Approach to Weight Loss/Gain

Question 1

What is the clinical definition of significant weight loss?

Answer 1

WL >5% of usual body weight over 6mths

Question 2

What are 5 psychosocial causes of unintentional weight loss?

Answer 2

Psychiatric:
1) Depression
2) Anorexia nervosa
3) Dementia

Social:
4) Poverty
5) Barriers to obtaining food (eg. physical disability)

Question 3

What are 7 organic nonmalignant causes of unintentional weight loss?

Answer 3

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

Question 4

What is the main etiology of involuntary weight loss?

Answer 4

Malignancies

Question 5

What are the 2 essential pieces of information in a weight loss/gain Hx?

Answer 5

Duration and amount of weight loss/gain

Question 6

What are features of a weight loss Hx that are indicative of cardiovascular aetiology (eg. CHF)?

Answer 6

1) SOB
2) Orthopnea
3) Dyspnea on exertion
4) Hx of Valvular heart disease or endocarditis

Question 7

What are features of a weight loss Hx that are indicative of endocrine aetiology (eg. thyroid disorders, DM, Addison’s)?

Answer 7

1) Heat intolerance
2) Tremulousness
3) Palpitations
4) Polyuria
5) Polydipsia

Question 8

What are features of a weight loss Hx that are indicative of GI aetiology (eg. IBS, Coeliac, Chronic pancreatitis)?

Answer 8

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

Question 9

What are features of a weight loss Hx that are indicative of Neurologic aetiology (eg. Parkinson’s disease, motor neuron disease, neuromuscular disorders)?

Answer 9

1) Impaired memory
2) Headaches
3) Resting tremor
4) Hx of stroke

Question 10

What are features of a weight loss Hx that are indicative of psychosocial aetiology (eg. Depression, Anorexia nervosa, Dementia, Poverty, etc.)?

Answer 10

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

Question 11

What are features of a weight loss Hx that are indicative of Respiratory aetiology (eg. COPD)?

Answer 11

1) Cough
2) Hemoptysis
3) Severe dyspnea
4) PPD+ (TB)
5) Foreign body

Question 12

What are features of a weight loss Hx that are indicative of renal aetiology (eg. ESRD)?

Answer 12

1) Hx of renal disease
2) Pruritus
3) Hematuria

Question 13

What are features of a weight loss Hx that are indicative of Rheumatologic aetiology (eg. Connective tissue disorders, vasculitis)?

Answer 13

1) Joint or muscle pain
2) Rash
3) Alopecia

Question 14

What are 5 diagnostic tests used for uncovering the aetiology of involuntary weight loss?

Answer 14

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

Question 15

What is the difference between primary and secondary weight gain/obesity?

Answer 15

Primary: imbalance in nutritional intake versus energy expenditure

Secondary: another/underlying medical condition that makes you gain weight

Question 16

What is the clinical definition of significant weight gain?

Answer 16

Weight gain of >5% of usual body weight over 6mths

Question 17

What are 5 pharmacological causes of weight gain?

Answer 17

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

Question 18

What are 5 personal/social factors that can lead to clinically significant weight gain?

Answer 18

1) Primary weight gain/obesity
2) Menopause
3) Smoking cessation
4) ↑caloric intake
5) ↓physical activity level

Question 19

What are 5 endocrinological disorders that can lead to clinically significant weight gain?

Answer 19

1) Cushing’s syndrome
2) Hypothyroidism
3) Hyperinsulinemia
4) Polycystic ovary syndrome
5) Hypogonadism

Question 20

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)?

Answer 20

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

Question 21

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)?

Answer 21

1) Cranial radiotherapy/head trauma/surgery
2) Neurological abnormalities
3) Hyperphagia
4) Decreased vision

Question 22

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)?

Answer 22

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

Question 23

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)?

Answer 23

Weight gain related to initiation or dose increase of a drug with weight gain as a potential adverse effect

Question 24

What are features of an adult weight gain/obesity Hx that are indicative of psychological aetiology (eg. Binge-eating disorder, Bulimia Nervosa, Depression, etc.)?

Answer 24

1) Severe repeated binge-eating w or w/o inadequate compensation behavior

2) Depressive complaints

Question 25

What are features of an adult weight gain/obesity Hx that are indicative of lifestyle aetiology (eg. hypercaloric intake, lack of exercise, alcohol abuse, noctural eating OSA, repeated low calorie diets with yo-yo effects)?

Answer 25

1) Unhealthy food intake
2) Lack of exercise
3) <7hrs of average sleep
4) Disturbed sleep
5) Snoring/apnea
6) Shift work
7) Alcohol use
8) Stress
9) Smoking cessation
10) Sociocultural background
11) Meal timing
12) Sedentary lifestyle

Question 26

What are 5 red flags during a weight gain/loss Hx?

Answer 26

1) Rapid onset (days/weeks)
- accumulation of fluids
- CHF, CKD, CLD

2) PND/Peripheral edema
- CHF

3) Increased in waist diameter
- ascites, GI obstruction

4) GI symptoms
- jaundice/tea coloured urine (cholestasis)
- excessive bleeding (liver failure)

5) Increase thirst or urination
- DM

6) Snoring or narcolepsy
- Obstructive sleep apnea