{"id":4512,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/weightloss\/"},"modified":"2026-03-25T14:22:29","modified_gmt":"2026-03-25T14:22:29","slug":"weightloss","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/medicineoftheelderlygeriatrics\/weightloss\/","title":{"rendered":"Weight Loss"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Information<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unintentional weight loss may affect 15 &#8211; 20% of adults over 65.<\/li>\n\n\n\n<li>Unintentional weight loss of more than 5% body weight may indicate serious underlying pathology. Causes include medical and psychiatric illnesses and social factors. Weight loss is common in some conditions such as COPD and late-stage dementia. These conditions may occur in isolation or in combination.<\/li>\n\n\n\n<li>Rates in care home residents may be as high as 60%.<\/li>\n\n\n\n<li>Diagnosis can be challenging, and no identifiable cause is found in up to 25% of patients despite investigation.<sup> (1)<\/sup><\/li>\n\n\n\n<li>Frailty can be both a causative and\/or confounding factor when a patient presents with unintentional weight loss.<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Weight loss and Cancer <\/h4>\n\n\n\n<p>(from the <a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspect Cancer 2025<\/a>)<\/p>\n\n\n\n<p>Weight loss is a non-specific symptom that poses a diagnostic challenge in primary care. It can be associated with several conditions including cancer. Published data shows that the likelihood of a cancer diagnosis is increased in the <strong>3-6 months after the first record of unexpected weight loss in primary care<\/strong>.<\/p>\n\n\n\n<p>The strongest association was in men aged 50 and over and women aged 70 and over.<\/p>\n\n\n\n<p>The most frequent cancer types were pancreas, gastro-oesophageal, lymphoma, hepatobiliary, lung, bowel, and renal-tract.<\/p>\n\n\n\n<p>Data has shown that the amount of weight loss and the duration are important in assessing a person\u2019s risk of cancer.<\/p>\n\n\n\n<p>In the guidance, where weight loss is referred to, it is <strong>unintentional<\/strong> (e.g. not due to weight loss therapy or lifestyle changes) and <strong>greater than 5% or more of body weight<\/strong>. It should be noted that it is not always possible for primary care to verify a patient\u2019s weight loss through recorded weights. This is particularly relevant for those without access to scales at home. <strong>Therefore, it is acceptable to include a strong clinical suspicion of weight loss, such as dropping dress sizes or needing a tighter hole on a belt<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Weight loss and Frailty<\/h4>\n\n\n\n<p>Frailty can be both a causative and\/or confounding factor when a patient presents with unintentional weight loss. Any assessment of an older adult with unintentional weight loss should include an assessment of Frailty using the Clinical Frailty Scale (see Resources and Links). Any assessment of <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/medicineoftheelderlygeriatrics\/frailty\/\" target=\"_blank\" rel=\"noreferrer noopener\">Frailty<\/a> should include questions about diet, appetite and change in weight.<\/p>\n\n\n\n<p><strong>J.B &amp; A.C &#8211; 25-03-2026<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Frail older people with clinically significant weight loss (weight loss of &gt; 5% of body weight over 6 months*, though see guidance above if exact weights cannot be recorded in primary care) in whom no clear specific cause is identified after investigations detailed in Primary Care Management section.<\/p>\n\n\n\n<p>* <strong>Primary care assessment<\/strong> does not have to wait until weight loss has been established for six months. In terms of next steps, GPs should take a patient-centred approach to assessment, considering the principles of <a href=\"https:\/\/realisticmedicine.scot\/\" target=\"_blank\" rel=\"noreferrer noopener\">Realistic Medicine<\/a>, particularly <strong>Shared Decision Making <\/strong>and a<strong> Personalised Approach to Care<\/strong>, when deciding on next steps in terms of referral for further assessment of weight loss. <\/p>\n\n\n\n<p>If further assessment is appropriate, then please be aware that GPs can follow the guidance on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary)<\/a> if they have a strong suspicion of suspected underlying malignancy due to clinical assessment including unexplained weight loss of &gt;5% body weight over <strong><u>three months<\/u><\/strong>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>Single organ pathology should be referred to the appropriate specialty.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Patients should be referred via SCI Gateway to their local Medicine of the Elderly service.