already increased in people with PD due to a redistribution of body fat and restriction of movement. A final concern is that of cachexia. More than just weight loss, and including muscle wasting, cachexia has recently been looked at as a significant cause of premature death.

As noted earlier, a 2016 study found that patients who experienced weight loss were noted to have faster progression of their disease. Despite these findings, this remains a "chicken and the egg" problem for researchers, and it's not known if the weight loss was the cause of worsening disease, or if weight loss was the result of more severe disease.

Managing Weight Loss with Parkinson's Disease

Since weight loss clearly appears to lessen at least quality of life for those with Parkinson's disease, it's important to address any factors that can be helpful in stabilizing weight. Here are some tips:

  • Add spices and seasonings to foods to compensate for a decreased sense of taste.
  • Take a look at the aesthetics of eating. Improving the mood with a tasteful table, music, even candles can sometimes be as important as improving the taste of foods.
  • Make sure you have an adequate amount of time to eat. Feeling rushed can be a hindrance, especially for those whose digestive tract smooth muscles are working more slowly than normal.
  • Seek treatment for depression and other mood disorders if present.
  • Add a little exercise. Even a small amount of physical activity may stimulate appetite.
  • Choose high calorie foods when possible.
  • Choose foods that you most enjoy.
  • Eat at the times of day when you have the most energy.
  • Skip liquids and drink them after a meal instead of before or during the meal if possible.
  • Consider nutritional counseling.
  • Consider nutritional supplements such as Ensure.
  • Ask your doctor if your medications need to be adjusted as some of these may contribute to weight loss.
  • Most importantly, talk to whoever is responsible for preparing your meals. Family caregivers for people with Parkinson's disease tend to experience stress and sometimes caregiver burnout. At the same time, these are the people most often responsible for helping with meal preparation. Consider asking for help from other family members or members of your church, synagogue, or other social group. Many people feel helpless to know what to do to help, and would feel honored to be able to prepare a meal or two.

 

Sources:

Akbar, U., He, Y., Dai, Y. et al. Weight Loss and Impact on Quality of Life in Parkinson’s Disease. PLoS One. 2015. 10(5):e0124541.

Malochet-Guinamand, S., Durif, F., and T. Thomas. Parkinson’s Disease: A Risk Factor for Osteoporosis. Joint Bone Spine. 2015. 82(6):406-10.

Sheard, J., Ash, S., Mellick, G., Silburn, P., and G. Kerr. Markers of disease Severity are Associated with Malnutrition in Parkinson's Disease. PLoS One. 2013. 8(3):e57986.

Wills, A., Perez, A., Wang, J. et al. Association Between Change in Body Mass Index, Unified Parkinson's Disease Rating Scale Scores, and Survival Among Persons With Parkinson Disease: Secondary Analysis of Longitudinal Data From NINDS Exploratory Trials in Parkinson Disease Long-term Study 1. JAMA Neurology. 2016. 73(3):321-8.

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