Updated August 27, 2021

what questions should I and my family be asking?

• Do I feel my clothes getting wider?

• Do I feel that I lost some height?

• Do I feel more tired, have a low appetite, or wake up with a lot of sweat?

• Do I feel problems swallowing such as coughing or choking when I eat?

• Do I have stomach pain, nausea, or constipation?

• Do I have easy access to healthy food?

• How is my mood and do I feel depressed?

• Are all my long-term (chronic) diseases under control and treated?

What actions can i take for this agenda?

• Weigh yourself every week or so at home to keep track if you feel you’re losing weight

• Keep a record of your weight over time to share with your doctor

• Be sure you have access to food and eating three healthy meals a day

• Consider using food and grocery delivery services in your area

• Ask your doctor if you need to be seen by a dietician or social worker that can help with your weight loss and financial support

• Visit your dentist especially if you have teeth or gum problems

• Review the medications you are taking with your doctor

• Refer to the “nutrition” and “medication” agendas for more details

What does unintentional weight loss mean?

• Unintentional weight loss means you did not mean to lose weight but did

• Some people want to lose weight intentionally by exercising or dieting

• Some lose weight but did not mean to

• This can be a sign of a disease or disorder that should be looked into

• Older adults above the age of 65 are more likely to have this kind of weight loss

• Progressive unintentional weight loss can be a serious medical problem

What amount of unintentional weight loss is considered not normal?

• Losing 5% or more of your weight over 3 months is not normal

• Your doctor should look into reasons as to why this is happening

• For example, if you weigh 65 kilograms, losing about 3 kilograms in 3 months is considered too much and not normal

Unintentional weight loss is losing weight you did not mean to lose

this can be from serious medical issues that need to be looked into

Losing 5% or more of your weight in 3 months is not normal

Why is losing weight in older adults unhealthy?

• Can decrease your survival and increases the risk of death

• Can impair your function to do the things you want to do because you feel weaker

• Can cause you to remain in hospital longer and make it difficult to rehab

• Can increase your risk of falling and serious injury if you fall

• Can increase your risk of needing a nursing home

What can cause unintentional weight loss?

• There are many causes for unintentional weight loss

• The following are broad categories and examples of causes:

• Stomach and intestinal problems: Stomach ulcers or bowel inflammation

• Swallowing problems: Teeth and gum issues are common as we age. Throat muscles and the esophagus (the tube between your mouth and stomach) are examples

• Mental health problems: Depression and eating disorders

• Cancer: Almost all cancers cause weight loss

• Hormone problems: Thyroid and adrenal glands are important regulators of weight. Diabetes is also a common disease that can cause weight loss

• Infection: Long-term (chronic) infections can cause weight loss. Examples are HIV, Hepatitis B and C, and Tuberculosis (TB)

• Long-term (chronic) illnesses: Heart failure, lung disease such as COPD, and kidney diseases

• Nervous system problems: Strokes, thinking (cognitive) problems such as dementia, and Parkinson’s disease

• Social problems: Difficult access to food or financial issues

• Medication side effects: Note below for details on this

Unintentional weight loss can cause an increase risk of falling, staying in hospital, feeling tired, and death

There are many causes of weight loss that your doctor should look into to help find out why

Do some medications cause unintentional weight loss?

• Yes, as an unwanted side effect of some medications cause weight loss

• Always ask your doctor before starting or stopping a medication

• Not everyone who takes the medications develops weight loss

• Examples of medications and substances that can cause weight loss are:

• Alcohol

• Tobacco

• Anti-seizure medications

• Anti-diabetic medications

• Thyroid medications

• “NSAIDS” such as Ibuprofen

• Cancer treatments (chemotherapy)

• Dementia medications such as “Donepezil”

• Diuretics and other heart medications

How does this happen? Why do these diseases cause weight loss?

• Poor diet intake is an obvious way (not eating enough or eating low-calorie foods). This happens from financial issues or social isolation

• Appetite loss (anorexia) is also another way this happens. Some diseases cause low appetite and feeling full at the start of a meal (early satiety)

• Muscle loss (sarcopenia) is important to note in older adults. Some diseases cause the size and number of muscles to decrease. This can impair function and your ability to do the things you used to do

• Inflammation causing weight loss (cachexia) is another way this can happen. Some diseases cause inflammation in the body and your immune system thus worsening weight loss

There are medications that can have a side effect of weight loss

there are many reasons your body loses weight from these diseases

Examples are decreased appetite, muscle cell loss, and inflammation

Can normal aging cause weight loss too?