<\/p>\n\n\n\n<p>Links to each of the referral pathways for localities can be found on the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/medicineoftheelderlygeriatrics\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp MOE landing page<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>An up-to-date weight is vital (Note diurnal body weight can fluctuate by +\/- 2kg) if possible. It should be noted that it is not always possible for primary care to verify a patient\u2019s weight loss through recorded weights. This is particularly relevant for those without access to scales at home. <strong>Therefore, it is acceptable to include a strong clinical suspicion of weight loss, such as dropping dress sizes or needing a tighter hole on a belt<\/strong><\/li>\n\n\n\n<li>Dietary history<\/li>\n\n\n\n<li>Examination:<ul><li>Chest<\/li><\/ul><ul><li>Abdomen<\/li><\/ul><ul><li>Breast tissue for masses<\/li><\/ul><ul><li>Digital rectal examination for obvious masses (if alteration in bowel habit)<\/li><\/ul><\/li>\n\n\n\n<li>Assess for lymphadenopathy \u2013 cervical, axillary, inguinal<\/li>\n\n\n\n<li>Investigations<ul><li>FBC, U&amp;Es, LFTs, Albumin, Calcium, TFTs, CRP, Blood glucose<\/li><\/ul><ul><li>Myeloma screen<\/li><\/ul><ul><li>Consider Coeliac screen (if new anaemia +\/- change in bowel habit)<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Consider PSA (if new LUTS symptoms as well as DRE)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Urinalysis for haematuria, proteinuria, or glycosuria<\/li>\n\n\n\n<li>Review of mood and cognition<\/li>\n\n\n\n<li>CXR (if not done in past 6 months)<\/li>\n\n\n\n<li>Consider CT Chest Abdomen and Pelvis &#8211; <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP access to CT scan for suspected cancer (No clinically obvious primary)<\/a><\/li>\n\n\n\n<li>Consider referral to community dietician or provision of Food First\u201d\/ Nourishing Ideas Leaflet (see Resources)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>References<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Investigation and management of weight loss in older adults <a href=\"https:\/\/www.bmj.com\/content\/342\/bmj.d1732\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bmj.com\/content\/342\/bmj.d1732<\/a><\/li>\n\n\n\n<li>When should unexpected weight loss warrant further investigation to exclude cancer? <a href=\"https:\/\/www.bmj.com\/content\/366\/bmj.l5271\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bmj.com\/content\/366\/bmj.l5271<\/a><\/li>\n\n\n\n<li>BMJ Best Practice Guideline: Unintentional weight loss: <a href=\"https:\/\/bestpractice.bmj.com\/topics\/en-gb\/548\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/bestpractice.bmj.com\/topics\/en-gb\/548<\/a><\/li>\n<\/ul>\n\n\n\n<p><strong>Dietetics Resources<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2023\/03\/Nourishing_Drinks.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Dietetics Nourishing Drinks Leaflet (NHS Lothian PIL)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/policyonline.nhslothian.scot\/wp-content\/uploads\/2024\/07\/Food-First-simple-and-budget-friendly.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Dietetics Food First Nourishing ideas leaflet (NHS Lothian PIL)<\/a><\/li>\n<\/ul>\n\n\n\n<p><strong>Frailty Assessment Resources<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MoE-HatH-Rockwood-Clinical-Frailty-Scale-April-2020.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Rockwood Clinical Frailty Score <\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Frailty_Information_Resource.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Detailed Frailty Resource<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/frailty-questionnaire-self-CFS.pdf\" data-type=\"attachment\" data-id=\"27391\" target=\"_blank\" rel=\"noreferrer noopener\">Frailty Questionnaire Self-Assessment<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Weight loss and Cancer (from the Scottish Referral Guidelines for Suspect Cancer 2025) Weight loss is a non-specific symptom that poses a diagnostic challenge in primary care. It can be associated with several conditions including cancer. Published data shows that the likelihood of a cancer diagnosis is increased in the 3-6 months after the<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4118,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[313],"class_list":["post-4512","page","type-page","status-publish","hentry","category-weight-loss"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/medicineofelderlygeriatrics\/weight-loss\/\" rel=\"tag\">Weight Loss<\/a>","rttpg_excerpt":"Information Weight loss and Cancer (from the Scottish Referral Guidelines for Suspect Cancer 2025) Weight loss is a non-specific symptom that poses a diagnostic challenge in primary care. It can be associated with several conditions including cancer. Published data shows that the likelihood of a cancer diagnosis is increased in the 3-6 months after the","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4512","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4512"}],"version-history":[{"count":14,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4512\/revisions"}],"predecessor-version":[{"id":27397,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4512\/revisions\/27397"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4118"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4512"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4512"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}