Weight loss in children and adolescents — viva

Opening (must-hit)

"I will confirm true weight loss against baseline, quantify percentage loss, assess medical stability including cardiovascular signs and glucose red flags, then keep restrictive eating and organic disease open together while I plan safe nutrition and follow-up." [1] [2]

Branch A — Data quality

Examiner: The last weight was in clothes after sport.
Candidate: I re-weigh with minimal clothing on a calibrated scale, compare with premorbid baseline, estimate percent loss, and interpret BMI as context only — not as a veto on concern. [1] [2]

Branch B — Atypical anorexia

Examiner: BMI is still 'normal'. Why admit anyone?
Candidate: Large percentage loss plus bradycardia, orthostasis, electrolyte risk or suicidality defines medical danger. Atypical anorexia can be unstable despite non-low BMI. [1] [2]

Branch C — DKA gate

Examiner: The history also includes thirst and night wees.
Candidate: I check glucose now and assess for DKA. Polyuria, polydipsia and weight loss are new diabetes until proven otherwise. [3]

Branch D — Organic gut pathway

Examiner: Instead there is nocturnal diarrhoea and mouth ulcers.
Candidate: IBD ranks high; I take a gut-focused history, examine for perianal disease, and arrange directed tests and gastroenterology rather than assuming pure restriction. [5]

Branch E — Thyrotoxicosis

Examiner: Appetite is good with heat intolerance and tremor.
Candidate: I consider hyperthyroidism and order thyroid function rather than forcing an intake-only model. [6]

Branch F — ARFID

Examiner: There is no fat-phobia; only five accepted foods after choking.
Candidate: ARFID phenotype — still assess medical risk, micronutrients and refeeding need; involve feeding-skilled supports. [7]

Branch G — Refeeding

Examiner: How do you restart nutrition after prolonged restriction?
Candidate: Supervised plan with monitoring for phosphate, potassium and magnesium shifts and clinical complications — ASPEN-informed principles, local protocol for exact steps. Not an uncontrolled binge. [4] [2]

Branch H — Communication

Examiner: Parents feel blamed.
Candidate: I name weight loss as a medical problem with many causes, use teach-back, involve the adolescent with confidential space for safety issues, and avoid shame while keeping clear medical boundaries. [1]

Closing pearl

"Percent loss and physiology beat a single BMI number; glucose and gut red flags never close just because psychology is loud." [1] [2] [3]