WEIGHT LOSS
Definition:
WEIGHT LOSS will be the result of reduced energy intake or increased energy expenditure. Weight loss is divided into voluntary and involuntary (ie with or without the will). Progressive involuntary weight loss hides a serious organic or psychiatric illness. Voluntary weight loss in overweight or obese people usually does not hide organic disease.
In general, significant WEIGHT LOSS is defined as the loss of more than 5% of normal body weight over a period of 6 months. When involuntary weight loss exceeds 10% of normal weight (in non-obese individuals), an investigation should be performed. Involuntary weight loss of more than 20% of normal weight is associated with severe protein malnutrition, nutritional deficiencies and multiorgan dysfunction.
Where is it due?
WEIGHT LOSS will be followed by fatigue and constant tiredness. In the absence of fever or other cause that justifies increased energy expenditure, weight loss is mainly due to reduced food intake.
Involuntary weight loss
Progressive involuntary weight loss indicates severe organic or psychiatric illness, which may be accompanied by anorexia. Common causes include:
•Endocrine diseases :(hyperthyroidism, diabetes mellitus, chronic primary adrenal insufficiency, hyperparathyroidism)
•Gastrointestinal diseases :
There are many mechanisms that can cause weight loss in gastrointestinal diseases: anorexia, abdominal pain, early satiety, dysphagia, edema, gastrointestinal motility, diarrhea, malabsorption, chronic hemorrhage, chronic bleeding, chronic inflammation, chronic inflammation, chronic inflammation excisions and bypasses of the digestive tract.
•Malabsorption can lead to weight loss with increased or normal appetite. However, celiac disease, one of the most common causes of malabsorption , is usually not accompanied by weight loss or diarrhea in adults.
•Idiopathic inflammatory bowel disease ( Crohn's disease and ulcerative colitis ) may be associated with late malabsorption. The Crohn's disease is often accompanied by early significant weight loss, probably due to inflammation and poor appetite. In contrast, ulcerative colitis is usually not accompanied by early weight loss, although weight loss occurs in advanced disease.
•Vascular insufficiency (due to intestinal ischemia and therefore malabsorption)
Cancer
•HIV and other infections (eg tuberculosis, hepatitis C)
•Advanced stage of heart, lung and kidney disease
•Neurological diseases (stroke, dementia, Parkinson's disease, and amyotrophic lateral sclerosis)
•Systemic inflammatory disorders
Psychiatric disorders (especially depression)
•Taking drugs (addictive substances)
•Herbs, tea, food additives (preservatives)
•Medications (antiepileptics, antidepressants, levodopa, digoxin, metformin, thyroid medications, etc.) or discontinuation of antipsychotic medications (eg chlorpromazine, haloperidol)
•Alcohol abuse
•Heavy tobacco use
•Infections:
In acute and chronic infections, the appetite is often reduced. In addition, there are often symptoms such as fatigue and poor performance. Sometimes these symptoms are the first signs that something is wrong with the body. Infectious diseases that are associated with particularly severe weight loss are, for example, HIV / AIDS and tuberculosis .
People who harbor parasites in their intestines , such as beef tapeworm or fish tapeworm, also lose weight .
•Food allergies and intolerances:
Allergies and intolerances to certain foods such as a lactose intolerance ( lactose intolerance ) can lead to weight loss - the enjoyment of "critical" food often triggers violent namely complaints such as abdominal pain , bloating and nausea from. For fear of this, many of those affected do not dare to eat much - or they forego a meal entirely if nothing acceptable is available.
In the case of some intolerances, the body can only partially process the food it has consumed. This is the case, for example, with a gluten intolerance ( celiac disease ).
•Other digestive tract disorders:
Diseases such as gastrointestinal infections, ulcers, inflammation of the stomach lining (gastritis) and inflammation of the pancreas (pancreatitis) can cause nausea and / or pain in the abdomen, which can significantly reduce the desire to eat. In some diseases, the body cannot absorb enough nutrients through the intestines ( malabsorption ). This is the case, for example, with diarrheal diseases and chronic inflammatory bowel diseases such as Crohn's disease .
•Diseases of other organs:
They can also be associated with a loss of appetite. This applies, for example, to liver cirrhosis , kidney weakness ( renal insufficiency ), obstruction of the bile ducts or the adrenal disease Addison's disease .
•Metabolic diseases:
Metabolic diseases can also be the reason for weight loss, for example hyperthyroidism ( overactive thyroid ). The metabolism runs at full speed due to an overproduction of certain hormones - the calorie consumption increases sharply, so that those affected inadvertently lose weight despite the constant eating behavior.
People with type 1 diabetes ( type 1 diabetes ) lose weight if their blood sugar is not adequately controlled. Due to a malfunction of the immune system, the pancreas produces too little or no insulin at all . The lack of this hormone means that body cells cannot absorb the high-energy blood sugar. In order to get the energy it needs, the body then has to fall back on the fat deposits.
•Cancers:
They are often associated with massive weight loss - sometimes even before chemotherapy leads to nausea or the fear of death costs those affected by their appetite. Inexplicable weight loss is often the first symptom of a malignant tumor disease: as tumors grow, they deprive the body of nutrients, so that the patient loses weight. Doctors therefore sometimes speak of "consuming diseases".
•Mental illness:
Mental illness can also lead to weight loss. People with anxiety disorders or depression often have little appetite and therefore eat little. The diseases can also express themselves the other way round - through weight gain , as those affected eat a lot to compensate for the negative feelings.
In the case of eating disorders such as anorexia or eating-vomiting addiction ( bulimia ), things are different again. In the case of anorexia, the sick have to fight against hunger - at least initially. Since they eat extremely little and often exercise excessively, they keep losing weight.
Bulimics, on the other hand, repeatedly succumb to binge eating. In order to prevent them from gaining weight, they then vomit selectively - for example by sticking a finger down their throat. Sometimes bulimics lose weight as a result.
•Medication and drugs:
Some medications can also spoil your appetite. These include, for example, the heart drug digitalis, certain asthma drugs, attention deficit disorder (ADD / ADHD ) drugs , antidepressants, and other psychotropic drugs .
Weight loss can also occur in people who use drugs. This includes alcohol, although it is high in calories. Because whoever drinks beer, wine & Co. excessively over a long period of time brings their organism into a nutritional deficiency, since alcoholics take in more and more "empty" calories from alcohol. This leads to malnutrition and weight loss.
Voluntary weight loss
Many people lose weight voluntarily. Weight loss should be encouraged in overweight and obese patients who wish to lose weight, while in normal or underweight patients voluntary weight loss may indicate psychogenic (nervous) anorexia.
What shall I do?
As can be deduced from the multitude of causes for WEIGHT LOSS, there is no single diagnostic approach for all patients. Each case should be individualized based on the patient's findings and clinical examination. There are currently no widely accepted guidelines for the clinical evaluation of weight loss.
Are there any special exams?
The diagnostic test should include:
Blood tests: General blood test, biochemical test (electrolytes, glucose, calcium, kidney and liver function, thyroid hormones), hemoglobin A1, general urine, erythrocyte sedimentation rate and C-reactive protein (CRP).
Chest X-ray
Endoscopic examination ( gastroscopy and colonoscopy )
Computed tomography imaging is not recommended in the first phase, although it may be requested later
I did the above tests but the cause of my weight loss was not found.
What to do:
If no organic or psychiatric illness develops after the initial investigation, you should return for a new clinical laboratory test after 1-6 months.
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