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Unexplained weight loss a bad sign for older people ::--
*****************************************************************-------------------------------------------------------------------------------------Everyday, Americans across the country hear repeated warnings about the grave dangers of obesity. As waistlines expand, chronic diseases have increased as well, and recent research shows that obese adults have a higher risk of premature death. Just recently beyond the age of 75, however the more you weight the longer you live. And weight loss, either voluntary or involuntary is a predictor of illness and early death. I saw an overweight 76-year-old patient who came to see me beaming that for the first time in her life she had lost weight, and she wasn't even trying. For her this was an ominous sign.After the age of 75, an individual who loses 6 percent or more of his body weight in 6-12 months is at increased risk of illness and even death. For those over the age of 80, weight loss is the single most sensitive predictor of death within the next year. Studies suggest that for adults over the age of 80 even voluntary weight loss carries an increased risk of disease. The message is simple: if you are beyond the age of 75, be wary of weight loss and diet only if there is a good medical reason to justify it.When an older person has lost weight involuntarily it is important to identify and treat any underlying conditions. Side effects of medications are very common (and imminently treatable) causes of weight loss. This occurs with drugs to treat heart disease, high blood pressure and depression.Oftentimes, the drugs suppress appetite. Alternately, appetite suppression results from a high drug concentration in the blood because the prescribed dosage is excessive or if illness, reduced kidney or liver function declines impair clearance of the drug from the body. In the case of multiple medications, one drug can interact with another and lead to weight loss. Whenever we see a patient with weight loss, a pharmacist carefully analyzes all the prescriptions the patient is taking to determine if medications could explain weight loss.Depression is another classic cause of weight loss that is readily diagnosed and treated. Although appetite suppression is a frequent side effect of many antidepressants, improved mood often leads to weight gain.After depression and drugs are excluded, a careful history, physical examination, blood tests and X-rays are done to identify other possible causes of weight loss. Many diseases can cause loss of weight, including cancer, tuberculosis, fungal disease and illnesses that affect immune function and promote inflammation. In addition, an unusual, yet imminently treatable, condition called polymyalgia rheumatica can occur with weakness, severe fatigue and weight loss.Recently, an article published in the Archives of Neurology indicated that weight loss could be an early but sensitive symptom of Alzheimer's disease. Here the weight loss was more subtle but still clinically significant.It follows that unexplained weight loss in an older person almost always is a marker of an underlying illness. Identifying and correcting the illness will often cure the patient and weight gain will occur. In many patients, the illness is chronic and not curable. Here, reversing weight loss is more difficult. We do know that the only way in which weight gain will occur is through a combination of treating the underlying disease, increased calorie and protein intake and as vigorous an exercise program as possible.The best way to increase protein and calorie intake is to consume high-fat, high-protein foods. As weight loss is such a dangerous harbinger of severe disease we worry more about gaining weight than we do about heart risks. So I tell my patients who have lost a significant amount of weight that they should eat food that is bad for them. This would include red meat, fried fish and full cream ice cream. Empty calories such as fruit juices or sodas and candy should be avoided, but milkshakes and rich chocolate are fine. Combine this with exercising with weights to build muscle and improve metabolism and weight gain could occur.Always remember that if you are older, unexplained weight loss is not something to celebrate and should be attended to quickly to identify and treat serious underlying illnesses.Dr. David Lipschitz is the medical director for the Mruk Family Education Center onAging and the Fairlamb Senior Health Clinic. Contact him ataskdrdavid@ gmail.com.-------------------------------------------------------------------------------------------
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