Evaluation of weight loss

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1. weight loss A measurable decline in body weight (BW) either intentionally or from malnutrition or illness. It is considered mild when 5% of BW is lost, moderate when 5-10% of BW is lost, and high when more than 10% of BW is lost.

2. remember Always ask about weight change Change of 5% over 6 months is significant Relative change is also important Significant weight loss – marker of serious illness Persistence & periodic evaluation to identify the cause - important

3. Mechanisms of weight loss Increased energy expenditure Increased energy loss Decreased food intake

4. weight loss classification

5. weight loss classification

6. If the patient complains of weight loss, ask: How much weight did you lose? Over what period? How is your appetite ? How is your bowel habit ? (If frequent diarrhea or loose motion, ask details regarding color, amount, presence of blood, etc.).

7. If the patient complains of weight loss, ask: Do you feel excessively thirsty and micturate frequently ? Do you have other symptoms , such as cough, fever, night sweat? Do you have palpitation ? Do you prefer hot or cold environment ?

8. If the patient complains of weight loss, ask:

9. If the patient complains of weight loss, ask:

10. If the patient complains of weight loss, ask: Do you feel that you are getting darker than before ? (any change in your complexion?) Do you have vomiting ? If yes, is it spontaneous or induced? Do you take alcohol or any other substance?

11. Weight loss in Addison’s disease

12. Note Also remember the following points: ¯ ¯ A detailed systematic enquiry should be made to find out any malignancy . ¯ ¯ History regarding intravenous drug intake, blood or blood product transfusion, extramarital sexual contact, traveling abroad and other high-risk behavior for HIV infection should be sought. ¯ ¯ Weight loss means reduction of 5% of body weight or 5 kg within 6 months is considered significant. ¯ ¯ Weight loss may be physiological because of dieting, exercise, starvation or less intake in old age.

13. Causes of weight loss I. Involuntary with increased appetite A. Increased energy expenditure B. Increased energy loss Hyperthyroidism Pheochromocytoma Extensive exercise Diabetes Mellitus Malabsorption syndromes Chronic pancreatitis Ulcerative colitis Chrohn’s disease Celiac sprue

14. Causes of weight loss  II. Involuntary with decreased appetite Medical disorders Psychiatric Disorders Chronic drug use Cancer and chronic Infections, Diabetes Mellitus Depression Alcohol, Metformin, Anti cancers, ART