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Weight Loss



In assessing a patient with weight loss, it is important to determine whether the loss has been intentional or non-intentional. While intentional weight loss may have been a desired outcome, non-intentional weight loss is a concerning symptom which may herald underlying systemic disease.


  • Causes of Weight Loss

  • Lifestyle changes - reduced food intake, increased physical activity
  • Malignancy
  • Gastrointestinal - peptic ulcer disease, obstruction, IBD, chronic pancreatitis, coeliac disease, gastric bypass surgery
  • Chronic infection - TB, HIV, chronic bacterial infection
  • Endocrine - hyperthyroidism, poorly controlled diabetes, Addison's, phaeochromocytoma
  • Neurological - stroke, Parkinson's, dementia
  • Medications - chemotherapy, opioids, metformin, digoxin, antipsychotics, SSRIs, caffeine, thyroxine
  • Drugs of abuse - alcohol, tobacco, amphetamines, cocaine, opioids
  • Organ failure - renal failure, liver failure, CCF, respiratory failure
  • Psychiatric - eating disorders, depression, schizophrenia
  • Dysphagia
  • Poor dentition
  • Dry mouth
  • Loss of taste sensation

History of Presenting Complaint

  • Intent

  • Whether the weight loss was intentional or unintentional.
  • Severity

  • Amount of weight loss over how long.
  • Associated Symptoms

  • Nausea / vomitingNonspecific symptom, but think about DKA or Addison's
  • DiarrhoeaNonspecific symptom that can also result in weight loss
  • Abdominal PainSuggestive of GI pathology or potentially Addison's
  • Malaena / HaematemesisSuggestive of bleeding peptic ulcer or cirrhosis with varices
  • Increased appetiteSuggestive of hyperthyroidism, poorly controlled diabetes or malabsorption
  • FeversSuggestive of infection, inflammation or malignancy
  • Night sweatsRed flag for malignancy or infection
  • Heat intoleranceSuggestive of hyperthyroidism
  • TremorSuggestive of hyperthyroidism or alcohol withdrawal
  • Fear of weight gainA feature of anorexia nervosa
  • Leg swellingSuggestive of CCF, liver failure or renal failure
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