“The loss of 5% of body weight in a period of six to 12 months requires immediate execution of additional studies.”
When a patient comes to consultation for a weight loss, before undertaking an extensive search it is important to verify that there is indeed weight loss and measure the period in which it occurred.
Almost 50% of patients who claim to have experienced significant weight loss actually have no change in body weight that can be measured objectively.
It is not uncommon to see patients who have not noticed that they have really lost weight to a significant degree.
Any significant weight loss that a previously healthy person has not deliberately pursued usually indicates the existence of the systemic disease.
That is why it is important to systematically quantify the bodyweight of each patient in the consultation.
What are the symptoms of weight loss?
Patients who suffer from pathological conditions that justify weight loss usually have signs and symptoms that make it possible to suspect the affection of a certain organ, apparatus, or body system.
Tumors of the digestive system, including those of the pancreas and liver, can impair food intake early and cause weight loss before other symptoms appear.
Lung cancer can present as post obstructive pneumonia with dyspnea, or cough, and hemoptysis, but it is also usually symptom-free and should be suspected even in nonsmokers.
Depression and isolation can lead to significant weight loss, particularly in the elderly. In chronic obstructive pulmonary disease and congestive heart failure, anorexia and increased energy expenditure at rest may appear.
Weight loss can be the first manifestation of some infectious diseases, such as HIV infection, tuberculosis, endocarditis, and fungal and parasitic infections.
Hyperthyroidism or pheochromocytoma increase basal metabolism; the elderly with apathetic hyperthyroidism may present with weight loss and weakness, with few other manifestations of thyrotoxicosis.
New-onset diabetes mellitus is usually associated with weight loss due to glycosuria and loss of the anabolic effects of insulin.
Adrenal insufficiency can be suspected by hyperpigmentation, hyponatremia, and hyperkalemia.
Most common symptoms:
- Weightloss.
- Fatigue.
- General discomfort.
How is weight loss diagnosed?
Look for signs or symptoms that are associated with conditions that commonly cause weight loss, such as fever, pain, dyspnea or cough, palpitations, changes in urination, and signs of neurological disease.
Gastrointestinal disorders, such as difficulty eating, dysphagia, anorexia, nausea, and changes in bowel habits should also be looked for.
You should ask about travel and the consumption of cigarettes, alcohol, and all kinds of medicines, and also inquire about the history of other diseases or surgical interventions, as well as the diseases of the relatives.
Risk factors for HIV infection should be assessed, and signs of depression or senile dementia should also be looked for.
The physical examination that is carried out is complete and it is evaluated device by device to check for alterations. In men, a rectal examination should be performed to palpate the prostate and a study to identify occult blood in feces; and all women should have a gynecological examination, even if the womb has been removed.
Laboratory tests should consist of a complete blood count with glucose and electrolyte counts, liver and kidney function tests, calcium and TSH, urinalysis, and a chest X-ray.
In all cases, the recommended screening tests (screening) must be updated/repeated for some cancers, according to sex and age group, such as mammography and Pap smears.
If gastrointestinal signs or symptoms are present, upper or lower endoscopy (or both) and abdominal study using computed tomography or magnetic resonance imaging have a relatively high diagnostic confirmation rate.
If no cause is found to explain the weight loss, careful clinical monitoring of the patient should be scheduled, rather than insisting on other tests without any clinical guidance
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