Weight Loss, Even Intentional Weight Loss, Associated with Cancer

Losing weight is hard — success might signal that something else is wrong.

F. Perry Wilson, MD MSCE

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As anyone who has been through medical training will tell you, some little scenes just stick with you. I had been seeing a patient in our resident clinic in West Philly for a couple of years. She was in her mid-60s with diabetes and hypertension and a distant smoking history. She was overweight, and had been trying to improve her diet and lose weight since I started seeing her, without much luck. One day she came in and was delighted to report she had finally started shedding some pounds — about 15 in the last two months.

I enthusiastically told my preceptor that my careful dietary counseling had finally done the job. She looked through the chart for a moment and said… yeah… is she up to date on her cancer screening? A workup revealed adenocarcinoma of the lung. She did well, actually, but the story… you know… stuck with me.

The textbooks call it “unintentional weight loss”, often in big scary letters and every doctor will go just a bit pale if a patient tells them that, despite efforts not to, they are losing weight.

But true unintentional weight loss is not really that common. After all, most of us are at least half-heartedly trying to lose weight all the time. Should doctors be worried when we are successful?

A new study suggests that, perhaps, they should.

We’re talking about this study, appearing in JAMA, which combined participants from two long-running observational cohorts: 120,000 women from the Nurses’ Health Study, and 50,000 men from the Health Professionals Follow-up Study. (These cohorts started in the 70s and 80s so we’ll give them a pass on the gender-specific study designs).

The rationale of enrolling healthcare providers in these cohort studies is that they would be reliable witnesses of their own health status. If a nurse or doctor says they have pancreatic cancer, it’s likely they truly have pancreatic cancer. Detailed health surveys were distributed to…

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F. Perry Wilson, MD MSCE

Medicine, science, statistics. Associate Professor of Medicine and Public Health at Yale. New book “How Medicine Works and When it Doesn’t” available now.