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SECTION FOR PROFESSIONALS IN THE TREATMENT OF OBESITY AND OTHER EATING DISORDERS

Professional Bariatric History

Sample file to be used as a guide for professional in the treatment of obesity.

Part (II)

DAILY RUTINES:

WAKING UP HOUR:  
Time past between waking hour and going to work:  
GOING TO BED HOUR:  
Time past between going to bed and falling asleep:  
TIME AND PLACE OF BREAKFAST:  
TIME AND PLACE OF LUNCH:  
TIME AND PLACE OF DINNER:  
 ALCOHOL BEVERAGES INTAKE:  
WHICH:  
QUANTITY:  
TIMES PER WEEK:  
SMOKING:  
QUANTITY:  
SMOKING SINCE:  
EXERCISE:  
WHICH:  
HOW LONG:  
TIMES PER WEEK:  
EXCERCISING SINCE:  
AMUSEMENT ACTIVITIES:  
WHICH:  

 

DIETARY HISTORY

YOUR 5 FAVORITE MEALS:  
1  
2  
3  
4  
5  
FREQUENCY OF EATING THEM:  
1  
2  
3  
4  
5  
5 MEALS YOU DON'T EAT:  
1  
2  
3  
4  
5  
 5 MEALS YOU DON'T LIKE TO EAT:  
1  
2  
3  
4  
5  
HAVE YOU BEEN ON A DIET SOMETIME:  
WHAT FOR:  
WHAT TYPE:  
HOW LONG:  
RESULTS:  
WHAT FOR:  
WHAT TYPE:  
HOW LONG:  
RESULTS:  
WHAT FOR:  
WHAT TYPE:  
HOW LONG:  
RESULTS:  
IS SOMEONE IN YOUR FAMILY ON A DIET:  
WHO:  
WHY:  
WHO:  
WHY:  
WHO PREPARES MEALS AT HOME:  
WHAT KIND OF RESOURCES DO YOU HAVE TO EAT AT WORK:  
DESCRIBE YOUR WEEKLY EATING HABITS:  
HOUR / PLACE  
BREAKFAST  
between:  
LUNCH:  
between:  
DINNER:  
after:  
DESCRIBE YOUR WEEKEND EATING HABITS:  
HOUR / PLACE  
BREAKFAST  
between:  
LUNCH:  
between:  
DINNER:  
after:  

NEXT: SAMPLE PROFESSIONAL FILE PART III


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Dear visitor: The object of this web site is to inform and educate. Therefore, the information contained herein does not substitute professional medical attention.
If you have any doubt with respect to this information consult your personal doctor.

Medical supervision by Dr. Arieh Goldberg Kalik.
Bariatric physician, certified medical nutrition specialist. Certificate # 1010084

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