Weight loss itself can be deadly, especially lean body mass (LBM). Loss of about 40% of LBM can be fatal because LBM is the site of 99% of the body’s metabolic functions. Several reports have consistently found that as many as one in five patients with cancer will die from weight loss, malnutrition, and its complications. Despite the appreciation of weight loss as a prognostic factor (of health) for more than seven decades, only recently is there a growing understanding of the science of involuntary weight loss and therapeutic options. In the 1930s, IWL of more than 10% was noted to increase complications and risk of death in surgical patients. In the 1970s, this was quantified with 10% loss as significant if it occurred within a period of six months with similar risks of 7.5% loss in three months, 5% in one month, or 2% loss in one week. Work in AIDS has shown similar findings, with adverse outcomes with weight loss as little as 3%.
IWL in small amounts is significant for a number of reasons. The significant loss of lean body mass may complicate medical conditions which include decreased muscles required for breathing and coughing, decreased extremity muscle mass and function decreased immunity, and less functional organs with impaired tolerance of medications used to treat the underlying diseases.
Beyond issues of complications and death, IWL impacts both the patient and family. People with IWL often complain that they “don’t feel like themselves.” When they look in a mirror, the frail, skeletal appearance—thin arms and legs, drawn faces, and sunken cheeks and eyes—is a constant reminder that they are facing a potentially deadly disease. Depression, a loss of self-esteem and self-confidence, is often the result of a change in body shape. People who are depressed and fatigued are less inclined to take steps to improve their health, such as preparing and eating regular nutritious meals and exercising.
