Assessment of weight loss and treatment Indications of assessment .

Assessment of weight loss and treatment

Indications of assessment .

1. Following are the indication for assessment of weight loss . When the patient has 
2. 5% weight loss in one month
3. 10% weight loss in six months
4. Body mass index < 21
5. Change in fit of clothing
6. Change in appetite, smell, or taste
7. Abdominal pain, nausea, vomiting, diarrhea, constipation, dysphagia

Assessment of people with weight loss.

Those with significant weight loss usually manifest , four cardinal manifestation.They are given below

1. Loss of appetite
2. Loss of muscle mass Cachexia (combines weight loss, loss of muscle and adipose tissue,loss of appetite, and weakness)
3. Dehydration.
4. Detailed history and physical examination  including dental evaluation is very important .

Other things to be done as part of assessment are

1. Cancer screening
2. Mini-Mental State Examination
3. Mini-Nutritional Assessment
4. Assessment Questionnaire
5. Observation of eating
6. Activities of daily living
7. Instrumental activities of daily
8. Living

Almost all patients with malignancy and more than 90% of those with weight loss due to a reason will have at least one laboratory abnormality.Tests to be done are

Laboratory tests

Complete blood count
Comprehensive electrolyte and metabolic panel,including liver and kidney  function tests

Thyroid function tests

Erythrocyte sedimentation rate

C-reactive protein

Ferritin

HIV testing, if indicated in high risk persons

Radiology

Chest x-ray

Abdominal ultrasound (USG)

Treatment

1. First thing to be done is to identification and treatment of  the underlying cause.
2. Certain causes are treatable which include metabolic, psychiatric, infectious, or other systemic disorders .That will help to restore the weight.
3. Drugs causing nausea and loss of appetite should be changed.
4. Nutritional supplementation , high-energy drinks,supplements should be taken between meals
5. In some patients  antidepressant mirtazapine results in a significant increase in body weight.

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Causes of Loss of Appetite (anorexia)

Loss of appetite is called anorexia. A variety of disease can cause anorexia. It may be associated with significant weight loss. Anorexia should be differentiated from early satiety or painful swallowing. 

Following are the important cause of anorexia

Depression : Patients will have depressed mood ,disturbed sleep and inertia

Drugs : Certain drugs are well known to produce anorexia following are the common agents Digoxin, narcotics, diuretics, amphetamines, antidepressants (SSRIs), and antihypertensives (especially ACE inhibitors)

Anorexia nervosa : Patients usually avoid food than anorexia due to alteration in body perception. Seen in females they are usually very thin, hypothermic and will have constipation.

Congestive heart failure : Occur only in advanced heart failure. Patient will have leg edema and breathlessness.

Hepatitis : In patients with hepatitis anorexia occur prior to clinical jaundice. Patient will have associated right sided abdominal pain.

Cancer : Prominent in gastric and pancreatic cancer and in cancer with liver metastases. In these patients weight loss is out of proportion to anorexia.

HIV infection : Anorexia occur as a part of disease or due to opportunistic infection or due to side effects of drugs.

Uremia : Waxy oedema  sallow colour and  decreased urine output are seen.

Addison disease : It is due to deficiency of hormone cortisol. Patients will also have fatigue or tiredness low blood pressure increased skin pigmentation especially of palmar creases and buccal mucosa.

Mesenteric ischemia : patients will develop abdominal pain after food intake due to poor blood supply to intestine, so they avoid eating. Features of systemic vascular disease is found.

Hypothalamic lesion : Certain lesions of hypothalamus such as tumors can cause visual field defect and anorexia .

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