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Licensed Unlicensed Requires Authentication Published by De Gruyter April 21, 2023

Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care

  • Goutham Rao EMAIL logo , Kelsey Ufholz ORCID logo , Paola Saroufim , Harry Menegay and Mark Beno
From the journal Diagnosis



Identify the incidence, rate of physician recognition, diagnostic practices and cancer outcomes for unintentional weight loss (UWL).


We completed a secondary analysis of structured and unstructured EHR data collected from adult patients between January 1, 2020 and December 31, 2021. We used four common definitions to define UWL, excluding patients with known causes of weight loss, intentional weight loss, and pregnancy. Unstructured physicians’ notes were used to identify both intentional weight loss (e.g. dieting) as well as physician recognition of UWL. Cancer outcomes were identified within 12 months of UWL using diagnostic codes. Physician actions (lab tests, etc.) in response to UWL were identified through manual chart review.


Among 29,494 established primary care patients with a minimum of two weight measurements in 2020 and in 2021, we identified 290 patients who met one or more criteria for UWL (1 %). UWL was recognized by physicians in only 60 (21 %). UWL was more common and more likely to be recognized among older patients. Diagnostic practices were quite variable. A complete blood count, complete metabolic profile, and thyroid stimulating hormone level were the three most common tests ordered in response to UWL. Five patients were diagnosed with cancer within 12 months of UWL (3 in whom UWL was recognized; two in whom it was not.)


Unintentional weight loss is poorly recognized across a diverse range of patients. A lack of research-informed guidance may explain both low rates of recognition and variability in diagnostic practices.

Corresponding author: Goutham Rao, MD, Jack Medalie Professor and Chairman, Department of Family Medicine and Community Health, University Hospitals and Case Western Reserve University, 11100 Euclid Avenue, Lerner Tower, Suite 1056, Cleveland, OH 44106, USA, Phone: (216)-844-3791, Fax: (216)-844-3799, E-mail:

Award Identifier / Grant number: 1R18HS029358-01

  1. Research funding: The work described in this manuscript was funded by AHRQ award 1R18HS029358-01 for the University Hospitals ADVANCE (Advancing Diagnosis through Validated Analytics and Novel Collaborations for Excellence) Center.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and have approved its submission.

  3. Competing interests: None for any of the authors.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies, and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013),and has been approved the Institutional Review Board of University Hospitals of Cleveland.

  6. Data availability: The data analyzed in this study can be made available on reasonable request in completely de-identified for only.


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Supplementary Material

This article contains supplementary material (

Received: 2023-01-05
Accepted: 2023-04-07
Published Online: 2023-04-21

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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