• Yes, normal aging does affect your weight and how your body deals with food. This agenda covers unintentional weight loss that needs to be looked into and treated

• The normal changes that happen with age that may cause weight loss are:

• Decrease in taste and smell sensitivity

• The stomach emptying the food slowly

• Feeling full early when eating (early satiety)

• Decreased saliva and dental problems

What should my weight ideally be?

• An easy way to know if your weight is normal is by your body mass index (BMI). The BMI accounts for your height and weight

• A normal BMI for younger adults (below age 65) should be between 18 to 25. Studies are showing that in older adults (above age 65) it is ok to be a little overweight

• As we age, it is more concerning to be underweight than a little overweight. Ranges differ, but generally, for older adults a normal BMI is between 22 to 30

• Ask your doctor to calculate your BMI to see if you’re at a healthy weight

• Remember that being too overweight or obese also has bad health results

• There are other ways to assess your weight aside from just the BMI

Normal aging can worsen weight loss too. as we age, our bodies deal with food differently

finding out your bmi can easily show you if your weight is normal

as we age, it is better to be a little overweight than underweight

How can I know if I am losing weight?

• If you feel your clothes are getting wider and bigger that could be a sign

• If you feel you’re losing height that is also another sign

• Measuring your weight over time is also an objective way to know clearly

• It can be difficult for some to measure their weights often at home

• Whenever you visit your doctor, ask them to weigh you to see

How can my doctor tell if I have unintentional weight loss? Are there tests they can do to help?

• Since there are many causes of weight loss, your doctor will take a careful history about you to know more

• They usually do a thorough physical exam of your body, head, neck, lungs, heart, and belly

• They may need to do basic bloodwork or imaging to see why you’re losing weight. They may refer you to a dietician, social worker, or gastro-intestinal (GI) doctor if needed for further assessment

if you feel that your clothes are wider or bigger you may be losing weight. it is best to weigh yourself over time to know

Your doctor will ask you questions and do a careful physical exam to find out why

Is there treatment for unintentional weight loss?

• Since there are many causes of weight loss, the main treatment is addressing the cause

• Note the above list of causes your doctor will address to try to relieve more weight loss

• Seeing a dietician can help with ways to increase calories in your diet too

If inflammation and immune problems cause weight loss, can’t I just take anti-inflammatory medications or hormone supplements?

• Our bodies lose weight in complex ways when it comes to diseases

• Although inflammation and the immune system are involved, studies have not found good evidence or benefit from taking anti-inflammatory medications or hormone supplements. They also have their share of side effects too

• Overall, the harms of these usually offset the limited benefits

• The best evidence is in treating the cause of weight loss

• For example, if it is caused by problems swallowing or depression we address them. Or if it is caused by cancer or a long-term (chronic) illness then we treat them

The treatment for unintentional weight loss depends on the cause. your doctor will treat the reason you’re losing weight

anti-inflammatory and hormone drugs generally do not have much benefit and can be harmful

Should I be taking supplements to help with my weight loss?

• That depends on if you have a deficiency in a specific nutrient

• There are many proteins, electrolytes, and vitamins our bodies need

• However, eating a healthy balanced diet can provide us with most of them

• Always talk to your doctor before taking any supplements

• Vitamin B12 and Vitamin D are commonly needed supplements in older adults

• Be cautious about “multivitamins” as these might overlap with other vitamins you might be taking

• Only take vitamins if you need them and ask your doctor first

• Refer to the “nutrition” agenda for more details

Do appetite stimulants work to help with weight loss?

• Generally, studies have suggested not treating people with appetite stimulants even with unhealthy weight loss

• The reason is that research has shown limited evidence

• The evidence that does exist shows little benefit, but many side effects

• Ask your doctor before considering appetite stimulants

• They usually do not help much and can cause more harm than good

only take vitamins and supplements if your body needs them. ask your doctor about this

vitamin b12 and vitamin d are commonly low in older adults

appetite stimulants generally do not help and can be harmful

What resources can help with this agenda? 

References

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2. Hazzard's Geriatric Medicine and Gerontology 7th edition (2016)

3. Jayna Holroyd-Leduc et al. Evidence Based Geriatric Medicine (2012)

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13. Bosch X, Monclús E, Escoda O, et al. Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients. PLoS One 2017; 12:e0175125.