should include improvement in one or more of these comorbidities if present to a degree considered clinically significant by a health-care provider.

Improved Health Practices

Improved health practices include obtaining health-related knowledge; engaging in good eating habits and regular physical activity; obtaining regular medical attention, particularly regular screening if one has not achieved a healthy weight (to identify as early as possible the presence of comorbid conditions); and improving self-esteem and attitudes about self-care. Such practices help to maximize one's chances for successful weight management, decrease the risks of developing a variety of degenerative chronic diseases, and enable many major medical problems to be caught at an early stage.

Obese individuals, as they go through treatment, should develop a reasonable understanding of the disease, including its causes and treatments, the benefits of diet and exercise, the effects of excess weight on the body over time, and the benefits to health from weight loss. Short of giving individuals tests as they begin and complete a program to see if knowledge of obesity has increased, this component can be assessed indirectly by evaluating whether basic information about obesity is presented by the option (e.g., discussed prominently in a diet book or as part of the classes and counseling sessions in a commercial program) and whether the individual reads or hears it (e.g., reads the book in its entirety or attends most of the classes and counseling sessions of the program).

Eating habits can be assessed by using one of the dietary assessment tools in Appendix A. For practical purposes, we define a good dietary pattern as one where the individual meets the recommendations of the Food Guide Pyramid on at least 4 of 7 days. (Such a dietary pattern might be inappropriate during the treatment phase of a clinical program where specially formulated products are used. During this period, the standard of nutritional adequacy should be meeting the Recommended Dietary Allowances for all nutrients except energy over the course of a week.) Again for practical purposes, we define regular physical activity as the accumulation of one-half hour or more of moderate-intensity activity (such as brisk walking) four or more times a week, and preferably daily. We believe it prudent for an obese individual to see a physician at yearly intervals for a physical examination and appropriate follow-up. Individuals who have not achieved a healthy weight (such as a BMI of less than 25 through age 34 and less than 27 beyond age 34; see Chapter 2) either have obesity-related comorbidities or are at risk of developing them at some



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