Medically Fit For Exams
Medically Fit For Exams

Weight loss history taking

Weight loss history taking


Differential diagnoses

Cancer (colorectal, lung, pancreatitis, bladder, liver etc)




Coeliac disease

Inflammatory disease (RA, SLE, valculitis)

Viral/bacterial illness, acute or chronic (inc. TB)

Eating disorder (anorexia nervosa, bulimia nervosa)

  • Wash hands and introduce yourself
  • Check the patient’s name and DOB
  • Ask if it’s okay to talk to the patient before they see the doctor


History of presenting complaint

  • Ask what has brought the patient in today
  • Ask them to tell you more about their weight loss
  • Make sure you find out the following about the weight loss:
    • How much weight they’ve lost (absolute and relative)
    • Over how long
    • If they’ve been trying to lose weight (ED)
    • If their appetite has changed (hyperthyroid)
    • If their level of exercise has increased (ED)
    • Ask when they last weighed themselves (reliability)
    • Ask if they have noticed clothes/belts/rings being too big (reliability)
  • Ask about fever and night sweats (TB, RA, IBD)
  • Cancer screen
    • Coughing (+ blood)
    • Vomiting blood
    • Melena
    • Change in bowel habits (+ blood)
    • Blood in the urine
    • Difficulty swallowing
    • Abdominal pain
    • Back pain
    • Excess bruising
  • Thyroid screen
    • Palpitations + tachycardia
    • Diarrhoea
    • Increased appetite
    • Tremors
    • Sensitivity to heat
  • Diabetes screen
    • Polyuria/nocturia
    • Polydipsia
    • Diabetes family history
  • Coeliac screen
    • How much gluten in your diet?
    • Abdo pain/ diarrhoea after eating (gluten)
  • IBD screen
    • Diarrhoea
    • Abdo pain
  • RA screen
    • Joint pain
  • Systems enquiry if necessary
    • ‘I’d like to ask you a series of quick questions about the rest of your health’
    • Headaches, faints, fits
    • Change in vision or sensation
    • Breathlessness
    • Chest pain
    • Abdo pain
    • Change in bowel habits
    • Changes in waterworks
  • Summarise and check what the patient has told you


Past medical history

  • Ask if they have any current or previous medical problems
  • Previous surgery
  • History of cancer


Drug history

  • Ask if they take any medications, and about recent changes
  • Ask if they take over the counter medications
  • Ask about supplements



  • Ask if they have any allergies
  • Ask what happens


Family history

  • Ask if any family members have any serious health problems
  • Ask about:
    • Diabetes
    • Cancer
    • Thyroid


Social history

  • Ask about smoking + pack years
  • Ask about alcohol intake + weekly units
  • Ask about occupation
  • Ask about who they live with
  • Ask about coping at home/type of accommodation (especially if old)



  • Ask if the patient has any questions or any concerns
  • Ask if they think you have missed anything
  • Summarise again if appropriate
  • Thank the patient for talking to you



Cancer referrals for weight loss

>40, weight loss + abdo pain


2 week wait referral

<50, weight loss + rectal bleeding


2 week wait referral

>40, weight loss + ever smoked

Lung or mesothelioma

2 week wait CXR

>40, weight loss + asbestos exposure


2 week wait CXR

>40, weight loss + cough OR fatigue OR SOB OR chest pain OR appetite loss

Lung or mesothelioma

2 week wait CXR

>55, weight loss + upper abdo pain OR dysphagia OR reflux

Oesophageal or stomach

2 week wait gastroscopy

>55, weight loss + raised platelets OR nausea OR vomiting

Oesophageal or stomach

Non-urgent gastroscopy

>60, weight loss + diarrhoea OR constipation OR back pain OR abdo pain OR nausea OR vomiting OR new-onset diabetes


2 week wait CT or ultrasound if not available




Weight loss history taking.docx
Microsoft Word document [18.2 KB]

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