Welcome to our Decision Guide on Unintentional Weight Loss.

This guide is designed to provide insight as to why you are losing weight without purposefully trying to diet. The guide should be used as a complement to the care you receive from a health professional. It is not intended to replace direct interaction with your doctor.

Doctors become most concerned about unintentional weight loss if it reaches more than five percent of the usual body weight (about ten pounds), especially if your weight has not stabilized and continues to go down.

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It is quite common for weight to fluctuate a few pounds in either direction. People who tend to retain fluid and get swollen legs can quickly lose several pounds of water over one to two days. This is especially true if a person takes water pills (diuretics).

Weight loss related to water only is not the subject of this guide. Weight loss in this guide refers to a decrease in "dry" weight.

Most people who lose weight and are concerned about it often have a diminished appetite.

Has your appetite decreased?

Yes, my appetite has decreased.

No, my appetite is still good.

Sometimes people remain hungry and look forward to eating while still losing weight. Maintaining a good appetite while unintentionally losing weight suggests a different set of possibilities.

A person who has become physically much more active can burn more calories than they take in. This is usually pretty obvious and it takes a lot of exercise to get there. Other causes of losing weight while maintaining a good appetite include an overactive thyroid, diabetes and eating disorders such as bulimia.

With an overactive thyroid, your metabolism increases and you burn more calories.

Do you have some of the following symptoms:

• hand tremor

• feeling hot and sweaty

• a swelling in the front of your neck

• feeling jittery and anxious

• palpitations?

Yes, I have one or more of these symptoms.

No, I do not have any of these symptoms.

Doctors call this anorexia. There are many reasons for anorexia, including physical, emotional, psychological and disease-related causes. Let's explore some possibilities.

Are you having persistent pain in addition to weight loss?

Yes, I have persistent pain.

No, I am not in pain.

People can lose weight if they are not absorbing nutrients properly, a condition called malabsorption. With malabsorption, appetite may be normal or slightly decreased. There may be some abdominal discomfort and bloating.

When the primary problem is one of fat digestion or absorption, there will usually be changes in stool color and consistency. A disorder of the intestine, pancreas or liver could cause this.

Do your stools show one or more of the following changes:

• yellow or beige color

• a foul smell

• oily, floating consistency?

Yes, I do notice one or more of these symptoms.

No, I do not have any of these symptoms.

Although you don't have the typical symptoms of fat malabsorption, you may have a problem absorbing other nutrients. Celiac disease is quite common, especially in people of European ancestry. A simple blood test is the first step in screening for celiac disease.

Before contacting your doctor, let's explore some other possibilities for weight loss and decreased appetite.

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Depression is a common cause of diminished appetite.

Have you also noted one or more of the following:

• feeling sad or low

• loss of enjoyment in things that you previously liked to do

• blaming yourself for circumstances and events in your life

• difficulty sleeping

• staying in bed for most of the day?

Yes, this sounds like me.

No, I don't think I have depression.

The presence of fever or night sweats with weight loss might mean that you have an infection. Some types of arthritis and rheumatism can also have these symptoms. In addition, certain types of tumors cause fever and weight loss.

Are you having fevers and/or night sweats?

Yes, I have one or both of these symptoms.

No, I don't either of these symptoms.

Contact your doctor. You should be screened for depression while other reasons for your weight loss are being considered.

You could have another reason for weight loss and poor appetite, not just depression.

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The presence of fever or night sweats and weight loss might mean that you have an infection. Some types of arthritis and rheumatism can also have these symptoms. In addition, certain types of tumors cause fever and weight loss.

Are you having fevers and/or night sweats?

Yes, I have one or both of these symptoms.

No, I don't either of these symptoms.

If a person loses weight but otherwise feels strong and energetic and has no other symptoms, it is quite likely that body weight will stabilize. If your weight continues to fall over the next week or two, contact your doctor. Call sooner if you begin to have any fatigue, shortness of breath or develop pain.

You might also want to learn about a few conditions that cause weight loss without a decreased appetite.

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Maintaining a good appetite while unintentionally losing weight suggests a different set of possibilities.

A person who has become physically much more active can burn more calories than they take in. This is usually pretty obvious and it takes a lot of exercise to get there. Other causes of losing weight while maintaining a good appetite include an overactive thyroid, diabetes and eating disorders such as bulimia.

With an overactive thyroid, your metabolism increases and you burn more calories.

Do you have some of the following symptoms:

• hand tremor

• feeling hot and sweaty

• a swelling in the front of your neck

• feeling jittery and anxious

• palpitations?

Yes, I have one or more of these symptoms.

No, I do not have any of these symptoms.

