Appetite loss refers to a decreased urge to eat due to various factors like infections, medical conditions, psychiatric disorders, or medications. The article highlights the importance of history, warning signs, and appropriate interventions for individuals with appetite loss.

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Anyone may lose their appetite, and there are several causes for this. People may lose interest in food, feel nauseous at the thought of eating, or have a decreased urge to eat.

If a person is not consuming enough food to fuel their body, they may also suffer exhaustion and weight loss, in addition to losing their appetite. In this post, we'll examine the approach to such patients with a lack of appetite.

The significance of collecting a thorough history and warning signs in people with appetite loss.

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Telltale signs

• Age more than 55
• Noteworthy unintentional reduction in weight
• New-onset dyspepsia
• Dysphagia
• Symptoms increasing doubt of malignancy
• Signs of alcoholism
• Consistently low mood
• Mini-Mental State Examination (MMSE) score, or equivalent indicating cognitive impairment
• Genitourinary, gastrointestinal, or respiratory symptoms
• Loss of taste or smell causing a loss of appetite

When asking about additional presenting symptoms, you could learn that the patient has lost their appetite. A focused history is essential since it has a wide range of differential diagnoses.

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The course of history

1. It's critical to comprehend what the patient means when she/he says she/he they have lost their appetite. Try to ascertain what their typical appetite is and how long ago their appetite was at its peak. The patient may not have noticed their lack of appetite, but friends or relatives may have.
2. Ask the patient if they can explain why they believe they have lost their appetite and if anything in their lives has changed that may be the cause. Find out why the patient came in at this time.
3. When the lack of appetite started, what the patient eats daily, and if there are any accompanying physical symptoms that prevent the patient from eating (such as dysphagia, odynophagia, epigastric discomfort, or reflux) are all significant aspects of the history.

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Some potential reasons for not feeling hungry

Short-term or long-term bacterial or viral infections, such as COVID-19.

• Moderate to severe frailty, now a recognised diagnosis
• Metabolic issues, like hypothyroidism
• Malignancy
• Gastrointestinal conditions, like gastritis, duodenitis, or oesophagitis
• Psychiatric disorders, like depression, anxiety, alcohol or drug dependence
• Cognitive impairment
• Eating disorders
• Chronic conditions, like chronic obstructive pulmonary disease (COPD)
• Certain drugs, like opiates and tricyclic antidepressants

If the patient has an acute illness and a brief history of lack of appetite, reassure them that their appetite will return after their infection clears up. Find out whether they have lost their sense of taste or smell, since this may indicate a COVID-19 infection.

Loss of appetite and changes in bowel habits are potential effects of celiac disease.

A key factor might be respiratory problems. Patients with respiratory tract infections, especially kids, often report losing their appetite.

Further testing is necessary in cases with loss of appetite accompanied by a history of recurrent night sweats in order to rule out chronic infection, HIV, or haematological malignancy. Another potential factor is tuberculosis. Its frequency is greater in certain regions of the nation.

Loss of appetite is a common symptom on many of these measures used by doctors to determine which group of symptoms have the greatest and lowest positive predictive values for cancer.

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Cancer, frailty, and psychiatric problems are also factors

1. A chronic condition like COPD may cause patients to have less of an appetite.
2. Along with moderate or severe frailty, appetite loss is a frequent symptom of advanced dementia. Consider referring someone to a memory clinic if they exhibit signs of cognitive impairment, such as a substantial memory issue that affects function.
3. Consistently poor mood, early morning wake-up, weight loss, anergia, lack of attention, anhedonia, helplessness and despair are only a few symptoms that might indicate a psychological cause.
4. A risk assessment is crucial if there is evidence of depression. As alcoholism sufferers have decreased appetites, you should inquire about the patient's drinking habits.

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The queries to ask during a virtual consultation

1. If you are familiar with the patient, you may be able to watch for indications of cachexia or weight loss through a video connection.
2. It could become obvious that there is a cognitive impairment below. Over the phone or over a video link, some diseases, including depression or alcoholism, may have certain characteristics that may be recognised, such as a flat affect or sluggish speaking.

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Consultation in person

1. Wear the proper protection if a direct face-to-face consultation is required. Look out for cachexia symptoms. Keep an eye out for any signs of cognitive decline or lack of emotion.
2. The past will serve as a guide for the remaining investigation. There may be a need for a thorough gastroenterological evaluation. The neck and throat may need to be examined if the patient has odynophagia. Additionally, you may want to feel for lymph nodes and look for any abdominal organomegaly.
3. The patient should be weighed and have their body mass index (BMI) determined. Compare these numbers to any earlier values found in their archives. Ask the patient or a caretaker whether they can use a BMI calculator to provide an updated BMI if the assessment is being done remotely.

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Investigations should proceed in more detail

• Other tests include: Blood tests, such as FBC, LFTs, U&Es, ESR, coeliac screen, and HIV serology
• Helicobacter pylori stool antigen, if dyspepsia symptoms are present
• A chest X-ray, if clinically necessary
• An abdominal ultrasound, if necessary. although a referral from general care may be necessary for more in-depth imaging, such as an urgent CT of the chest, abdomen, and pelvis, this will depend on local availability
• Depression testing 
• A test for alcohol use
• COVID-19 test
• A cognitive test that is comparable to the MMSE, such as the Six-Item Cognitive Impairment Test (6CIT) or the GP evaluation of cognition (GPCOG)

Loss of appetite is a symptom of reflux illness. An urgent endoscopy may be required if the patient is above 55 years old and this is a fresh onset. To rule out cancer, lower gastrointestinal examinations may be necessary.

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Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.