Although we do not prescribe a minimal level of energy intake for safe weight loss, clients should be made aware that energy intakes of less than 1,200 kcal/day will usually not meet nutrient requirements and that a vitamin-mineral supplement will be needed. Diets of less than 800 kcal/day should not be used except under a physician's supervision.

Physical Activity Regular physical activity is also essential for long-term weight management because it helps to promote weight loss and decrease regain, reduce obesity-related risk factors, and decrease morbidity and mortality. For practical purposes, we define a minimal level of 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.

Safety All programs should be reasonably safe and pose minimal untoward health risks to clients. Risks vary by program. Generally, approaches that require oversight by physicians (e.g., use of drugs and surgery) or special diets that deviate substantially from healthy eating patterns, or are very low in energy content, pose the most risk. The nature of complications varies with the weight-loss method used. Diets that are not nutritionally adequate in protein, vitamins, minerals, and dietary fiber should be used only for compelling reasons—on a temporary basis and with appropriate supplementation—during the treatment phase of weight loss.

Program's Perspective: 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 as well as 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

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