Human beings are essentially social animals, and meals are important social functions. People eating in a group are likely to eat better, or at least to have a wider variety of foods and a more lavish and luxurious meal, than people eating alone. Entertaining guests may be an excuse to eat foods that we know to be nutritionally undesirable, and perhaps to eat to excess. The greater the variety of dishes offered, the more people are likely to eat. As we reach satiety with one food, so another, different, flavour is offered to stimulate appetite. A number of studies have shown that, faced with only one food, people tend to reach satiety sooner than when a variety of different foods is on offer. This is the difference between hunger and appetite — even when we are satiated, we can still 'find room' to try something different.
Conversely, and more importantly, many lonely single people (and especially the bereaved elderly) have little incentive to prepare meals and no stimulus to appetite. Although poverty may be a factor, apathy (and frequently, especially in the case of widowed men, ignorance) severely limits the range of foods eaten, possibly leading to undernutrition. When these problems are added to the problems of infirmity, ill-fitting dentures (which make eating painful) and arthritis (which makes handling many foods difficult) and the difficulty of carrying food home from the shops, it is not surprising that we include the elderly among those vulnerable groups of the population who are at risk of undernutrition.
In hospitals and other institutions there is a further problem. People who are unwell may have low physical activity, but they have higher than normal requirements for energy, and nutrients, as a part of the process of replacing tissue in convalescence (section 188.8.131.52), or as a result of fever or the metabolic effects of cancer (section 8.4). At the same time, illness impairs appetite, and a side-effect of many drugs is to distort the sense of taste, depress appetite or cause nausea. It is difficult to provide a range of exciting and attractive foods under institutional conditions, yet this is what is needed to tempt the patient's appetite.
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