Weight loss

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; M.Umer Tariq [3]

Overview

Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight. An individual may lose weight due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. Weight loss can be unintentional, intentional, or therapeutic.

Classification

There is no formal classification system for weight loss. Based on the intention it can be classified into unintentional, intentional, and therapeutic weight loss.

Unintentional Weight Loss

A myriad of additional scientific considerations are applicable to weight loss, including but not limited to physiological and exercise sciences, nutrition science, behavioral sciences, and other sciences.

One area involves the science of bioenergetics including biochemical and physiological energy production and utilization systems, that is frequently evidence of diabetes, and ketone bodies, acetone particles occurring in body fluids and tissues involved in acidosis, also known as ketosis, somewhat common in severe diabetes.
Substantial, unintentional weight loss can be a symptom of an acute or chronic illness, especially if other evidence is demonstrated. Weight loss accompanied by insatiable thirst, hunger and fatigue may indicate diabetes mellitus (DM). To read more about diabetes mellitus, click here A chronic disease, characterized by an abnormal accumulation of carbohydrates in the bloodstream due to insufficient production of or tissue resistance to insulin.^[1] Poor management of insulin-dependent diabetes mellitus (IDDM), also known as diabetes mellitus type I, leads to an excessive amount of glucose and an insufficient amount of insulin in the bloodstream. It triggers the release of triglycerides from adipose tissues and catabolism of amino acids in the muscle tissue. This results in a loss of both fat and lean mass, predisposing a significant reduction in total body weight.
Infections such as HIV may alter the metabolism, leading to weight loss.^[2]
Hormonal disruptions, such as an overactive thyroid (hyperthyroidism), may also lead to weight loss.^[3]
In addition to weight loss due to a reduction in fat and lean mass, illnesses such as diabetes, certain medications, lack of fluid intake, and other factors can trigger fluid loss. A fluid loss in addition to a reduction in fat and lean mass poses a risk for cachexia. Loss of muscle mass in cachexia is due to combined effect of decreased protein synthesis in combination with an increased protein degradation via lysosomes and ubiquitin-proteasome pathway.^[4]

Intentional Weight Loss

Intentional weight loss may refer to the loss of total body mass in an effort to improve fitness, health, or appearance.

Therapeutic weight loss, in individuals who are overweight, can decrease the likelihood of developing diseases such as diabetes.^[5] Overweight and obese individuals face a greater risk of health conditions such as type 2 diabetes, heart disease, high blood pressure, stroke, osteoarthritis,^[6] and certain types of cancer. For healthy weight loss, a physician should be consulted to develop a weight loss plan that is tailored to the individual.

It is not uncommon for people who are already at a medically healthy weight to intentionally lose weight. In some cases, it is with the goal of improving athletic performance or to meet weight classifications in a sport. In other cases, the goal is to attain a more attractively shaped body. Being underweight is associated with health risks. Health problems can include fighting off infection, osteoporosis, decreased muscle strength, trouble regulating body temperature and even increased risk of death.^[7]

Therapeutic Weight Loss Techniques

The least intrusive weight loss methods, and those most often recommended by physicians, are adjustments to eating patterns and increased physical exercise. Usually, health professionals will recommend that their overweight patients combine a reduction of the caloric content of the diet with an increase in physical activity.^[8]

Other methods of losing weight include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume. Surgery is another method. Bariatric surgery artificially reduces the size of the stomach, limiting the intake of food energy. Some of these treatments may have serious side-effects.

Causes

Common Causes

Intentional weight loss: Dieting, dexatrim, and aerobic exercise
Unintentional weight loss:
Nicotine and smoking (may be an intentional caue).
Drug side effects (mentioned below)
Age >65 years^[9]:
- Malignancies (specifically digestive and non-hematologic)
- Neurological disorders: Dementia, stroke, parkinson's disease
- Oral disorders
- Chronic disorders: Chronic renal failure
Age <65 years^[9]:
- Endocrine disorders (such as hyperthyroidism)
- Infections such as TB and HIV
- Psychiatric disorders such as depression, anxiety, and OCD, eating disorders
- Malignancies such as hematologic

