Weight loss

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; M.Umer Tariq [3]

Overview

Weight loss, can be either:

Causes

Common Causes

Causes by Organ System

Cardiovascular Congestive Heart Failure,
Chemical / poisoning

Ephedra, Fucus vesiculosus L., Arsenic Poisoning, Cannabis (drug), Cocaine, Nicotine

Dermatologic No underlying causes
Drug Side Effect

Abatacept Injection (patient information), Adderall, Allopurinol (patient information), Aminopterin, Amiodarone Oral (patient information), Amphotericin B Injection (patient information), Benzodiazepine withdrawal syndrome, Bevacizumab Injection (patient information), Bumetanide (patient information), Busulfan (patient information), Calcitriol (patient information), Carboplatin (patient information), Carmustine (patient information), Cetuximab Injection (patient information), Chlorambucil (patient information), Clenbuterol, Clofarabine Injection (patient information), Cytarabine (patient information), Dexmethylphenidate, Donepezil (patient information), Duloxetine, Enfuvirtide Injection (patient information), Ethosuximide, Felbamate (patient information), Fluorouracil (patient information), Fluticasone Nasal Spray (patient information), Fluticasone Oral Inhalation (patient information), Furosemide (patient information), Galantamine (patient information), Gatifloxacin (patient information), Gefitinib (patient information), Indapamide (patient information), Interferon beta-1a Intramuscular Injection (patient information), Interferon beta-1a Subcutaneous Injection (patient information), Interferon Beta-1b Injection (patient information), Leflunomide (patient information), Leuprolide (patient information), Levothyroxine, Liothyronine (patient information), Lithium (patient information), Lomustine (patient information), Mechlorethamine (patient information), Melphalan (patient information), Mercaptopurine (patient information), Methsuximide Oral (patient information), Methylphenidate, Miglustat, Modafinil, Natalizumab injection (patient information), Nevirapine (patient information), Oxaliplatin injection (patient information), Peginterferon alfa-2a (patient information), Peginterferon alfa-2b (patient information), Pemetrexed injection (patient information), Pemoline (patient information), Phenformin, Phenylbutazone, Phenytoin oral (patient information), Piroxicam (patient information), Posaconazole (patient information), Pramipexole (patient information), Pramlintide, Protriptyline (patient information), Rasagiline (patient information), Ribavirin (patient information), Rivastigmine (patient information), Sargramostim, Sorafenib, Spironolactone and hydrochlorothiazide (patient information), Sultiame, Sunitinib (patient information), Tamoxifen (patient information), Thioguanine (patient information), Thiotepa (patient information), Thyroglobulin (patient information), Torsemide Injection (patient information), Trimetrexate Glucuronate (patient information), Vorinostat (patient information), Zoledronic Acid Injection (patient information), Zonisamide (patient information)

Drug used medically

Dexfenfluramine, Dexatrim, Dextroamphetamine, ECA stack, Eskatrol, Exenatide, Hydrolyzed collagen (hydrolysate), Hydroxycitric acid, Phendimetrazine, Phenmetrazine, Synephrine, Tiagabine, Tolmetin,

Ear Nose Throat

Dysphagia, Eating disorder

Endocrine

Addison's disease, Adrenocorticotropic hormone deficiency, Basedow syndrome, Diabetes mellitus type 1, Graves' Disease, Hashimoto's thyroiditis, Hyperthyroidism, Multiple endocrine neoplasia type 1, Pheochromocytoma, Toxic multinodular goiter

Environmental No underlying causes
Gastroenterologic

Achalasia, Alcoholic Hepatitis, Autoimmune pancreatitis, Barrett's esophagus, Blind loop syndrome, Celiac disease, Cholangiocarcinoma, Chronic pancreatitis, Cirrhosis, Crohn's disease, Diarrhea, Eosinophilic gastroenteritis, Esophageal cancer, Esophageal candidiasis, Familial adenomatous polyposis, Fundic gland polyposis, Gallbladder cancer, Gastric lymphoma, Gastroesophageal reflux disease, Glucose-galactose malabsorption, Ileitis, Inflammatory bowel disease, Irritable bowel syndrome, Ischemic colitis, Liver Failure, Malabsorption, Malassimilation, Ménétrier's disease, Pancreatic cancer, Peptic ulcer, Pyloric stenosis, Stomach cancer, Ulcerative colitis

Genetic Cystic Fibrosis
Hematologic

Acute lymphoblastic leukemia, Acute myeloid leukemia, Acute promyelocytic leukemia, Waldenström's macroglobulinemia

Iatrogenic

Adjustable gastric band, Gastric bypass surgery, Mini sleeve gastrectomy, Short bowel syndrome

Infectious Disease

Actinomyces, Aspergillus clavatus, Aspergillus fumigatus, Blastocystosis, Blastomycosis, Byssinosis, Chagas disease, Cladosporium, Dientamoeba fragilis, Diphyllobothrium infection, Entamoeba histolytica, Fasciola hepatica, Giardia lamblia, Hepatitis C, HIV, Hookworm, Isosporiasis, Leishmania infection, Malaria, Marburg virus, Micropolyspora faeni, Mucor stolonifer, Mycobacterium avium complex infection, Q Fever, Streptobacillus, Syphilis, Tuberculosis, Tularemia, Whipple disease

Musculoskeletal / Ortho

Mitochondrial myopathy, Osteoporosis, Panniculitis, Pott's disease

Neurologic

Krabbe disease, Parkinson's disease

Nutritional / Metabolic

Beriberi, Calorie restriction, Dieting, Folate deficiency, Food intolerance, Malnutrition, Marasmus

