Why am I losing weight?

Q: I am a 39-year-old man who comes from a family of ‘large-bodied’ men – a physical attribute we pride ourselves on. Over the past six months I have noticed a disturbing trend in my weight.

I seem to be losing weight despite not being on a diet or changing my exercise programme (I have been jogging daily for the past 15 years). Initially, I thought it was due to work related stress, but there is nothing out of the ordinary happening at my workplace. I have started eating larger servings, but I am still losing weight.

I am 6 foot 2 inches and my usual weight is about 92 kilogrammes – I am now 77 kilogrammes— In the past six months I have lost 15 kilos. I have even stopped my evening jog because I’m afraid of losing more weight.

My wife also commented that I sweat more than usual — something I also noted but attributed to the hot weather. I am also constantly tired.

What could be wrong with me?
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A: Body weight is a very dynamic thing and most of us go through changes in our body size as we age. Unintentional weight loss is considered a health concern if you have lost 4.5 kilogrammes (10 pounds) or five per cent of your normal body weight over six to 12 months without knowing the reason.

In your case you have lost close to 20 per cent of your body weight— this warrants concern. Potential causes of your unexplained weight loss include:

Diabetes

Diabetes can occur at any age and it is often associated with unexplained weight loss. In addition, most people report constantly being thirsty, passing large amounts of urine, tiredness and increased appetite.

Cancer

Cancer is a well-known cause of weight loss. However, it usually isn’t the only symptom you would get. Usually, the site of the cancer will determine the symptoms you will get. For example, cancer of the bladder may cause bloody urine whereas throat cancer can cause you to have a hoarse voice.

Hormonal issues

The most common hormonal problem causing weight loss is an overactive thyroid. Most people report eating adequate volumes of food, but still losing weight. In addition, they may notice, excessive sweating, hands (tremors), restlessness, irritability, and nervousness, frequent passage of stool, poor sleeping habits (insomnia) and palpitations. Problems with adrenals (a little gland on top of the kidney) can also be associated with weight changes.

Depression

Not everyone recognises that they have depression. Some people will report that they constantly feel low or ‘not right’ and cannot say why but since they always feel like this, they think of it as just normal for them. Depression can cause one to unintentionally eat less leading to weight loss.

Stress or anxiety

Just like depression, stress and anxiety can lead to unintentional weight loss. In addition, most people report mood changes, poor work performance and even physical symptoms like excessive sweating and palpitations.

Alcohol dependence

You haven’t gone into detail about your drinking habits, but alcohol dependence is a well-known cause of weight loss. People who binge drink over weekends and holidays will not notice any weight loss (in fact, they may gain weight since they tend to also over-indulge in high calorie foods in addition to the calories found in the alcohol).

People who drink heavily everyday tend not to look after their nutritional needs very well and have been known to skip meals. In addition, the alcohol damages both the liver and the pancreas which are vital organs for one’s nutritional well-being.

HIV infection

HIV may present with unexplained weight loss, recurrent colds, coughs and sore throats, and painless swollen nodes in different parts of the body (neck, armpit, groin etc.) In addition, it can give persistent diarrhoea.

Tuberculosis (TB)

Contrary to popular belief, TB does not just affect the lungs — it can affect any part of the body. You also do not have to be HIV positive to get TB. Most of the time, tuberculosis causes excessive sweating (most people describe them as ‘drenching night sweats’), weight loss, fatigue and symptoms related to the organ which has the infection.

For example, if you have TB of the intestines, you will have abdominal pain, if it is in the lungs, you will have a persistent cough, and TB of the brain will give severe headaches, confusion and even seizures.

Worm infestation

This is rare in adults but it has been known to happen. Infestation with hook worms and tape worms can lead to weight loss as these parasites take in nutrients from the food you eat causing you to lose weight.

In most cases, worm infestation does not give any other symptom but it has been known to cause abdominal discomfort. In Kenya, however, it tends to be more common in the pastoralist communities.

Malabsorption syndromes

In malabsorption syndromes, you may eat a well-balanced diet but your intestines are unable to absorb nutrients from the food you have eaten. In some cases, you even get loose stool. This lack of absorption of food inevitably leads to weight loss.

Failure of the pancreas to function properly can also give you problems with digestion (however, this tends to happen in people who have had repeat attacks of inflammation of the pancreas mainly due to alcohol abuse or gall stones).

Medication side effects

Drugs used to treat mood disorders, hormonal problems etc. may cause unwanted weight loss. Performance enhancing drugs have also been known to cause unexpected weight changes.

This list is by no means exhaustive but as you can see, the possible causes of your weight loss is long. For this reason, you will need to see a doctor. He/she will work with you to try to determine what is causing the weight loss.

The doctor will have to take a very detailed clinical history from you.

Try and find out about health conditions that run in your family before you visit your doctor as this information is often vital. In addition, carry any prescription or herbal therapy you may be using.

If you are using over the counter sports or sexual enhancement pills, carry those as well. Be honest about your drinking habits, smoking and mention any illicit drug habit you may have.

The doctor will then do a full physical exam looking for possible tell-tale signs for the cause of your weight loss. In addition, you will probably require a few basic laboratory tests (these will be determined by your doctor after the examination).

The thought of possibly having cancer is very scary but you do not need to demand whole body scans to look for hidden cancers.