Rapid Weight Loss in Adolescents: Causes and Solutions

Q: Rapid Weight Loss in Adolescents: Causes and Solutions

Hello： Your questions are as follows： "1. <br>What diseases can cause such rapid weight loss? Besides organ diseases, significant psychological stress can also be a factor, such as depression or loss of motivation in life. <br>2. <br>Which specialty should we consult? An experien

Weight decreased from 45 kilograms to 36.8 kilograms within two months?

Hello Dr.
Wang, my child is 14 years old.
Before August, his weight was 45 kg, but after two months, it has suddenly dropped to 36.8 kg.
On June 26, 2008, he was injured by a classmate before the final exam.
He was originally innocent and romantic, and had never fought with anyone; when he was hit, he didn't know how to retaliate.
That night, he couldn't sleep, and he performed poorly on the exam, which made him even more upset.
In July, he experienced chest tightness several times, but we ignored it.
His condition began on the night of August 5, 2008, when he complained of difficulty breathing and we called an ambulance to take him to the hospital.
It was determined to be hyperventilation.
An X-ray was performed that day, and his chest was normal.
An ENT consultation revealed mild throat inflammation.
After resting for an hour, no other symptoms were found, and his breathing normalized, so he was discharged.
Later, he returned to the ENT for follow-up and received some medication.
A few days later, he kept complaining of abdominal discomfort and difficulty swallowing.
The gastroenterologist performed an ultrasound and suspected bloating.
After taking medication, there was no improvement.
Subsequently, he felt abdominal discomfort every day, and despite multiple visits to the gastroenterologist, he did not improve.
His appetite decreased, and sometimes he couldn't finish a meal, leading to continuous weight loss.
He used to enjoy sports, but after school started, he often felt unwell and lacked stamina, resulting in reduced physical activity.
On September 14, his weight was recorded at 37.8 kg.
We arranged for him to receive nutritional injections, and the pediatrician suggested seeing a psychiatrist.
A few days later, we took him to see a psychiatrist, who determined that it was caused by "stress" and did not prescribe medication, instead advising him to find ways to cope with the stress.
Due to frequent feelings of bloating, we continued to give him gastrointestinal medications and encouraged him to relax.
At the end of September, we took him back to the psychiatrist, who prescribed anti-anxiety medication and a parasympathetic blocker (also a medication for hypertension).
After being ill for a long time and with continued weight loss, on October 12, he experienced chest tightness and difficulty breathing, with his weight dropping to 36.8 kg.
His blood pressure was 90/40, and he appeared very thin, losing confidence and expressing fear about being ill, sometimes even complaining that life was worse than death.
On October 12, we saw a pediatrician, who examined him and noted abdominal bloating and phlegm in the trachea, prescribing medications for bloating and respiratory issues.
We are unclear whether this is a "psychological" or "physical" issue, and we are very worried as he is just entering puberty.
We fear it may affect his height and development for life.
Could you please advise: 1.
What diseases could cause such rapid weight loss? 2.
Which specialty should we consult? 3.
What tests should be conducted? 4.
What methods can help him? Thank you for your response and assistance.

David, 10~19 year old female. Ask Date: 2008/10/13

Dr. Wang Zhengzhong reply Family Medicine

Hello: Your questions are as follows: "1.
What diseases can cause such rapid weight loss? Besides organ diseases, significant psychological stress can also be a factor, such as depression or loss of motivation in life.
2.
Which specialty should we consult? An experienced family medicine physician.
3.
What tests should be conducted? Many tests have already been performed, and numerous recommendations have been provided.
4.
What methods can help him? Mental health issues require psychological treatment, as the saying goes.
In terms of medication, options include those that relax the mind, help improve appetite, and address insomnia or anxiety.
Additionally, leisure activities, travel, and enjoying good food can also be beneficial."

Reply Date: 2008/10/13

More Info

Understanding rapid weight loss in adolescents can be a complex issue, often involving both physical and psychological factors. In the case of your 14-year-old child, the significant weight loss from 45 kg to 36.8 kg over a two-month period is concerning and warrants a thorough investigation.

1. Causes of Rapid Weight Loss
Several medical and psychological conditions can lead to rapid weight loss in adolescents:
- Psychological Stress and Anxiety: The incident of being bullied and the subsequent academic pressure may have led to significant psychological stress. Stress can manifest physically, causing symptoms such as loss of appetite, gastrointestinal discomfort, and even panic attacks, which can contribute to weight loss.

- Gastrointestinal Disorders: The complaints of abdominal discomfort and difficulty swallowing could indicate an underlying gastrointestinal issue, such as gastritis, esophagitis, or even functional gastrointestinal disorders like irritable bowel syndrome (IBS). These conditions can lead to decreased food intake and subsequent weight loss.

- Endocrine Disorders: Conditions such as hyperthyroidism can cause rapid weight loss due to increased metabolism. Although less common, it is essential to rule out any hormonal imbalances.

- Infections or Chronic Illnesses: Undiagnosed infections or chronic illnesses can also lead to weight loss. Conditions such as diabetes, celiac disease, or even malignancies can present with weight loss as a symptom.

2. Recommended Specialists
Given the complexity of the symptoms, it would be advisable to consult with a multidisciplinary team:
- Pediatrician: Start with a pediatrician who can perform a comprehensive evaluation and refer to specialists as needed.

- Gastroenterologist: If gastrointestinal symptoms persist, a gastroenterologist can conduct further investigations, such as endoscopy or imaging studies, to identify any underlying conditions.

- Psychiatrist or Psychologist: Given the psychological stressors, consulting a mental health professional is crucial. They can provide therapy and, if necessary, medication to help manage anxiety and stress.

3. Suggested Tests
To determine the underlying cause of the rapid weight loss, the following tests may be recommended:
- Blood Tests: Complete blood count (CBC), thyroid function tests, metabolic panel, and tests for infections or inflammatory markers.

- Gastrointestinal Evaluation: Depending on the symptoms, tests such as an upper GI series, endoscopy, or ultrasound may be warranted.

- Psychological Assessment: A mental health evaluation can help assess the impact of stress and anxiety on your child's eating habits and overall health.

4. Management Strategies
Addressing both the physical and psychological aspects is essential for recovery:
- Nutritional Support: A registered dietitian can help create a meal plan that ensures adequate caloric intake and nutritional balance. This may include small, frequent meals that are easy to digest.

- Psychological Support: Therapy can provide coping strategies for dealing with stress and anxiety. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety and can help your child develop healthier thought patterns and behaviors.

- Physical Activity: Encourage gentle physical activity, as it can help improve mood and appetite. However, avoid any strenuous exercise until your child’s health stabilizes.

- Family Support: Open communication within the family is vital. Encourage your child to express their feelings and concerns, and provide a supportive environment.

Conclusion
The rapid weight loss your child is experiencing is a serious concern that requires immediate attention. By addressing both the physical and psychological aspects of their health, you can help them regain their strength and confidence. It’s essential to work closely with healthcare professionals to ensure a comprehensive approach to your child’s recovery. Remember, early intervention is key to preventing long-term health issues and supporting healthy development during this critical stage of adolescence.

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