UH Study Highlights Need for Conservative Approach to Unexplained Unintentional Weight Loss Evaluation

• A new study examining the evaluation of unintentional weight loss (UWL) calls into question the widespread use of routine diagnostic testing when weight loss is unexplained, and underscores the need for a more conservative approach.
• Until this study, there was a lack of evidence-based guidance on how to best manage UWL.
• This study finds that serious conditions as causes of unexplained unintentional weight loss, including cancer, are uncommon.

CLEVELAND - Researchers at University Hospitals Cleveland Medical Center have completed a study aimed at improving how physicians evaluate unintentional weight loss, a common but challenging clinical problem, particularly among older adults.

The research was completed by the UH ADVANCE (Advancing Diagnosis through Validated Analytics and Novel Collaborations for Excellence) Center, a diagnostic error center of excellence funded by the Agency for Healthcare Research and Quality (AHRQ).

The UH ADVANCE Center found that diagnostic abnormalities were no more likely to occur among adults with unintentional weight loss than among comparison patients. In the vast majority of cases, the weight loss was not linked to a serious underlying condition. Researchers found the overall rate of cancer among patients with unintentional weight loss to be .7%.

Unintentional weight loss (UWL) frequently triggers extensive diagnostic evaluations, as physicians seek to rule out serious underlying causes. Researchers found that unintentional weight loss remains under-recognized in primary care settings, consistent with previous findings. In only 38% of cases UWL was recognized by physicians. When it is identified, physicians often respond with extensive testing. The study used electronic health record data to identify more than 3,000 patients with unintentional weight loss. Common diagnostic tests and procedures were compared among patients with recognized UWL and patients without UWL.  

The study showed none of the tests were more likely to be abnormal in patients with recognized UWL compared with patients without UWL. Based on this surprising finding, with a stakeholder panel, the UH ADVANCE Center developed a set of conservative recommendations for diagnostic evaluation of  UWL. While careful inquiry into causes of weight loss such as depression, lack of access to food, and chronic diarrhea is recommended, routine laboratory and other testing when such findings aren’t present is not recommended.

“These findings are striking,” said first author Goutham Rao, MD, Chief Clinician Experience Officer, University Hospitals Cleveland Medical Center. “They challenge long-standing assumptions and highlight the need for a more measured, evidence-based approach when we can’t find an obvious cause of weight loss. Our results can help clinicians better balance thorough evaluation and avoid unnecessary tests and procedures.”

Rao and his team recommend asking all patients who have lost weight the simple question, “I see you’ve lost X pounds since I last saw you. Can you tell me more about that?” That simple question is first likely to reveal whether the weight loss is intentional or point to another cause. If no obvious cause is present, Rao and his team recommend weekly self-weighing to monitor weight, rather than extensive testing. “Most patients who lose weight unintentionally gain it back within a year,” Rao noted.

In the future, researchers hope to see this recommendation incorporated into clinical decision support in electronic health records systems to raise awareness of UWL to both caregivers and patients.

“Despite how common unintentional weight loss is, there has historically been little evidence-based guidance to help clinicians determine the most appropriate evaluation,” said Rao. “Our goal is to provide physicians with data-driven insights into how often serious abnormalities are actually found and how best to approach care for these patients.”

The study began in 2022 and concluded in 2025 with the goal of providing physicians guidance on how to manage patients who are losing weight without trying. This study adds new evidence to guide caregivers in managing unintentional weight loss, with the potential to improve patient experience, reduce unnecessary testing, and support a more accurate and efficient diagnosis.