Weight loss in children and adolescents — OSCE

Station brief (candidate)

• Quantify percentage loss and explain why BMI band alone is not reassurance.
• Screen for medical red flags (including polyuria/polydipsia) and restriction behaviours.
• Outline examination priorities (vitals, orthostatics) and first-line tests.
• Agree a plan: safety, nutrition restart principles, team involvement, follow-up and safety-net.
• Use respectful language with adolescent and caregiver; teach-back. [1] [2]

Role-player notes

Parent is worried but also proud of "healthy eating." Adolescent is quiet, minimises concern, and becomes engaged if spoken to directly without humiliation. If the doctor only reassures on BMI, parent relaxes incorrectly; if the doctor is shaming, adolescent shuts down. [1]

Expected candidate performance

• States ~12% loss and medical significance despite non-extreme BMI. [1] [2]
• Asks confidentially about restriction, exercise, purge, mood and safety. [1]
• Screens thirst/polyuria (glucose gate). [4]
• Plans vitals/orthostatics, directed labs, and possible medical admission criteria discussion. [2]
• Mentions refeeding awareness if nutrition will increase substantially. [3]
• Safety-nets dizziness, collapse, chest symptoms, ongoing loss, mood crisis. [2] [5]

Marking anchors