A clinical presentation of weight loss is extremely common and often a source of marked anxiety for the patient. The commonest cause of unintentional weight loss (UWI) is gastrointestinal tract disease, and not malignancy.
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Terminology
The published literature lacks a consistent definition of what constitutes clinically-significant unintended weight loss. A loss of body weight of ≥5% in ≤6 months is often employed for this purpose 2. Although in the context of lymphoma, the presence of weight loss, as one of the B symptoms, is defined as a loss of body weight of ≥10% within six months 3.
Although severe weight loss (in adults) is almost always a feature of cachexia, the latter term refers specifically to a complex metabolic syndrome seen in the context of malignancy and other chronic diseases in which there is severe decrease in skeletal muscle bulk (sarcopenia) 5.
Pathology
Etiology
Unintentional weight loss
- gastrointestinal
- malignancy
- infections
- psychosocial
- endocrine
- cardiopulmonary
- alcohol excess
- rheumatological
- miscellaneous
Intentional weight loss
- dieting/starvation
- physical exercise
- surgery: bariatric surgery, cosmetic surgery (e.g. liposuction)
- medications (purgatives, anxiolytics, diuretics, etc.)
- self-induced vomiting
Radiographic features
On cross-sectional imaging, the most striking feature of a patient who has lost a large amount of weight is usually the distinct lack of subcutaneous and intra-abdominal fat. This often makes studies difficult to read as the solid organs, bowel loops and nodes may be difficult to separate visually, especially on non-contrast CT examinations.
The use of imaging to identify the underlying cause of unintentional weight loss is increasingly common. In a retrospective study of 200 patients with unexplained weight loss, from 2018, whole body CT was able to elucidate the primary cause in a third of patients (33.5%) 4.
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