DEAR DR. ROACH: I am a 72-year-old man in good health. I have lost about 12 pounds in the past year, with no explanation. I’m 5 feet, 9 1/2 inches tall, and my morning weight has dropped from 166-168 pounds to 154-156 pounds. It is still slowly falling.
I eat well, and I’ve exercised an hour every other day for 36 years. I’ve had on-and-off atrial fibrillation for 14 years, with two ablations, but since I began flecainide two years ago, no more episodes. I also take 10 mg simvastatin and 1,000 mg vitamin D3 daily.
My doctor did bloodwork and ordered a full CT scan, but found nothing. Since the pandemic began, I’ve been walking 3 miles every other day, alternating with my days on the stationary bike at home. The doctor thinks I may be burning more calories than I’m eating, but I doubt it.
A: Unexplained weight loss should be taken seriously, especially in an older person. Getting bloodwork and a CT scan is a reasonable start, but there are some additional issues that should be considered.
Your doctor is right to think about energy intake as well as energy expenditure. The first to do is to see how many calories you are eating. A careful food diary can accomplish this.
Sometimes, the body cannot absorb calories properly. Celiac disease and inflammatory bowel disease are the most common, but there are others. The body may lose calories; diabetes causes sugar to come out through the urine. Some infections can cause profound weight loss, such as tuberculosis — “consumption” is an old name for this disease — HIV, viral hepatitis and parasites.