Weight Loss - Approach

 

• Recall significant weight loss is >5% of body weight/6 months (or 10 pounds or 4.5kg)
• Consider whether it is voluntary or involuntary. Involuntary weight loss has been shown to have increased mortality.
• In the elderly the most common causes are depression, benign GI disease and malignancy

 

General categories to consider:

- Endocrine: diabetes, adrenal insufficiency, pancreatic insufficiency

- GI disease- benign or otherwise, including IBD and malabsorption

- Malignancy

- Infections- HIV, hep C, active TB, endocarditis, weight loss

- Neurologic diseases that impair cognition, swallowing etc

- psychiatric disorders, especially depression

- chronic diseases such as cardiac, pulmonary, ESRD

- drugs: substance abuse, herbal meds

 

 

Another approach is to see if the weight loss is coupled with increased or decreased appetite.
Increased Appetite/Decreased weight:
-hyperthyroid
-uncontrolled diabetes
-malabsorption
-pheo
-increased activity

Decreased Appetite/Decreased weight:
-Cancer
-HIV
-Endocrine: adrenal insufficiency, hypercalcemia, diabetes
-Chronic Dz: advanced heart failure or lung disease
-GI dz
-depression *** especially in elderly
-substance use (cocaine, heavy tobacco, amphetamine)

 

 

 

Initially work up for weight loss might include:
-CBC, CMP, CBC, ESR, TSH, UA and CXR
-Often, gender and age appropriate cancer screening is recommended... but it can turn out to be something very different.

Next steps, depending on results of above tests might include:
CT chest and abdomen, EGD and colo.
SPEP, UPEP, ANA, RF

 

(Katharine Cheung MD, 9/3/10, 1/27/11)