From the Guidelines
A workup for difficulty gaining weight should begin with a comprehensive medical evaluation by a healthcare provider, including a detailed medical history, physical examination, and laboratory tests to identify potential underlying causes, as recommended by the American Gastroenterological Association 1. This evaluation should assess thyroid function, complete blood count, comprehensive metabolic panel, inflammatory markers, and screening for celiac disease. Additional tests may include:
- Stool studies to check for malabsorption or parasites
- Imaging studies if structural issues are suspected
- A detailed dietary history and caloric intake assessment is essential, as many individuals struggling to gain weight simply aren't consuming enough calories relative to their metabolic needs, as highlighted in the ESPEN guidelines for nutrition screening 1. Psychological evaluation may be warranted if eating disorders are suspected. For those without underlying medical conditions, the treatment typically involves:
- Increasing caloric intake by 300-500 calories above maintenance levels
- Focusing on nutrient-dense foods
- Consuming 1.6-2.2g of protein per kg of body weight daily
- Implementing a structured resistance training program Small, frequent meals and calorie-dense foods like nuts, avocados, and healthy oils can help increase overall intake. Underlying conditions like hyperthyroidism, malabsorption disorders, or chronic infections must be specifically addressed with appropriate medical treatments before weight gain strategies will be effective. The ESPEN guidelines emphasize the importance of screening, assessment, and monitoring in identifying patients at nutritional risk and providing appropriate nutritional care plans 1. By following this approach, healthcare providers can help individuals with difficulty gaining weight to achieve a healthy weight and improve their overall quality of life.
From the FDA Drug Label
Oxandrin is indicated as adjunctive therapy to promote weight gain after weight loss following extensive surgery, chronic infections, or severe trauma, and in some patients who without definite pathophysiologic reasons fail to gain or to maintain normal weight The work up for difficulty gaining weight may include the use of oxandrolone as adjunctive therapy to promote weight gain in certain patients, such as those who have experienced weight loss due to:
- Extensive surgery
- Chronic infections
- Severe trauma
- Or those who fail to gain or maintain normal weight without a clear medical reason 2
From the Research
Difficulty Gaining Weight
To address difficulty gaining weight, several studies have investigated the use of megestrol acetate (MA) and other interventions. The key findings are summarized below:
- Megestrol Acetate (MA): MA has been shown to increase appetite and weight gain in various patient populations, including those with cancer-related anorexia/cachexia 3, 4, elderly haemodialysis patients 5, and HIV patients 6.
- Weight Gain: Studies have reported significant weight gain with MA treatment, ranging from 1.45 kg to 2.25 kg 3, and up to 5.3 kg with combination therapy 6.
- Quality of Life: While MA may improve appetite and weight gain, its effect on quality of life is less clear, with some studies reporting no significant improvement 3, 4 and others showing improvements in physical and mental domains 5, 6.
- Adverse Events: MA has been associated with adverse events, including thromboembolic risk, especially with higher doses 4, and excessive fluid gain in haemodialysis patients 5.
- Combination Therapy: Combination therapy with MA, oxandrolone, and dietary advice has been shown to be effective in restoring weight in HIV patients 6.
- Dietary Advice: Dietary advice and increased caloric intake have been associated with weight gain and improved physical health 6.
Key Considerations
When considering interventions for difficulty gaining weight, the following factors should be taken into account:
- Patient Population: The effectiveness of MA and other interventions may vary depending on the patient population, such as cancer patients, elderly haemodialysis patients, or HIV patients.
- Dose and Duration: The optimal dose and duration of MA treatment are unclear, with studies reporting varying results 3, 4.
- Combination Therapy: Combination therapy with MA and other agents, such as oxandrolone, may be effective in certain patient populations 6.
- Dietary Advice: Dietary advice and increased caloric intake should be considered as part of a comprehensive approach to addressing difficulty gaining weight 6.