Weight Loss
Unintentional weight loss is often a manifestation of significant underlying disease and should never be ignored.
Causes
Systemic Disease
Infective
Other
• Substance abuse (e.g. laxatives, amphetamines, opiates)
• Drugs, e.g. excessive thyroxine replacement
• Malnutrition (Fig. 68) • (common in developing countries)
History
General
The timeframe and amount of weight loss should be noted. A dietary history is required to determine the amount and type of food ingested. Decreased dietary intake may result from loss of appetite or loss of interest in eating due to depression. On the other hand, patients with thyrotoxicosis lose weight, despite a voracious appetite.
Enquiries should be undertaken regarding perception of body image, as patients with anorexia nervosa believe that they are overweight, despite being severely underweight. Risk factors for HIV should be screened for and a sexual history as well as information regarding intravenous drug use should be obtained. Systemic enquiry is required to identify features suggestive of malignancy or organ failure in each system to account for unintentional weight loss. A butterfly rash may be present in cases of SLE.
