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It is a long held belief that weight loss is a basic indicator of surgical risk. Many experienced surgeons, however, think otherwise. We have investigated the proposition that weight loss is a risk factor for postoperative complications but only when associated with clinically obvious physiologic impairment. Before major surgery, 102 patients had a careful history taken to ascertain if there had been recent weight loss and a reduction in the capacity for activity. Physical examination included assessment of mood, skeletal muscle function, respiratory muscle function, and wound healing. Plasma albumin was also measured. Using this information the patients were placed into one of three groups. Group I (N= 43) were normal, group II (N= 17) had weight loss greater than 10% but no clinical evidence of physiologic impairment, and group III (N= 42) had weight loss greater than 10% with clear evidence of dysfunction of two or …