Some people with new onset diabetes will have an increased appetite and yet lose weight. This can occur with both type 1 diabetes and type 2 diabetes.

Are you urinating a lot and/or thirsty all the time?

Yes, I have one or both of these symptoms.

No, this does not apply to me.

Body image can play a significant role in attitudes toward weight loss. People with eating disorders can feel fat despite losing a lot of weight and actually being too thin.

Do you see yourself as too heavy, despite family and friends thinking otherwise?

Yes, I see myself as too heavy.

No, I am worried about my weight loss.

Anxiety, stress or grief from loss of a loved one can cause weight loss. Usually appetite also falls off in these situations.

Do you think that stress, anxiety or grief is the cause of your weight loss?

Yes, I think that this is likely.

No, I don't think so.

Some medications and over-the-counter supplements can interfere with your appetite and desire to eat. Some drugs cause a bitter or metallic taste that makes eating unpleasant. Many drugs can cause nausea or upset stomach. A few drugs inhibit the part of our brain that sends out hunger signals.

Are you taking any new medications that coincide with losing weight?

Yes, I am taking new medication.

No, I am not taking any new medications.

Another possible cause of weight loss with a good appetite is malabsorption. This is a problem in the digestive system that interferes with the ability of nutrients to get from the intestine into the blood. People with malabsorption often have diarrhea, but not always. Celiac disease is one example. The particular condition is quite common, especially in people of European ancestry. A simple blood test is the first step in screening for celiac disease.

If you have lost more than ten pounds or five percent of your body weight, contact your doctor. If the weight loss is less than this, you might wish to check your weight daily or every other day. If your weight continues to fall over the next few weeks, contact your doctor.

Ask your pharmacist or doctor if the medicine may be contributing to your weight loss.

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Another possible cause of weight loss with a good appetite is malabsorption. This is a problem in the digestive system that interferes with the ability of nutrients to get from the intestine into the blood. People with malabsorption often have diarrhea, but not always. Celiac disease is one example. The particular condition is quite common, especially in people of European ancestry. A simple blood test is the first step in screening for celiac disease.

If you have lost more than ten pounds or five percent of your body weight, contact your doctor. If the weight loss is less than this, you might wish to check your weight daily or every other day. If your weight continues to fall over the next few weeks, contact your doctor.

Losing weight secondary to stress, anxiety or grief is quite common. If you continue to lose weight or you need help working through your personal situation, call your doctor's office for advice.

You need to contact your doctor to discuss the possibility that your weight loss is related to one of the eating disorders, such as bulimia.

These symptoms may indicate that you have developed diabetes mellitus. The other less common possibilities include high blood calcium levels, other endocrine disorders or a problem with the kidneys. Contact your doctor for further evaluation.

Your symptoms suggest that you may have an overactive thyroid (hyperthyroidism). Call your doctor to arrange an appointment and/or a blood test.

Contact your doctor. While anxiety might cause night sweats, it should not cause a fever.

If you are not sure about the presence of fever, take your temperature several times over the next couple days.

Is your body temperature running higher than normal?

Yes, I have fever.

No, I have night sweats without fever.

It is possible that weight loss, decreased appetite and night sweats could be just anxiety. However, this group of symptoms is worrisome and will need more thorough medical evaluation. Contact your doctor.

Contact your doctor and arrange an evaluation. Your doctor will want to learn more details of your symptoms, perform a physical examination and probably order some initial diagnostic tests.

Make an appointment with your doctor. You will need evaluation for possible fat malabsorption.

The presence or absence of other symptoms may provide clues as to why you are losing weight.

Do you have any of the following symptoms:

• constipation

• diarrhea

• vomiting

• red or black stools (suggests blood)?

Yes, I have one or more of these symptoms.

No, I do not have any of these symptoms.

Even without diarrhea, weight loss and abdominal discomfort may indicate a problem with fat digestion and absorption, a condition known as fat malabsorption.  A disorder of the small intestine, pancreas or liver could cause this.

With fat malabsorption, there will often be changes in stool color and consistency.

Do your stools show one or more of the following changes:

• yellow or beige color

• a foul smell

• oily, floating consistency?

Yes, one or more of these describe my stools.

No, I do not have any of these symptoms.

So far you have indicated that you have weight loss and pain. Contact your doctor. Discovering the cause of your pain and relieving it may be all that is needed to correct the weight loss.

Your symptoms suggest a problem with your ability to properly digest and absorb fats. This can cause weight loss, vitamin and micronutrient deficiencies. Contact your doctor.

Your answer indicates a potentially serious intestinal disorder. Contact your doctor.