Concerned About Weight Loss? What You Should Know
Our family practice doctors often hear from our patients that they or their parents are losing weight and don’t know why. Unintentional weight loss, especially in older adults, can be a sign of a serious problem. On the other hand, it is a frequent occurrence that comes with aging, and may have no medical significance.
The Mayo Clinic reports, “The point at which unexplained weight loss becomes a medical concern is not exact.”
According to the National Institutes of Health (NIH), unintentional or involuntary weight loss is a common phenomenon among older adults, occurring in approximately 13 percent of that population annually. Problematic weight loss in older adults is defined as a loss of five percent of body weight in one month or ten percent over six or more months. Thus, a ten-pound loss in a 200-pound man or a six-to-seven pound loss in a130-pound woman is considered significant and requires investigation.
The problem with unexpected weight loss in older people is the difficulty in pinpointing a cause. In fact, despite extensive evaluation and testing, in as many as 40 percent of cases a specific diagnosis remains elusive.
All cases should be evaluated, however, because even when no disease is found to be present, studies show that those who lose weight involuntarily are between 10 percent and 35 percent more likely to die within one to two years than those who maintain a consistent weight. Those who have experienced involuntary weight loss are also more likely to fall and have more difficulty recovering from illnesses.
Possibilities
In general, there are five major reasons that older people lose weight unintentionally.
Physical
Physical disease is the most common cause of loss of weight in older people. Such diseases can include cancer, cardiovascular disease, diabetes, thyroid imbalances, gastrointestinal disease, or respiratory disorders, among others. If the cause is physical, tests will usually reveal the underlying trigger.
Mechanical
Many older people experience problems with eating due to poorly fitting teeth, difficulty or pain while chewing or swallowing, or an inability to feed themselves properly because of arthritis, essential tremor, or other similar mobility issues. If it’s challenging for someone to leave the house to shop for food, whether from transportation restrictions, limited mobility, or fear of the novel coronavirus, then they may end up eating less than they want to.
Emotional
Depression is a common cause of weight loss in older people, because loss of appetite is one symptom of clinical depression. Early-stage dementia may also be a factor, if paranoia and the suspicion that food may be poisoned cause them to refuse food or to eat less. Other emotionally based situations which may cause someone to eat less or not at all include such stresses as changing living quarters, divorce, or bereavement.
Medication
Side effects from the numerous medications prescribed to older patients are an often-overlooked cause of weight loss. It’s important to ensure that all of a person’s doctors are aware of all the medications they are taking, and to consider this as a possible factor in weight loss.
Food availability
Some seniors are on a limited budget, and can’t afford enough food to maintain their normal weight. Others may be on a medically restricted diet and simply dislike the choices available to them (e.g., low fat, low salt, low carb, etc.).
Treatment Options
For all of these reasons, if you or your parent complain of weight loss, rest assured we will examine all these factors. But also be aware that, because there are so many possible causes of involuntary weight loss, it may take some time to narrow down the root cause. It’s even possible that there are multiple factors involved.
Because there are so many possible causes of unintentional weight loss, and because so many diseases are difficult to pinpoint in the early stages, the path to diagnosis may involve numerous tests.
A thorough clinical evaluation must include, first, an extensive evaluation of the person’s lifestyle. This might resolve the puzzle without further testing. Otherwise, we will perform a thorough physical, including blood tests, and possibly imaging tests, to rule out physical causes.
Treatment consists of correcting the underlying problem, whether physical or otherwise. Unfortunately, if no definitive cause can be determined, there is no prescription medication that is approved for use to stimulate appetite or encourage weight gain in older people.
In that case, we would recommend various kinds of nutritional solutions, such as introducing additional protein and calories to the diet, possibly including nutritional supplements.
As noted above, weight loss in older adults can often be a frustrating, and even frightening, problem. But with careful evaluation and monitoring, it can often be corrected, allowing the person an improved quality of life.
If you or your parent is experiencing unintentional weight loss, don’t just ignore it. Instead, let us know.
And remember, our offices are now open and receiving patients with strict sanitary measures in place. We are now also offering buzzer devices for those who wish to await their appointment in their car.
For those who prefer an in-home option, we will continue to conduct Telehealth visits.
