Every August 11, in Argentina, the Día del Nutricionista is celebrated. It is an opportunity to highlight a profession that goes beyond drafting dietary plans and that accompanies people at every stage of life, even when the goal is no longer to cure an illness but to alleviate suffering and preserve the best possible quality of life.
“It’s been days since they’ve not wanted to eat.” It is, probably, one of the phrases most often heard by those of us who work in palliative care. A daughter says it with worry. A husband with distress. A son who feels he is failing because, no matter how much he prepares their favorite dishes, their loved one barely tastes a bite. And behind that sentence another one appears, almost inevitable: “What more can I do to make them eat?”
Our response rarely begins by talking about calories or proteins. It begins by listening. Because when a person faces an advanced chronic illness, eating stops being a purely biological act and becomes a deeply human experience.
Eating does not merely mean incorporating nutrients. It means sharing a table, sustaining a conversation, celebrating a special date, preserving a family tradition, or simply savoring the aroma of coffee or the taste of a meal that evokes memories.
Food also speaks of identity, autonomy, and affection. Therefore, when eating becomes difficult, it is not only the nutritional status that is affected. Social life, bonds, and perceived quality of life can also be impacted.
In this scenario, the nutritionist specializing in palliative care plays a role that is often invisible, but essential. Palliative care accompanies people with advanced chronic illnesses and their families, with the aim of alleviating suffering and improving quality of life. They are active, comprehensive, and person-centered care. And nutrition is part of that approach from the very beginning.
Advanced illnesses are commonly accompanied by symptoms that interfere with eating: loss of appetite, nausea, vomiting, changes in taste and smell, dry mouth, pain when swallowing, dysphagia, constipation, diarrhea, fatigue, or a feeling of early fullness. Often, eating stops being a pleasant moment and becomes an effort.
In face of these difficulties, the nutritionist’s work is not merely to tell which foods to eat. It is to understand what is happening and to search for strategies so that eating becomes a source of well-being again.
Sometimes it will be necessary to modify the texture of foods to make swallowing safer. Other times, adjust temperatures, flavors, or seasonings to improve acceptance. On occasion, prioritize small portions of highly nutritious foods or indicate oral nutritional supplements when they can truly offer a benefit. And many other times, simply listen to which foods that person still enjoys and build the plan from those.
Because in palliative care there is no “perfect” diet. There is a feasible one. And that difference completely changes the way we care. We often accompany families through one of the most difficult processes: understanding that a diminishing appetite is part of the evolution of many advanced illnesses.
For years we learned that feeding is caring. And that is true. But caring also means respecting the person’s timing, desires, and boundaries. It means preventing each meal from turning into a negotiation, an argument, or a source of suffering. Often, the greatest relief for a family arrives when they understand that sharing a few bites calmly can be worth much more than insisting on finishing an entire plate.
In palliative care we frequently speak of quality of life. Yet, we rarely consider that quality of life can also be built around a table. It includes the power to choose what to eat. To enjoy a favorite dessert. To share a mate with friends. To maintain a family tradition. To savor an ice cream on a summer afternoon, even if it’s just a couple of spoonfuls. They may seem small, but they are profoundly meaningful.
Illness-related malnutrition is one of the most common problems among people with advanced diseases. It is estimated that between 40 and 80% of cancer patients have some degree of malnutrition, a rate that rises in the later stages of the disease. In tumors of the pancreas, stomach, or esophagus, prevalence can exceed 80%.
It is estimated that up to 8 out of 10 people with advanced cancer show some degree of malnutrition, a condition that directly impacts strength, autonomy, tolerance to treatments, and quality of life. However, the role of nutrition is rarely discussed when the main goal of care shifts from curing to accompanying.
Scientific evidence shows that early nutritional management can help improve symptoms, preserve functionality, and promote well-being. Yet there is something the evidence also confirms and that those of us who work at Pallium Latin America with patients see clearly every day: feeding does not always mean nourishing, and nourishing does not always mean caring. Caring means understanding that behind each plate there is a person with a story, preferences, fears, and desires.
On the Day of the Nutritionist, it is worth remembering that our profession does not work only with foods. It works with people. And when illness changes the rules, our challenge is no longer chasing the ideal nourishment, but finding the one that allows continued enjoyment, sharing, and living with the greatest possible dignity. Because, even when cure is no longer possible, care remains possible. And often, that care is also expressed through nourishment.
Source: Lic. Agustina Senese, member of the Board of the NGO Pallium Latin America
