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, and associated symptoms such as fever, night sweats, changes in appetite, gastrointestinal symptoms, or psychological distress 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 potential causes of weight loss
- Initial laboratory tests should include complete blood count, comprehensive metabolic panel, thyroid function tests, urinalysis, and inflammatory markers like erythrocyte sedimentation rate and C-reactive protein
Additional Testing
- Consider additional first-line tests such as fecal occult blood testing, chest X-ray, and age-appropriate cancer screenings
- For patients over 50 or with concerning symptoms, consider endoscopic evaluation with upper endoscopy and colonoscopy
- Further specialized testing may include CT scans of the chest, abdomen, and pelvis, HIV testing, tuberculosis screening, and additional hormone evaluations
Psychiatric Assessment
- A psychiatric assessment for depression, anxiety, or eating disorders is important as these conditions frequently cause weight loss
Nutritional Support
- Throughout the evaluation, monitor nutritional status and consider nutritional supplementation if deficiencies are identified The systematic approach is necessary because unintentional weight loss can indicate serious underlying conditions including malignancy, chronic infection, gastrointestinal disorders, endocrine abnormalities, or psychiatric illness, with significant morbidity and mortality rates associated with weight loss exceeding 5% of body weight over a short period 1.
From the Research
Evaluation of Unintentional Weight Loss
The evaluation of unintentional weight loss involves a thorough history and physical examination to identify potential etiologies and special factors to consider in selected groups, such as older adults 2.
Potential Etiologies
The potential etiologies of unintentional weight loss are diverse and can be organic (e.g., malignancy or gastrointestinal disease) or inorganic (e.g., psychosocial) 3. Some of the common causes of unintentional weight loss include:
- Non-malignant gastrointestinal conditions
- Cancer
- Psychosocial disorders
- Oral disorders in patients aged ≥65 years 4, 5
Diagnostic Approach
The diagnostic approach to unintentional weight loss involves a stepwise evaluation, including:
- Laboratory tests
- Imaging studies, such as computed tomography (CT) scans 4
- Physical examination
- Review of clinical history
Imaging Studies
Imaging studies, particularly CT scans, are crucial in the diagnosis of unintentional weight loss, especially in evaluating for the presence of malignancy 3, 4.
Management
The management of unintentional weight loss involves treatment of the underlying cause, and close follow-up is warranted, especially in cases where no diagnosis is made after comprehensive workup 6. Regular follow-up (e.g., yearly visits) is recommended for patients with unexplained unintentional weight loss, and autopsies should be pursued when facing unsolved deaths 5.