Protein-calorie malnutrition Quiz: Ace Your Exams

A 56-year-old woman presents to the primary care clinic to discuss recent weight loss. The patient has unintentionally lost 7% of her weight in the past six months and has been eating less food for more than three weeks. She has no past medical history and takes no medications. The patient’s father has hypertension, and her mother has a reported gluten intolerance. The patient had a small bowel biopsy last year which did not show pathology, and celiac disease antibodies were negative at that time. Currently, the patient works full-time as an accountant, and she owns a car and a condominium. Body mass index is 20 kg/m2. Vital signs are unremarkable. On physical examination, the patient appears well. Muscle mass is measured and is decreased from previously. Mental status exam shows no signs of anxiety, depression, or disordered eating. Initial blood work does not reveal an underlying cause for the weight loss and decreased food consumption. Which of the following is the best next step in management?