"That makes eight pounds I've lost over the past four months," a patient of Consumer Reports' chief medical adviser, Marvin M. Lipman, reported. An obviously concerned 80-year-old, she asked, "When is this going to stop?" She added that she felt well and that her appetite and activity pattern had not changed at all.
Hers was not an uncommon complaint. As many as 1 in 5 people older than 65 have significant undesired weight loss over time. And her concern was warranted because most physicians agree that an unexpected weight loss of 5 percent or more — Lipman’s patient had lost about 6 or 7 percent — in such a short time is worrisome. Worrisome because unintentional weight loss, or UWL, is linked to a higher risk of sickness and even death. Thus, Lipman’s first goal was to find the cause of the weight loss, which can be difficult.
Could it be cancer?
Uppermost in the mind of anyone with UWL is the possibility of cancer. Studies have shown that in up to 35 percent of people with substantial UWL, cancer was the cause. (The ways in which cancer can lead to weight loss are numerous, including a reduced appetite.)
The good news is that if no cancer is detected on the initial evaluation, it’s unlikely that cancer is responsible.
After cancer, other common causes of UWL are gastrointestinal disease and mental health problems. Noncancerous diseases of the gastrointestinal tract account for 10 to 20 percent of UWL cases, even when appetite and bowel function remain normal. Sometimes early signs and symptoms of conditions such as celiac disease and ulcerative colitis can be so subtle as to make detection difficult, with weight loss being the only evident symptom.
In older adults and people in nursing homes, depression can have a powerful effect on eating behavior without being obvious to the victims. Mental health disorders, particularly depression, account for up to 58 percent of cases of UWL in nursing home residents.
Many times, factors such as dementia, loneliness, poorly fitted or missing dentures, hearing loss and medication effects may be the cause. Occasionally it’s situational, as with an elderly patient who skipped meals simply because the walk from her room in an assisted-living facility to the dining area was too far — and she was reluctant to admit it.
Those with hyperthyroidism and diabetes can also present with UWL. In older adults, an overactive thyroid often masquerades as apathetic hyperthyroidism because typical signs — such as heat intolerance, frequent bowel movements and nervousness — are lacking. Weight loss occurs despite a good appetite. Weight loss caused by a shortage of sugar in the urine may be the only manifestation of Type 2 diabetes, and elevated blood sugar might produce no symptoms.
A happy resolution
Despite our sophisticated techniques, up to 1 in 4 people with significant UWL fails to get an adequate diagnosis. Lipman thought that would hold true for his patient.
He was surprised and delighted when he detected an irregular heartbeat, of which she was totally unaware, in an otherwise normal physical exam. An electrocardiogram showed atrial fibrillation, an abnormal heart rhythm that’s sometimes associated with thyroid overactivity.
Her laboratory tests results, available the next day, confirmed his suspicion that she had an overactive thyroid. After a few weeks on medication to treat her apathetic hyperthyroidism, she gained not only the pounds she had lost but also a few more that she didn’t want. Lipman smiled when she then regaled him with the same question she asked on that first visit: “When is this going to stop?”
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