Too much weight loss can be a bad thing

Jan 21 2009

Doctors are not doing enough to pick up on problems with excessive weight loss, says a Saint Louis University physician who helped draft recent guidelines to diagnose the condition called "cachexia" (kuh-kex-ee-uh).

"In sick people, weight loss is an important indicator of disease and potentially impending death," said John Morley, M.D., an endocrinologist and director of the division of geriatric medicine at Saint Louis University School of Medicine.

"Cachexia is an extraordinary problem for people who are having other health problems, yet this is something that many physicians don't pay attention to."

A group of physicians and scientists agreed on a definition of cachexia, which was published in the December edition of the medical journal, Clinical Nutrition .

"The definition is important because it gives physicians the guidelines to make a diagnosis and treat the condition," Morley said. "A definition of cachexia also makes it easier for scientists to conduct research and potentially develop new therapies for the problem."

About half of hospitalized patients and between 10 and 15 percent of sick patients who see a doctor have cachexia. The condition accompanies diseases such as cancer, congestive heart failure, HIV, diabetes, kidney failure and COPD (chronic obstructive pulmonary disease).

Adults with cachexia lose weight and children don't grow. Muscle mass melts away, and those with cachexia also may lose fat.

Those who traditionally have had difficulty taking off weight and suddenly find the pounds melting off should beware, Morley said. They may be ill and could get even sicker as they become weaker and weaker.

"Cachexia should be seen as a wasting disease that requires specialized treatment from a physician who is familiar with the problem," Morley said.

The researchers clarified the definition of cachexia by noting it is always linked to an underlying disease. They differentiated it from starvation; loss of muscle mass that comes with aging; depression; thyroid problems; and the body's difficulty in absorbing nutrients. Rather, cachexia is a complicated metabolic syndrome that is often associated with anorexia, inflammation, insulin resistance and increased muscle protein breakdown.