Weight loss resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-in-Chief: Javaria Anwer M.D.
Synonyms and keywords: weight loss management guide, unintentional weight loss management guide, loss of weight resident survival guide, pathologic weight loss resident survival guide.
|Weight loss resident survival guide microchapters|
|Diagnosis and Management|
A loss of >5% of the usual body weight within 6 - 12 months represents pathologic weight loss. Weight loss may be intentional or unintentional. Unintentional weight loss is more common among the elderly. Common causes of weight loss among patients aged >65 years include malignancies (specifically digestive and non-hematologic), dementia, stroke, parkinson's disease, and polymyalgia rheumatica. In comparison, Endocrine disorders, infections, and psychiatric disorders make up the majority of the causes of weight loss among individuals aged <65 years. A thorough history from the patient or a caregiver provides useful insights to the cause. It is important to assess the availability of food and nutritional status first. A detailed physical exam and observing an elder patient have a meal in front of the physician may provide clues to neurocognitive dysfunctions. CBC, CMP provides a general picture of patient condition. Follow-up is necessary to completely treat the known and identify unknown causes of weight loss. A multidisciplinary approach ensures the optimum management option. Nutritional supplements may be warranted in selected cases but should act as an adjunct to normal meals.
Life Threatening Causes
- Electrolyte disturbances as a result of malnutrition may lead to arrhythmias and be life-threatening if not corrected in time.
Age >65 years
- Malignancies (specifically digestive and non-hematologic)
- Parkinson's disease
- Polymyalgia rheumatica
- Oral disorders.
Age <65 years
- Endocrine disorders
- Infections such as TB and HIV
- Psychiatric disorders such as depression, anxiety, and OCD
- Malignancies such as hematologic
Common causes classified
- The chart below demonstrates the cause of unintentional weight loss in adult population. The incidence describes the full range of occurrence described in five studies in older individuals.
- To read about other causes of unintentional weight loss click here.
Diagnosis and Management
Abbreviations: GI: Gastrointestinal system; GERD: Gastroesophageal reflux disease; BMI: Body Mass Index; HEENT: Head, Eyes, Ears. Nose, and Throat exam; IM: Infectious Mononucleosis; CBC: Complete blood count; ESR: Erythrocyte sedimentation rate; LDH: Lactate dehydrogenase; CMP: Comprehensive metabolic panel; CRP:C-reactive protein; TSH: Thyroid stimulating hormone; PTH: Parathyroid hormine; COPD: Chronic Obstructive Pulmonary Disease
Shown below is an algorithm summarizing the diagnosis of weight loss.
|Patient presents with weight loss/ incidental finding|
|Loss of >5% of the usual body weight within 6 - 12 months|
❑ Source of history:
❑ Past medical history:
Communicable infectious diseases/ travel to high-risk areas.
|Nutritional status |
❑ Dietary history: Food availability, diet adequacy in the quantity (daily caloric intake), and quality (balance of nutrition), and nutritional supplements.
|Weight loss history|
|No||Reaccess in weekly|
|Characterise the severity of the condition|
❑ BMI assessment or simply weight among immobile or bed-ridden patients.
❑ Observing the patient having a meal may demonstrate
|Intentional weight loss|
|Unintentional weight loss|
|Nutritional status/ caloric intake|
|Suspect malabsorption||Suspect altered metabolism||Access to food|
|Suspect cognitive dysfunction/ consider social factors||Consider oral or dental issues/ dysphagia/ dysgeusia|
|Order initial screening labs and|
|Provisional diagnosis established||Progressive oropharyngeal or esophageal dysphagia/ oral/ dental issues||Peptic ulcer|
celiac disease, whipple disease
|Suspected malignancy||Suspected nutritional deficiency|
❑ Nephrotic syndrome: 24-hour urine collection (urine protein >3.5 g/day).
❑ Chronic diarrhea: Stool osmotic gap, culture, ova and parasite, electrolytes, leukocytes, lactoferrin, and C. difficile test.
❑ Food as puree or thickened liquids
❑ Speech therapy for oropharyngeal issues
❑ Dentist referral for dental issues
❑ Esophageal cancer treatment
❑ Decreased dietary restrictions
❑ Increase oral intake with frequent small servings
❑ Nutritional supplements with regular meals
❑ Community support services if required
❑ Multidisciplinary approach
Follow-up in 1 or 3 months depending upon the cause.
|Weight gain||No weight gain/ continued weight loss|
|Monitor until the desired weight is achieved||Reevaluate|
|Cause identified||Cause unidentified|
6 months after presentation cause still unidentified
|No weight gain||Unexplained unintentional weight loss|
|Consider feeding tube|
- Perform a thorough physical exam to evaluate for cause of weight loss.
