Background: Recognizing involuntary weight loss in patients may provide important clues to diagnosis of significant medical conditions. Limited data exist to describe how often clinicians recognize periods of weight loss in their patients, whether this weight loss is voluntary or involuntary and which underlying diagnoses are recognized or missed.
Methods: In a random sample of approximately 100,000 patients seen in our outpatient clinics between 2005 and 2009, we identified patients with at least two weights recorded between 180 and 365 days apart. We randomly selected 1,000 patients whose subsequent weight was >=10lb lower than the earlier weight. Using a linear regression-based algorithm, we identified periods of weight loss of >10%/year. We reviewed in-depth 100 of these loss periods. We identified "index visits" at which patients had lost 10lbs to determine whether: (1) the clinician recognized the weight loss; (2) the weight loss was voluntary vs. involuntary; and (3) an explanation for the weight loss became apparent within the subsequent 2 years.
Results: In our group, 43,906 patients had pairs of weights measured 180-365 days apart. Of these, 14,680 had a 2nd weight >=10lbs lower than the earlier weight. In a random subset of 1,000 of these patients, our algorithm identified 577 periods with weight loss of at least 10%/year. We found that 7/100 of the apparent weight loss cases were due to errors in weight recording. The weight loss was recognized in about half the cases (45/100)--most often noted in the physical examination (n=42), vitals (n=24) and history of present illness (n=14) sections of the note. The weight loss was addressed in the assessment and/or plan in only 6/100 cases. Weight loss was voluntary in 23 cases, involuntary in 15 cases, with the remainder being unclear from the notes. Within 2 years following the "index visits," at least one explanation for weight loss emerged in 63/100 cases.
Conclusion: Periods of weight loss of more than 10%/year occur frequently in ambulatory general medicine patients. Clinicians document recognition of weight loss in fewer than half of the cases and fail to document assessment of its significance 94% of the time. Consequently, it is often difficult to determine whether this weight loss is voluntary vs. involuntary through chart review. New diagnoses that may explain the weight loss often emerge within 2 years of the loss periods with a failure to recognize weight loss potentially contributing to a delay in the diagnosis.
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