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Sudden Weight Loss Calls for Doctor's Full Attention
Recently, Apple founder Steve Jobs exhibited sudden and extreme weight loss, prompting much concern for his health. Involuntary weight loss is typically indicative of a significant medical problem. While Jobs initially attributed his weight loss to a hormonal imbalance, we now recognize that it is much more serious.
Because Jobs has a history of pancreatic cancer, many physicians are speculating that the sudden weight loss indicates a recurrence of his cancer. It is not uncommon for recurrent tumors to cause such sudden declines in a patient's weight because the presence of the tumor causes the release of molecules called cytokines, which can lead to appetite suppression and the breakdown of muscle and fat. With a complete removal of the tumor, the body can restore its balance.
Regardless of Jobs' particular situation, anytime an individual experiences involuntary weight loss equal to 6 percent or more of his original weight, it almost certainly points to a major medical problem and indicates a high risk of severe illness. In patients older than 70, this degree of weight loss is a powerful predictor of death within 12 months. Any complaint of weight loss must be taken seriously and requires a comprehensive examination to identify the main cause.
Often, weight loss is the first and only manifestation of an illness, which can be perplexing for patients and physicians. The quest to identify the root cause of involuntary weight loss always begins with a careful evaluation of a patient's history. This can determine whether the patient is using any medications of which appetite suppression and weight loss are recognized side effects.
Medications used to treat depression — particularly the classic selective serotonin reuptake inhibitors, such as Zoloft, Prozac, Wellbutrin, Paxil, Celexa and Lexapro — all cause weight loss. Weight loss is also a side effect of many medications that treat heart disease, Alzheimer's disease and many other conditions. In addition, narcotics (including many illegal drugs) and alcohol can play a role in weight fluctuation.
In addition to identifying any medications that can cause weight loss, a careful medical history evaluation also can detect another major factor that can affect your weight: depression.
If drugs and depression can be excluded, the physician must investigate further to identify other medical conditions. Serious infections, immune diseases and cancers all can be present with extreme and sudden weight loss. Tuberculosis and a number of fungal infections can cause extreme weight loss. To exclude TB, a skin test and an X-ray of the chest are needed to make the diagnosis.
The common inflammatory illnesses that cause weight loss include lupus erythematosus, polyarteritis nodosa, severe rheumatoid disease and a very common condition in older people called polymyalgia rheumatica. These conditions are excluded by physical examinations and specific blood tests.
Finally, the most common cancers that cause weight loss are pancreatic, lung and kidney cancers, as well as colon cancer that has spread widely throughout the body. Blood tests, X-rays and CT scans, where indicated, are needed to make the diagnosis. In the very old, weight loss occasionally occurs for no good reason.
This condition has been called "failure to thrive in the elderly," and despite our very best efforts, the prognosis remains very poor.
Once the physician diagnoses the main cause of unexplained weight loss, weight gain will occur naturally if the condition can be treated or cured. If not, the best approach is to liberalize the diet by making it rich in calories and protein; in other words, if it is bad for you, eat it! Ice cream, fatty meats, bacon and eggs are good choices. Nutritional supplements can be of value, as can exercise and physical therapy. While our weight-obsessed world tends to glorify shedding pounds, never ignore sudden or unexplained weight loss. It is typically a symptom of a much larger medical problem.
Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.
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