Weight loss may be voluntary or involuntary.Voluntary weight loss occur due to dieting,exercise, starvation or decreased intake in older people.If the weightloss is involuntary particular attention should be given since it may be an indicator of underlying serious disease.Weight loss can be identified from the hospital or general practice weight record.In some patients weight loss occur without an underlying cause,which is regained and stabilise over time.
What is significant weight loss?
Loss of weight more than 4.5 kg or more than 5% of one’s body weight over a period of 6–12 months is called significant weight loss
Important causes of weight loss are the following.
They belong to four main groups
1.Cancer
2.Chronic infection and inflammation
3.Metabolic disorder such as diabetes, hyperthyroidism
4.Psychiatric disorders
Cancer
It is the cause of involuntary weight loss in upto 25% of cases. Following are the malignancies which are frequently associated with weight loss.
Gastrointestinal, liver, blood, lung, breast, genitourinary, ovarian and prostate.20% of cancer death is due to severe weight loss and cachexia.
Gut problems(gastrointestinal)
Almost any disease of gut can result in weight loss.
Inflammatory bowel disease, Crohn’s disease or ulcerative colitis cause loss of appetite, fear of eating,loss of protein and nutrients from body. Malabsorption, peptic ulcer, pancreatitis Obstruction/constipation, pernicious anemia are the most common gut problems leading to weight loss.
Infections
Tuberculosis, parasites, fungal diseases, subacute bacterial endocarditis, and HIV are common treatable causes.
Endocrine and metabolic
Hyperthyroidism, diabetes mellitus, pheochromocytoma, adrenal insufficiency
Chronic heart and lung disease
Causes weight loss due to increased metabolic demand, decreased food intake due to disease and decreased appetite
Psychiatric causes
Significant weight loss is seen associated with depression and isolation so that patient fail to take care of nutritional needs. Bereavement is also a well known cause of weight loss.Alcoholism is an important cause of weight loss due to malnutrition and self neglect .Other psychiatric disease causing weight loss are anxiety and paranoia, anorexia nervosa, bulimia
Neurologic disease
Stroke, parkinson’s disease, neuromuscular disorders and dementia
Old age
Decreased taste and smell, functional disabilities, age related change in body all result in poor nutrition
Drugs
Cause loss of weight due to decreased appetite, nausea, vomiting, stomach ulceration, diarrhea, dry mouth, altered taste all these are more common in elderly who are on 5 or more drugs .Examples are sedatives, antibiotics, nonsteroidal antiinflammatory drugs, serotonin reuptake inhibitors, metformin levodopa ,angiotensin-converting enzyme Inhibitors.
