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KEITH I. MARTON, M.D.; HAROLD C. SOX, Jr., M.D.; and JAN R. KRUPP, M.D.; Palo Alto, California
We prospectively evaluated 9 1 patients with involuntary no firm basis for a comprehensive diagnostic approach to
weight loss. Thirty-two ( 3 5 % ) had no identifiable physical patients with weight loss. Because of these difficulties, we
cause of weight loss, whereas the remainder had various prospectively studied 91 patients with involuntary weight
physical illnesses. During the year after the index visit, 23
( 2 5 % ) of the patients died and another 14 ( 1 5 % ) loss to ascertain the common causes of weight loss, to
deteriorated clinically. Physical causes of weight loss estimate the prognosis of patients with weight loss, and to
were clinically evident on the initial evaluation in 55 of 59 develop an efficient diagnostic strategy for such patients.
patients. The four patients in whom the diagnosis was
initially missed had cancer, and in only one of these Methods
patients was the illness truly occult. Because diagnoses
PATIENT SELECTION
were usually made rapidly in patients with a physical cause
of weight loss, we conclude that involuntary weight loss is Study patients were enrolled at the Palo Alto Veterans Medi-
rarely due to "occult" disease. We developed a decision cal Center between September 1975 and September 1978. Our
rule that used six attributes to correctly identify 57 of 59 goal was to detect all patients whose weight loss was a diagnos-
patients ( 9 7 % ) with a physical cause of weight loss and tic problem to their physician. Therefore, all patients were be-
23 of 32 patients without. Thus, our rule may help in the ing evaluated for weight loss when they were identified as possi-
early triage of patients with involuntary weight loss. ble study patients. Thirty patients (33%) had weight loss as the
chief complaint at the index visit. In the remainder, weight loss
was discovered as an incidental complaint because of docu-
M A R K E D weight loss is generally viewed as a manifesta- mented changes in weight or because of the patient's physical
tion of serious disease ( 1 ) . The list of potential causes of appearance. To find patients, we made weekly visits to the three
weight loss is extensive (1, 2), and the diseases causing largest medical clinics and to the inpatient medical, surgical,
and psychiatric wards. The clinic staff were asked about pa-
weight loss have many different pathophysiologic mecha- tients with involuntary weight loss and were regularly reminded
nisms. The physician's diagnostic dilemma is further to notify one of the investigators of any such patients. On the
complicated by at least three considerations. First, not all inpatient wards, nurses and house staff were questioned about
patients with weight loss have serious physical illness, so patients with involuntary weight loss, and randomly chosen in-
patient charts were reviewed for any mention of involuntary
an extensive clinical evaluation will sometimes fail to weight loss. To check on the adequacy of detection, the head
identify disease. Second, many patients who claim to nurse in the general medical clinic reviewed the chart of every
have lost weight have not lost weight at all ( 3 ) . Third, patient seen during 3 months for evidence of weight loss, as
there are no published studies of a cohort of patients with documented by serial measurements of body weight recorded at
each clinic visit. We also reviewed the charts of every patient
weight loss and therefore no information on the relative admitted to the medical service during a 3-month period
prevalence of various causes of weight loss. Thus, there is (March through May 1976) for evidence of recent weight loss
as recorded in the admitting history. On the basis of these data
From the Department of Medicine, Stanford University, and the Veterans Ad-
ministration Medical Center; Palo Alto, California. we enrolled approximately 80% of all patients eligible for the
Annals of Internal Medicine. 1 9 8 1 ; 9 5 : 5 6 8 - 5 7 4 . 1 9 8 1 American College of Physicians