People who want to achieve long-term weight control need to spend at least 30 minutes a day, for a minimum of 6 months, trying to change their eating, exercise, and thinking habits.
What has been your highest weight after age 21? number of lbs* lbs at age* years old.
What has been your lowest weight (not due to illness) that you have weighed after age 21? number of lbs* lbs at age* years old.
Maintained for number of years years.
What was your weight 6 months ago? * lbs.
What was your weight 1 year ago? * lbs.
What was your weight 2 years ago? * lbs.
Do you ever eat large amounts of food and stop only because of the following:
Weight Loss Attempts: Make a list of the diets, medications, and/or other measures you have tried, how old you were when you tried them, when you tried each one, how much weight you lost, the length of time the weight stayed off, and how much weight you gained back.
Indicate if you have had or have any of the medical conditions listed below:
List all medications (including any over the counter, herbal, natural) that you take regularly and for what:
During the past year:
MENTAL HEALTH HISTORY
List any counseling services that you have received which may include individual, group, or marital therapy:
List your children/step-children's age and sex, and indicate whether they are overweight, average, or underweight. Include any children from previous relationships, whether they are living with you or not.
Describe your parents' weights while you were growing up:
Describe your parents' weights throughout your adulthood: