"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today because you've noticed you've been losing weight without trying. Is that right?"
"Before we go any further, what are your thoughts about what might be causing this weight loss, or what it might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"
"Could you please tell me more about your weight loss? Has it been unintentional, meaning you haven't been trying to lose weight?"
"How much weight have you lost? Do you know your current weight, or what your weight was before you started losing it? Sometimes people can tell by how their clothes fit, or if their belt size has changed."
"Over what period of time have you lost this weight? For example, has it been over the last 3 months, 6 months, or longer?"
"What about your appetite? Has it increased, decreased, or stayed the same? Have you noticed any changes in your taste, or developed any aversions to certain foods? Do you feel full very quickly after eating (early satiety)?"
"Can you tell me about your typical eating habits and meal patterns? What do you usually eat for breakfast, lunch, and dinner? Do you snack? How much fluid do you drink in a day? Have you changed your diet recently, perhaps because of other symptoms like difficulty swallowing or nausea?"
"How about your exercise levels? Have you been doing more physical activity or a different kind of exercise recently?"
"Have you noticed any other symptoms happening with the weight loss? This is very important. For example, have you had any fevers, night sweats, or felt unusually tired or generally unwell? (Constitutional symptoms)
"What about any stomach or bowel issues? Have you had difficulty swallowing (dysphagia) or pain when swallowing (odynophagia)? Any abdominal pain, nausea, vomiting, or feeling full quickly? Have you noticed any changes in your bowel habits, such as diarrhoea or constipation? Have you passed any black, tarry stools (melaena), or fresh blood from your back passage? Have you noticed any yellowing of your skin or eyes (jaundice)?"
"Regarding your breathing, have you had a cough, or coughed up any blood (haemoptysis)? Are you short of breath?"
"What about symptoms related to your hormones? Are you excessively thirsty, passing urine a lot, sensitive to heat or cold, or experiencing palpitations or tremor?"
"Have you had any headaches, visual changes, weakness, or numbness (neurological symptoms)?"
"How about your mood? Have you been feeling low, anxious, or losing pleasure in things you used to enjoy? Do you have any concerns about your body image?"
"Do you have any new or persistent pain anywhere in your body?"
"I also need to ask about some important 'red flag' symptoms. Has your weight loss been rapid – more than 5% of your body weight in the last 6 to 12 months? Are you having fevers, night sweats, or severe fatigue that can't be explained? Do you have persistent difficulty or pain when swallowing? Have you had persistent abdominal pain, passed black, tarry stools, or coughed up blood? Have you noticed any unexplained lumps or bumps, or yellowing of your skin/eyes? What about any new neurological symptoms?"
"Are you experiencing any other symptoms anywhere else in your body? This helps us to get a full picture and look for any other clues to the underlying cause of your weight loss."
"Do you have any existing medical conditions, such as diabetes (especially if it's new or not well-controlled), thyroid disorders (particularly an overactive thyroid), inflammatory bowel disease like Crohn's or ulcerative colitis, coeliac disease, chronic infections like HIV or tuberculosis, chronic kidney disease, chronic liver disease, or conditions that affect nutrient absorption (malabsorption syndromes)? Do you have any mental health conditions like depression, anxiety, or eating disorders? What about any history of cancer?"
"Have you ever had any operations or procedures, especially any surgery on your digestive system, or bariatric surgery for weight loss?"
"For women, I'd also like to ask a few questions about your gynaecological history. Are your menstrual periods regular? Have you been pregnant before? Are you currently going through menopause, or have you already?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? Some medications, like metformin for diabetes, thyroid hormones, stimulants (e.g., for ADHD), certain antidepressants (SSRIs can cause initial weight loss), or chemotherapy, can affect appetite or metabolism."
"Have there been any recent changes to your medications?"
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you had?"
"Does anyone in your close family – like your parents, siblings, or children – have a history of malignancy (especially gastrointestinal cancers, breast, or ovarian cancer), autoimmune diseases, thyroid disorders, or malabsorption syndromes?"
"Could you tell me a little about your living situation and who you live with? Do you have adequate cooking facilities and access to food? Do you have good social support around you? Are you able to manage all your daily activities independently? Have you experienced any recent financial difficulties that might affect your access to food?"
"How about your lifestyle? Do you smoke, and if so, how much? How much alcohol do you drink in a week? Do you use any recreational drugs?"
"What's your typical diet like, and how about your fluid intake and exercise levels? How do you manage stress?"
"Have you travelled recently, especially to areas where certain infections (like tuberculosis or parasitic infections) are common?"