General Medicine
Unexpected Weight Loss
#Unexpected Weight Loss
Intake
- How much weight lost: *** 5+% of body weight is considered clinically significant
- What period of time: *** within 6-12 months is more concerning
- Changes in diet or activity: *** restriction, dieting, new exercise
- Associated signs/symptoms: *** loss of appetite, nausea, vomiting, diarrhea, constipation, dysphagia, abdominal pain, chest pain, SOB, fatigue, night sweats, chills, lymphadenopathy, blood in stool, changes in hair/skin, palpitations, heat intolerance, polyuria/polydipsia
- Changes in Mood: *** PHQ-2: over the last 2 weeks little pleasure in doing things or down/depressed/hopeless
- New medications: *** levothyroxine, diuretics, GLP1-agonists, metformin
- Substance use: *** EtoH, tobacco, cocaine
- Co-morbidities: *** diabetes, thyroid disease, cancer
Plan
- First Pass Labs: CBC, CMP, TSH with reflex T4, ESR/CRP, A1c, UA, HIV/HCV
- If Diarrhea: ***
- If h/o smoking or pulmonary sxs: CXR
- PHQ-9 to rule out mood disorder
- MOCA or MMSE for cognitive testing
- Age-appropriate cancer screening
- Screen for social risk factors including food insecurity, social isolation/loneliness, abuse, transportation difficulty
- Consider consult to nutrition services for counseling and supplementation
Differential
- GI Disorders - malabsorption, celiac, PUD, IBD, dysphagia
- Malignancy - commonly colon, lung, lymphoma, renal, prostate
- Endocrinopathy - hyperthyroidism, diabetes, adrenal insufficiency
- Psychiatric - depression, eating disorder
- Infectious - HIV, hepatitis, TB, chronic fungal infection
- Neurologic - dementia, stroke, Parkinson
- Rheumatologic - SLE, RA, vasculitis
- Chronic Advanced Disease - CHF, COPD, ESRD, cirrhosis
- Substance Use - EtOH, cocaine, tobacco, amphetamines
- Medications - most commonly levothyroxine, diuretics, GLP1-agonists, metformin
Template coming soon!
Patient Guidance and Information
Unexpected Weight Loss - Initial Message
Hello ***,
You have lost *** pounds over the last *** months. While weight can fluctuate for many reasons, unexpected or unexplained weight loss can sometimes be a sign of underlying health issues. These can range from gastrointestinal disorders, endocrine conditions, infections, and even certain types of cancer. It could also be related to social factors, like changes in diet, stress, or mood.
Our goal is to help identify if there's a specific cause for your weight loss. As part of this process, we will be ordering some lab tests. In addition, we will need to ask some more detailed questions about your health, diet, lifestyle, and recent symptoms, if any. This will help us to get a better understanding of your overall health and any possible factors that may be contributing to your weight loss.
In the meantime, please feel free to reach out with any questions or concerns.
If You Remember Nothing Else
Unintentional weight loss is a 5% or greater decrease in body weight over 6-12 months. Unexpected weight loss can be a symptom of a serious underlying condition including malignancy, GI diseases, endocrine disorders, or mental health disorders including depression. A detailed history will guide your workup, and a systematic approach is crucial. Most patients woudl benefit from basic labs and age-appropriate cancer screening. Reassure patients that weight loss is often due to non-malignant causes, but emphasize that follow up and further investigation is needed.
Clinical Pearls
- Common causes of unintentional weight loss in the elderly include dementia, depression (pseudo-dementia), physical disability, diarrhea, dysphagia, occult malignancy
- Mirtazapine may be used for both appetite stimulation and depression symptoms, though usually at different doses
Other Resources
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