If you’ve ever worked a medical ward in Balochistan — say, with a frail old gentleman from Panjgur who insists he’s “just fine” despite clearly shrinking away in his kameez — you’ll know how tricky it can be to pin down unintentional weight loss in the elderly.
Sometimes it’s a missed malignancy. Sometimes it’s their dentures. And sometimes it’s the fact that their son changed their diet to boiled everything “for cholesterol.”
Let’s make it easy to remember.
🧠 Mnemonic: “MEALS ON WHEALS”
| Letter | Cause | Clinical Insight |
|---|---|---|
| M | Medication effects | Diuretics, SSRIs, digoxin — all can dull appetite or cause nausea |
| E | Emotional issues (esp. depression) | Often missed. Ask about anhedonia and sleep. Dr. Behroz Rahim sees it daily. |
| A | Anorexia nervosa, alcoholism | Yes, anorexia does exist in older adults (usually quiet, masked by other issues) |
| L | Late-life paranoia | Paranoid delusions about poisoned food are more common than you think |
| S | Swallowing disorders | Post-stroke, Parkinsonism, dementia — even unnoticed aspiration |
| O | Oral issues (dentures, dental pain, candidiasis) | If the roti hurts, they won’t eat it. Check inside the mouth! |
| N | No money | Can’t afford food = can’t eat food. Especially in rural Balochistan. |
| W | Wandering/dementia-related behavior | Forgetting to eat, pacing instead of sitting down for meals |
| H | Hormonal: thyroid, adrenal, parathyroid | Subclinical hyperthyroidism is a sneaky weight killer |
| E | Enteric problems (malabsorption, malignancy, IBD) | Look for loose stools, anemia, low albumin |
| A | Eating issues (can’t feed self, stroke, tremors) | Parkinson’s, post-hemiplegia, or plain arthritis |
| L | Low salt/low fat diet | Well-meaning family restrictions that take all joy out of food 🫠 |
| S | Stones & Social: Isolation, no access to food | “She eats only when her neighbour visits.” Classic case from Mashkel |
Clinical Commentary From My Hospital
I recently assessed a 78-year-old from Turbat — cachectic, MCV 104, weight loss of 7 kg in 3 months. No cancer, no IBD. Just a perfect storm of oral thrush, forgotten dentures, and a diet of boiled spinach. One week of proper dentures, nystatin, and biryani later — he was back to arguing with the nurses. A full recovery, by local standards 😅, LOL HAHA!
Happy learning, friends! 🙂
