Changes to diet and physical activity are the key to any obesity treatment. The evaluation of current dietary and physical activity patterns will therefore form an important part of the assessment process. Making recommendations for change and formulating a plan of action is difficult without a baseline measure of current practices.

Those experienced in obesity treatment report that initially this can be the most challenging part of the assessment process. Eating healthily and exercising regularly are viewed as admirable qualities and, not unexpectedly, people often find it difficult to disclose the opposite behaviour! In addition many obese people fear that they will be unfairly stereotyped as fast food loving, television addicts.

It must not be forgotten that some patients have an uncomfortable relationship with food and find it difficult to reveal even to themselves the extent of the problem. The frustration arises when the health professional places a high level of importance on getting the patient to categorically reveal what they are currently eating. However, this part of the assessment should be regarded as a self-assessment by the patient, which is only guided by the health professional.

An open-ended question such as, “If you could chose to change one thing about your diet, what would that be?” can help identify areas for change.

Many patients are very aware of the food choices they make and how that impacts on their weight. Others may need prompting about factors such as irregular meal patterns, snack foods, large portion sizes, lack of fruit and vegetables. Anything, which the patient identifies and is prepared to change, is a good start in the process of improving their diet. A good strategy is to ask patients to describe how food fits into a ‘typical day’.

In terms of assessing activity levels, Kusner & Pendarvis (1999) 8 suggest starting with a question such as, “Tell me about the most physically active thing you do”.

Once an initial assessment has been made, more detailed information can be collected by encouraging the patient to keep a food and activity diary. This is referred to in obesity management as self-monitoring and is regarded as a key technique. The primary goal is to increase self-awareness of current eating habits and activity levels. The practice of writing down accurately what is eaten is a skill that needs to develop, but this will help patients to recognize key patterns of behaviour. Self-monitoring should be encouraged in the early phase of weight loss treatment but it is also a useful ongoing strategy. In fact research has shown self-monitoring to be a practice that distinguishes successful weight maintainers from less successful maintainers.9 An explanation should be provided with regard to what and when to record.

• Ask patients to keep a small notebook or provide a food diary
• Encourage the practice of writing down all food and drink as soon as it is eaten to avoid memory lapse
• Ask patients to record as much detail as possible about the types of foods eaten, the amounts and the cooking methods
• Remind patients to include drinks, especially alcohol
• It is useful to record the time and place and any influences such as the presence of others on eating

If suggesting a food diary to a patient, it is important to take time to explain this fully and to adopt a non-judgmental approach. Reassure the patient that the diary is something that others have found beneficial and that the time and effort invested in doing this can help with realistic and effective goal setting.