Weight loss - unintentional

Definition:

A decrease in body weight that is not voluntary. Weight loss will occur with decreased food intake, increased metabolism, or both. See also intentional weight loss.

Alternative Names:

Loss of weight

Considerations:

There are many causes of unintentional weight loss including endocrine, gastrointestinal, and psychiatric disorders, as well as nutritional deficiencies, infections, tumors and neurological disorders.

Anorexia nervosa appears almost exclusively in adolescent girls. While many teenagers go through a phase of excess dieting (see intentional weight loss), only a few actually develop anorexia nervosa. Of those who do, up to 15% die from complications of the condition. Anorexic girls tend to come from families that often talk about the "right" amounts or kinds of things to eat, and these girls may use their refusal to eat as a way to manipulate their parents. See also bulimia.

Common Causes:

manipulative behavior (in children)
unrealistic expectations of caretakers (with children)
depression
conditions that prevent food consumption such as painful mouth sores, newly applied orthodontic appliances, or loss of teeth
malnutrition
drug abuse and smoking
acute infection
loss of appetite
drugs (including amphetamines, chemotherapeutic agents, laxative abuse, and thyroid medications)
unrecognized intentional weight loss
unrecognized anorexia nervosa or bulimia
AIDS
malignancy

Home Care:

Practice moderation and maintain a balanced program in both diet and exercise. For weight loss caused by oral or dental problems, see the dentist. For weight loss caused by disease, follow prescribed therapy in treating the underlying cause.

Call your health care provider if:

an adolescent daughter (or son) has an unrealistic image of herself (himself) as being too fat and seems to be dieting excessively.
weight loss is excessive (greater than 10% of normal body weight) and unexplained.
weight loss is accompanied by other unexplained symptoms.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting weight loss in detail may include:

time pattern
- When did the weight loss begin?
- Has it been sudden or gradual?
quality
- How much weight has been lost?
- Has appetite decreased?
- Has amount or kinds of food eaten changed?
- Has physical activity level increased?
aggravating factors
- Has there been an illness?
- Have there been dental problems or mouth sores?
- Have stress or anxiety levels increased?
accompanying symptoms
- Is there vomiting?
- Is there self-induced vomiting?
- Is there an apparent increased energy level?
- Has there been excessive physical exercise?
- Is there fainting?
- Is there occasional uncontrollable hunger with palpitations, tremor, and sweating?
- Has there been a change in the vision?
- Is there increased sensitivity to cold or heat?
- Is there constipation or diarrhea?
- Is there increased thirst or drinking?
- Is there increased urinary output?
- Has there been any hair loss?
additional important information
- What medications/drugs are being taken?
  - Diuretics?
  - Laxatives?
  - Alcohol?
  - "Street drugs"?
- Has there been severe depression?
- How is the body image -- is there an awareness of weight loss? How does the person feel about the weight loss -- pleased or concerned?

The physical examination may include a general physical examination and a measurement of the body weight.

Diagnostic tests that may be performed are:

nutritional assessment
blood tests including a chemistry profile

Intervention:
Psychological counseling may be recommended in cases where anorexia nervosa or depression are the cause of the weight loss. In the early stages, anorexia nervosa may be best treated in a hospital with close supervision. Even after anorexia nervosa has apparently been cured, the individual should visit the doctor periodically. Relapse is not uncommon.

For weight loss caused by a chronic illness, tube feeding may be administered in order to maintain nutrition and to prevent edema, poor healing, and muscle wasting.

The patient may be referred to a dietitian for nutritional counseling.

After seeing your health care provider:
You may want to add a diagnosis related to unintentional weight loss to your personal medical record.

Review Date: 12/3/2001
Reviewed By: Steven Angelo, M.D. Department of Internal Medicine, Yale School of Medicine, Hospital of Saint Raphael, New Haven, CT. Review provided by VeriMed Healthcare Network.

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