Approach to Weight Loss/Gain Flashcards
(26 cards)
What is the clinical definition of significant weight loss?
WL >5% of usual body weight over 6mths
What are 5 psychosocial causes of unintentional weight loss?
Psychiatric:
1) Depression
2) Anorexia nervosa
3) Dementia
Social:
4) Poverty
5) Barriers to obtaining food (eg. physical disability)
What are 7 organic nonmalignant causes of unintentional weight loss?
1) Cardiopulmonary:
- CHF
- COPD
2) Endocrine:
- Thyroid disorders
- DM
- Addison’s
3) Neuro:
- Parkinson’s
- Motor neuron disease
- Neuromuscular disorder
4) Renal
- ESRD
5) Rheumatological
- Connective tissues disorders
- Vaculitis
6) Malabsorption:
- IBD
- Coeliac
- Chronic Pancreatitis
7) Infective:
- HIV
- TB
What is the main etiology of involuntary weight loss?
Malignancies
What are the 2 essential pieces of information in a weight loss/gain Hx?
Duration and amount of weight loss/gain
What are features of a weight loss Hx that are indicative of cardiovascular aetiology (eg. CHF)?
1) SOB
2) Orthopnea
3) Dyspnea on exertion
4) Hx of Valvular heart disease or endocarditis
What are features of a weight loss Hx that are indicative of endocrine aetiology (eg. thyroid disorders, DM, Addison’s)?
1) Heat intolerance
2) Tremulousness
3) Palpitations
4) Polyuria
5) Polydipsia
What are features of a weight loss Hx that are indicative of GI aetiology (eg. IBS, Coeliac, Chronic pancreatitis)?
1) Altered taste
2) Smell
3) Ill-fitting dentures
4) Odynophagia
5) Dysphagia
6) Abdo pain
7) NSAID use
8) Early satiety
9) Nausea
10) Vomiting
11) Diarrhea
12) Difficult to flush stools
13) Jaundice
14) Dark urine
15) Hx of Hepatitis
16) Change in bowel habits
17) Constipation
18) Hematochezia
19) Melena
What are features of a weight loss Hx that are indicative of Neurologic aetiology (eg. Parkinson’s disease, motor neuron disease, neuromuscular disorders)?
1) Impaired memory
2) Headaches
3) Resting tremor
4) Hx of stroke
What are features of a weight loss Hx that are indicative of psychosocial aetiology (eg. Depression, Anorexia nervosa, Dementia, Poverty, etc.)?
1) Financial or social stressors
2) Living arrangements
3) Bereavement
4) Anhedonia, hopelessness, etc.
5) Alcohol screen
6) Illicit drug use
7) Sexual Hx
8) Tobacco use
What are features of a weight loss Hx that are indicative of Respiratory aetiology (eg. COPD)?
1) Cough
2) Hemoptysis
3) Severe dyspnea
4) PPD+ (TB)
5) Foreign body
What are features of a weight loss Hx that are indicative of renal aetiology (eg. ESRD)?
1) Hx of renal disease
2) Pruritus
3) Hematuria
What are features of a weight loss Hx that are indicative of Rheumatologic aetiology (eg. Connective tissue disorders, vasculitis)?
1) Joint or muscle pain
2) Rash
3) Alopecia
What are 5 diagnostic tests used for uncovering the aetiology of involuntary weight loss?
1) FBC
- anemia
- haematological malignancies
2) Renal
- CKD
3) Liver function
- hypoalbuminemia
- transaminitis
4) Thyroid function
- hyperthyroidism
5) FBG/HbaA1c
- DM
6) Rheumatological markers
7) CXR
- lung masses
- cavitating lesions (eg. TB)
- CHF
8) Mammogram
- breast masses
What is the difference between primary and secondary weight gain/obesity?
Primary: imbalance in nutritional intake versus energy expenditure
Secondary: another/underlying medical condition that makes you gain weight
What is the clinical definition of significant weight gain?
Weight gain of >5% of usual body weight over 6mths
What are 5 pharmacological causes of weight gain?
1) Glucocorticoids
2) DM meds (Sulfonylureas, insulin)
3) Anticonvulsants (gabapentin, valproic acid, carbamazepine)
4) Antipsychotics (phenothiazines, butyrophenones, atypical agents)
5) Antidepressants (TCAs, MOAis, Mirtazapine)
6) Injectable or oral contraceptives
What are 5 personal/social factors that can lead to clinically significant weight gain?
1) Primary weight gain/obesity
2) Menopause
3) Smoking cessation
4) ↑caloric intake
5) ↓physical activity level
What are 5 endocrinological disorders that can lead to clinically significant weight gain?
1) Cushing’s syndrome
2) Hypothyroidism
3) Hyperinsulinemia
4) Polycystic ovary syndrome
5) Hypogonadism
What are features of an adult weight gain/obesity Hx that are indicative of monogenetic/syndromic aetiology (eg. Prader Willi, Bardet Biedl, Allbright, 16p11.2 deletion, MC4R, Leptine R, POMC, Prohormone convertase-1)?
1) Young onset
2) Hyperphagia
3) Red hair
4) Hypopigmentation
5) Extreme weight diff btwn family members
6) Dysmorphic feature
7) Developmental delay
8) Autism/ADD
9) Short stature
10) Poly/syndactyly
11) Retinal abnormalities
12) Severe myopia
13) Congenital deafness
14) Nephropathy
What are features of an adult weight gain/obesity Hx that are indicative of hypothalamic aetiology (eg. post-radiation therapy, post-surgery, hypothalamic tumour, malformation)?
1) Cranial radiotherapy/head trauma/surgery
2) Neurological abnormalities
3) Hyperphagia
4) Decreased vision
What are features of an adult weight gain/obesity Hx that are indicative of endocrine aetiology (eg. PCOS, Hypogonadism, post-pregnancy weight retention, menopause, Cushing’s, Hypothyroidism, Growth Hormone Deficiency)?
1) Acne
2) Hirsutism
3) Irregular menses
4) Acanthosis nigricans
5) Erectile dysfunction
6) Post-pregnancy
7) Menopause
8) Bradycardia
9) Muscle weakness
10) Cushingoid features
11) Hx of radiotherapy/severe head trauma
What are features of an adult weight gain/obesity Hx that are indicative of pharmacological aetiology (eg. antidepressants, antipsychotics, anti-epileptics, corticosteroids, ß-blockers, insulin)?
Weight gain related to initiation or dose increase of a drug with weight gain as a potential adverse effect
What are features of an adult weight gain/obesity Hx that are indicative of psychological aetiology (eg. Binge-eating disorder, Bulimia Nervosa, Depression, etc.)?
1) Severe repeated binge-eating w or w/o inadequate compensation behavior
2) Depressive complaints
