Investigators Find Unintentional Weight Loss goes Unrecognized by Physicians

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The study addresses the need for consistent diagnostic practices related to unintentional weight loss in primary care patients as practices vary widely among physicians.

Investigators from the University Hospitals and Case Western Reserve University analyzed unintentional weight loss in close to 30,000 primary care patients. The team aimed to identify the incidence, rate of physician recognition, diagnostic practices, and cancer outcomes for unintentional weight loss.1

Goutham Rao, MD, University Hospitals and Case Western Reserve University School of Medicine, and investigators analyzed data from 29,494 patients from primary care settings who had at least 2 weight measurements in both 2020 and 2021.

“Weight loss may be a sign of a range of medical, psychological, and social conditions, such as a number of chronic illnesses, depression, and poverty, so it is essential to improve recognition by primary care physicians, who are on the front line of treating patients, to recognize this condition,” Rao said in a statement from Case Western Reserve University.2

The data exhibited 290 patients met one or more criteria for unintentional weight loss, representing 1% of the total population. However, unintentional weight loss was only recognized by physicians in 60 of the patients, indicating a recognition rate of 21%.1

“Our results show that unintentional weight loss is grossly under-recognized in primary care, though more likely to be recognized in older patients. Also, diagnostic practices among patients in whom it is recognized are variable,” he stated.2

The study noted diagnostic practices varied widely, but a complete blood count, complete metabolic profile, and thyroid stimulating hormone level were the 3 most common tests ordered in response to unintentional weight loss.1

Within 12 months of experiencing the weight loss, five patients were diagnosed with cancer, investigators reported. Three of these patients had their weight loss recognized by their physicians, while two did not.

“While the best approach to the problem is yet to be determined, we can recommend, at the very least, the electronic health record alert care teams to significant weight loss, so they could ask whether weight loss was intentional or about other causes,” Rao stated.2

The team conducted a secondary analysis of structured and unstructured electronic health record (EHR) data collected from adult patients between January 1, 2020 - December 31, 2021. They used 4 common definitions to define unintentional weight loss, excluding patients with known causes of weight loss, intentional weight loss, and pregnancy.1

It was also noted that unstructured physicians' notes were used to identify both intentional weight loss as well as physician recognition of unintentional weight loss.

“A larger study may have greater power to detect significant differences,” Rao noted. “(Unintentional weight loss) may be more common among women as they be more prone to causes of (Unintentional weight loss) such as depression.”2

The need for improved recognition of unintentional weight loss by primary care physicians, who are on the front line of treating patients was highlighted by investigators. Additionally, early detection of malignancy and other underlying health conditions can improve patient outcomes, and further research is needed to develop evidence-based guidelines for diagnosing unintentional weight loss.


  1. Rao G, Ufholz K, Saroufim P, Menegay H, Beno M. Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care. Diagnosis. 2023;0(0)
  2. University Hospitals and Case Western Reserve University weight researchers seek to develop steps for primary care doctors to recognize this potentially serious condition. The Daily, Case Western Reserve University. April 26, 2023. Accessed April 28, 2023.,However%2C%20physicians%20poorly%20recognize%20UWL.