Appetite As A Vital SignThursday, May 23, 2019
As any clinician knows, changes in appetite are an important part of taking a good medical history. While loss of appetite is generally a warning sign that your patient may be seriously ill (sometimes, loss of appetite is the first sign of an illness – physical or mental), an increase in appetite may likewise indicate a serious problem.
In order to assess whether the reported change in appetite is clinically relevant, it is important to follow any appetite question with a “weight change” question. Thus, if a patient reports loss of appetite, an obvious follow-up question would be to ask whether the patient has lost weight. In contrast, if the patient reports an increase in appetite, it is only fair to ask if this has been associated with weight gain. In fact, even if the patient says that their appetite has not changed, it would be fair to ask if their weight has been stable.
While some patients (and clinicians) may be wary of bringing up the issue of weight, no patient in my experience has ever objected to being asked about their appetite. In addition, no patient has ever objected to being asked a weight question after first being asked about their appetite.
Thus, in my experience, the easiest way to start a conversation about body weight, is to begin by asking about appetite.
A typical conversation could run as follows:
Clinician, “So have you notice any change in appetite?“
Patient, “Funny you should ask, yes, I seem to be particularly hungry after dinner, I often have to eat a sandwich before I go to bed“
Clinician: “So have you noticed any change in your weight?“
Patient: “Well, I think I may have gained a few pounds since I last saw you“
Clinician: “Is that something that concerns you, something you’d like to talk about?“
Obviously, the tone of this conversation needs to be completely non-judgemental and if the patient is not interested or willing to talk about this issue, we can always park this discussion for later.
In any case, if you’ve ever wondered how to start a discussion about body weight with a patient, try first talking about appetite. As a mnemonic, I call this the A&W (Appetite & Weight) approach to discussing body weight.