Synopsis
Confirm clinically important weight loss, identify malignancy, dysphagia, inflammatory disease, endocrine illness, mental ill health and deprivation without diagnostic anchoring, and start safe nutrition support with explicit refeeding-risk management.
- Verify measured weights, timeframe, percentage change and fluid shifts; a patient's concern matters even when the available chart is incomplete.
- Malnutrition is not synonymous with low BMI: oedema and obesity can conceal major muscle loss, while ascites can make weight appear stable.
- Separate reduced intake, impaired absorption, increased requirements or losses, and catabolic disease; more than one mechanism commonly coexists.
Key red flags
Progressive dysphagia, iron-deficiency anaemia, rectal bleeding, jaundice, palpable mass, persistent vomiting, focal pain or new change in bowel habit with weight loss requires the live NICE suspected-cancer pathway.
Investigation priorities
Record current and previous weights, height, BMI, percentage loss, intake history, MUST or another validated score, grip or functional change, muscle and fat loss, oedema and hydration.
Management branches
Objective or credible weight loss accompanies a cancer, obstruction, infection or organ-failure warning sign.
- Assess urgency, hydration, sepsis, bleeding, aspiration and electrolyte disturbance; admit or escalate on the same day when unstable or unable to maintain intake.
- Use the current NICE symptom- and age-specific suspected-cancer recommendation rather than relying on a remembered threshold.