Weight Loss: Is It Physical or Mental Health Issues?

I can't distinguish whether it's a physiological issue or depression-related anxiety?

Hello, doctor.
I am an 18-year-old college student.
Over the past two years, I have lost about 10 kilograms, but I did not intentionally lose weight; I just feel that my appetite is not as good as before, and my gastrointestinal system is more prone to discomfort.
Initially, I thought it was due to the stress of exams, which caused my weight loss, but my weight has not increased since then.
I tend to be sensitive, not very good at socializing, and I easily feel depressed.
I often worry about having a serious illness or terminal disease.
Last year, I had pain in my testicles and went for an examination, where the doctor also performed an ultrasound of my kidneys.
The results were normal, and they suggested it might be a varicocele, prescribing some medication, which helped.
However, my weight continued to decrease, and I felt tightness in the upper left abdomen near the ribs.
Concerned, I visited a clinic in May and underwent routine blood tests, including lipid profile, blood sugar, complete blood count, liver function tests, kidney function tests, and urinalysis, all of which were normal.
I also had an abdominal ultrasound that showed no abnormalities.
At the start of the university semester, I had a chest X-ray that indicated slight scoliosis.
I have occasionally felt chest tightness since around the first year of junior high school, so I have seen several doctors, including having an echocardiogram, which showed no abnormalities.
However, my blood pressure readings at the hospital have been quite high, around 170/80.
Therefore, I started taking blood pressure medication regularly since October of the year before last, and it is now stable, so I take half a pill daily.
After seeing so many doctors, my parents think I might be a bit neurotic, which has made me uncertain.
Recently, I have started to feel gastrointestinal discomfort again.
I am not sure if it is because I saw a K-drama where the main character has stomach cancer or if I really have a problem with my stomach.
I am unsure if I should continue with further examinations, such as an endoscopy.
Please help me analyze my situation.
Lastly, I am attaching my weight changes from my high school health check-up: 1st year (1st semester) 68.4 kg, (2nd semester) 70.1 kg; 2nd year (1st semester) 69.9 kg, (2nd semester) 66.2 kg; 3rd year (1st semester) 62.9 kg, (2nd semester) 61.4 kg; currently around 58 to 59 kg.
I would like to note that during my first and second years of high school, I had about six months of recurrent tonsillitis, and I am unsure if that has had any impact.

2321, 10~19 year old female. Ask Date: 2014/02/13

Dr. Chen Zonglin reply Family Medicine

There are many reasons for weight loss.
You may start by keeping a food diary for a period of time and then bring your previous medical reports to the school health office to consult with the school physician.
If there is no school physician available, you can also visit a nearby clinic to have a comprehensive evaluation by a family medicine doctor.
Gastrointestinal discomfort does not necessarily require an endoscopy; it is still important to have a face-to-face assessment by a physician to make a decision.
Regardless of the examination results, please do not worry excessively.
Maintaining a normal daily routine and a positive mindset is essential for good health.
Wishing you good health.

Reply Date: 2014/02/13

More Info

Understanding weight loss can be complex, as it often intertwines both physical and mental health issues. In your case, it appears that your weight loss over the past two years—approximately 10 kilograms—has not been a result of intentional dieting but rather a combination of decreased appetite and gastrointestinal discomfort. This situation can be concerning, especially for someone your age, as it may indicate underlying health issues that need to be addressed.

Firstly, it's important to recognize that significant and unintentional weight loss can be a symptom of various medical conditions. Given that you have already undergone several medical evaluations, including blood tests, ultrasounds, and X-rays, and have not found any alarming results, it may be beneficial to consider other factors that could be influencing your health. Stress and anxiety, particularly in a high-pressure environment like college, can lead to changes in appetite and digestive health. Your mention of feeling sensitive, socially withdrawn, and prone to feelings of depression suggests that mental health may play a significant role in your current situation.

The connection between mental health and physical health is well-documented. Anxiety and depression can manifest physically, leading to symptoms such as gastrointestinal discomfort, changes in appetite, and even elevated blood pressure, as you've experienced. Your high blood pressure readings, particularly at a young age, warrant attention and may be exacerbated by stress or anxiety. It's crucial to manage these mental health aspects, as they can significantly impact your overall well-being.

You mentioned experiencing testicular pain and subsequent evaluations that ruled out serious conditions. However, the anxiety surrounding your health concerns could contribute to a cycle of worry that affects your appetite and mental state. It's not uncommon for individuals who are sensitive or anxious to become hyper-aware of their bodily sensations, leading to increased stress and further physical symptoms.

Given your history of recurrent tonsillitis in high school, it's also worth considering whether chronic health issues could have long-term effects on your overall health and immune system. While your recent tests have shown no abnormalities, if you continue to experience gastrointestinal discomfort, it may be worthwhile to consult a gastroenterologist for further evaluation, including the possibility of endoscopic procedures if deemed necessary.

In terms of your mental health, it may be beneficial to seek support from a mental health professional. Therapy can provide you with coping strategies to manage anxiety and depression, which may, in turn, help alleviate some of your physical symptoms. Cognitive-behavioral therapy (CBT) is particularly effective for addressing anxiety and can help you reframe negative thoughts about your health.

In conclusion, your weight loss and gastrointestinal discomfort may be influenced by a combination of physical and mental health factors. While your medical evaluations have not indicated serious physical health issues, the psychological aspects of your health should not be overlooked. Addressing both your mental and physical health through appropriate medical care and psychological support can lead to a more comprehensive understanding of your situation and help you achieve better overall health. If you continue to experience discomfort or have concerns about your health, do not hesitate to seek further medical advice.

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