Unexplained Weight Loss 

Unexplained weight loss is described as a significant drop in body weight when a person is not actively attempting to lose weight. It can be a sign of a more serious condition or simply indicate that a person is not eating enough. It is natural for our weight to fluctuate throughout the year. However, unexpected weight loss is frequently observed in adults over 65. Nonetheless, a weight loss of more than 5-6 kg over a short period of time should be a cause for serious concern.

What is Unexplained Weight Loss (Sudden weight loss)?

Unexpected weight loss is defined as a loss of weight that exceeds 5-10% of the total body weight in less than six months. Serious conditions like cancer or diabetes may manifest symptoms of unexplained weight loss. In such circumstances, it is crucial to seek medical help.

Who is at risk for Unexplained Weight Loss?

Anyone can experience unexplained weight loss; however, it is more common and concerning in adults over the age of 65. Even a weight loss of less than 5% of body weight or 10 pounds in older adults may indicate a potentially dangerous disease. Adult women between the ages of 25 and 29, as well as those over the age of 35, have a significantly higher risk of developing Crohn's disease compared to males. Men, on the other hand, are more prone to developing ulcerative colitis after the age of 45 than women.

Other risk factors

Several factors can increase the likelihood of losing weight without a clear reason:

• In Older Adults: Around 15-20% of people aged 65 and older experience unexplained weight loss, with smoking and higher body fat distribution also increasing this risk in older people.
• In Children and Adolescents: Certain factors can lead to unintentional weight loss in children:
  • Breastfeeding Challenges: New parents may face difficulties with breastfeeding or formula preparation, impacting the baby’s weight. It's important to monitor the baby's weight and seek help from a pediatrician if needed.
  • Allergies: Babies can develop allergies to certain formulas, which can take time to identify.
  • Eating Disorders: About 2.7% of teens struggle with eating disorders, with girls being more affected than boys. Unexplained weight loss can be a sign that a teen may need evaluation for this issue.
• In Males vs. Females: Males generally have higher rates of certain conditions, such as endocarditis, pancreatic cancer, and lung cancer. Females are more likely to develop chronic obstructive pulmonary disease (COPD) and are significantly more prone to hyperthyroidism and rheumatoid arthritis (RA).

What are the causes of Unexplained Weight Loss?

Unintentional weight loss often occurs as a result of chronic medical conditions. However, short-term illnesses such as the flu or a cold can also lead to weight loss due to digestive discomfort.

• Overactive Thyroid - This condition typically causes sleep difficulties, heart palpitations, and persistent heat. The thyroid gland helps regulate the metabolism of the body, and an overactive thyroid can increase caloric expenditure, resulting in weight loss.
• Diabetes - Diabetes impairs the body's ability to absorb glucose and other nutrients, causing rapid weight loss as nutrients are expelled.
• Inadequate Eating - As individuals age, physical activity decreases, lifestyles become more sedentary, and metabolism slows down. This can lead to feeling satisfied for longer periods. Additionally, the part of the brain that regulates hunger and fullness weakens with age.
• Anxiety - Individuals with anxiety often have high levels of the hormone cortisol, which can suppress appetite and lead to weight loss.
• Depression - Depressed individuals tend to experience a decrease in appetite as hormone levels that regulate blood pressure, metabolism, and glucose levels decline.
• Addison’s Disease - Although rare, this autoimmune condition can cause weight loss. In Addison's disease, the body's immune system damages the adrenal glands, leading to a lack of hormone production, which affects metabolism and hunger.
• Celiac Disease - This autoimmune condition occurs when the body's immune response damages the small intestine upon gluten consumption, resulting in bloating, diarrhea, and weight loss.
• Rheumatoid Arthritis - This autoimmune disorder involves the body attacking healthy tissues, causing inflammation and joint problems. This can also impact gut metabolism, leading to weight loss.
• Pancreatitis - The pancreas produces enzymes that help in food digestion. Inflammation in the pancreas can reduce its capacity, resulting in weight loss.
• Inflammatory Bowel Diseases - Inflammation in the gastrointestinal tract from conditions such as Crohn's disease and ulcerative colitis impairs digestion, leading to diarrhea and weight loss.
• Muscle Atrophy - Muscle atrophy, or muscle loss, occurs when muscles waste away or diminish. This can happen due to malnutrition or being bedridden.
• Dysphagia - Individuals with dysphagia struggle with swallowing, often avoiding solid foods. Malnutrition and weight loss can be potential outcomes.
• Cancer - Cancer is a condition where human cells grow and mutate improperly, affecting healthy tissues and organs. Weight loss can be a side effect depending on the size and stage of the cancer.

