What’s Up Doc column: Dad’s weight loss concerns son-in-law

Dr. Jeff Hersh
More Content Now

Columns share an author’s personal perspective.


Q: My thin, elderly father-in-law has lost about 20 pounds in the last couple of months despite trying to put weight on. What can cause this?

A: Unintentional weight loss is defined as a loss of more than 5% of the patient’s body weight over six to 12 months or less. It is more common than people think, specifically in the elderly where it occurs in over 15% of those over age 65 when they are followed for 5 to 10 years. Risk factors include advanced age, smoking and overall poor health.

One way to think about weight loss is to “follow the calories.” Things that can cause unintentional weight loss include:

*Inadequate caloric intake: this can be due to inadequate access to nutritious food, psychiatric illnesses (for example depression, an eating disorder, others), neurological disorders (such as Alzheimer’s, others), alcoholism, dental/swallowing issues, or other causes.

*Decreased absorption of ingested foods: this can be from gastrointestinal issues (for example peptic ulcer disease, celiac disease, inflammatory bowel disease, others), certain medications, or other causes.

*Decreased ability to utilize the absorbed calories: this can be due to organ dysfunction (liver, kidney, pancreas, other), endocrine disorders (such as diabetes, others), or other causes.

*Increased caloric requirements: this can be from endocrine conditions (such as high thyroid condition, others), cancers, certain infectious diseases (for example HIV, tuberculosis, others), cardiac diseases, lung disease, chronic vigorous exercise, drugs (for example cocaine abuse), medications, or other causes.

A nice acronym that sums up possible causes of unintentional weight loss is MEALS ON WHEELS:

M: medications.

E: emotional, psychological.

A: alcoholism.

L: late-life issues including depression, neurological conditions, others.

S: swallowing issues.

O: oral factors, including dentition.

N: nosocomial or other infections.

W: wandering and other dementia-related issues.

H: “hyper” (high) thyroid or calcium conditions, or even low (“hypo”) adrenal function.

E: enteral issues (gastrointestinal issues).

E: eating issues.

L: low calorie or other inappropriate diets.

S: social issues, including inadequate access to food.

Evaluation of patients with unintentional weight loss will include careful monitoring of the amount and pattern of their weight loss, a history and physical exam to try to identify any risk factors for any of the conditions noted above (e.g. access to food, depression, dentition, etc.), possibly having the patient keep a food log of what they eat (there are screening tools to assess nutrition), assessment of concomitant symptoms which may increase suspicion of other conditions (such as fever, night sweats, changes in bowel movements, other), medication review, focused testing (for example blood tests for thyroid and/or other endocrine function, organ function, other conditions), and other evaluations as indicated (for example testing for cancers that may be suspected, although an undiagnosed cancer is an uncommon cause of unintentional weight loss).

A diagnosis of unintentional weight loss is associated with an overall increase in mortality, probably related to the underlying cause(s) of the weight loss. Therefore, the treatment of unintentional weight loss is centered around identifying and addressing the underlying cause. While the patient’s evaluation is ongoing, a nutritional consult may be advised, and other consults may be indicated depending on the suspicion(s) for other underlying conditions.
