intervals or more frequently after the weight-loss phase of a program. This will act as a useful periodic check on these two major influences of weight and will help to maintain weight loss.
The third portion of the model focuses on the outcomes of the program. We have identified four components of successful weight management: (1) long-term weight loss, (2) improvement in obesity-related comorbidities, (3) improved health practices, and (4) monitoring of adverse effects that might result from the program. 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 program), each of these areas. We recommend that the following be used as guidelines to determine if these goals are met:
Long-term weight loss: Long-term means 1 year or more, and weight loss of any significance is the loss of ≥ 5 percent of body weight or a reduction in BMI by 1 or more units.
Improvement in obesity-related comorbidities: One or more associated risk factors (e.g., high blood pressure; elevated blood concentrations of cholesterol, triglycerides, or glucose; and non-insulin-dependent diabetes mellitus), if present, should be improved to a degree considered clinically significant.
Improved health practices: Obtaining health-related knowledge may be assessed indirectly by evaluating whether basic information about obesity is presented by the program and whether the individual reads or hears it. Engaging in good eating habits may be assessed by using a dietary assessment tool such as those cited in Appendix A or evidence that the individual meets the recommendations of the Food Guide Pyramid on at least 4 of 7 days. Engaging in regular physical activity involves one-half hour or more of moderate-intensity activity (e.g., brisk walking) four or more times a week and preferably daily. Obtaining regular medical attention includes seeing a physician at yearly intervals, particularly if the individual has not achieved a healthy weight. 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 or continuation of appropriate treatment. Improved well-being can be assessed through questionnaires described in Appendix A. For all programs, we recommend a test such as the Dieting Readiness Test prior to