From the Guidelines
Unintentional weight loss is typically defined as a loss of more than 5% of body weight over 3 months, which may indicate underlying medical conditions such as undernutrition, obesity, or other health issues. This definition is based on the ESPEN guidelines for nutrition screening 2002, which suggests that recent weight loss can be obtained from the patient’s history or previous measurements in medical records 1. The cause of unintentional weight loss can be multifactorial, including:
- Underlying medical conditions such as thyroid disorders, diabetes, cancer, or digestive diseases
- Mental health issues like depression
- Decreased food consumption
- Increased metabolic demands It is essential to evaluate unintentional weight loss by a healthcare provider to identify the root cause and provide proper treatment. While waiting for medical evaluation, patients can focus on consuming nutrient-dense, calorie-rich foods, including lean proteins, healthy fats, and complex carbohydrates.
Some key points to consider when evaluating unintentional weight loss include:
- Recent weight loss history
- Previous measurements in medical records
- Presence of underlying medical conditions
- Mental health status
- Dietary habits and food intake
- Energy expenditure and physical activity level
Identifying the cause of unintentional weight loss is crucial for proper treatment, as medications are typically prescribed to treat the underlying condition rather than the weight loss itself. Therefore, a thorough medical evaluation is necessary to determine the root cause of unintentional weight loss and develop an effective treatment plan 1.
From the Research
Causes of Unintentional Weight Loss
- Nonmalignant diseases are more common causes of unintentional weight loss in older adults than malignant causes 2, 3
- Malignancy accounts for up to one-third of cases of unintentional weight loss 2, 4
- Medication use and polypharmacy can interfere with the sense of taste or induce 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, 3
- Cancer, depression, and disorders of the gastrointestinal tract may be the most common causes of involuntary weight loss 5
- In approximately 25% of cases, no cause of weight loss is found despite extensive evaluation and prolonged follow-up 5
Diagnostic Evaluation
- Recommended tests include age-appropriate cancer screenings, complete blood count, basic metabolic panel, liver function tests, thyroid function tests, C-reactive protein level, erythrocyte sedimentation rate, lactate dehydrogenase measurement, ferritin, protein electrophoresis, and urinalysis 2, 3
- Chest radiography and fecal occult blood testing should be performed 2, 3
- Abdominal ultrasonography may also be considered 3
Treatment
- Treatment should focus on the underlying cause if known 2, 3
- Dietary modifications that consider patient preferences and chewing or swallowing disabilities should be considered 2, 3
- Nutritional supplements and flavor enhancers may be considered 3
- Appetite stimulants are not recommended due to serious adverse effects and no evidence of decreased mortality 2, 3