Weight Loss/Appetite Suppression
Carole K. H. Bartoo
1.Weight loss is a predictor of mortality: Unintentional loss of 5 lbs over 3 years predicts an increase of mortality in community dwelling older adults (Wannamethee, Shaper, & Lennon, 2005). Clinically significant weight loss is considered to be 5% loss of usual body weight in 3 months or 10% loss in 6 months.
2.Evaluation:
a.Monitor weight patterns/Bbody mass index (BMI). (Caution: BMI is not used to identify loss of muscle mass. See sarcopenia in the section Frailty
.)
b.Labs:
i.CMP: Albumin can indicate either poor nutritional (protein) intake, or poor processing of nutritional intake in the gut. The liver enzymes can help determine if hepatic dysfunction (cirrhosis, cancer) is involved in weight loss.
ii.Thyroid function tests (TFTs) can determine if hyperthyroid or over-repletion of the thyroid hormone is involved.
iii.Fecal occult testing (usually 2 samples, each taken on a different day) can determine if colon cancer is the cause of weight loss (Huffman, 2002).
3.Multiple factors can contribute to low food and fluid intake and unintentional weight loss among older adults including:
a.Chronic diseases.
b.Cognitive impairment.
c.Physical impairment.
d.Depression.
e.Polypharmacy.
f.Declining smell and taste.
g.Decreased elasticity of the fundus of the stomach
h.Delayed gastric emptying in response to larger meals.
i.Increased amount and effectiveness of cholecystokinin (CCK; Morley, 2017), the major gastrointestinal satiety hormone.
j.Leptin increase due to increased fat mass (leptin increases satiety).
k.Reduced social support.
l.Poor oral health.
m.Reduced nutrient absorption.
Screening
Evaluation listed earlier should be performed at least annually in older adults. If there is a concern, patients can be evaluated for nutritional risk.