Best Practices for Diagnostic Evaluation of Unintentional Weight Loss

Evidence-based guidance for the evaluation of unintentional weight loss (UWL) is lacking. Using electronic health record data, common diagnostic tests ordered among patients with UWL were identified, as well as their usefulness, by comparing rates of abnormalities to patients without UWL and reviewing reports. Only 38% of cases of UWL were recognized by physicians. Among 1471 patients with recognized UWL, a wide variety of laboratory tests (eg, thyroid-stimulating hormone, complete blood count, prostate specific antigen) potentially related to UWL evaluation were ordered. None of these was more likely to be abnormal in patients with recognized UWL compared with patients without UWL. Neither upper or lower endoscopy nor imaging was found to be useful in identifying a cause. With a stakeholder panel, we developed a conservative approach to UWL. Routine diagnostic evaluation of patients with UWL is not recommended. Patients should monitor their weight weekly as a useful indicator of overall health and undergo recommended routine cancer screening.