DPP Lifestyle Progress Summary

Participant ID                             Name Code                       Today’s date                   

1.	Reasons for joining DPP                                                                                       

                                                                                                                                 

2.	Progress toward goals (review graphs)

	Weight (lbs)	Activity (min/week)	
Session 1 (Date:                                   )	 		
Most Recent Visit (Date:                            )
     (Week since randomization:                  )			
DPP Goal			
Personal Goal			

Fat goal (grams)                               Calorie goal                                        

Typical fat intake                              Calories                                              

3.	Major challenges

To weight loss                                                                                                         

                                                                                                                                 

To physical activity                                                                                                  

                                                                                                                                  

4.	Changes made

In eating                                                                                                                   

In activity                                                                                                                  

Other                                                                                                                         

5.	What has helped

In eating                                                                                                                    

To improve activity                                                                                                  

6.	What are your thoughts about your progress so far?   

                                                                                                                                  
7.	How important is it to you to make any new changes? 
 (On a scale of 1-10, with 1= not important at all and 10 = very important)

	In eating                                                                                                                    
	In physical activity                                                                                                   
8.	How confident are you than you can make any new changes? 
 (On a scale of 1-10, with 1= not confident at all and 10 = very confident)

	In eating                                                                                                                    
	In physical activity