Weight loss

Published on 10/03/2015 by admin

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Chapter 43 WEIGHT LOSS

Theodore O’Connell

Clinically significant weight loss can be defined as the loss of 10 pounds (4.5 kg) or more than 5% of the usual body weight over 6 to 12 months, especially when the weight loss is progressive. Weight loss greater than 10% in that amount of time represents protein-energy malnutrition, which is associated with impaired physiologic function, such as impaired cell-mediated and humoral immunity. Weight loss greater than 20% in the same time represents severe protein-energy malnutrition and is associated with organ dysfunction.

Dieting and eating disorders, such as anorexia nervosa and bulimia nervosa, account for most cases of intentional weight loss. Unintentional weight loss can be divided into four problems: anorexia, dysphagia, weight loss despite normal intake, or socioeconomic problems.

Malignancies account for approximately one third of all patients with unintentional weight loss. Gastrointestinal disorders are the most common nonmalignant organic causes in patients with unintentional weight loss, accounting for about 15% of cases. Medications are a frequently overlooked potential cause of unintentional weight loss, particularly in elderly patients. Adverse effects of medications, such as anorexia, nausea, diarrhea, dysphagia, and dysgeusia, may alter the intake, absorption, and use of nutrients.

Weight loss occurs commonly in elderly individuals. Among noninstitutionalized elderly persons, depression, cancer, and benign gastrointestinal tract diseases are the most common causes of weight loss. Among nursing home residents, psychiatric and neurologic illnesses account for the greatest proportion of weight loss.

In most patients, the cause of unintentional weight loss may be identified through a detailed history and physical examination. The first step in evaluating a complaint of weight loss is quantifying the weight loss. The symptoms documented from the history can guide the clinician to one of the four causal categories: anorexia, dysphagia, weight loss despite normal intake, and social factors. The suggested laboratory evaluation is outlined later in this chapter. Additional testing should be directed by findings from the history, physical examination, or initial laboratory evaluation. Patients with normal physical examination and laboratory findings are unlikely to have a serious physical illness.

Medications Associated with Weight Loss

Angiotensin-converting enzyme (ACE) inhibitors

• Ciprofloxacin

• Clarithromycin

• Doxycycline

• Griseofulvin

• Metronidazole

• Pentamidine

• Tetracycline

Anticholinergics

Anticonvulsants

Benzodiazepines

Bisphosphonates

Calcium channel blockers

Chemotherapeutic agents

Corticosteroids

Dopamine agonists

Hormone replacement therapy

Hydrochlorothiazide

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Selective serotonin reuptake inhibitors

Tricyclic antidepressants

Causes of Weight Loss

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