Persons should be encouraged to find what works for them and should evaluate different approaches until a sustainable activity plan is developed.

  • Ensuring program safety: Generally, the more restrictive the diet, the greater are the risks of adverse effects associated with weight loss. Do-it-yourself and nonclinical programs must be relatively safe (i.e., carry minimal risk) for their clients. Clinical programs must also be as safe as reasonably possible, given that they are likely to be designed for the very obese with comorbidities and health problems. Programs must insist that clients with one or more obesity-related comorbidities be monitored. A client should expect a program to provide detailed information about any potential risks that could occur. Special attention must be paid to the safety of programs for children, pregnant women, and the elderly. There are a variety of minor and major risks associated with dieting. For example, there is an increase in the risk of gall bladder disease among people who lose weight rapidly on very-low-fat diets. Risks to health from weight loss vary with the individual and the type of program.

Our recommendations related to Criterion 2 are described below and summarized in Table 2.

Program's Perspective on Criterion 2: Is My Program Based on Sound Biological and Behavioral Principles, and Is It Safe for Its Intended Participants?

All providers should take steps to ensure that their programs are safe and sound. Nonclinical and clinical programs can provide information about the qualifications and training of staff, appropriate corporate managers, and, if desired, consultants involved in developing the program. Authors and other originators of do-it-yourself programs should cite their credentials, qualifications, and experiences in managing obesity.

Clinical programs should be able to assess the physical and psychological health of their patients. Nonclinical and do-it-yourself programs, in contrast, can only encourage clients to have such an assessment conducted by their health-care providers. All programs should encourage individuals to know their blood pressure and blood lipid concentrations; whether or not they have diabetes, osteoarthritis in weight-bearing joints, or sleep apnea; and whether a family member has died prematurely from coronary heart disease. Do-it-yourself and nonclinical programs should strongly encourage individuals who have one or more of these risk factors to be under the care of a health-care provider. These programs should develop simple checklists for clients to highlight the importance of routinely

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