Dear Doctor: I am a 72-year-old male with no health problems other than GERD, which is well-controlled, and neurological problems associated with a back injury and surgeries. But in the past eight months, I've gone from 189 pounds to 142 pounds. Initially, I attributed this to stress over my wife's death six months ago, but now I don't know. A general physical, along with blood tests, CT scans of the chest and head, and X-rays of the chest have found nothing unusual. What should I do?
Dear Reader: I can understand why you're worried. Although unexplained weight loss is relatively common -- an estimated 15 to 20 percent of adults over 65 will have unintentional weight loss if followed over 10 years -- your degree of weight loss needs to be investigated further. After all, you've lost 25 percent of your initial weight.
In 15 to 37 percent of cases, cancer is the underlying cause of unintentional weight loss. The tests you list show that your doctor has searched for a possible malignancy and ruled out many cancers already. He or she should also rule out gastrointestinal malignancies. Together, a colonoscopy and upper endoscopy can detect cancers of the colon, stomach and esophagus.
Other potential causes of weight loss, seen 10 to 20 percent of the time, are stomach ulcers, inflammatory bowel disease or another gastrointestinal disease. I would expect some symptoms with this, such as poor appetite, stomach pain or diarrhea. Again, an endoscopy and colonoscopy can help rule out these causes.
As for infection, that too can be a cause of weight loss, but it's often associated with sweats and fevers, and the imaging studies or blood work likely would have found the cause. Similarly, blood tests would have identified high thyroid levels, uncontrolled diabetes and adrenal insufficiency, all of which can lead to weight loss.
Potential illness aside, studies have shown a consistent small degree of weight loss among people who lose a spouse, especially among older couples. For some, the weight loss is largely a side effect of difficulties in food preparation, especially if the person who passed had been the one preparing the meals. In those scenarios, taking a more active role in food shopping and preparation, or having a service deliver meals, are both good options.
But for many people, the cause is not focused on the practical, but is rather much deeper and more complex. The loss of a partner -- especially if it was unexpected -- is clearly traumatic. For that reason, I want to gently suggest that you not discount psychiatric causes as a reason for your weight loss.
Anxiety and depression can cause a decrease in appetite, which in turn leads to weight loss. Depression can also lead to isolation and dampen the desire for certain activities, such as exercise, which then leads to decreased muscle mass and weight loss. Bereavement groups, other family members or religious organizations can help manage these feelings, as can psychological therapy. For extreme cases, anti-depressants such as mirtazapine might be needed to help boost both mood and appetite.
Because many of the physical causes appear to have been ruled out, and the weight loss coincides with the passing of your wife, I would encourage you to get help adjusting to the changes you've experienced. Difficult though it may be, now is the time to focus on the life ahead.
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