Unintentional weight loss a growing problem

There are some people who try various methods to lose weight:they go on a diet, enrol in a gym, exercise religiously, monitor their food intake zealously... some even resort to surgery.

And then there are some who may be shocked to find that they are losing weight dramatically, even though they do not want to.

Unintentional weight loss, a drastic decrease in body weight that is not voluntary, is a widespread problem according to Mariam Saleh, a clinical dietician at the American Hospital, Dubai. She says she treats a fairly large number of patients suffering fromthis condition.

Unintentional weight loss, says Saleh, "is the loss in body mass without desiring or attempting to do so. And it is very different from intentional weight loss. The latter is defined as a drop in weight of the body's total mass in an effort to improve fitness and health and to change appearance. Unlike unintentional weight loss, intentional weight loss tends to improve the overall health, appearance and boost fitness levels. In the former, the individual does not have control over the process. In many cases it is caused by [or there are preliminary signs of] an underlying disease."

People who have no regular eating habits, who experience stress or work irregular shifts are all prone to unintentional weight loss. "For these people," she says, "food choices are limited and so they make do with whatever is available to them. Students involved in many sports activities are also victims of unintentional weight loss."

Trigger factors

According to Saleh, unintentional weight loss can start through increased physical activity or through eating less and thereby limiting calorie intake. Increased physical activity speeds up one's metabolism and therefore burns up more calories and energy, thus exacerbating the problem.

"Eating less also gives the body fewer calories to be transformed into body mass," she says.

The dietician says this type of weight loss is extremely difficult to diagnose as it can have a multitude of causes. "Unexplained weight loss can be categorised into four groups: organic, psycho-social, unknown aetiology, social and age-related issues," says Saleh. "Although the most common cases of unwanted weight loss are anorexia nervosa and bulimia, other reasons include increased metabolism, hyperthyroidism, undiagnosed diabetes mellitus or increased blood sugar levels, cancer, depression, Parkinson's disease, smoking, isolation and age-related factors. "Exercising more than necessary could also lead to unintentional weight loss… Some patients may also notice a drasticdrop in their weight following an illness. When the body is sick, it usually creates extra white blood cells to help combat the disease. Extra energy used by the body to produce the cells to fight the disease leaves it strained and tired. This in turn causes weight loss. In other cases like diabetes, the deficit of insulin production makes carbohydrates, a major source of energy for the body, unavailable. This makes the body resort to other sources of energy like muscle and fat."

Having dental problems or mouth sores can also cause a drop in weight. "Dental problems can cause difficulty in chewing or swallowing the food due to pain as well as inflammation and tenderness of the mouth. This could lead to weight loss due to an inability to ingest food."

Role of medication

Stress and anxiety too can cause unintentional weight loss. "Stress-causing factors," she says, "like employment changes, travel, relocation or uncomfortable social situations may trigger the onset of gastrointestinal disorders such as irritable bowel syndrome (IBS). The syndrome involves diarrhoea, constipation or abdominal pain. Gastrointestinal discomfort after meals, bloating, gas and psychological distress, all or any of these make the person restrain from eating to avoid the symptoms. This, too, in turn leads to unintentional weight loss.

"Besides the medication used for dieting, which is actually used to induce weight loss," she says, "there is a range of medicines that induces unwanted weight loss as a side effect. This is identified with extremely powerful drugs that are usually used to treat rather serious diseases. The particular medicines could lead to weight loss by reducing the appetite of a person, even nausea or vomiting, headaches and other such symptoms."

Saleh insists on a nutritional assessment to ascertain that the patient is indeed suffering from unintentional weight loss.

"Assessing the cause and the extent of being underweight before starting a treatment programme is important. A thorough history and pertinent medical tests usually determine whether underlying disorders are causing [the patient to lose weight].

"Assessment of body fat is useful, especially in dealing with the patient who has an eating disorder and needs to begin the body acceptance process. Biomedical measurements will indicate whether malnutrition accompanies being underweight. In some cases,a psychological counselling is required and recommended.

"It is very important in cases where the unwanted weight loss is not due to physical illnesses but rather caused by things such as stress, depression and anxiety and especially anorexia nervosa and bulimia."

Consequences

The physical appearance is the first casualty, says Saleh. "If you notice a sudden drop in size of clothes or people observe and comment on your weight loss or the weighing scale indicates that your weight is an issue, it is time for you to sit up and take charge of the situation. In extreme cases of malnutrition and lack of vitamin A, even the vision can get affected. In some cases, the body has an increased sensitivity to cold or heat," she adds.

"If you're under your ideal body weight, you may not have enough subcutaneous fat to insulate yourself against colder temperatures. Very thin people often complain of cold sensitivity, particularly women. In general, women appear to be more intolerant to cold than men due to their lower overall muscle mass."

When the weight loss is as high as 10 per cent of the body's weight in a short span of time, it is common to expect symptoms like fatigue, short temper, lethargy, loss of muscle power, a weakened immune system and sickness.

According to Saleh, constipation and diarrhoea can also cause an unwanted weight loss. "Diarrhoea occurs when there is an excessively rapid transit of intestinal contents through the small intestine," she says. "Decreased enzymatic digestion of foodstuffs and decreased absorption of fluids and nutrients leads to weightloss. One of the side effects of weight loss from constipation isa gradual loss of hair. This can happen ifthe body is deprived of the essential nutrients and vitamins."

When to seek help

"Clinically, if the weight loss isabove 4.5kg or the loss of the total body mass is over 5 per cent overa span of 6 to 12 months, it is timeto visit the doctor. This tends to be even more important when it seems to be progressive. In this case, we advise the individual to go and seea specialist.

"When a patient comes in with signs of unintentional weight loss,a general physical exam is carried out to assess vital organs such as the heart and lungs. At the same time, the full medical history is assessed in order to look for signs of past illnesses that could potentially lead to unwanted weight loss. The GP would also look at any other symptoms the patients might be experiencing such as pain or nausea. Furthermore, a number of blood tests are carried out like a complete blood count which in many cases gives an indication of potential illnesses that the patient might be experiencing. The doctor might also ask the patient to get the thyroid functions and blood glucose levels tested."

Treatment is based on the tests and on a case-by-case basis.

Factors to consider in assessing weight loss

According to Saleh, there are a few questions one must ask before coming to the conclusion that weight loss is indeed unintentional. These are:

• Have you been eating properly? At times,due to a hectic lifestyle, stress and busy schedules, people forget to eat at regular intervals and in adequate portions.
•  Have you been feeling ill very often? Ask yourself if there are any other significant symptoms besides the drop in weight that might be of concern.
• Have you been monitoring your weight? You should measure weight loss over regular periodsof time to see whether itis progressive.Have you been involved in more physical activity than usual? Physical activity is related to an acute loss of weight as it uses energy and tends to burn fat.
• Are you prone to losing weight easily? Some people have a much faster metabolism than others and therefore tend tolose weight more quickly than them.