What Causes Weight Loss in Parkinson's Disease

Weight loss may indicate your Parkinson's is progressing

Person standing on a scale
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If you have Parkinson's disease (PD), you may feel that one of the few benefits of PD is weight loss, but that's not necessarily true. Weight loss in people with Parkinson's disease isn't universal, but approximately four times as many people with Parkinson's disease lose weight when compared to people of a similar age and background who do not have the disease. Most of the time, the weight loss is only mild to moderate, but some people have lost upwards of 40 or 50 pounds after their diagnosis.

Weight loss may be a "red flag" indicating more severe disease since those who experience weight loss have been found to have a faster worsening of their disease statistically. Weight loss appears to be more common in women with Parkinson's disease than with men and increases with age as well as higher doses of levodopa. 

Why People With Parkinson's Tend to Lose Weight

There are many theories about the origin of weight loss for people with Parkinson's disease. Some believe a loss of smell, which can affect appetite, leads to weight loss as well as increased energy expenditure and fat burning due to tremors and dyskinesias. Other theories point at mood disorders related to Parkinson's disease such as depression. Yet, none of these factors have been definitely confirmed as the sole cause of weight loss. 

Weight loss is thought to be more common in those who are treated with levodopa/carbidopa infusion gel (LCIG) with poor control of dyskinesias.

If you have Parkinson's disease, you may also have gastrointestinal dysfunction, which is believed to be the most likely cause of weight loss. Comorbid conditions like gastroparesis and decreased bowel peristalsis keep food from moving through the digestive at a normal pace. This decreased motion of smooth muscles in the digestive tract and elsewhere with the disease is often referred to as "autonomic dysfunction," and may lead to weight loss.

 

Risk of Malnutrition

Different than weight loss alone, malnutrition is another risk you may face if you live with Parkinson's. Studies have found malnutrition to be present for between zero and 24 percent of those with PD, with another 3 to 60 percent being at risk for malnutrition. Since there aren't many studies looking at this topic, the true numbers may be much higher than this. 

Why Weight Loss Is Concerning

Researchers have found that weight loss, defined as the loss of an average of one pound per month, is linked with a significantly lower quality of life. Though weight loss was not found to lower survival, the small sample size of some of these studies makes a true judgment of the effect of weight loss on survival difficult to assess.

One concern is that people with Parkinson's disease appear to be at a higher risk of osteoporosis, and osteoporosis is a significant cause of both illness and death in older adults. Weight loss has been found to increase the risk of osteoporosis in people with PD—people who already have an elevated risk of developing osteoporosis. Weight loss also increases the risk of pressure ulcers (bed sores), another condition which is already increased in people with PD due to a redistribution of body fat and restriction of movement.

More than just weight loss, Cachexia is another concern and is considered a significant cause of premature death.

One study found that those with PD who lost weight had faster disease progression. However, researchers aren't sure if weight loss causes Parkinson's to worsen or if weight loss is the result of more severe disease. 

Managing Your Parkinson's and Weight 

If you are concerned about the amount of weight you've lost, speak to your doctor. Beyond evaluating your Parkinson's progression, here are some tips that may help you manage your weight:

Make mealtime an enjoyable experience. Add spices and seasonings to foods to compensate for a decreased sense of taste.

Take a look at the aesthetics of eating. Improving the mood with a tasteful table, music, even candles can sometimes be as important as improving the taste of foods. Make sure you have an adequate amount of time to eat. Feeling rushed can be a hindrance, especially for those whose digestive tract smooth muscles are working more slowly than normal.

Work with professionals. Seek treatment for depression and other mood disorders you may have. You should also ask your doctor if your medications need to be adjusted as some of these may contribute to weight loss. You can also work with a nutritionist or try nutritional supplements. You can also work with a trainer or physical therapist to boost your activity. Adding a little exercise, even a small amount of physical activity, may stimulate your appetite.

Optimize your meals. Choose high-calorie foods whenever possible and don't be afraid to eat the foods you most enjoy. You should also eat at the times of day when you have the most energy as well as skip liquids and drink them after a meal instead of before or during the meal, if possible.

Sources:

Akbar, U., He, Y., Dai, Y. et al. Weight Loss and Impact on Quality of Life in Parkinson’s Disease. PLoS One. 2015. 10(5):e0124541.

Malochet-Guinamand, S., Durif, F., and T. Thomas. Parkinson’s Disease: A Risk Factor for Osteoporosis. Joint Bone Spine. 2015. 82(6):406-10.

Sheard, J., Ash, S., Mellick, G., Silburn, P., and G. Kerr. Markers of disease Severity are Associated with Malnutrition in Parkinson's Disease. PLoS One. 2013. 8(3):e57986.

Wills, A., Perez, A., Wang, J. et al. Association Between Change in Body Mass Index, Unified Parkinson's Disease Rating Scale Scores, and Survival Among Persons With Parkinson Disease: Secondary Analysis of Longitudinal Data From NINDS Exploratory Trials in Parkinson Disease Long-term Study 1. JAMA Neurology. 2016. 73(3):321-8.

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