Unless a resident is on a weight management program with a goal of losing a few pounds, unintentional weight loss is not a good thing. What exactly is “unintentional weight loss”? “A loss of greater than 5% of your body weight within a 6–12-month period. However, it is important to remember that unintentional weight loss does not always mean “failure to thrive”, which is often what attending physicians will document. Failure to thrive is a syndrome where the body is wasting (cachexia) because of illness or loss of muscle mass (sarcopenia), not just weight loss. Failure to Thrive in Elderly Adults: Background, Pathophysiology, Etiology 

Dr. Eva Szymanski from Penn’s Division of Geriatrics was interviewed in a recent “Curbsiders” podcast and explained how important it is to distinguish between the two. Dr. Szymanski’s team developed the “5Ms” framework to assist providers in identifying the cause of unintentional weight loss in geriatric patients. Use the Geriatric 5Ms to Manage Unintentional Weight Loss The 5 Ms are: 

• Mentation: are there mood issues? Is there cognitive impairment? Are they depressed? 

• Medications: could medications be causing weight loss? Are we de-prescribing? 

• Mobility: How active are they? Can they get around? Can they perform their ADLs? 

• Matters: What matters? What do they value? What makes them happy? 

• Multimorbidity: What else is going on with this patient? What other illnesses could be contributing to unintentional weight loss? 

What happens if you work through the 5 Ms and can’t identify a clear cause for the weight loss? Try liberalizing their diet! Liberalizing diets is not new, in fact, many centers use liberalized diets frequently. The use of high calorie foods (super foods), 20 Foods to Help You Gain Weight and Build Muscle varying food taste, temperature, texture, and smell; make meals more social, encourage residents to “dine” versus “eating”. And of course, address any underlying mood disorders. 

Remember, unintentional weight loss can lead to more than a regulatory citation; it can impact your resident’s quality of life. It might be a good time to review your current weight logs, discuss your current menu, vary things up a little, get your QAPI team together, and hold an ad hoc meeting and most importantly, ask the residents what they would like for dinner! Even if you THINK your plan is solid, if you have residents experiencing unintentional weight loss, you could be wrong! Stay well and stay informed!