Author:

Editor(s):

Updated:

ULY CLINIC

20 Septemba 2025, 04:08:02

Excessive weight loss

Excessive weight loss occurs when caloric intake is insufficient, absorption is impaired, or metabolic demands are increased, or when multiple factors combine. Causes include endocrine, neoplastic, gastrointestinal, and psychiatric disorders; nutritional deficiencies; infections; and neurologic conditions that impair swallowing or mobility. Weight loss may also result from painful oral lesions, ill-fitting dentures, tooth loss, poverty, fad diets, excessive exercise, or certain medications.

In chronic diseases such as heart failure or renal failure, weight loss may appear late, usually due to anorexia.

History and Physical Examination

History

Detailed dietary history, including caloric intake and patterns.
Determine if weight loss was intentional or unintentional.
Assess for recent lifestyle or occupational changes, emotional stress, bereavement, or divorce.
Ask about GI symptoms: nausea, vomiting, diarrhea, steatorrhea, abdominal pain.
Evaluate for endocrine symptoms: polyuria, polydipsia, heat intolerance.
Review drug history, noting diet pills, laxatives, or medications affecting appetite or metabolism.

Physical Examination

Measure height and weight, and compare with previous values.
Assess general appearance: malnutrition, muscle wasting, clothing fit.
Examine skin: turgor, pigmentation, pallor, jaundice.
Inspect oral cavity: teeth, dentures, mucosal lesions, hyperpigmentation.
Assess eyes for exophthalmos; neck for thyroid enlargement.
Evaluate lungs for adventitious sounds.
Abdominal examination: wasting, tenderness, masses, hepatomegaly.
Laboratory and radiologic studies (CBC, serum albumin, urinalysis, chest X-ray, upper GI series) often reveal the cause.

Medical causes

Cause	Key Features	Associated Findings	Pathophysiology	Management
Adrenal insufficiency	Weight loss, anorexia, fatigue	Weakness, irritability, syncope, nausea, vomiting, abdominal pain, diarrhea/constipation, hyperpigmentation	Cortisol deficiency → decreased appetite, GI upset	Hormone replacement (glucocorticoids ± mineralocorticoids)
Anorexia nervosa	Self-imposed weight loss (10–50% of premorbid)	Skeletal muscle atrophy, hypotension, constipation, dental caries, cold intolerance, hair loss, amenorrhea	Psychiatric disorder → severe caloric restriction	Multidisciplinary therapy: nutrition, psychotherapy, medical monitoring
Cancer	Progressive weight loss	Fatigue, pain, nausea, vomiting, anorexia, palpable mass	Malignant metabolic demand, catabolism	Treat underlying malignancy; supportive care
Crohn’s disease	Chronic cramping, diarrhea	Abdominal pain, anorexia, fever, tachycardia, abdominal tenderness, perianal lesions	Malabsorption, inflammation	Anti-inflammatory therapy, nutrition support
Cryptosporidiosis	Diarrhea-induced weight loss	Watery diarrhea, abdominal cramps, anorexia, malaise, fever, nausea, vomiting	Protozoan infection → malabsorption	Rehydration, antiparasitic therapy if indicated
Depression	Weight loss or gain	Insomnia/hypersomnia, anorexia, fatigue, worthlessness, indecisiveness, suicidal ideation	Psychiatric disorder → altered appetite	Psychological counseling, pharmacotherapy
Diabetes mellitus	Weight loss despite polyphagia	Polydipsia, polyuria, weakness, fatigue	Insulin deficiency/resistance → catabolism	Glycemic control, lifestyle modification
Esophagitis	Painful swallowing → reduced intake	Dysphagia, anterior chest pain, hypersalivation, tachypnea, hematemesis	Inflammation of esophagus → decreased oral intake	Treat underlying cause, dietary modification
Gastroenteritis	Acute or chronic diarrhea	Poor skin turgor, dehydration, abdominal pain, nausea, vomiting, fever	Malabsorption, fluid loss	Rehydration, supportive care, treat infection
Leukemia	Acute: rapid; Chronic: gradual	Fever, fatigue, pallor, bleeding, lymphadenopathy, hepatosplenomegaly, neurologic symptoms	Malignant hematopoietic proliferation → catabolism	Chemotherapy, supportive care
Lymphoma	Gradual	Fever, night sweats, fatigue, hepatosplenomegaly, lymphadenopathy, pruritus	Malignant lymphoid proliferation → catabolism	Chemotherapy, radiation therapy
Pulmonary tuberculosis	Gradual	Fatigue, weakness, anorexia, night sweats, low-grade fever, cough, hemoptysis	Chronic infection → catabolic state	Antitubercular therapy
Stomatitis	Oral pain → reduced intake	Fever, increased salivation, malaise, bleeding/swollen gums	Inflammation → decreased caloric intake	Treat underlying cause, maintain oral hygiene
Thyrotoxicosis	Weight loss with increased appetite	Nervousness, heat intolerance, diarrhea, palpitations, tachycardia, diaphoresis, tremor, goiter, exophthalmos	Excess thyroid hormone → increased metabolism	Antithyroid drugs, beta-blockers, definitive therapy
Drugs	Weight loss	Amphetamines, excessive thyroid meds, laxative abuse, chemotherapy	Appetite suppression, malabsorption, GI irritation	Review, adjust or discontinue offending drugs

