Unintended weight loss involving depletion of a person’s fat tissue and skeletal muscle mass is sometimes related to a condition called unintended weight loss and Cachexia. Unintended weight loss and Cachexia is a separate disease from intended or explained weight loss associated with eating disorders such as anorexia nervosa.
Unintended weight loss and cachexia as specific diseases have been recognized for two decades within the medical community and by numerous United States government health agencies. The Centers of Medicare and Medicaid Services excludes appetite stimulants for cosmetic weight gain from the Medicare Part D prescription benefit, however, it does not exclude drugs “to improve your appetite and gain weight due to a long-term disease such as cancer, AIDs, heart failure, or lung, kidney, or liver disease. CMS also includes drugs for AIDS wasting or cachexia. There are also several drugs approved by the Food and Drug Administration for use in the management of unintended weight loss and cachexia separate from the appetite stimulants.
There are numerous adverse health outcomes caused by unintended weight loss and cachexia. These include:
Increase in mortality rate. Causes are likely multifactorial and may include systemic dysregulation of metabolism, increased resting energy expenditure and immune changes, notably increased activity of proinflammatory cytokines.
Causes of unintended weight loss and cachexia and the differences from other weight loss are:
The two main factors are felt to be altered metabolism and inadequate energy intake
An altered metabolism is likely the result of a reduction of various anabolic factors such as insulin, testosterone, growth hormone, and an increase in various catabolic factors such as glucagons, cortisol, proinflammatory cytokines, eicosanoids, proteolysis-inducing factor, cholecystokinin.
Inadequate energy intake may be due to psychosocial and other factors, which include:
- Lack of access to adequate foods
- Cognitive dysfunction
- Medications that cause nausea or vomiting
- Impediments such as diarrhea, loss of teeth, and oral lesions
The unintended nature of losing weight is what differentiates wasting and cachexia from intended or explainable weight loss as seen in starvation, anorexia nervosa, acute self-limiting illnesses or intestinal malabsorption.
During the process of malnutrition in unintended weight loss and cachexia, energy is preferentially provided by protein. This is caused by a breakdown of body cell mass contained in skeletal muscle and other protein-containing tissues. There is a disproportionate loss of body cell mass relative to body weight and body fat. This pattern is in contrast with the pattern of weight loss seen in starvation, where body fat is depleted in an effort to spare protein stores.
Persons with AIDS, cancer, various other chronic diseases and older people are at risk for significant clinical problems which include:
- Accelerated disease progression
- Loss of muscle protein mass
- Impairment of strength and functional status
- Diminished immune function
- Shortened survival
- Opportunistic infections
- Decreased tolerance of other therapies
- Increased utilization of healthcare resources
- Reduced quality of life
Treatment options include:
- Primary treatment goal of unintended weight loss and cachexia is to stop or slow down the loss of body cell mass and body weight
- Correction of immediate causes of cachexia includes treating of opportunistic infections, diarrhea, malignancies and mood disorders. These treatments should be started immediately.
- Early intervention that includes nutrition and exercise is generally viewed as the best prevention of unintended weight loss and cachexia, however, early intervention is often inadequate.
- Drug therapy to treat wasting and cachexia is usually necessary.
- The FDA has approved several drugs for the treatment of the specific disease states of unintended weight loss cachexia.
In conclusion, unintended weight loss and cachexia are serious conditions that can lead to mortality especially in patients with various chronic conditions. These diseases are recognized as a medical disorder by multiple medical and governmental agencies. There are several therapeutic options to treat unintended weight loss and cachexia. Such therapies are not excluded from the Medicare Prescription Drug Benefit as agents used for weight gain or for cosmetic purposes.