Unexplained weight loss in women vs. men

Unexplained weight loss can be concerning and might indicate health issues. Although it can happen to both men and women, the causes may vary.

• In Women:

• Hormonal Changes: Menopause or imbalances can affect weight.
• Mental Health: Conditions like anxiety, depression, or eating disorders can lead to weight loss.
• Chronic Illness: Diseases like autoimmune disorders or thyroid issues may cause weight changes.
• Malnutrition: Poor diet or absorption problems can result in weight loss.

• In Men:
  • Cancer: Certain cancers often lead to significant weight loss.
  • Hormonal Changes: Low testosterone levels can impact body weight.
  • Mental Health: Depression can affect appetite and lead to weight loss.
  • Chronic Conditions: Heart issues or diabetes can also cause weight loss.

Symptoms of Unexplained Weight Loss

Unexplained weight loss refers to a significant decrease in body weight that occurs without a deliberate effort to lose weight. It is often considered a concerning symptom and can be associated with various underlying medical conditions. Common symptoms of unexplained weight loss may include:

• Rapid Reduction in Weight: Losing a noticeable amount of weight without changes in diet or physical activity is a key symptom.
• Loss of Appetite: A decreased interest in food or loss of hunger is often a contributing factor to unexplained weight loss.
• Fatigue: Feeling excessively tired or lacking energy can accompany unexplained weight loss.
• Muscle Atrophy: A decrease in muscle mass or strength may be evident, especially if the weight loss is substantial.
• Weakness: A generalized sense of physical weakness or frailty can be experienced.
• Digestive Problems: Symptoms like nausea, vomiting, diarrhea, or abdominal pain may be present, which can affect the ability to eat and maintain weight.
• Change in Bowel Habits: Alterations in bowel movements, such as chronic diarrhea or constipation, can be associated with weight loss.
• Fever: Unexplained fever may accompany weight loss and can indicate an underlying infection or inflammatory condition.
• Excessive Thirst and Urination: Frequent thirst and urination may be signs of conditions like diabetes, which can lead to weight loss.
• Changes in Skin and Hair: Dry, pale, or easily bruised skin, as well as brittle hair, are potential indicators of underlying health issues.

How is Unexplained Weight Loss Diagnosed?

Unintentional weight loss can be indicative of various underlying diseases. To accurately identify the cause of the weight loss, the doctor assesses the patient's symptoms and recent lifestyle changes. Initially, the doctor will thoroughly examine the patient's medical history, search for potential risk factors associated with different clinical disorders, and then conduct a physical examination. Depending on the findings, the doctor may recommend additional tests and radiological examinations to monitor weight reduction.

Commonly carried out tests consist of:

• Complete blood count (CBC)
• Blood sugar (glucose)
• Liver function tests
• Thyroid panel
• Kidney function tests
• Urinalysis
• Inflammation tests 
• Electrolytes 
• Chest X-Ray
• Computed tomography (CT)
• Positron emission tomography (PET) 

To check for signs of gastrointestinal reasons for weight loss, endoscopic procedures can also be carried out, such as upper gastrointestinal endoscopy or colonoscopy.

How is Unexplained Weight Loss treated?

Identifying the cause of weight loss can help address unintentional weight loss. If no reason can be identified, a nutritionist or dietitian may advise the patient to follow a special diet and exercise regimen. In cases where weight loss is a result of a digestive illness, such as inflammatory bowel disease, a specific diet during times of inflammation may be necessary to obtain the required nutrients. This may also involve the use of over-the-counter supplements.

If an imbalance in hormones is the underlying cause of unintentional weight loss, the doctor will likely recommend medication. In situations where unintended weight loss could indicate a more serious problem, such as cancer, the doctor may recommend additional tests to gather more information.

When should I see a doctor?

