Weight loss

NOTE: NOT the same as low weight (there needs to be a change in weight)

• Often 10% (or >3kg) in 6 months is used as a rough guide of what is abnormal
  • However this is not a strict definition

History

• Clarify how much over what time period (try and procure some evidence for this as well e.g. weight measurements from notes)
  • Clarify if there was any intention or other physiological cause for weight loss
    • Possibly take a dietary and exercise history
  • Have their clothes felt looser?
• Ask about appetite and satiety.
• Are there any body image concerns or worries about eating?
• Any recent changes to social circumstance/lifestyle? Mood
• Any other symptoms?
  • Change in bowel habit?; tiredness/lethargy?; difficulty swallowing?; vomiting/nausea?; chest/abdominal pain?; features or hyperthyroidism (e.g. agitation, tremor, palpitations etc)?
• Any medical conditions?
  • Change in symptoms? e.g. worsening SOB in COPD patient
  • Change in drug dosage or regime?

Examination

• As with other CCP, examine as per suspicion.  However, with weight loss, often there will be little clues as to what/where to examine
• Good idea to have a good general examination, as well as cardiorespiratory and abdominal examination
  • Checking for lymphadenopathy is also a good idea

Investigations

• Urinalysis for sugar, protein and blood
• Blood tests
  • FBC
    • any anaemia, infection
  • CRP/PV
  • U&Es and LFTs
  • Glucose
  • TFTs
  • Autoantibodies (if there is a suspicion of immune mediated cause)
• Other tests are only really indicated if symptomatic, although if weight loss is severe and rapid, they may be performed as part of work-up
  • CXR
  • Endoscopy/sigmoidoscopy/colonoscopy etc

Causes

• Physiological- change in physical activity, diet or even social circumstances (the latter can often be difficult to identify as a cause, particularly in elderly patients)
• Psychiatric illness
  • Anorexia nervosa
  • Bulimia
  • Affective disorders, including depression
  • Alcoholism
• Systemic diseases
  • Chronic infection e.g. TB, recurrent urinary/chest infections, HIV-related illness, COPD
  • Chronic inflammatory conditions e.g. rheumatoid arthritis; polymyalgia rheumatica; SLE
  • Malignancy
• GI disease
  • Inflammatory bowel disease
  • Malignancy (particularly pancreatic and gastric)
  • Malabsorption from pancreatic disease or small bowel causes
• Endocrine/Metabolic causes
  • Diabetes mellitus (particularly type I)
  • Hyperthyroidism
  • Addison’s disease
  • Panhypopituitarism