Causes by Organ System

Cardiovascular	Congestive Heart Failure,
Chemical / poisoning	Ephedra, Fucus vesiculosus L., Arsenic Poisoning, Cannabis (drug), Cocaine, Nicotine
Dermatologic	No underlying causes
Drug Side Effect	Abatacept Injection (patient information), Adderall, Allopurinol (patient information), Aminopterin, Amiodarone Oral (patient information), Amphotericin B Injection (patient information), Benzodiazepine withdrawal syndrome, Bevacizumab Injection (patient information), Bumetanide (patient information), Busulfan (patient information), Calcitriol (patient information), Carboplatin (patient information), Carmustine (patient information), Cetuximab Injection (patient information), Chlorambucil (patient information), Clenbuterol, Clofarabine Injection (patient information), Cytarabine (patient information), Dexmethylphenidate, Donepezil (patient information), Duloxetine, Enfuvirtide Injection (patient information), Ethosuximide, Felbamate (patient information), Fluorouracil (patient information), Fluticasone Nasal Spray (patient information), Fluticasone Oral Inhalation (patient information), Furosemide (patient information), Galantamine (patient information), Gatifloxacin (patient information), Gefitinib (patient information), Indapamide (patient information), Interferon beta-1a Intramuscular Injection (patient information), Interferon beta-1a Subcutaneous Injection (patient information), Interferon Beta-1b Injection (patient information), Leflunomide (patient information), Leuprolide (patient information), Levothyroxine, Liothyronine (patient information), Lithium (patient information), Lomustine (patient information), Mechlorethamine (patient information), Melphalan (patient information), Mercaptopurine (patient information), Methsuximide Oral (patient information), Methylphenidate, Miglustat, Modafinil, Natalizumab injection (patient information), Nevirapine (patient information), Oxaliplatin injection (patient information), Peginterferon alfa-2a (patient information), Peginterferon alfa-2b (patient information), Pemetrexed injection (patient information), Pemoline (patient information), Phenformin, Phenylbutazone, Phenytoin oral (patient information), Piroxicam (patient information), Posaconazole (patient information), Pramipexole (patient information), Pramlintide, Protriptyline (patient information), Rasagiline (patient information), Ribavirin (patient information), Rivastigmine (patient information), Sargramostim, Sorafenib, Spironolactone and hydrochlorothiazide (patient information), Sultiame, Sunitinib (patient information), Tamoxifen (patient information), Thioguanine (patient information), Thiotepa (patient information), Thyroglobulin (patient information), Torsemide Injection (patient information), Trimetrexate Glucuronate (patient information), Vorinostat (patient information), Zoledronic Acid Injection (patient information), Zonisamide (patient information)
Drug used medically	Dexfenfluramine, Dexatrim, Dextroamphetamine, ECA stack, Eskatrol, Exenatide, Hydrolyzed collagen (hydrolysate), Hydroxycitric acid, Phendimetrazine, Phenmetrazine, Synephrine, Tiagabine, Tolmetin,
Ear Nose Throat	Dysphagia, Eating disorder
Endocrine	Addison's disease, Adrenocorticotropic hormone deficiency, Basedow syndrome, Diabetes mellitus type 1, Graves' Disease, Hashimoto's thyroiditis, Hyperthyroidism, Multiple endocrine neoplasia type 1, Pheochromocytoma, Toxic multinodular goiter
Environmental	No underlying causes
Gastroenterologic	Achalasia, Alcoholic Hepatitis, Autoimmune pancreatitis, Barrett's esophagus, Blind loop syndrome, Celiac disease, Cholangiocarcinoma, Chronic pancreatitis, Cirrhosis, Crohn's disease, Diarrhea, Eosinophilic gastroenteritis, Esophageal cancer, Esophageal candidiasis, Familial adenomatous polyposis, Fundic gland polyposis, Gallbladder cancer, Gastric lymphoma, Gastroesophageal reflux disease, Glucose-galactose malabsorption, Ileitis, Inflammatory bowel disease, Irritable bowel syndrome, Ischemic colitis, Liver Failure, Malabsorption, Malassimilation, Ménétrier's disease, Pancreatic cancer, Peptic ulcer, Pyloric stenosis, Stomach cancer, Ulcerative colitis
Genetic	Cystic Fibrosis
Hematologic	Acute lymphoblastic leukemia, Acute myeloid leukemia, Acute promyelocytic leukemia, Waldenström's macroglobulinemia
Iatrogenic	Adjustable gastric band, Gastric bypass surgery, Mini sleeve gastrectomy, Short bowel syndrome
Infectious Disease	Actinomyces, Aspergillus clavatus, Aspergillus fumigatus, Blastocystosis, Blastomycosis, Byssinosis, Chagas disease, Cladosporium, Dientamoeba fragilis, Diphyllobothrium infection, Entamoeba histolytica, Fasciola hepatica, Giardia lamblia, Hepatitis C, HIV, Hookworm, Isosporiasis, Leishmania infection, Malaria, Marburg virus, Micropolyspora faeni, Mucor stolonifer, Mycobacterium avium complex infection, Q Fever, Streptobacillus, Syphilis, Tuberculosis, Tularemia, Whipple disease
Musculoskeletal / Ortho	Mitochondrial myopathy, Osteoporosis, Panniculitis, Pott's disease
Neurologic	Krabbe disease, Parkinson's disease
Nutritional / Metabolic	Beriberi, Calorie restriction, Dieting, Folate deficiency, Food intolerance, Malnutrition, Marasmus
Obstetric/Gynecologic	Hyperemesis gravidarum
Oncologic	Aggressive NK-cell leukemia, Cervical cancer, Colorectal cancer, Glucagonoma Syndrome, Hemangiosarcoma, Hodgkin's lymphoma, Kaposi's sarcoma, Liposarcoma, Malignancy, Mantle cell lymphoma, Mediastinal tumor, Neuroendocrine tumors, Small intestine cancer
Opthalmologic	Cogan syndrome
Overdose / Toxicity	Nevirapine (patient information), Botulinum toxin
Psychiatric	Anorexia nervosa, Bulimia nervosa
Pulmonary	Chronic Obstructive Pulmonary Disease, Diabulimia, Empyema Thoracis, Lung cancer, Mesothelioma, Pulmonary alveolar proteinosis, Silicosis
Renal / Electrolyte	Chronic Renal Failure, Diabetic Ketoacidosis, Hypercalcemia, Interstitial nephritis, Renal cell carcinoma
Rheum / Immune / Allergy	Churg-Strauss Syndrome, Polyarteritis nodosa, Polymyalgia Rheumatica, Sarcoidosis, Systemic lupus erythematosus, Takayasu's Arteritis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Aerobic exercise, Castleman's disease, Chronic fatigue syndrome, Chronic wasting disease, Dehydration, Diaphoresis, Frailty syndrome, Kikuchi disease, Liposuction, SSRI discontinuation syndrome

