How to Manage Unintended Weight Loss from COPD

Eating small, nutrient-dense meals — and allowing yourself to ask for help — can help you manage unintended weight loss from COPD.

You look in the mirror, and something seems off. Perhaps your face has less definition, or your shirt and pants are looser than usual.

Maybe a family member recently asked if you’ve lost weight.

You remember the comment as you reach for a belt, but not before stepping on the scale for the first time in a long time. Your suspicions are confirmed: You’ve lost weight.

Weight loss in people with obesity or overweight is often recommended as a way to slow the progression of COPD, but losing too much unintentionally can be jarring.

Sandeep Gupta, MD, a pulmonologist at Memorial Hermann Health System in Houston, Texas, says the keyword here is “unintentional.”

He says this can be a particular source of discomfort for people “because they are not consciously doing anything to lose weight, and weight loss seems to be progressive.”

Understanding the reasons and ways to manage unintended weight loss from COPD can empower you to feel your best.

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Why does COPD cause weight loss?

People living with COPD will want to monitor unplanned weight loss, especially because it’s common: One 2022 study involving 200 participants with COPD found that 21.5% experienced unintended weight loss over 3 months. Doctors say there are many reasons why.

Calories in, calories out

Weight gain and loss are typically a numbers game. “Calories in, calories out” is frequently discussed when discussing weight. Many aspects of COPD can affect the amount of calories a person consumes and burns. Let’s start with “calories out.”

“Breathing difficulties in COPD require more energy, leading to burning more calories at rest and during activity, contributing to weight loss,” Emanuele Santomauro, MD, a pulmonologist at Hackensack Meridian Health in Lodi, New Jersey.

At the same time, a person may have little desire to eat.

“Shortness of breath and fatigue associated with COPD can make eating difficult and unappealing, leading to decreased calorie intake and weight loss,” Santomauro said.

The shortness of breath and food intake can also play off one another, Gupta says. He explains that people may find eating a large meal challenging because of breathing problems. COPD can cause hyperinflated lungs, which means air gets trapped in the lungs during an exhale, stopping you from taking a normal breath.

Bloating can also cause breathing problems and make eating seem unappetizing. Gupta also says that inhalers used to treat COPD can change the taste of food, making it less appealing.

Chronic illness, disease, or infection

COPD can increase your risk of other chronic issues — physical and mental.

“Those with advanced COPD can pick up chronic lung infections, such as nontuberculous mycobacterium or a chronic fungal infection,” said Jimmy Johannes, MD, a pulmonologist at MemorialCare Medical Group in Long Beach, California. “The increased inflammation associated with these infections can result in worse appetite and higher energy [spending], resulting in weight loss.”

Unintended weight loss can also be a sign of cancer. Johannes suggests seeking a doctor’s evaluation for lung cancer if you notice this sign, as an early diagnosis can improve your treatment options and outcome.

Mental health

While physical COPD symptoms like difficulty breathing and eating, for instance, are often discussed, the disease can also take a toll mentally.

Research published in 2023 suggests that people with COPD have a higher risk of experiencing anxiety and depression, which might increase the chances of flare-ups.

Santomauro says anxiety and depression can also contribute to appetite changes.

Severity

Unintended weight loss can signal that COPD is progressing and trigger the above reasons, like spending more energy breathing, explains Johannes.

The 2024 Global Initiative for Chronic Obstructive Lung Disease report suggests that COPD can be linked to being underweight.

Gupta says you or your loved ones might first notice weight loss in stage 3 COPD when you have more difficulty performing daily to-dos.

“It may be evident to one’s spouse and other family members, and the person might also see loose-fitting clothes, and they may notice muscle [loss] and general weakness,” Gupta said.

Tips for maintaining a healthy weight

Maintaining a healthy weight can boost your health and quality of life.

“It improves muscle strength and endurance, boosts the immune system, and reduces the risk of complications,” Santomauro said.

One study from 2019 found that low body weight can increase the chance of death. The weight range varies, but Johannes cites 2022 data that suggests a body mass index (BMI) below 20 or above 35 increases health risks, including death. But it’s more than a number.

Santomauro says a healthy weight for someone living with COPD is not just about a number on the scale.

“It’s about achieving a weight that optimizes lung function and reduces breathlessness, maintains muscle strength and endurance, and supports overall health and well-being,” he said.

Experts shared tips for doing just that.

Eat nutrient-dense foods

Since weight loss can also lead to muscle loss and weakness, Johannes says eating nutrient-dense foods, especially protein, is essential.

Foods and beverages with protein include:

• milk
• yogurt
• poultry
• fish
• nuts
• beans
• protein
• eggs

“Eating food with complex carbohydrates, fruits, and vegetables is also recommended,” Johannes said. “Some may need further supplementation with supplemental nutritional shakes.”

Eat small, frequent meals

The idea of eating three protein-starch-veggie meals per day? Go ahead and ditch it if you want.

“Bigger meals are harder to tolerate because of the feeling of early satiety, but multiple small meals may be tolerated,” Gupta said.

Santomauro recommends eating smaller meals five to six times per day. Taking breaks between bites and sitting upright can boost digestion while reducing shortness of breath. Santomauro recommends remaining hydrated during and after meals. Your best bet? H2O.

“Drink plenty of water throughout the day to prevent dehydration, which can worsen fatigue and breathlessness,” he said.

Ask for help

COPD can feel lonely, and weight loss you weren’t trying for can be confusing. But you don’t have to go it alone.

“Having meals delivered or having family members bring meals may also improve their nutritional status,” Gupta said, adding that a dietitian can help you find nourishing foods you love.

Try pulmonary rehab

Pulmonary rehab can also give you tools to improve your quality of life, including eating. 

“Pulmonary rehabilitation and improving strength with exercise can help tell the body to build more muscle and improve symptoms,” Johannes said. “Optimizing lung function with medications more efficient breathing can further help.”

Bonus: Pulmonary rehab often includes education on diet.

Be diligent (and kind)

Gupta says it’s important to have patience with yourself. While frequent weight checks may be stressful, they can help you stay on top of your gains and losses.

Working with your care team, including a mental health professional, can help you address stressors that can worsen appetite and related weight loss.

Takeaway

Unintended weight loss from COPD is common. Aspects of COPD can lower your appetite, including treatment using inhalers (which can change taste), bloating, and difficulty breathing.

Unplanned weight loss is also a sign of worsening COPD and other chronic issues, like infections or cancer. Anxiety and depression are also common reasons for appetite changes and weight loss.

While common, weight loss isn’t inevitable with COPD, and you can manage it if you experience it. Eating nutrient-dense foods and small, frequent meals can ward off some common culprits for lower appetite, like bloating. It’s important to keep an eye on weight, and how you feel physically and mentally should the number on the scale change.

Give yourself some grace during the process — it may take some trial and error. Consider speaking with your care team if you’re concerned so you can chart the best course together.