Involuntary Weight Loss
Involuntary Weight Loss - Description, Causes, and Risk Factors
Involuntary weight loss (IWL) is weight loss that you did not intend. In other words, you were not dieting or trying to lose the weight. Body weight is determined by the interplay of calorie intake, activity level, and the metabolic rate. Weight loss becomes a major concern when you have the involuntary weight loss of more than 10% of your normal body weight within 12 months or 7.5% within 6 months.
Involuntary weight loss is a common finding and one associated with increased morbidity and mortality, especially in the elderly patient. The precise mechanisms by which weight loss occurs are currently being elucidated and probably involve the actions of classic hormones as well as cytokines, such as TNF (cachectin), adipsin, and interleukin-1 and interleukin-6.
Most causes of isolated IWL belong to one of three categories: Malignant neoplastic diseases, chronic inflammatory/infectious diseases, or psychiatric disorders. Other common diseases are also possibilities, such as hyperthyroidism or diabetes.
Risk Factors May Include:
- Eating disorders.
- Social isolation.
- Depression or dementia.
- Manic or anxiety states.
- Alcohol, cocaine, amphetamines.
- Persistent diarrhea.
- Recurrent vomiting.
- Fistulous drainage.
- Inflammatory bowel disease.
- Uncontrolled diabetes mellitus.
- Gastrointestinal disease.
- Peptic ulcer.
- Tumor of adrenal gland pheochromocytoma.
- Fever and/or infection, malaria, TB, HIV.
- Trauma and burns.
Some of the consequences of IWL include:
- Decreased cognition.
- Immune dysfunction.
- Muscle loss.
- Hip fractures.
- Pressure sores.
Patient evaluation follows a 3-step approach, focusing on malignancies, nonmalignant GI disorders, and depression.
- Step 1: A comprehensive medical examination is required, along with a medication regimen review and depression screening. Core laboratory tests are conducted, including an ultrasensitive thyroid-stimulating hormone test, urinalysis, and a fecal occult blood test.
- Step 2: Computed tomography imaging from neck to pelvis with contrast (and a mammogram for women) should be ordered, especially if step 1 findings are unremarkable.
- Step 3: A GI endoscopy, esophagogastroduodenoscopy, or colonoscopy is conducted. These diagnostics have a high yield for a select group of patients.5,6
If the cause of weight loss is not obvious, the physician should check initial laboratory tests including CBC, HIV, blood chemistry, chest x-ray, and routine recommended cancer screening.
Clinicians should seek common treatable causes of weight loss in elderly patients. One approach is to distinguish among four basic causes of weight loss: Anorexia, dysphagia, socioeconomic factors, and weight loss despite normal intake.
The first step in treating involuntary weight loss is to identify any medical causes.
The second step is to contact your dietitian who can analyze what you are currently eating and help you to create a personalized weight gain plan. Regardless of the cause, if you use more energy than you take in, you will lose weight. To start taking in more energy, keep in mind the tips below to power pack the foods that you eat.
- Do what works best for you. Decide if bigger meals, more snacks, or both are your best bet for eating more.
- Adequate protein is very important if you are below your healthy weight and have a difficult time maintaining muscle mass.
- Eat or drink several rich sources of protein each day such as meats, beans, dairy products, eggs, soy products, quinoa, and nuts.
- Once you have stopped losing weight, avoid foods that are high in saturated fat like fried foods, pastries, fatty meats (red meat), and full-fat dairy products. They make you feel full more quickly and may reduce your appetite for other more nutritious foods.
In situations where standard dietary and medical treatments are not enough, additional medications may be prescribed. Although medications may help to promote appetite and weight gain in older patients with unintentional weight loss, drugs should not be considered the first-line treatment. Even if drugs are successful in inducing weight gain, their long-term effects on quality of life are unknown.
Patients with depression should receive an antidepressant that has orexigenic properties. Orexigenic drugs should be used when no obvious treatable cause of IWL is present and when nonpharmacological interventions are ineffective. Close monitoring for potential side effects is necessary in elderly patients. More studies are needed to define the role of these medications in end-of-life and palliative care.
Disclaimer: The above information is for educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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