Chapter 79

Introduction

Among young women dieters in modern society about 1 in 20 will become preoccupied with their appearance and progress to the eating disorders of anorexia nervosa and bulimia.

Professor Doris Young 1988

In family practice complaints of loss of weight are more frequent than complaints about being too thin. Of great significance is the problem of recent loss of weight. A very analytical history is required to determine the patient's perception of weight loss. The equivalent problem in children is failure to gain weight or thrive.

Weight loss is an important symptom because it usually implies a serious underlying disorder, either organic or functional. It may or may not be associated with anorexia and thus diminished food intake.

Key facts and checkpoints

• Any loss of more than 5% of normal body weight is significant.

• The most common cause in adults of recent weight loss is stress and anxiety.1

• Serious organic diseases to consider are:

• malignant disease

• diabetes mellitus

• chronic infections (e.g. tuberculosis)

• thyrotoxicosis

• The most important variable to consider in evaluating weight loss is appetite. Eating and weight go hand in glove.

• Two conditions commonly associated with weight loss are anaemia and fever; they must be excluded.

• Early detection of eating disorders improves outcome.

A diagnostic approach

A summary of the diagnostic strategy model is presented in Table 79.1.

Table 79.1

Weight loss: diagnostic strategy model (other than deliberate dieting or malnutrition)

Probability diagnosis

Excluding planned dietary restriction, psychological factors are the most common cause, particularly recent stress and anxiety.1 Elderly people with adverse psychological factors, neglect and possibly drug effects can present with wasting.

Serious disorders not to be missed

Many of the problems causing weight loss are very serious, especially malignant disease.

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