From the Guidelines
Unintentional weight loss of more than 5% over 3 months is usually regarded as significant and warrants a thorough workup. The evaluation should begin with a comprehensive history and physical examination to identify potential causes, including documenting the pattern and amount of weight loss, dietary changes, and associated symptoms like fever, night sweats, fatigue, gastrointestinal complaints, or changes in bowel habits 1.
Initial Evaluation
- Start by assessing the patient's history, including recent measurements in medical records to determine the extent of weight loss
- Perform a physical examination to identify any signs of underlying conditions
- Initial laboratory testing should include:
- Complete blood count
- Comprehensive metabolic panel
- Thyroid function tests
- Urinalysis
- Inflammatory markers (ESR, CRP)
- Fecal occult blood testing
Additional Testing
- Consider additional first-line tests, such as:
- Chest X-ray
- Age-appropriate cancer screenings (e.g., mammography, colonoscopy, or PSA testing)
- If the initial evaluation is unrevealing, consider more specialized testing based on clinical suspicion, including:
- CT scans of chest/abdomen/pelvis
- Upper endoscopy
- HIV testing
- Tuberculosis screening
- Tests for malabsorption
Psychiatric Evaluation and Supportive Care
- Psychiatric evaluation may be warranted if depression, anxiety, or eating disorders are suspected
- Throughout the workup, it's essential to monitor the patient's nutritional status and provide supportive care with dietary counseling and nutritional supplements if needed, as unintentional weight loss can indicate serious underlying conditions, including malignancy, chronic infections, gastrointestinal disorders, endocrine diseases, or psychiatric conditions 1.
From the Research
Evaluation of Unintentional Weight Loss
- Unintentional weight loss in older adults is associated with increased morbidity and mortality, with nonmalignant diseases being more common causes than malignant ones 2, 3.
- The most common etiologies of unintentional weight loss in older adults include malignancy, nonmalignant gastrointestinal disease, and psychiatric conditions 3.
- Medication use and polypharmacy can interfere with taste or cause nausea and should not be overlooked as causative factors 2, 3.
- Social factors, such as isolation and financial constraints, may contribute to unintentional weight loss 2.
Diagnostic Approach
- Recommended tests for unintentional weight loss include:
- Imaging studies, such as abdominal ultrasonography, may also be considered 3.
- A multi-modality diagnostic approach is important in evaluating unintentional weight loss, with imaging studies crucial in diagnosing malignancy 4.
Management
- Treatment should focus on the underlying cause of unintentional weight loss, if known 2, 3, 5.
- Dietary modifications that consider patient preferences and chewing or swallowing disabilities should be considered 2, 3.
- Appetite stimulants are not recommended due to serious adverse effects and lack of evidence for decreased mortality 2, 3.
- Treatment should focus on feeding assistance, addressing contributing medications, providing appealing foods, and social support 2.