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Weighing the Options: Criteria for Evaluating Weight-Management Programs
ASSESSMENT OF PHYSICAL HEALTH AND PSYCHOLOGICAL STATE
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. Since weight-management programs provide a service that can potentially improve or worsen the health of their clients, nonclinical or clinical programs that do not provide screenings of some kind should not be considered acceptable.
At a minimum, a person beginning a do-it-yourself program should measure body weight and height to calculate body mass index (BMI) and measure waist and hip circumference to obtain the waist-to-hip ratio. A nonclinical program should take these measurements and provide the client with the results. If a patient is being treated for obesity by a health-care provider, standards of acceptable medical practice should be followed. Weight-reduction efforts should not be made a prerequisite for treating a patient for conditions associated with obesity except for some types of elective surgery where obesity would compromise substantially the chance of success. A physical examination of the obese individual should include the standard components (e.g., measurements of weight and height; assessment of vital signs), as well as measurements of blood pressure and blood glucose and cholesterol concentrations, which indicate the status of comorbid conditions. The health-care provider should also conduct some type of psychological evaluation, perhaps using one or more of the scales, questionnaires, and other assessment instruments described in Appendix A. Screening for bulimia, binge eating, and depression is important because all require special attention if identified.
Certain questions should be posed by or to individuals before they begin any weight-management program. For a person interested in undertaking either a do-it-yourself or a nonclinical program, the answers will help him or her to determine which of the programs in these two categories are most likely to be successful or whether evaluation and advice from a health-care provider is called for first. A health-care provider should ask these questions as part of the patient assessment, and a