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Personal Dietitian's Counseling Self-Assessment Inventory

The assessment tool below is designed to assess whether you might be interfering with your long term weight loss success.  By taking this self scoring/ self-evaluation survey you can find out if you would benefit from one of the optional support systems offered at Personal Dietitian. If after your self-assessment you find that you could benefit from professional assistance, we highly recommend our counselor, Julie Lang, MFT (Note: This is a fee based counseling). We also offer free online assistance via our other support options:  the "Ask Your Dietitian" (offering technical diet support), Staff Counselors (Staff counselors are invaluable if you need some personal help and do not need professional counseling support). We also offer Diet Pals (a mutual peer support option). Our support team believes each of these support systems should be given serious consideration as recent research shows valid reasons for using them.

Reasons to complete the Self Assessment Inventory 

The survey below can help you determine what level of support you could most benefit from.  While Personal Dietitian offers a superior diet and weight loss program,  it is only one part of the answer to long term weight control and good health. If diet was the only answer, why are the percentage of American adults who are overweight increasing by almost 1 percent a year, and why have obesity rates soared from 12 percent in 1991 to almost 18 percent of the U.S. adult population in 1998, despite the abundance of weight loss and diet programs everywhere?  

Only about 5% of those who start a weight loss program without some support structure are successful in keeping weight off long term. The causes of overeating are not removed from most diets and diet plans, and in many cases where the diet is extreme, dieting can actually increase compulsive eating.  At Personal Dietitian we believe you deserve a successful long-term weight control program and deserve a better approach to weight loss.  Through a professional diet that you can live with, a sensible exercise routine, and effective emotional support ( from friends, family, epals, and counselors), we believe you will have what you'll need to accomplish your task. 

 

A Good Reason for Support

Why should  you access our weight loss counseling support options? In a very recent research study of 65 overweight adults, it was found that visiting weight-loss information web sites can help to shed pounds, but the study shows that a more important component  is access to counseling advice from behavioral therapists.  Dieters who accessed internet counseling lost three times as much weight in six months as their counterparts. The study, led by Brown University researcher Deborah F. Tate, appeared in The Journal of the American Medical Association (3-7-01).  Personal Dietitian offers several email components to support continued successful weight loss (diet pals, dietitian support, a staff counselor, and behavioral counseling support). 

Support Survey

Self-compassion, self-reflection, and self-nurturing  are very important in life and deserves your attention. Developing emotional insight through understanding one’s feelings and the process of communicating these emotional desires can also help to eliminate the need to use food or body weight to cope with your problems. Through a genuine understanding of our emotional selves, a well planned diet program, and a routine of exercise, you are most likely to find the weight loss success you seek along with the rewards of  greater happiness,  peace, and improved health and fitness.

Now, take the survey below to help you determine your need for support in your efforts. Do yourself a favor, don't try to second guess the questions as they are placed in no particular scoring order.  Instead, be honest with yourself and your results will be of greater benefit. The results of this survey help determine whether you would benefit from a counselor's viewpoint regarding your weight loss issues. Often times our efforts fall short in weight loss programs and we lose incentive or quit because of barriers in our life that can be beyond our control.  Our counselor offers a professional's assessment as a way for you to identify your particular barriers.  In general, self-assessment alone can be beneficial.  We advise you to use this tool as an indicator of your need for support. It is not our intention to misrepresent the survey as a scientifically validated survey, instead it is a useful tool to evaluate your need for greater support.

 

Directions:
For accuracy, answer all the questions. Answer each question with only one  choice. After you have  finished answering all the questions and have totaled your scores (numbers 1-11) please use the scoring guide to total your answers. Please use the self scoring guide:
 ? Scoring Guide 
Note: If your computer does not allow access to the calculator please use pencil and paper.

 

Prior weight loss programs
1. Have you started previous weight loss programs but did
    not succeed?
A. This is the first time on any weight loss program 
B.  Only one other time 
C. Two or more times

2. Reasons for weight loss
A.   I know why I want to lose weight.
B.   I know I would like to lose weight, but am not sure why.
C.   I can't think of any reason why I should lose weight.
3. Sense of Control (select only one)
A. A. My weight loss goals are within my control.
B. B. At times I do not feel my weight loss goals are within my control.
C. C. I never feel as though my weight loss goals are within my control.

4. Attitudes Toward Health
A. At least one of the reasons for my weight loss is my health 
B.
It is important that I reach my goal weight, regardless of what affect it will
have on my overall health.
C. My main goal for my weight loss is not health related.

5.  Lifestyle Changes
A.


 I understand that successful weight management is a long-term process and involves incorporating healthy behaviors (e.g. exercise) into my daily       schedule.
B.


 I don't believe weight loss has to be a long-term process involving a lifestyle makeover.  I can lose the weight I need and resume my lifestyle with some minor changes.

6. Exercise
A.

 Incorporating exercise into my life is just as an important a step towards achieving my weight loss goals as my dietary changes.
B.

 Incorporating exercise into my life is not as important to long term success as my diet changes (i.e. eating less).
C. I have always started to exercise program when I try to lose weight.
D.

 I have always started to exercise program when I try to lose weight but find that I lose enthusiasm for the exercise.

7. Support System
A.

 I feel as though I have a strong support system (including  friends and family) who help me to work towards my weight loss goal.
B.

 I have a couple of people in my life who support my weight loss efforts,
but it would be nice if I had more.
C.

 I have not made any effort to get any support for my weight loss efforts
at this time but plan to.
D.

