Swallowing / Appetite & Weight

Many people with traumatic injuries do not drink or eat normally for a period of time after the injury. As a result, they lose weight.

Once the person is fully awake from an unconscious or comatose state and is able to follow directions, their swallowing ability can be evaluated. It is important to fully evaluate swallowing before the injured person drinks or eats.

The purpose of evaluating the person’s ability to swallow is to make sure that what they eat goes into the stomach, not into the lungs. When food or fluid slips into the lungs, it often results in pneumonia.

A speech or occupational therapist evaluates the service member or veteran’s swallowing. This may be done in the person’s hospital room or the radiology department.

Once the service member or veteran is medically cleared to drink or eat, they may only be able to consume certain types of liquids and foods. Most people do best with food of a medium consistency, rather than thin fluid or very chewy, tough foods. With practice, most people will return to a normal diet.

Appetite can be affected as a result of the TBI. Some people with TBI complain of a reduced appetite while others gain weight due to boredom, memory problems, and an increased appetite.

Work with the healthcare team to learn how to help your family member develop and maintain a healthy diet and a healthy weight.

What might you see?

  • Choking, coughing, or difficulty swallowing during meals
  • Pocketing of food inside the mouth and/or drooling
  • Decreased interest in eating
  • Weight loss, without trying to lose weight (may possibly be due to loss of taste and/or smell)
  • Overeating, resulting in weight gain
  • Memory problems (failure to remember when to eat or when they last ate)

How can you help?

  • Do not offer fluids or food until your family member has been medically evaluated and cleared to drink and eat.
  • If they are placed on a special diet with restricted fluids and foods, work with the therapists and dietitians to learn what foods and fluids are allowed. Learn how to assist your family member to drink and eat, and if special strategies are needed (for example, eat slowly, chin tuck during swallow, double swallow, follow every bite of food with fluid).
  • If needed, the healthcare team can modify consistency of foods or fluids to ensure the safe intake and limit the risk of foods or fluids going down the "wrong tube" (for example, into the trachea and lungs instead of the esophagus and stomach).
  • Short-term changes in appetite are common after a TBI. Don’t worry about early weight loss. Most often, the weight is regained once the person is released from the hospital and recovering at home. However, if weight loss continues, a medical evaluation will be necessary.
  • Monitor your family member’s body weight and learn what his or her ideal weight range is from the dietitian.
  • Report appetite changes to the healthcare team. These may be a sign of depression, general emotional distress, medication problems, or other medical conditions.
  • Ask for a dietitian to review dietary intake and to learn more about meal preparation and a balanced diet.
  • It is common to have reduced taste and smell following TBI. Talk with the dietitian about how to use spices and flavorings to perk up the taste of food.
  • Weight gain following TBI is common and typically occurs in the later stages of recovery. Weight gain is usually due to lack of physical activity. To maintain a healthy weight and avoid weight gain, establish set meal times, discourage overeating or too many snacks, and encourage regular physical activity every day. A good strategy is to write meal times in the planner or memory book and check off meals when finished. The same can be done for physical activities.
  • Encourage your family member to be as involved as they are able, physically and cognitively, in grocery shopping and meal planning and preparation.