From the Guidelines
Unintentional weight loss should be promptly evaluated by a healthcare provider, especially if more than 5% of body weight is lost within 6-12 months without trying, as it may indicate underlying medical conditions such as cancer, thyroid disorders, or other serious health issues 1. When evaluating unintentional weight loss, it is crucial to consider the patient's overall health status, including their medical history, current medications, and lifestyle habits. The patient should maintain a nutrient-dense diet with adequate protein (1-1.5g per kg of body weight), healthy fats, and complex carbohydrates, as muscle protein depletion is a hallmark of cancer cachexia and severely impinges quality of life 1. Some key points to consider in the evaluation and management of unintentional weight loss include:
- Identifying and addressing underlying medical conditions that may be contributing to weight loss, such as cancer, thyroid disorders, or digestive issues 1
- Providing optimal nutritional care, including nutritional supplements like Ensure, Boost, or Carnation Breakfast Essentials, to ensure sufficient calories and nutrients 1
- Encouraging physical activity as tolerated to preserve muscle mass and overall health 1
- Monitoring food intake and adjusting the diet as needed to prevent further weight loss and promote weight gain if necessary 1
- Considering the use of novel drug interventions, such as selective androgen receptor modulators or ghrelin analogues, if proven to be effective in preventing or reducing cachexia 1 Medical evaluation typically includes blood tests, physical examination, and possibly imaging studies to identify the underlying cause of weight loss. Treatment will depend on the underlying condition and may involve medication adjustments, treatment of infections, management of chronic diseases, or addressing mental health concerns. It is essential to prioritize the patient's quality of life, morbidity, and mortality when evaluating and managing unintentional weight loss, and to provide individualized care based on their specific needs and circumstances 1.
From the Research
Definition and Diagnosis of Unintentional Weight Loss
- Unintentional weight loss is defined as a loss of weight of at least 5% in 6 months 2.
- The diagnostic work-up of unintentional weight loss includes attention to somatic and functional causes, as well as iatrogenic causes like side-effects of medication 2.
- Recommended tests for unintentional weight loss include age-appropriate cancer screenings, complete blood count, basic metabolic panel, liver function tests, thyroid function tests, and others 3.
Causes of Unintentional Weight Loss
- Nonmalignant diseases are more common causes of unintentional weight loss in older adults than malignant causes 3.
- Malignancy accounts for up to one-third of cases of unintentional weight loss in older adults 3.
- Medication use and polypharmacy can interfere with the sense of taste or induce nausea and should not be overlooked as causative factors 3.
- Social factors such as isolation and financial constraints may contribute to unintentional weight loss 3.
- Predominant etiologies of unintentional weight loss include digestive organic disorders (nonmalignant and malignant) and psychosocial disorders 4.
Treatment and Management of Unintentional Weight Loss
- Treatment should focus on the underlying cause if known 3, 5.
- Dietary modifications that consider patient preferences and chewing or swallowing disabilities should be considered 3.
- Appetite stimulants and high-calorie supplements are not recommended 3.
- Treatment should focus on feeding assistance, addressing contributing medications, providing appealing foods, and social support 3.
- Close follow-up is warranted for patients with unexplained unintentional weight loss, as malignancies may be undetectable until death 4.