Identifying Unintended Weight Loss

Woman stepping on scale

Nancy was the main caregiver for her 89 year old mother, Mrs. Garcia who lived at home alone. Although Nancy visited as often as she could, she was also working full time and taking care of her own home and family. Nancy made sure she kept her mom’s kitchen well stocked with foods and beverages. When Nancy finally realized that many of the frozen meals had been piling up in her mom’s freezer untouched, she started investigating. She found that her mom was mostly eating convenience foods such as granola bars, bread, and soft fruit.

At first, Nancy chalked up her mom’s decreased appetite to older age and a more sedentary lifestyle. However, Mrs. Garcia was also weaker than she used to be, and this was now affecting her ability to do important things for herself. Nancy realized that her mom’s clothes were looser than normal and decided to weigh her. At 5’2” she had unintentionally lost a significant amount of weight going from her usual 140 pounds down to 118 pounds in the past 3 months. With the small quantity of food she was eating, Nancy worried that her mom’s diet was not meeting her nutritional needs.

What is Significant Weight Loss?

Understanding the significance of weight loss is crucial in identifying potential health concerns and initiating interventions. Significant weight loss is defined as any unintended weight loss of 5% or more in 1 month, 7.5% in 3 months or 10% in 6 months. Weight loss can also happen over time, so it’s important to weigh regularly and keep records of weights over time.

Mrs. Garcia’s weight loss is particularly noteworthy. She lost 22 pounds in 3 months from a weight of 140 to a weight of 118 pounds. This equates to a 15.7% weight loss, which is considered severe weight loss. Further assessment is needed to address the underlying cause of her weight loss and the potential health implications.

Risk Factors and Implications of Unintended Weight Loss

Recognizing risk factors can help identify individuals at risk for unintended weight loss so appropriate interventions can be implemented to prevent decline. Mrs. Garcia’s risk factors included dementia, depression, reduced food/fluid intake, and stress due to dealing with the challenges of living alone. Her weakness may have been a sign of muscle wasting as a result of unintended weight loss. This puts her at risk for additional challenges such as malnutrition and risk of falling. It is evident that Mrs. Garcia’s array of risk factors necessitates a multifaceted approach to address both the underlying causes of her weight loss and the associated health implications.

Prevention and Treatment of Unintended Weight Loss

Caregivers like Nancy can help prevent unintended weight loss by monitoring food intake at mealtime, obtaining and monitoring weight on a regular basis (monthly – or weekly if signs of weight loss occur), communicating concerns to health care practitioners, and discussing possible nutrition interventions to prevent and/or treat unintended weight loss. Nutrition interventions might include liberalizing a restrictive diet (with the physician’s approval), providing high calorie/high protein foods, oral nutritional supplements, and/or providing assistance at mealtime if needed. The goal is to identify concerns causing unintended weight loss and intervene as appropriate to promote the highest quality of life.

Referral to a Registered Dietitian Nutritionist

As in Mrs. Garcia’s case, the physician may suggest a referral to a registered dietitian nutritionist (RDN) who will complete a comprehensive nutritional assessment to evaluate factors including but not limited to medical condition, physical and cognitive abilities, food-medication interactions, and diet/food acceptance. A nutrition focused physical exam may include checking for signs of malnutrition and dehydration, indicators that a patient may have difficulty with eating such as missing teeth, and/or physical ability that may affect ability to feed oneself. Once risk factors are identified, the RDN can develop a care plan that targets individualized nutrition interventions.

During their time together, Mrs. Garcia admitted to the RDN that she was lonely and didn’t like eating by herself. Mrs. Garcia’s situation highlights a common yet often overlooked aspect of unintended weight loss: the emotional and social factors that can contribute to nutritional decline. Loneliness, especially in older adults, can significantly impact appetite and food intake. Mealtimes, traditionally a social event, have become solitary affairs for Mrs. Garcia. Without the companionship and conversation of others, she finds little enjoyment in eating, leading to decreased appetite and subsequent weight loss.

Studies have shown that social isolation and loneliness can have profound effects on physical health, including nutritional status. Older adults who feel lonely are more likely to experience a decline in appetite, reduced food intake, and ultimately unintended weight loss. Addressing Mrs. Garcia’s loneliness is crucial for improving her nutritional intake and overall well-being. Simply advising her to eat more or providing nutritional supplements may not be sufficient if the root cause of her decreased appetite remains unaddressed. Instead, a holistic approach that addresses both the physiological and psychological aspects of her situation is necessary.