From the Guidelines
For a 44-year-old experiencing weight loss, a comprehensive workup should begin with a detailed history and physical examination to identify potential causes, including assessment of BMI, waist circumference, and a complete physical examination, as recommended by the American Gastroenterological Association 1. The initial evaluation should include a comprehensive review of systems, identification of co-occurring health conditions, and a comprehensive physical examination, including assessment of vital signs, height, weight, and BMI, as well as physical appearance, including signs of malnutrition or purging behaviors 1. Initial laboratory tests should include a complete blood count, comprehensive metabolic panel, thyroid function tests (TSH, free T4), fasting glucose, HbA1c, urinalysis, and inflammatory markers like ESR and CRP, as well as electrolytes, liver enzymes, and renal function tests 1. Additional tests based on clinical suspicion may include HIV testing, tuberculosis screening, stool studies for malabsorption, and cancer screening appropriate for age and risk factors, as well as screening for symptoms suggestive of CVD and other obesity-related comorbidities 1. Imaging studies such as chest X-ray and abdominal ultrasound or CT scan may be warranted to rule out malignancy, and if gastrointestinal symptoms are present, endoscopy or colonoscopy might be indicated 1. The extent of testing should be guided by the patient's specific symptoms, risk factors, and the rate and amount of weight loss, with more urgent and extensive evaluation needed for rapid or significant weight loss exceeding 5% of body weight over 6-12 months, as significant weight loss may reveal undernutrition and predict further nutritional deterioration 1. Key considerations in the workup include:
- Detailed history and physical examination to identify potential causes of weight loss
- Laboratory tests to evaluate for underlying conditions such as endocrine disorders, chronic infections, and gastrointestinal disorders
- Imaging studies to rule out malignancy and other conditions
- Screening for symptoms suggestive of CVD and other obesity-related comorbidities
- Consideration of the patient's specific symptoms, risk factors, and the rate and amount of weight loss to guide the extent of testing.
From the Research
Investigations for Weight Loss
For a 44-year-old experiencing weight loss, several investigations are recommended to determine the underlying cause.
- The first step is to establish the incidence and causes of unintentional weight loss, as well as to compare prognoses 2.
- A careful history and physical examination should be conducted to identify any potential causes of weight loss 3.
- If the results of the initial tests are normal, a period of watchful waiting is preferable to blind pursuit of additional diagnostic testing 3.
- Simple diagnostic tests, such as endoscopic investigation of the upper and lower gastrointestinal tract and function tests, should be performed to exclude malabsorption if minimal diagnostic procedures cannot establish a diagnosis 2.
- The clinical evaluation should include an assessment of social, psychiatric, medical, and age-related factors that may be contributing to the weight loss 3.
Potential Causes of Weight Loss
The potential causes of weight loss can be divided into several categories, including:
- Non-malignant diseases, such as gastrointestinal disorders, which account for 60% of cases 2
- Malignant diseases, such as cancer, which account for 24% of cases 2
- Psychological disorders, such as depression, which account for 11% of cases 2
- Social and age-related factors, such as changes in appetite or mobility 3
Diagnostic Tests
Several diagnostic tests may be recommended to investigate the cause of weight loss, including:
- Endoscopic investigation of the upper and lower gastrointestinal tract 2
- Function tests to exclude malabsorption 2
- Imaging studies, such as X-rays or CT scans, to rule out underlying medical conditions 3
- Laboratory tests, such as blood work or urinalysis, to evaluate overall health and detect any potential underlying conditions 3