Causes in Alphabetical Order

Diagnosis

Laboratory Findings

The following laboratory studies should be considered:

Albumin/prealbumin
CBC
ESR
Glucose (diabetes test)
HIV
Serum chemistry
Thyroid function

Electrolyte and Biomarker Studies

Morning ACTH stimulation test should be done if there is a suspicion of adrenal insufficiency

Electrocardiogram

QRS voltage may increase with dramatic weight loss.

Other Imaging Findings

Age appropriate screenings for cancer
Upper GI endoscopy
Colonoscopy

Treatment

Medical Therapy

Acute Pharmacotherapies

Anti depressants to stimulate hunger
Pancreatic enzymes for malabsorption in the pancreas
Nutritionist referral
Social Services referral

Chronic Pharmacotherapies

Anorexia of malignancy and AIDS can be relieved with megestrol acetate or dronabinal.

Primary Prevention

Aggressive therapy with a psychiatrist or psychologist for anorexia nervosa.

References

↑ Ramachandran A (November 2014). "Know the signs and symptoms of diabetes". Indian J. Med. Res. 140 (5): 579–81. PMC 4311308. PMID 25579136.
↑ Mangili A, Murman DH, Zampini AM, Wanke CA (2006). "Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort". Clin. Infect. Dis. 42 (6): 836–42. doi:10.1086/500398. PMID 16477562.
↑ Overactive thyroid and weight loss
↑ Tisdale MJ (April 2009). "Mechanisms of cancer cachexia". Physiol. Rev. 89 (2): 381–410. doi:10.1152/physrev.00016.2008. PMID 19342610.
↑ Diabetes Study Shows Value In Diet, Exercise, september 2001
↑ Prevalence of various medical conditions increases with overweight and obesity
↑ Mayo Clinic: Being Underweight Poses Health Risks. Retrieved January 13,2007
↑ Choosing a Safe and Successful Weight Loss Program
↑ ^9.0 ^9.1 Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A (2017). "Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients". PLoS ONE. 12 (4): e0175125. doi:10.1371/journal.pone.0175125. PMC 5384681. PMID 28388637.

External Links

[pmid25579136-1] Ramachandran A (November 2014). "Know the signs and symptoms of diabetes". Indian J. Med. Res. 140 (5): 579–81. PMC 4311308. PMID 25579136.

[2] Mangili A, Murman DH, Zampini AM, Wanke CA (2006). "Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort". Clin. Infect. Dis. 42 (6): 836–42. doi:10.1086/500398. PMID 16477562.

[3] Overactive thyroid and weight loss

[pmid19342610-4] Tisdale MJ (April 2009). "Mechanisms of cancer cachexia". Physiol. Rev. 89 (2): 381–410. doi:10.1152/physrev.00016.2008. PMID 19342610.

[5] Diabetes Study Shows Value In Diet, Exercise, september 2001

[6] Prevalence of various medical conditions increases with overweight and obesity

[7] Mayo Clinic: Being Underweight Poses Health Risks. Retrieved January 13,2007

[8] Choosing a Safe and Successful Weight Loss Program

[pmid28388637-9] 9.0 ^9.1 Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A (2017). "Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients". PLoS ONE. 12 (4): e0175125. doi:10.1371/journal.pone.0175125. PMC 5384681. PMID 28388637.

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