Those who are struggling to lose weight sometimes joke that they envy those who can drop pounds without even trying. But unintentional weight loss, especially in older people, can be a sign of a serious problem. Your concierge family practice doctors at MD 2.0 in Jupiter, Florida, would like to examine the phenomenon and suggest what you can do about it.
According to the National Institutes of Health (NIH), unintentional or involuntary weight loss is a common phenomenon among older adults, occurring in approximately 13 percent of that population annually. Problematic weight loss in older adults is defined as a loss of five percent of body weight in one month or ten percent over six or more months. Thus, a ten-pound loss in a 200-pound man or a six-to-seven pound loss in a130-pound woman is considered significant and worthy of investigation.
The problem with unexpected weight loss in older people is the difficulty in diagnosis. In fact, in up to 40 percent of those cases a specific cause is never determined, despite extensive evaluation. All cases should be examined, however, because even when no disease is found to be present, studies show that those who lose weight involuntarily are between 10 percent and 35 percent more likely to die within one to two years than those who maintain a steady weight. They are also more likely to fall and less likely to recover from illnesses faster.
Because there are so many possible causes of unintentional weight loss, and because so many illnesses are difficult to discern in the early stages, the path to diagnosis may involve numerous tests.
In general, there are five major reasons that older people lose weight unintentionally.
Physical causes are the most common reason behind loss of weight in older people. This can include cancer, cardiovascular disease, gastrointestinal disease, thyroid imbalances, diabetes, or respiratory disorders, among other serious diseases. Tests will usually reveal the underlying trigger.
Many elderly people experience problems with eating due to poorly fitting teeth, difficulty or pain while chewing or swallowing, or inability to feed themselves properly because of arthritis, essential tremor, or other similar mobility issues. If it’s an effort for a person to leave the house to shop for food, whether from transportation restrictions or limited mobility, this can cause them to eat less than they normally would.
Depression is a common cause of weight loss in older people. So is early-stage dementia, in which paranoia and the suspicion that food may be poisoned cause them to refuse food or to eat less.
Side effects from the numerous medications prescribed to older patients are an often-overlooked cause of weight loss. It’s important to ensure that all of a person’s doctors are aware of all the medications they are taking, and to look into this as a possible factor in weight loss.
Some seniors are on a limited budget, and can’t afford enough food to maintain their normal weight. Others may be on a medically restricted diet and simply not like the choices available to them (low fat, low salt, low carb, etc.).
A thorough clinical evaluation must include, first, an extensive evaluation of the person’s lifestyle. This might resolve the puzzle without further testing. Otherwise, we will perform a thorough physical, including blood tests, and possibly imaging tests, to look for physical causes.
Treatment consists of correcting the underlying problem, whether physical or otherwise. Unfortunately, if no cause can be found, there is no prescription medication that is approved for use to stimulate appetite or encourage weight gain in older people.
In that case, we would recommend various kinds of nutritional methods, such as introducing additional protein and calories to the diet, up to and including supplements.
As noted above, weight loss in older adults can often be a frustrating, and even frightening, problem. But with careful evaluation and monitoring, it can often be corrected, allowing the person an improved quality of life.
If your parent is experiencing weight loss, be sure to talk to us. We can help.