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Checklist for Evaluating Weight Loss Programs and Services

Use this checklist to gather and compare information form all weight loss programs you're considering

Make several copies of the blank form so you can fill out one for each program. A provider's willingness to give you this information is an important factor in choosing a program. If you need help to evaluate the information you gather, talk with your primary health care provider or a registered dietician.

Program Name ______________________________________

Address ___________________________________________
                ___________________________________________

Phone ______________________________________

In this program, my daily caloric intake will be: _______________

My daily caloric intake is determined by: ___________________

I   Image of a check box will   Image of a check box will not   be evaluated initially by program staff.

The evaluation will be made by (check all that apply):
Image of a check box Physician      Image of a check box Nurse      Image of a check box Registered Dietician      Image of a check box Other company-trained employee

My progress is supervised by (check all that apply):
Image of a check box Physician      Image of a check box Nurse      Image of a check box Licensed Psychologist
Image of a check box Registered Dietician      Image of a check box Company-trained employee

I   Image of a check box will   Image of a check box will not   be evaluated by physician during the course of my treatment.

During the first month, my progress will be monitored:
Image of a check box Weekly      Image of a check box Biweekly      Image of a check box Monthly      Image of a check box Other ______________

After the first month, my progress will be monitored:
Image of a check box Weekly      Image of a check box Biweekly      Image of a check box Monthly      Image of a check box Other ______________

My weight loss plan includes (check all that apply):
Image of a check box Nutrition information about healthy eating Image of a check box At least 1,200 calories/day for women or 1,400 calories/day for men
Image of a check box Suggested menus and recipes Image of a check box Keeping food diaries or other monitoring activites

Image of a check box Portion control

 Image of a check box Liquid meal replacements
Image of a check box Prepackaged meals Image of a check box Dietary supplements (vitamins, minerals, botanicals, herbals)
Image of a check box Prescription weight loss drugs Image of a check box Help with weight maintenance and lifestyle changes
Image of a check box Surgery  


Checklist for Evaluating Weight Loss Products and Services continued
 

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