candidates for weight loss, and decide whether the time is right for them to devote the considerable attention and effort required to succeed. Individuals should expect a program to provide them with sufficient information to help assess whether they are appropriate or inappropriate potential candidates. We recommend that those contemplating a do-it-yourself or nonclinical program be evaluated first by a health-care provider (or have been assessed in the recent past) before proceeding. They should discuss the program or product with a knowledgeable health-care provider to determine whether it is sound and appropriate.
The programs themselves and their characteristics constitute the center section of the Weighing the Options model. Earlier, we described the three types of programs into which all options were placed: do-it-yourself, nonclinical, and clinical programs. Insofar as the vast majority of dieters choose to join weight-loss services or select do-it-yourself options, there is an almost total absence of controls for the efficacy and safety of weight-loss methods as actually practiced throughout the population. Because health risks may attend obesity and the process of losing weight, we believe that all programs should meet some minimum expectations. Specifically, we recommend that four critical areas be addressed by all weight-loss and weight-management programs: (1) assessment of physical health and psychological status, (2) attention to diet, (3) attention to physical activity, and (4) ensuring program safety. These critical areas are discussed in detail in Chapter 6 and summarized below.
Assessment of physical health and psychological status: Individuals considering a do-it-yourself or nonclinical program to lose weight should have some basic knowledge about their overall state of health before they begin. This is important not only because we believe that all adults should assume some responsibility for their health care, but because this self-assessment should help them determine which programs might be best for them. Many nonclinical programs screen potential clients by measuring height and weight and asking questions about health status. Ideally, however, obese individuals should have a physician review their health history and provide a physical examination, with particular attention to obesity comorbidities, prior to beginning a program. Individuals are almost always assessed by physicians as part of a clinical program.
Diet: How much one eats (and, to some extent, what one eats) is a major determinant of body weight. Therefore, food intake should play a central role in all weight-management efforts. The overall goal in obesity