- Assess the nutritional status of the patient and screen for possible depression.
- Assess serum electrolytes to assess for life-threatening electrolyte abnormalities.
- Prevent further weight loss by advising proper meals, supplements, and consulting a nutritionist.
- Treat the underlying cause.
- Medications for weight gain must be looked for side effects and recommendations for the elderly.
- Prefer liquid supplements to solids and serve separate from solid everyday meals.
- Encourage exercise and physical therapy.
- Do not miss the oral exam especially among the elderly.
- Do not rely on the patient history among patients with cognitioncognitive dysfunctions.
- Abed J, Judeh H, Abed E, Kim M, Arabelo H, Gurunathan R (September 2014). ""Fixing a heart": the game of electrolytes in anorexia nervosa". Nutr J. 13: 90. doi:10.1186/1475-2891-13-90. PMC 4168120. PMID 25192814.
- 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.
- Alibhai, S. M.H. (2005). "An approach to the management of unintentional weight loss in elderly people". Canadian Medical Association Journal. 172 (6): 773–780. doi:10.1503/cmaj.1031527. ISSN 0820-3946.
- Wu, Wen-Chih Hank; Bosch, Xavier; Monclús, Esther; Escoda, Ona; Guerra-García, Mar; Moreno, Pedro; Guasch, Neus; López-Soto, Alfons (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. ISSN 1932-6203.
- Gaddey HL, Holder K (May 2014). "Unintentional weight loss in older adults". Am Fam Physician. 89 (9): 718–22. PMID 24784334.
- Lankisch P, Gerzmann M, Gerzmann JF, Lehnick D (January 2001). "Unintentional weight loss: diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre". J. Intern. Med. 249 (1): 41–6. doi:10.1046/j.1365-2796.2001.00771.x. PMID 11168783.
- Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S (October 2012). "Addison's disease". Contemp Clin Dent. 3 (4): 484–6. doi:10.4103/0976-237X.107450. PMC 3636818. PMID 23633816.
- Brymer C, Winograd CH (September 1992). "Fluoxetine in elderly patients: is there cause for concern?". J Am Geriatr Soc. 40 (9): 902–5. doi:10.1111/j.1532-5415.1992.tb01987.x. PMID 1512386.
- Guigoz Y, Vellas B, Garry PJ (January 1996). "Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation". Nutr. Rev. 54 (1 Pt 2): S59–65. doi:10.1111/j.1753-4887.1996.tb03793.x. PMID 8919685.
- Morley JE, Kraenzle D (June 1994). "Causes of weight loss in a community nursing home". J Am Geriatr Soc. 42 (6): 583–5. doi:10.1111/j.1532-5415.1994.tb06853.x. PMID 8201141.
- Thompson MP, Morris LK (May 1991). "Unexplained weight loss in the ambulatory elderly". J Am Geriatr Soc. 39 (5): 497–500. doi:10.1111/j.1532-5415.1991.tb02496.x. PMID 2022802.
- Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z (July 2019). "Nutritional Risk Screening and Assessment". J Clin Med. 8 (7). doi:10.3390/jcm8071065. PMC 6679209 Check
|pmc=value (help). PMID 31330781.
- Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (August 2003). "ESPEN guidelines for nutrition screening 2002". Clin Nutr. 22 (4): 415–21. doi:10.1016/s0261-5614(03)00098-0. PMID 12880610.
- Gazewood JD, Mehr DR (July 1998). "Diagnosis and management of weight loss in the elderly". J Fam Pract. 47 (1): 19–25. PMID 9673603.
- Hu J, Van Valckenborgh E, Menu E, De Bruyne E, Vanderkerken K (November 2012). "Understanding the hypoxic niche of multiple myeloma: therapeutic implications and contributions of mouse models". Dis Model Mech. 5 (6): 763–71. doi:10.1242/dmm.008961. PMC 3484859. PMID 23115205.
- Biemer JJ (1984). "Hepatic manifestations of lymphomas". Ann. Clin. Lab. Sci. 14 (4): 252–60. PMID 6380395.
- Huffman GB (February 2002). "Evaluating and treating unintentional weight loss in the elderly". Am Fam Physician. 65 (4): 640–50. PMID 11871682.
- Kondrup, J (2003). "ESPEN Guidelines for Nutrition Screening 2002". Clinical Nutrition. 22 (4): 415–421. doi:10.1016/S0261-5614(03)00098-0. ISSN 0261-5614.