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How can I help my heroin-addicted daughter gain weight?

Asked by Ann, Central Pennsylvania

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Because of the complexity of this viewer question, three of CNNHealth's expert doctors are offering their advice. Read insights from Living Well expert Dr. Jennifer Shu here. Check back Tuesday for thoughts from Mental Health expert Dr. Charles Raison.

My daughter is a heroin addict -- the "new face" of the heroin addict. My question concerns her weight. She is 5 feet 3 and is probably somewhere in the 85-90 pound range (I hope). She has always eaten a large amount of food just to maintain her before-addict weight of 108-110 pounds. I realize most of the population does not have this problem, but how can we add weight gain to her? Is GNC OK? The one supplement I found has over 2,000 calories and I told her to half that amount and eat regularly. She still is not gaining weight. Are there any weight-gain "diets" out there for this small minority of people who have trouble gaining weight? I would like to have her eating something healthy to gain and maintain the weight. Is there a daily drink she could have? I'm afraid her little body will just give out one day.

We have a history of heart disease in our family. I can't always control the "addict" in her, but I do try and make sure she has food, etc. She's supposed to be taking Suboxone, which works great for her when we/she can afford it. It's such an awful addiction. Any help would be appreciated.

She is an identical twin and her twin sister is also an addict on Suboxone, and pregnant. She's due September 6 and has great prenatal care and a good job. I worry about the effects of the Suboxone on the baby, but it has to be better than the alternative. She is doing wonderful though on Suboxone and I hope that she can just continue to take it after the baby gets here. Thanks in advance.

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Diet and Fitness Expert Dr. Melina Jampolis Physician Nutrition Specialist

Expert answer

Hi Ann

First of all, I admire you for your strength and courage in this obviously challenging situation, and I'm happy to be able to do anything to try and help, although personalized professional treatment is without question the best course of action for your daughters. Since I am not an expert on addiction or the impact of drug addiction on pregnancy, I thought it would be best to bring in my fellow CNNHealth contributors to help answer this question in three parts. I will tackle the weight-gain question in my response. The others will share their thoughts on Monday and Tuesday.

It sounds like your daughter was naturally thin to begin with, so I imagine that it will be even more challenging to help her gain or maintain weight. As with any eating plan, it is important to pay attention to basic nutrition and choose the healthiest foods possible, so loading up on "fattening" food like ice cream, candy and fried food is not the best strategy. The goal is to try to maximize the calorie density of food (calories per ounce) that your daughter eats, especially since her appetite may be significantly decreased by heroin use. Fat is very calorically dense, so it is critical to sneak in mainly healthy fats whenever possible. Foods that are higher in fiber or water, like soup, non-starchy vegetables, and low-fat dairy, have much lower caloric densities, so if your daughter's appetite is limited, these foods should be minimized somewhat as they may fill her up without providing enough calories to help her gain weight. Here are a few ideas for increasing the calorie density of your daughter's diet in a healthy way. Without knowing more details about the nutrition of the supplement from GNC, it's hard for me to comment on that, but if it is calorically dense, as it sounds, it could be a helpful addition to the suggestions below.

1. Encourage your daughter to eat starchy carbohydrates such as cereal, bread, rice, potatoes, pasta or beans at every meal and snack. Make sure that at least half of these starches are whole grains for optimal health. And make sure to include calorie-dense toppings on everything from pasta to cereal to chili. Add dried fruit and nuts to cereal. Top pancakes with peanut butter and syrup. Make chili with extra beans and lean ground turkey and top with a little cheddar cheese and sour cream.

2. Add fat to meals whenever possible. Some less-healthy fats such as butter, sour cream, mayonnaise, and cheese are OK, but try to stick with mainly healthy fats such as nuts, peanut butter, olives, olive or canola oil, or avocado. Load salads with nuts, cheese, dried fruit and olive oil based dressing. Fill sandwiches with a slice or two of cheese, avocado, and even a little mayo for added calories. Cook eggs with sliced ham in olive oil and top with parmesan cheese for breakfast.

3. Try not to let her fill up on vegetables at meals. Even though they are healthy, they will prevent her from eating more energy dense foods. Fruits are filled with nutrients and have more calories, so if she gets full easily, make sure she eats more fruits than vegetables. Dried fruit is an even better choice as it is more calorically dense. Try topping salads and cereals with dried fruit, or suggest that she snacks on trail mix throughout the day. You might even want to include chocolate chips in the trail mix to boost calories even more.

4. Limit her consumption of beverages at meals, which may fill her up too quickly. If necessary, drink beverages after meals and stick with juice and milk instead of water as much as possible to increase calorie intake.

5. Finally, try to get her to consume a small meal or good-sized snack before bed. This might be a good time to drink a serving of the GNC supplement if it is designed for weight gain. Or make a super calorie-dense smoothie with high-quality protein powder or dry milk powder, frozen yogurt, a banana, and peanut butter. Other options include frozen or regular yogurt topped with dried fruit and nuts, a big slice of banana bread and milk, or even a bowl of pasta tossed with olive oil and parmesan cheese.

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