Endocrine, Nutrition & Obesity, Patient Education
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Weight Management Checklist
The Obesity Management Checklist is intended to be used in serial fashion to support and encourage weight loss in obese adults and children.
[select name="agegrp" value="Adult|Child"] Weight Loss Checklist

[conditional field="agegrp" condition="(agegrp).is('Child')"][select name="Q1a" value="no=0|YES=1"] <-- 1. Do you eat fast food, such as hamburgers or french fries, more than once per week?
[comment memo="Frequently consuming fast food is associated with higher daily energy intake and higher BMI among adults. Children who consume fast food have poorer quality diets and higher energy intakes compared with those who do not."]

[select name="Q2a" value="no=0|YES=1"] <-- 2. Do you drink more than one glass of fruit juice, fruit drink, nondiet soft drink, or energy drink per day?
[comment memo="Intake of sugar-sweetened beverages contributes to weight gain among children and adults."]

[select name="Q3a" value="no=0|YES=1"] <-- 3. Do you eat a nutritionally balanced breakfast soon after awakening?
[comment memo="Skipping breakfast is ineffective for controlling weight. Eating breakfast regularly is associated with a lower BMI."]

[select name="Q4a" value="no=0|YES=1"] <-- 4. Do you watch television, play video games, or use a computer (other than for schoolwork) for more than 2 hours/day?

[select name="Q5a" value="no=0|YES=1"] <-- 5. Do you engage in at least 30 to 60 minutes of physical activity per day?
[comment memo="Exercise, particularly in combination with dietary changes, is effective in promoting weight loss among adults. School-based programs that include promotion of physical activity are effective in preventing obesity among children."]

[select name="Q6a" value="no=0|YES=1"] <-- 6. Do you eat dinner with at least one parent on most days of the week?
[comment memo="Frequency of eating dinner with the family is associated with a lower baseline risk of being overweight among adolescents. Family dinner is associated with healthful dietary intake patterns."]

Interpretation --> [calc memo="Result" value="score1=(Q1a)+(Q2a)+(Q3a)+(Q4a)+(Q5a)+(Q6a);score1>0?'There are opportunities to improve your health':'Excellent. Keep up the great work!'"]

[/conditional][conditional field="agegrp" condition="(agegrp).is('Adult')"][select name="Q1b" value="no=0|YES=1"] <-- 1. Do you eat fast food, such as hamburgers or french fries, more than once per week?
[comment memo="Frequently consuming fast food is associated with higher daily energy intake and higher BMI among adults. Children who consume fast food have poorer quality diets and higher energy intakes compared with those who do not."]

[select name="Q2b" value="no=0|YES=1"] <-- 2. Do you drink more than one glass of fruit juice, fruit drink, nondiet soft drink, or energy drink per day?
[comment memo="Intake of sugar-sweetened beverages contributes to weight gain among children and adults."]

[select name="Q3b" value="no=0|YES=1"] <-- 3. Do you eat a nutritionally balanced breakfast soon after awakening?
[comment memo="Skipping breakfast is ineffective for controlling weight. Eating breakfast regularly is associated with a lower BMI."]

[select name="Q4b" value="no=0|YES=1"] <-- 4. Do you watch television, play video games, or use a computer (other than for schoolwork) for more than 2 hours/day?

[select name="Q5b" value="no=0|YES=1"] <-- 5. Do you engage in at least 30 to 60 minutes of physical activity per day?
[comment memo="Exercise, particularly in combination with dietary changes, is effective in promoting weight loss among adults. School-based programs that include promotion of physical activity are effective in preventing obesity among children."]

[select name="Q6b" value="no=0|YES=1"] <-- 6. Do you reward yourself with food for good behavior or, for example, after “a hard day” on a regular basis?
[comment memo="Using food as a reward or for comfort contributes to weight gain."]

Interpretation --> [calc memo="Result" value="score2=(Q1b)+(Q2b)+(Q3b)+(Q4b)+(Q5b)+(Q6b);score2>0?'There are opportunities to improve your health':'Excellent. Keep up the great work!'"][/conditional]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
reference:
[link url="//www.aafp.org/afp/2010/0615/p1449.html" memo="#1"] AAFP Office Management of Obesity article: Goutham (2010) Am Fam Phys 81: 1449-55
[/conditional]
Weight Management Checklist
The Obesity Management Checklist is intended to be used in serial fashion to support and encourage weight loss in obese adults and children.
Weight Loss Checklist


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