There’s no hiding it, America: You have a problem with your weight. The National Institute of Diabetes and Digestive and Kidney Diseases reports nearly 70 percent of Americans are classified as overweight or obese.
Clearly, most of us have a few pounds to lose, but that’s not usually the case for patients with chronic obstructive pulmonary disease. In the later stages of the disease, losing weight or having a low body mass index actually can be a sign of poor prognosis. According to the Lung Institute, a consortium of clinics across the United States that specialize in treating lung disease, “an estimated 40 to 70 percent of COPD patients experience unplanned weight loss.”
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Dr. Katina Nicolacakis, staff pulmonologist at Cleveland Clinic, says, “weight is actually something that’s really critical because many times, people with advanced lung disease develop something called pulmonary cachexia,” the clinical term for the muscle wasting syndrome that can cause them to lose weight and become weaker. “It’s an extreme,” she says, but even in less severe forms, “losing weight and losing muscle mass is a problem for people with advanced lung disease.”
Nicolacakis says this wasting occurs because as lung function declines, “there’s more work associated with breathing and that actually requires more calories.” It just takes more energy to breathe, and keeping yourself fueled adequately can become a challenge.
Similarly, because the body is struggling to get enough oxygen to fuel movement, doing “anything that requires multiple muscle groups like walking and talking, for example, and eating and talking at the same time — it becomes more difficult,” Nicolacakis says. The natural result of all this additional work is weight loss, and muscle mass loss further compounds the problem. “So losing weight and muscle is something we pay attention to,” she says.
Particularly once a COPD patient’s BMI falls below 20, (a 5-foot-10-inch tall man weighing 135 pounds has a BMI of 19.4, according to the Centers for Disease Control and Prevention‘s online BMI calculator) “not only do they not feel well, but they have an accelerated decline in lung function and they have an increased mortality. So it’s not a place you want to be.” In addition to feeling fatigued, weak and breathless, patients in this situation are also more prone to becoming malnourished and developing infections and exacerbations, or complications that make your COPD worse.
Michelle MacDonald, clinical dietitian at National Jewish Health in Denver, says that in addition to the body’s need for more energy to perform basic functions, the inflammation that accompanies COPD can cause the body to shift to burning muscle rather than fat. “Rather than maintaining [muscles] and repairing and building them up, burning lean body mass becomes part of the metabolism change.” She says she’s referring to the medical meaning of the term “inflammation,” which can cause “a real shift in your internal metabolism.” Under normal circumstances, your “body is happily humming along,” and when damage occurs to cells in the body, the “body goes and repairs it, ” MacDonald says. Protein from the diet is used to repair any damage incurred, and your muscle mass is maintained. But this isn’t the case for people with advanced COPD. “Someone who has chronic inflammation, their body isn’t doing as much of the normal repair maintenance and building up. It’s more in a breakdown mode,” which can lead to cachexia.
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To help combat this potential wasting syndrome, COPD patients are advised to follow a specific diet, which is often individualized, “partly because people have so many taste preferences and food preferences,” MacDonald says. The socioeconomic status of the patient may also factor into their diet plan, she says, because lower income patients may not have good access to high quality, nutritious foods. This is particularly an issue with COPD since it tends to afflict older patients who may be on a fixed income.
MacDonald says she typically recommends that depending on “what the person can afford and how much they can cook or how much help they have in the home,” patients should add “easily accessible foods such as whole milk, eggs cooked in oil, peanut butter or nuts, chicken, fish and meat and cottage cheese ” to help them maintain weight. She recommends taking a calculated approach and says “there are lots of opportunities to add protein and calories to the diet.”
For extremely underweight patients, your doctor may recommend a nutritional supplement, such as a high-calorie liquid shake. Patients with advanced COPD may experience a loss of appetite: Simply cooking and eating can become an exhausting activity. She also notes that COPD patients, especially those with emphysema, should be careful not to eat too much in one sitting. With emphysema, lungs can become hyper-inflated, taking up a large volume in the body. “This pushes down on stomach and makes it so they can’t eat as much. That’s when a liquid supplement can be useful.”
On the flip side, being overweight can also be a problem with COPD, but for very different reasons. Being overweight is not a risk factor for COPD as it is with many other chronic disease such as diabetes, but being overweight can make it harder to breathe and limit activity. “Not only are their lungs not allowing them to breathe, the weight is causing them to be short of breath, so the weight complicates things,” MacDonald says. Steroid treatments can also cause some patients to gain weight, which can be problematic if you’re already overweight.
For patients who need to lose weight, MacDonald recommends “a lower carb approach. The typical COPDer can’t move a whole lot — they tend to be sedentary and breathing is difficult,” so their ability to lose weight through exercise may be limited. She says removing liquid calories, such as soda, juices and sugary coffees can help. She also recommends reducing the amount of cereal, bread, pasta and potatoes you eat.
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Nicolacakis says reducing the volume of carbohydrates you consume may actually help you breathe better. “The more carbs you eat, these get converted to carbon dioxide [during digestion] and then you need to breathe more,” to expel that carbon dioxide. “In general, I think we should all eat less carbs, but definitely people with COPD need to eat less carbs,” she says.
MacDonald also cautions that COPD patients should aim to increase their calcium intake, because steroid treatments like “prednisone can decrease bone density. Patients with COPD are at higher risk for osteoporosis,” which is compounded because they’re “less active because they can’t breathe, and they might not have the best diet,” so she recommends speaking with your doctor about getting on the right diet for you and considering adding vitamin D and calcium supplements.
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What?s the Connection Between Body Weight and COPD? originally appeared on usnews.com