If the patient is losing weight without trying, it is much more crucial to schedule a visit with the doctor. Although it is normal for body weight to vary, if someone loses more than 5% of their starting weight in six to twelve months without changing their diet or exercise program, they should see a doctor.

A physical examination and a review of a patient's medical history are two ways that a doctor might determine the underlying reason for unexplained weight loss. In order to rule out particular illnesses like cancer, RA, or hypothyroidism, they can use additional blood tests, such as hormone panels or imaging investigations.

Numerous illnesses that might cause unintended weight loss are challenging to identify in the early stages; sometimes, numerous blood tests or imaging examinations are required to pinpoint the problem.

What to expect during my first visit?

Here’s what you can usually expect:

• Medical History Review: Your doctor will ask about your medical history, including any past illnesses, surgeries, or medications.
• Physical Examination: A thorough physical exam will be conducted to assess your overall health and identify any signs that may explain the weight loss.
• Questions About Symptoms: Expect questions about other symptoms you may have, such as fatigue, changes in appetite, gastrointestinal issues, or any recent stressors.
• Lifestyle and Diet Assessment: Your doctor will likely ask about your diet, exercise habits, and any recent lifestyle changes that might contribute to weight loss.
• Laboratory Tests: You may be ordered blood tests or other diagnostic tests to check for underlying conditions, such as thyroid disorders, diabetes, or infections.
• Follow-Up Plans: Based on your evaluation, your doctor may recommend further testing or refer you to a specialist. Discuss potential follow-up appointments or tests.

Conclusion

Unexpected weight loss can occur due to a variety of causes, ranging from inflammation to psychiatric disorders. Therefore, it is crucial for individuals to undergo regular examinations every six months to assess their health status. These routine checkups enhance people's awareness of their health and assist in preventing potential medical conditions.

FAQs

1. Is unexplained weight loss always serious?

Fluctuations in body weight can be common, but a sustained and unintentional loss of weight exceeding 5% of the total body weight within a span of 6 to 12 months is typically a cause for concern. Such significant weight loss may be an indication of malnutrition.

2. What tests are done for unexplained weight loss?

For sudden weight loss, various tests can often be conducted, including:

• Complete Blood Count
• Thyroid panel
• Liver function tests
• Kidney function tests
• Blood sugar (glucose)
• Urinalysis
• Tests for inflammation 
• Electrolytes

3. Can unexplained weight loss be normal?

Unexplained weight loss is usually not normal and should be checked by a doctor to rule out any underlying health issues.

4. How much unexplained weight loss is concerning?

Losing more than 5% of your body weight in six months to a year without trying is concerning and should be evaluated by a doctor.

5. What causes unexplained weight loss and fatigue?

Common causes include thyroid problems, diabetes, infections, cancer, digestive disorders, and mental health issues like depression or anxiety.

6. Can diabetes cause unexplained weight loss?

Yes, diabetes can cause unexplained weight loss, especially if it is not well-managed. High blood sugar levels lead to the body using fat and muscle for energy.

7. Can unexplained weight loss be a result of bad oral health?

Yes, bad oral health can lead to difficulty eating, pain, and infections, which can cause weight loss.

8. Why do I have unexplained weight loss with no other symptoms?

It can be due to a variety of reasons, including the early stages of a medical condition that hasn't shown other symptoms yet. It's important to see a doctor for a thorough evaluation.

9. How much weight loss is risky?

Rapid weight loss or losing more than 5% of your body weight within six months to a year without trying can be risky and should be evaluated by a doctor.

10. What are the signs of weight loss in females?

Signs include looser clothing, a drop in body measurements, a decrease in body fat, and noticing bones (like collarbones or ribs) more prominently.

11. How is unexplained weight loss treated?

Treatment depends on the underlying cause. It might include medication, dietary changes, treating underlying conditions, or addressing mental health issues.

12. What tests to run for unintentional weight loss?

Common tests include blood tests (CBC, thyroid function, blood sugar), urine tests, imaging tests (like X-rays or CT scans), and sometimes endoscopy or colonoscopy, depending on symptoms and medical history.

References:

https://my.clevelandclinic.org/health/diseases/17770-unexplained-weight-loss https://www.mayoclinic.org/symptoms/unexplained-weight-loss/basics/causes/sym-20050700

CARE Medical Team

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