Obstetric/Gynecologic

Hyperemesis gravidarum

Oncologic

Aggressive NK-cell leukemia, Cervical cancer, Colorectal cancer, Glucagonoma Syndrome, Hemangiosarcoma, Hodgkin's lymphoma, Kaposi's sarcoma, Liposarcoma, Malignancy, Mantle cell lymphoma, Mediastinal tumor, Neuroendocrine tumors, Small intestine cancer

Opthalmologic Cogan syndrome
Overdose / Toxicity

Nevirapine (patient information), Botulinum toxin

Psychiatric

Anorexia nervosa, Bulimia nervosa

Pulmonary

Chronic Obstructive Pulmonary Disease, Diabulimia, Empyema Thoracis, Lung cancer, Mesothelioma, Pulmonary alveolar proteinosis, Silicosis

Renal / Electrolyte

Chronic Renal Failure, Diabetic Ketoacidosis, Hypercalcemia, Interstitial nephritis, Renal cell carcinoma

Rheum / Immune / Allergy

Churg-Strauss Syndrome, Polyarteritis nodosa, Polymyalgia Rheumatica, Sarcoidosis, Systemic lupus erythematosus, Takayasu's Arteritis

Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous

Aerobic exercise, Castleman's disease, Chronic fatigue syndrome, Chronic wasting disease, Dehydration, Diaphoresis, Frailty syndrome, Kikuchi disease, Liposuction, SSRI discontinuation syndrome

Causes in Alphabetical Order


Diagnosis

Laboratory Findings

The following laboratory studies should be considered:

Electrolyte and Biomarker Studies

Electrocardiogram

Other Imaging Findings

Treatment

Medical Therapy

Acute Pharmacotherapies

  • Anti depressants to stimulate hunger
  • Pancreatic enzymes for malabsorption in the pancreas
  • Nutritionist referral
  • Social Services referral

Chronic Pharmacotherapies

  • Anorexia of malignancy and AIDS can be relieved with megestrol acetate or dronabinal.

Primary Prevention

Unintentional Weight Loss

A significant loss of total body weight is a serious, chronic illness. Substantial, unintentional weight loss is a symptom of acute or chronic illness, especially if other evidence is present.

Weight loss, for example, accompanied by insatiable thirst and hunger and fatigue may indicate diabetes mellitus, a chronic disease characterized by an abnormal accumulation of carbohydrates in the bloodstream due to insufficient production of insulin, a hormone produced in the pancreas that, when secreted into the bloodstream, permits cellular metabolism and utilization of glucose.

Poor management of insulin-dependent diabetes mellitus (IDDM), also known as diabetes mellitus type I, leads to an excessive amount of glucose and an insufficient amount of insulin in the bloodstream. This triggers the release of triglycerides from adipose tissue and catabolism of amino acids in muscle tissue. This results in a loss of both fat and lean mass, predisposing a significant reduction in total body weight.

A myriad of additional scientific considerations are applicable to weight loss, including but not limited to physiological and exercise sciences, nutrition science, behavioral sciences, and other sciences.

One area involves the science of bioenergetics including biochemical and physiological energy production and utilization systems, that is frequently evidence of diabetes, and ketone bodies, acetone particles occurring in body fluids and tissues involved in acidosis, also known as ketosis, somewhat common in severe diabetes.

In addition to weight loss due to a reduction in fat and lean mass, illnesses such as diabetes, certain medications, lack of fluid intake and other factors can trigger fluid loss. And fluid loss in addition to a reduction in fat and lean mass exacerbates the risk for cachexia.

Infections such as HIV may alter metabolism, leading to weight loss.[1]

Hormonal disruptions, such as an overactive thyroid (hyperthyroidism) , may also exhibit as weight loss.[2]

Intentional Weight Loss

Weight loss may refer to the loss of total body mass in an effort to improve fitness, health, or appearance.

Therapeutic weight loss, in individuals who are overweight, can decrease the likelihood of developing diseases such as diabetes.[3] Overweight and obese individuals face a greater risk of health conditions such as type 2 diabetes, heart disease, high blood pressure, stroke, osteoarthritis,[4] and certain types of cancer. For healthy weight loss, a physician should be consulted to develop a weight loss plan that is tailored to the individual.

Weight loss occurs when an individual is in a state of negative energy balance. When the human body is spending more energy in work and heat than it is gaining from food or other nutritional supplements, it will catabolize stored reserves of fat or muscle.

It is not uncommon for people who are already at a medically healthy weight to intentionally lose weight. In some cases it is with the goal of improving athletic performance or to meet weight classifications in a sport. In other cases, the goal is to attain a more attractively shaped body. Being underweight is associated with health risks. Health problems can include fighting off infection, osteoporosis, decreased muscle strength, trouble regulating body temperature and even increased risk of death.[5]

Therapeutic Weight Loss Techniques

The least intrusive weight loss methods, and those most often recommended by physicians, are adjustments to eating patterns and increased physical exercise. Usually, health professionals will recommend that their overweight patients combine a reduction of the caloric content of the diet with an increase in physical activity.[6]

Other methods of losing weight include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume. Surgery is another method. Bariatric surgery artificially reduces the size of the stomach, limiting the intake of food energy. Some of these treatments may have serious side-effects.

References

  1. Mangili A, Murman DH, Zampini AM, Wanke CA (2006). "Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort". Clin. Infect. Dis. 42 (6): 836–42. PMID 16477562. doi:10.1086/500398. 
  2. Overactive thyroid and weight loss
  3. Diabetes Study Shows Value In Diet, Exercise, september 2001
  4. Prevalence of various medical conditions increases with overweight and obesity
  5. Mayo Clinic: Being Underweight Poses Health Risks. Retrieved January 13,2007
  6. Choosing a Safe and Successful Weight Loss Program

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