Involuntary Weight Loss Evaluation
Frederick R. Jelovsek MD
Involuntary weight loss is defined as a decrease of at least 5% of body weight in a 6 month period that isn't due to dieting, diuretic use or medical diseases known to affect weight. If you are overweight, you may wish for this, but if you or a friend are losing weight unintentionally, it needs to be diagnosed so there is not an increased risk of disease or dying. Many times, involuntary weight loss is associated with elderly adults but it is possible to happen to anyone. Up to 8% of patients presenting to primary care physicians complain of weight loss. In 25% of those, no cause for the weight loss is ever found.
A recent review paper, Bianchi A, Toy EC, Baker B III: The evaluation of involuntary weight loss. Prim Care Update Ob/Gyns 1998;5:263-267, categorized three basic causes of weight loss:
- decreased intake - the most common cause, most often in teenagers and elderly adults
- increased fluid-nutrient loss - associated with malabsorption and diabetes
- excess metabolic demand - malignancies often associated with gastrointestinal tract, genitourinary system and breast
It is important to document the fact that weight loss is taking place. Believe it or not, many who complain of involuntary weight loss have no weight change by objective documentation. There are some factors, however, that are diagnostic predictors of underlying illness:
- recent change in cough
- nausea or vomitting
- a 20 pack-year history of smoking
- a recent change in appetite
- a decrease in activity due to fatigue
- an abnormality on physician's physical examination
If the cause of weight loss is not obvious, the physician should check initial laboratory tests including CBC, HIV, blood chemistry, urinalysis, thyroid function, chest xray and routine recommended cancer screening. The following specific diseases may be present.
Diseases Causing Involuntary Weight Loss
| Category | examples |
|---|---|
Decreased intake | |
| gastrointestinal disease | peptic ulcer, cholelithiasis |
| malignancy | G.I., ovarian |
| eating disorders | anorexia, bulemia nervosa |
| hyperemesis gravidarum | |
| poor dentition | |
| social isolation or poverty | |
| depression or dementia | |
| substance abuse | alcohol, cocaine, amphetamines |
| medications | digitalis, theophylline, procainamide |
| age-related changes | |
| infection | HIV |
| systemic diseases | |
Increased fluid- nutrient loss | |
| malabsorption | |
| persistent diarrhea | |
| recurrent vomitting | |
| fistulous drainage | |
| medications | cholestyramine, laxatives |
| pancreatic insufficiency | |
| infection | giardiasis |
| inflammatory bowel disease | Crohn's disease, diverticultits |
| uncontrolled diabetes mellitus | |
Excess metabolic demand | |
| hyperthyroidism | |
| tumor of adrenal gland | pheochromocytoma |
| malignancy | disseminated, metastatic |
| fever and/or infection | malaria, TB, HIV |
| manic or anxiety states | |
| trauma and burns | |
| excess exercise | |
| systemic disease | |
In one fourth of patients with this problem, no diagnosis will be found. Another one fourth will have malignancies. Of the remaining 50%, half will have depression or some psychiatric disease and half will have a medical cause. Although sometimes malignancies are found as a cause of involuntary weight loss, most of the time there are specific treatments that are successful for the remaining people without malignancies.
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