Weight Loss

Question 1

Why can weight loss occur?

Answer 1

Increased energy expenditure
Decreased energy intake
Loss of energy in stools/urine

Question 2

What is clinically significant weight loss?

Answer 2

Loss of more than 5% of baseline body weight over 6-12 months

Question 3

What are the two broad categories of weight loss?

Answer 3

Intentional

Unintentional

Question 4

Do people losing weight intentionally through diet and exercise present to the doctor?

Answer 4

Rarely

Question 5

What is the relationship between weight loss and appetite?

Answer 5

Important to ask if there’s an increase or decrease in appretite, as this can help point to underlying cause

Question 6

What can cause weight loss with an increased appetite?

Answer 6

Increased metabolism due to thyrotoxicosis
Loss of energy in
- Urine due to diabetes mellitus
- Stools due to malabsorption

Question 7

What can cause weight loss with decreased appetite?

Answer 7

Organic diseases
- Cancer
- Infections
- Upper GI disorders
- Severe cardiopulmonary conditions
Some medications
Psychological/psychiatric conditions
- Depression
- Anxiety
- Substance abuse

Question 8

What proportion of cases of weight loss are unexplained?

Answer 8

25%

Question 9

Is sudden, unexplained weight loss of concern?

Answer 9

Yes

Question 10

Is unexplained weight loss in the elderly of concern?

Answer 10

Yes

Question 11

In a young person with unexplained weight loss, what psychological condition can be considered?

Answer 11

Eating disorder

Question 12

What focused questions can you ask if you suspect hyperthyroidism as a cause of weight loss?

Answer 12

Heat intolerance

Tremor

Question 13

What focused questions can you ask if you suspect malabsorption as a cause of weight loss?

Answer 13

Change in bowel habit

Blood in stools

Question 14

What focused questions can you ask if you suspect diabetes as a cause of weight loss?

Answer 14

Polyuria
Polydipsia
Polyphagia
Family history - especially of T2D
Abdominal pain

Question 15

What focused questions can you ask if you suspect cancer as a cause of weight loss?

Answer 15

Fever
Night sweats
Bone pain

Question 16

What focused questions can you ask if you suspect medications as a cause of weight loss?

Answer 16

Recent change in medication
Recreational drugs
Thyroxine
Anything causing persistent GI upset

Question 17

What is the relationship between tumour burden and a change in weight and/or appetite?

Answer 17

Substantial amount of tumour mass needed to change weight and appetite

Question 18

Where can relatively small tumours be and still causes weight loss and changes in appetite?

Answer 18

Brain

Upper GI > causing dysphagia

Question 19

What can you ask about the site of weight loss?

Answer 19

Usually not helpful

Sometimes person loses weight more in some areas than others

Question 20

What can you ask about the quality of weight loss?

Answer 20

Intentional or unintentional
Have you been trying to lose weight?
KEY CARDINAL FEATURE

Question 21

What can you ask about the severity of weight loss?

Answer 21

How much weight in kilos do you think you have lost?

Have your clothes become looser?

Question 22

What can you ask about the time course of weight loss?

Answer 22

When did you first notice the weight loss?

Sudden unexplained weight loss should raise concern

Question 23

What can you ask about the context of weight loss?

Answer 23

Age
Change in lifestyle
- Diet
- Physical activity

Question 24

What can you ask about the aggravating factors of weight loss?

Answer 24

Can you think of something that might have caused the weight loss?
Have you started on a new medication recently?

Question 25

What can you ask about the relieving factors of weight loss?

Answer 25

Does anything limit the weight loss?

Question 26

What can you ask about the associated features of weight loss?

Answer 26

``` Have you noticed a change in your appetite? GI symptoms Endocrine symptoms Infection symptoms Malignancy symptoms ```