Ask Dr. Keith Roach M.D When underweight closes in on malnourished, it’s time to look for a medical cause

Ask Dr. Keith Roach M.D

When underweight closes in on malnourished, it’s time to look for a medical cause

DEAR DR. ROACH: I have a problem that is opposite many other peoples'. I lost 10 pounds, going from 130 to 120. I am 5 foot 7 inches tall. I would appreciate receiving information on what foods to eat to gain weight. — H.E.

ANSWER: I hear this question occasionally, and it makes me nervous. Unexplained weight loss has many possible causes, and since they are potentially very serious, it always is worth an evaluation by your doctor.

Weight change in anyone is an issue of calories in against calories out; however, that simple equation hides several important truths. Calories taken in as food are expended as energy. We require a certain number of calories a day to maintain our body functions, perhaps 1,200 or so calories a day, but we may expend many more in activities. Moreover, we can lose calories, both through the intestines (malabsorption, such as sprue) and through the kidney (sometimes protein but most often sugar, in uncontrolled diabetes).

The metabolism also may be increased, especially through an overactive thyroid, but also through active cancer. (Cancer causes weight loss via several different mechanisms, an important one being suppressing appetite).

Depression is a frequent cause of weight loss, and it is sometimes not recognized by patient or physician. Eating disorders, especially anorexia nervosa, can cause life-threatening weight loss, and may go unrecognized. Although they occur most commonly in adolescents, they can occur in older adults as well.

I had one patient with unexplained weight loss that, despite extensive testing, I just could not find a cause for. It wasn't until I visited her home that I found out she had literally no food to eat at home, and she was too embarrassed to tell me she couldn't afford it.

So, although I certainly could give you a list of highcalorie foods to eat, I'd urge you to get it from your doctor, after a thorough evaluation. I am very concerned by your current weight and your body mass index of 18.8, which puts you into the borderline malnourished zone.

DEAR DR. ROACH: In a recent column, you referred to the DNR (do not resuscitate) order. What do you think of having the DNR tattooed on the inner wrist, where hospitals place a plastic band? This would prevent a doctor or family from changing the wish of the patient. — S.B.

ANSWER: I understand this concern very well. People are concerned that their wishes might not be respected, and at least one study has shown that this is a valid fear, with only 46 percent of DNR decisions by hospitalized patients being understood by their doctors. In fact, I have known not one, but several physicians and nurses with large DNR tattoos on their chests, where the paddles to administer electric shocks would go.

Unfortunately, a tattoo is not necessarily a reflection of a reasoned decision. A recent published article involved a case of a DNR tattoo placed as part of a drinking game, and the person wanted attempted resuscitation. A tattoo cannot be honored as a legal document. Speak to your doctor or other provider about your wishes and about documenting them. A POLST form (www.polst.org) is a legally binding form accepted in many states. More information is available at www.agingwithdignity.org, http://bit.ly/20WY76J and www.caringinfo.org. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cor nell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.

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