future point. Regular screening of these individuals by a health-care provider will help to identify as early as possible the presence of comorbid conditions and lead to the initiation of appropriate treatment or continuation of it. Dietary patterns and physical activity are difficult to measure objectively since they usually depend on the individual's own characterization of these factors. In contrast, medical visits can be documented with the individual's physician.

Improved well-being is a positive subjective feeling by the individual that includes feeling good about oneself (positive self-esteem) and a healthy attitudes about self-care with a desire to practice it. These feelings can be assessed by available questionnaires (see Appendix A), but most of these tools are best used by health-care providers trained in their use and interpretation. We recommend that all programs administer a test such as the Dieting Readiness Test to assess how well equipped a person is to undertake a weight-management program; individuals in a do-it-yourself program will need to self-administer and score the test. Clinical programs, in addition to using the Dieting Readiness Test or a similar test, should administer a test such as the General Well-Being Schedule, which provides a useful evaluation of the psychological health of the client and can help uncover potential psychological pathologies. Both of these tests are provided in Appendix B.

Monitoring of Adverse Effects That Might Result from Program

As described in Chapter 6, weight loss poses potential risks to health. The more restrictive the diet, the greater are the risks of adverse effects. All clinical and nonclinical programs should periodically question their clients about any changes in health while on the program and should encourage them to volunteer such information if changes in health, particularly negative ones, occur. Consumers undertaking a do-it-yourself program should be particularly aware of the fact that their efforts may have adverse effects and should pay attention to any changes in their health. Experiencing an adverse effect while on a weight-management program may or may not be related to the program (it may be a worsening of health as a result of the obesity), but it should be evaluated. Depending on the nature of the problem, in some cases the program will need to be modified for the individual and in other cases it should be discontinued.

We believe that weight-loss programs should be judged by how well individuals do in these four areas, and potential clients should expect that a high-quality program will attend to, or urge attention be paid to (since most of these components are not under the direct control of the

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