 I do not have anyone in my life at this time with whom I can share my
weight loss goals.
E.

 I am not the type of person who likes to ask for help and would not be
interested in such support.

8. Life Balance
A.

 All areas of my life (work, personal life, etc) are stable enough for me to
make my weight loss/weight management goal a priority.
B.

 I feel I can successfully incorporate my weight loss goals into my busy
schedule without becoming too stressed.
C.

 While I know that it's difficult to juggle everything in my life, I have made
 weight loss a priority.
D. My life is pretty hectic but I'm going to succeed despite this barrier.

9. Self-Monitoring of Progress
A.

 I am currently tracking my weight loss progress or have plans to keep some kind of measurement of my weight loss progress.
B.


 I have heard that keeping a record of my progress can be helpful, but I'm unsure if  I am willing to do this.
C.

  I don't feel as though keeping a record of my progress is necessary in order  for me to reach my weight management goals.

10. Self-Confidence
A.

  I feel confident that I will be able to reach and maintain my weight-loss goal.
B.

 I am optimistic that I will reach my weight-loss goal, but sometimes I question my ability to actually succeed.
C.
 I'm not certain that I will reach my weight-loss goal.
D. I have no confidence that my goal will ever be reached.

11. Do you believe that you need to change?
A.
  I think I should lose weight at this time and I am doing it for me. 
B.  I think it might be a good idea for me to lose weight at this time.
C.  I'm losing weight for others (my spouse, family, friends, etc) and not for myself. 
D.  I really do not think I need to lose weight at this time.


Calculator

Scoring Guide
To score the survey 
Step 1:  To score the survey simply add the values that correspond to 
the answers numbered 1 -11 using the calculator above.
[Example:  0+0+5+0+50+10+0+0+15+0+10=total score of 80] 

Step 2: After you have totaled your score, compare your total score
to the Guidance and Support chart below, click here> Guide Chart

 
Score number 11 as follows:
If you answered A score  a 0
If you answered B score  a 10
If you answered C score  a 10
If you answered  D score  a  50
Score number 10 as follows:
If you answered A score  a  0
If you answered B score  a  5
If you answered C score  a 10
If you answered D score  a 50
Score number 9 as follows:
If you answered A score  a 0
If you answered B score  a 15
If you answered C score  a 20
Score number 8 as follows:
If you answered A score  a 0
If you answered B score  a 10
If you answered C score  a 50
If you answered D score  a 50
Score number 7 as follows:
If you answered A score  a  0
If you answered B score  a 15
If you answered C score  a 0
If you answered D score  a 50
If you answered E score  a 50
Score number 6 as follows:
If you answered A score  a  0
If you answered B score  a 10
If you answered C score  a 0
If you answered D score  a 40
Score number 5 as follows:
If you answered A score  a  5
If you answered B score  a 50
Score number 4 as follows:
If you answered A score  a 0
If you answered B score  a  5
If you answered C score  a 10
Score number 3 as follows:
If you answered A score  a 0
If you answered B score  a  5
If you answered C score  a 10
Score number 2 as follows:
If you answered A score  a  0
If you answered B score  a  5
If you answered C score  a 10
Score number 1 as follows:
If you answered A score  a  0
If you answered B score  a  5
If you answered C score  a 10
 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Guidance and Support Chart

If your total score is:

Your score indicates
0-100

Your score indicates that you probably do not need extra assistance and you appear to already have the support you need at this time. 

0-100 and an
Individual score of 50 on one question

Your score of 50 or more on a particular score 
does not indicate a need for professional counseling by itself, but is an indication that you might. We recommend that you join diet pals and address this particular issue with a diet pal and/or with a supportive friend. 

Recommended support: diet pals, family,  friends 

100 or more 
with no individual score of 50 on any particular question

You would likely benefit from talking to someone with some technical background that matches your highest scores.  
If your highest scores were in the categories of: Reasons for weight loss, Sense of Control, Lifestyle Changes, Support System, Life Balance, or Self-Confidence, we recommend accessing support from the Staff Counselor. 

If your highest individual scores were from Attitudes Toward Health, Self-Monitoring Progress please access the dietitian and let her know your highest scores.
100-250 and
one or more score of 50 on particular question

 

You would likely benefit from talking to someone with some technical background regarding the area that matches your highest scores.  

If your highest scores were in the categories of: Reasons for Weight Loss, Sense of Control, Lifestyle Changes, Support System, Life Balance, Self-Confidence we recommend getting support from the Staff Counselor. 

If your highest individual scores were from Attitudes Toward Health, Self-Monitoring Progress please access the dietitian and let her know your highest scores. 

One or more individual score of 50 does not indicate a need for professional counseling, but should serve as a warning that you might.  We do recommend that you join diet pals and address this with some extra support.

250 or more

More than 3 individual scores of 50 should serve as a indicator to contact a professional counselor.  Please recognize that we believe your need for counseling is weight loss related only.  

You would likely benefit from talking to someone with some technical background that matches your highest scores.  

If your highest scores were in the categories of: Reasons for Weight Loss, Sense of Control, Lifestyle Changes, Support System, Life Balance, Self-Confidence we recommend getting support from the Staff Counselor.  

If your highest individual scores were from "Attitudes Toward Health", "Self-Monitoring Progress" please access the dietitian and let her know your highest scores.

(Note): This is not a standardized survey and should serve only as a guide for you.  Scoring 250 or more means only that you had several individual scores greater than 50. These individual scores are flags to indicate that you might have some conflicts best addressed by a professional.