People are getting more health-conscious and trying to intentionally lose weight. Abnormal loss of weight, however, is unintended/unplanned weight loss. This type of loss of weight tends to be progressive until the underlying cause is found and addressed. Doctors get concerned when someone loses up to ten pounds in one month or has progressive decrease in weight over several weeks or months. Several medical conditions present as weight loss which can pose a challenge to making diagnoses. One of the vital factors in helping the doctor is your ability to give a very good history of things that happened to you since you noticed the weight loss or prior to it. Many times people may think that some complaints are likely unrelated to their weight loss, but it is better to tell the doctor everything.

 

Scenario 1: Doe is a 40 year-old male who immigrated to the United States about six years ago. He has not travelled out since then. He works as a well-paid chain store manager. He has had a monogamous relationship since getting married four years ago. As a bachelor he was involved in one relationship at a time, and more often than not had unprotected sex with his then-girlfriends that he trusted. He had broken ties with past relationships, so he does not know about their health. His sister who had not seen him for about four years was concerned when she noticed he had lost a lot of weight. Doe was not bothered because he did not feel sick or anything. His last physical two years ago was okay. His sister managed to convince him to seek medical advice. Should Doe have any concerns about his weight loss?

 

Ans: Doe has been ‘healthy’ since he came to the United States. Without going into the details of his other symptoms, his old sexual habits are a risk factor for sexually transmitted infections—particularly HIV. He had multiple sexual partners and unprotected sex prior to settling down to a monogamous relationship. Doe needs to be tested for HIV. HIV is one of the causes of unexplained weight loss and should be screened for as part of the initial test in evaluating weight loss. It is better to accept testing than to decline because of fear. Many treatment options are available in the event of a positive result.

 

Scenario 2: Jane worked in the healthcare field in her country for several years. Upon arriving in the United States, she has had to do work as a cashier in some stores. She has lost about 50 pounds in the past year despite eating well. She has being living in New York for the past eight years with no recent travels. She sweats a lot especially at night. She sees her GYN yearly and goes to the medical doctor only when she is really sick which she hasn’t been in two years. Her mom is concerned about her weight loss, though it is still normal for her height. Is her mom right for worrying at all, since her weight is okay for her height?

 

Ans: While it is good that Jane’s weight is normal for her height, in the setting that the normalcy was achieved unintentionally, it is a concern. Jane also sweats a lot along with the weight loss; though she thinks that has always been her pattern. Jane’s previous work in the healthcare field is a risk factor for exposure to tuberculosis. Tuberculosis (TB) infection can remain latent (‘quiet’) for several years before becoming an active infection. Although many people may have chronic cough, that is not always the case. People infected with the TB bacteria may exhibit several other symptoms including low-grade fever, night sweats, and progressive weight loss. Screening test for TB is done by primary care doctors, followed by a chest x-ray if positive. (Refer to the article on understanding your TB test). If Jane emigrated from a country with high incidence of tuberculosis, coupled with her other risk factors, TB may be the cause of her weight loss. If TB is confirmed as the cause, she can be treated with a standard regimen of drugs. Everyone who lives in Jane’s household should subsequently be screened for TB.

 

Scenario 3: John is 32 years old. He has been concerned about losing weight continuously for about six months. He has done HIV test two times in the past three months, both results were negative. He has become embarrassed by his friends who look at him suspiciously as if he is hiding something. Apart from the fact that he drinks a lot of water and is frequently hungry, he has not noticed anything extraordinary. He attributes his excessive thirst to the hot weather. A friend felt that his water drinking habit is almost becoming compulsive and urged him to have a check-up. Is there any relationship between his weight loss and thirst?

 

Ans: The doctor noticed that John excused himself to use the restroom about three times in the space of one hour and also finished about half a liter of water while in the examination room. The doctor requested to have John’s blood sugar tested; it was high. John has diabetes. Diabetes can present as weight loss with associated excessive thirst, frequent and large urination. The excess sugar in the urine is calories lost resulting in weight loss. The sugar draws water along with it, leading to increased urination. The lost calories and dehydration made John lose weight. He was started on treatment for diabetes and thereby regained his weight.

 

Take Home Message

Unintentional weight loss needs to be investigated. Several medical problems can present as weight loss and delay in diagnosis may lead to the progression of the disease. While some are easily diagnosed, others require extensive work-up to arrive at the right diagnosis. Do not give up when your doctor is trying to carry out a systematic approach at evaluating weight loss. Other causes of weight loss will be discussed in the next article.

 

Dr. Oluwatoyosi Dairo can be reached at Amazing Medical Services at 110-16 Sutphin Blvd; Jamaica, NY 11435 or by phone at 718-526-7600.

 

Disclaimer: This write-up is for informational purposes only and is not intended to replace the advice of your doctor.