Success cannot be achieved without motivation, a positive attitude and clear goals. At the Peel Weight Loss Clinic Clinic we want you to succeed on OPTIFAST^®. Your success motivates and energizes us.

We also understand that we can provide you with some tools, but true success comes from within. If you are serious about losing weight and keeping the weight off, we want to be your partner in this journey.

The questionnaire below can help you gauge whether you are ready for the OPTIFAST^® CORE Program. If you complete the test, please let us know during your initial assessment:

Question 1:
Compared to previous attempts, how motivated to lose weight are you this time?

1. Not at all motivated
2. Slightly motivated
3. Somewhat motivated
4. Quite motivated
5. Extremely motivated

Question 2:
How certain are you that you will stay committed to a weight loss program for the time it will take you to reach your goal?

1. Not at all certain
2. Slightly certain
3. Somewhat certain
4. Quite certain
5. Extremely certain

Question 3:
Consider all outside factors at this time in your life (the stress you’re feeling at work, your family obligations, etc.). To what extent can you tolerate the effort required to stick to a diet?

1. Cannot tolerate
2. Can tolerate somewhat
3. Uncertain
4. Can tolerate well
5. Can tolerate easily

Question 4:
Think honestly about how much weight you hope to lose and how quickly you hope to lose it. Figuring a weight loss of 1 to 2 pounds per week, how realistic is your expectation?

1. Very unrealistic
2. Somewhat unrealistic
3. Moderately unrealistic
4. Somewhat realistic
5. Very realistic

Question 5:
While dieting, do you fantasize about eating a lot of your favorite foods?

1. Always
2. Frequently
3. Occasionally
4. Rarely
5. Never

Question 6:
While dieting, do you feel deprived, angry and/or upset?

1. Always
2. Frequently
3. Occasionally
4. Rarely
5. Never

Tally up your score and see the scoring system below:

Total Score: (6-30): ____________

If you scored:

6 to 16:
This may not be a good time for you to start a weight loss program. Inadequate motivation and commitment together with unrealistic goals could block your progress. Think about those things that contribute to this, and consider changing them before undertaking a diet program.

17 to 23:
You may be close to being ready to begin a program but should think about ways to boost your preparedness before you begin. Please contact us an arrange an assessment with one of our team members.

24 to 30:
The path is clear with respect to goals and attitudes. We would love to partner with you and get you started on the OPTIFAST^® Core Program at PWL

The Diet Readiness Test and the General Well-Being Schedule.” Institute of Medicine. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: The National Academies Press, 1995. doi:10.17226/4756.