Dietitian case study: “Difficulty eating with tremor & weight loss”

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Dietitian Case Study: Betty came for a Dietitian assessment as she was concerned about her decreased appetite with gradual weight loss noted over the past three years. Betty was also having difficulty eating with her hand tremor and she found eating frustrating. She was also experiencing a decrease in her mobility the previous few months. Betty was aged in her late seventies, was diagnosed with Parkinson’s in 2015 and was living with her partner.

During assessment, the following information was obtained:

Current weight: 70 kg (154 pounds)

Estimated healthy weight range: 60-77 kg (132-170 pounds)

Betty reported the following:

• 6 kg (13 pounds) weight loss in a 3-year period.
• Decreased appetite for many years.
• Hand tremor with difficulty feeding herself.
• Preference for softer foods (no chewing or swallowing issues).
• Consumes 1-2 snacks in-between meals each day (mostly snacks on cakes or sweet biscuits).

Issues:

• Gradual and ongoing weight loss. Loss of muscle mass and likely strength with a decrease in mobility reported.
• Inadequate food and fluid intake due to a decreased appetite plus difficulty eating due to hand tremor.

Dietitian notes:

• Weight loss is commonly observed in people with Parkinson’s. Early detection of weight loss and malnutrition is critical.
• Decreased appetite is another common problem for people with Parkinson’s. It can affect a persons ability to consume an adequate amount of food and fluid. There are many reasons appetite may decrease including low mood, nausea, decreased sense of smell, constipation, swallowing difficulties, fatigue and certain medications. 
• Eating and drinking can be challenging if you have Parkinson’s which makes it harder to get good nutrition. A small study of people with Parkinson’s published in 2025 found most participants reported difficulties using regular cutlery, stating challenges such as spills and reduced grip stability. Despite these difficulties few had used adaptive cutlery previously. Barriers to using adaptive cutlery included lack of awareness, limited access, cost, and concerns about its appearance.

Dietitian case study – Treatment goals:

• Optimise nutritional intake
• Prevent further loss of weight
• Help to make eating at mealtimes easier (and hopefully more enjoyable)

Suggestions made following assessment:

An education session was held with Betty and her partner and the following was discussed/recommended:

• Try to eat something every 2-3 hours (setting an alarm to alert Betty every 2-3 hours could help her achieve this).
• Serve food on small plates as large meals can be overwhelming and discouraging.
• Calorie and nutrient-dense foods were suggested. Alternative snack options were discussed.
• Betty was encouraged to keep snacks on hand that are ready to eat as snacking is important if she is eating less at meals. It was also suggested that Betty take snacks with her if she is going out for the day.
• Try drinking fluids between meals as having fluids with meals could make Betty feel full. Aim to choose nourishing fluids and sip on these between meals.
• Advice was provided to fortify foods and fluids by adding extra calories and nutrients. It was suggested that fortifying foods and fluids with healthy fats was a great way for Betty to achieve this.
• A list of meal ideas, snacks, nourishing fluids and food fortifiers was provided to Betty and her partner.

 

Addressing difficulty eating:

A trial of adaptive cutlery was suggested and Betty subsequently had a session with an Occupational Therapist to trial different options.

For Betty, it was recommended she use weighted built-up cutlery with a bendable fork and spoon option, to allow easier eating. See below for a similar option that was suggested for Betty that is available to purchase online.

 

Other suggestions: 

• Ongoing Dietitian review sessions.
• Make an appointment with a Physiotherapist to guide appropriate exercises to help regain muscle mass.
• Make an appointment with her doctor to discuss weight loss.

 

For further information about adaptive equipment and aids click here. Remember, Parkinson’s affects everyone differently and what suits one person may not suit another. For individual advice on the need for adaptive equipment connect with an Occupational Therapist and/or Speech Pathologist.