Weight loss resident survival guide
Synonyms and keywords: weight loss management guide, unintentional weight loss management guide, loss of weight resident survival guide, pathologic weight loss resident survival guide.

# Overview
A loss of >5% of the usual body weight within 6 - 12 months represents pathologic weight loss. Weight loss may be intentional or unintentional. Unintentional weight loss is more common among the elderly. Common causes of weight loss among patients aged >65 years include malignancies (specifically digestive and non-hematologic), dementia, stroke, parkinson's disease, and polymyalgia rheumatica. In comparison, Endocrine disorders, infections, and psychiatric disorders make up the majority of the causes of weight loss among individuals aged <65 years. A thorough history from the patient or a caregiver provides useful insights to the cause. It is important to assess the availability of food and nutritional status first. A detailed physical exam and observing an elder patient have a meal in front of the physician may provide clues to neurocognitive dysfunctions. CBC, CMP provides a general picture of patient condition. Follow-up is necessary to completely treat the known and identify unknown causes of weight loss. A multidisciplinary approach ensures the optimum management option. Nutritional supplements may be warranted in selected cases but should act as an adjunct to normal meals.

# Causes

## Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. The life-threatening causes of weight loss include:
- Electrolyte disturbances as a result of malnutrition may lead to arrhythmias and be life-threatening if not corrected in time.

## Common Causes

### Age >65 years
- Malignancies (specifically digestive and non-hematologic)
- Dementia
- Stroke
- Parkinson's disease
- Polymyalgia rheumatica
- Oral disorders.

### Age <65 years
- Endocrine disorders
- Infections such as TB and HIV
- Psychiatric disorders such as depression, anxiety, and OCD
- Malignancies such as hematologic

### Common causes classified
- The chart below demonstrates the cause of unintentional weight loss in adult population. The incidence describes the full range of occurrence described in five studies in older individuals.
- To read about other causes of unintentional weight loss click here.

# Diagnosis and Management
Abbreviations: GI: Gastrointestinal system; GERD: Gastroesophageal reflux disease; BMI: Body Mass Index; HEENT: Head, Eyes, Ears. Nose, and Throat exam; IM:  Infectious Mononucleosis; CBC: Complete blood count; ESR: Erythrocyte sedimentation rate; LDH: Lactate dehydrogenase; CMP: Comprehensive metabolic panel; CRP:C-reactive protein; TSH: Thyroid stimulating hormone;  PTH: Parathyroid hormine; COPD: Chronic Obstructive Pulmonary Disease
Shown below is an algorithm summarizing the diagnosis of weight loss.

# Do's
- Perform a thorough physical exam to evaluate for cause of weight loss.
- Assess the nutritional status of the patient and screen for possible depression.
- Assess serum electrolytes to assess for life-threatening electrolyte abnormalities.
- Prevent further weight loss by advising proper meals, supplements, and consulting a nutritionist.
- Treat the underlying cause.
- Medications for weight gain must be looked for side effects and recommendations for the elderly.
- Prefer liquid supplements to solids and serve separate from solid everyday meals.
- Encourage exercise and physical therapy.

# Don'ts
- Do not miss the oral exam especially among the elderly.
- Do not rely on the patient history among patients with cognitioncognitive dysfunctions.