Weight Loss

INTRODUCTION

Weight loss is an important symptom because it usually implies a serious underlying disorder, either organic or functional.

Key history Document the weight loss carefully and evaluate the patient’s recordings. Determine food intake and obtain the help of an independent witness such as a spouse or parent (if possible). Food intake may be reduced with psychogenic disorders and cancer but increase with endocrine disorders such as diabetes and hyperthyroidism, and with steatorrhoea.

Key examination

Consider:

• vital parameters (e.g. BMI, pulse, BP, temperature, urine analysis [dipstick])

• thyroid and signs of hyperthyroidism

• abdominal examination (e.g. organomegaly, masses)

• rectal examination

• look for acid dental erosion on surface of upper teeth (bulimia)

Key investigations

Consider:

• FBE

• ESR/CRP

• thyroid function tests

• U&E

• HIV

• blood sugar

• faecal occult blood

• CXR

• endoscopy upper GIT

• specific imaging (e.g. CT scan abdomen)

FAILURE TO THRIVE

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EATING DISORDERS IN THE ADOLESCENT

Anorexia nervosa

Characterised by the obsessive pursuit of thinness through dieting with extreme weight loss and disturbance of body image. It has the highest mortality and suicide rate of any psychiatric disorder. Refer to the SCOFF screening tool.

Typical features

• Adolescent and young adult females

• Up to 1% incidence among 16-yr-old schoolgirls

• Bimodal age of onset: 13–14 and 17–18 yrs

• Unknown cause

• Amenorrhoea

• Sallow, dry and scaly skin, hair loss

• ↑ Lanugo body hair

Bulimia nervosa

Bulimia is episodic secretive binge eating followed by self-induced vomiting, fasting or the use of laxatives or diuretics. There are 2 types: purging and non-purging (fasting + excessive exercise)

Typical clinical features

• Young females

• Begins at later ...