Special considerations

Psychological counseling: For body-image–related concerns or psychiatric disorders.
Nutritional support: Hyperalimentation or tube feeding for patients with chronic disease or severe malnutrition.
Monitoring: Daily calorie counts, weekly weights.
Referral: Nutritionist for individualized diet and supplementation.

Patient counseling

Provide dietary guidance and instruction in maintaining a food diary.
Educate on oral hygiene.
Recommend psychological counseling if appropriate.
Encourage gradual weight gain and monitoring.

Pediatric pointers

Causes in infants: failure-to-thrive syndrome.
Causes in children: diabetes mellitus, marasmus, chronic infections, celiac disease, child neglect/abuse.
Intervention: Balanced nutrition, psychosocial evaluation, medical management of underlying disease.

Geriatric pointers

Mild, gradual weight loss may occur due to loss of height, lean body mass, and lower basal metabolic rate.
Rapid, unintentional weight loss predicts morbidity and mortality.
Non-disease contributors: tooth loss, chewing difficulty, social isolation, alcoholism.

References

Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. St. Louis (MO): Mosby Elsevier; 2008. p. 444–447.
Colyar MR. Well-Child Assessment for Primary Care Providers. Philadelphia (PA): F.A. Davis; 2003.
Lehne RA. Pharmacology for Nursing Care. 7th ed. St. Louis (MO): Saunders Elsevier; 2010.
McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights (MO): Mosby Elsevier; 2010.
Sommers MS, Brunner LS. Pocket Diseases. Philadelphia (PA): F.A. Davis; 2012.
Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of unintentional weight loss. N Engl J Med. 2017;376:55–65.
Klevay LM. Nutrition and unintentional weight loss. J Am Coll Nutr. 2000;19:3–15.
DiBaise JK, Zhang H, Crowell MD, Krajmalnik-Brown R, Decker GA, Rittmann BE. Gut microbiota and obesity. Am J Gastroenterol. 2008;103:177–184.
Levine ME, Crimmins EM. Evidence of accelerated aging among cancer survivors: Unintentional weight loss and frailty. J Gerontol A Biol Sci Med Sci. 2015;70:473–479.
Volkert D, Beck AM, Cederholm T, et al. ESPEN guidelines on nutrition in geriatrics. Clin Nutr. 2019;38:10–47.
Gariballa S, Sinclair AJ. Nutritional assessment and management of unintentional weight loss in older people. Clin Interv Aging. 2007;2:611–617.
Volkert D. Malnutrition in older adults—urgency for prevention and intervention. J Nutr Health Aging. 2013;17:592–600.
Sacks HS, Bray GA. Management of unintentional weight loss. Endocrinol Metab Clin North Am. 2012;41:419–437.