Rationale

Weight loss may be a symptom of a serious underlying condition.

Causal Conditions

(list not exhaustive)

1. Decreased nutritional intake

   1. Psychiatric disease (e.g., anorexia nervosa, bulimia)

   2. Medical disease (e.g., chronic illness, esophageal cancer)

   3. Illicit drugs or medications (e.g., alcohol, opiates, cocaine, amphetamines, anticancer)

2. Increased energy expenditure

   1. Hormonal (e.g., hyperthyroidism)

   2. Chronic illness (e.g., chronic obstructive pulmonary disease, congestive heart failure)

   3. Malignancy

   4. Infection

   5. Excessive physical activity (e.g., runners)

3. Caloric loss

   1. Malabsorption (e.g., diarrhea)

   2. Diabetes

Key Objectives

Given a patient with weight loss, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. In particular, the candidate will investigate for underlying medical conditions where appropriate.

Enabling Objectives

Given a patient with weight loss, the candidate will

1. list and interpret critical findings, including

   1. identify the primary mechanism of the weight loss (e.g., decreased nutritional intake, increased expenditure);

   2. recognize the features of anorexia nervosa where present;

   3. identify the medical consequences of the weight loss;

2. list and interpret critical investigations, including

   1. assessment of the nutritional status of the patient, including appropriate laboratory investigations;

   2. investigation of potential underlying medical condition (e.g., blood glucose, thyroid-stimulating hormone);

   3. investigation of social and family history (psychosocial stressors);

3. construct an effective initial management plan, including

   1. initiate nutritional support or counselling, where needed;

   2. initiate treatment of underlying medical condition, if appropriate;

   3. refer the patient for specialized care, if necessary.