Weight loss in children and adolescents — formative SAQs

SAQ 1 (10)

A 15-year-old has lost 10 kg (about 12% of premorbid weight) over five months. BMI remains on the 35th percentile. Resting heart rate is 46/min with orthostatic dizziness. The young person describes fear of fatness and compulsive running. Caregivers thought the BMI chart was reassuring. [1] [2]

1. State the problem representation and explain why BMI percentile alone is insufficient. (3) [1] [2]
2. List immediate medical assessment priorities and admission-oriented risk features. (3) [2] [6]
3. Outline a stepwise management plan including refeeding awareness and multidisciplinary care. (4) [2] [4] [1]

Model answer

Problem representation. Adolescent with large percentage weight loss, bradycardia and body-image-driven restriction — medically significant restrictive eating (atypical anorexia pattern possible despite non-low BMI). BMI band does not cancel percent loss or physiology. [1] [2]

Medical priorities. ABCDE if unwell; resting HR, orthostatic vitals, temperature; electrolytes including phosphate/Mg/K; ECG as indicated; suicide/safety screen; quantify percent loss. Admission-oriented features: bradycardia, orthostasis, electrolyte abnormality, medical instability, suicidality, failed outpatient care, rapid ongoing loss. [2] [6]

Plan. Medical stabilisation pathway if unstable; supervised nutrition restart with refeeding monitoring principles (PO4/K/Mg); dietetic and family-based/mental-health pathway in parallel; clear follow-up and safety-net; avoid shaming. [2] [4] [1]