Congratulations on making the decision to begin your weight loss journey. The first step in making a lifestyle change is finding the right program to meet your unique needs. By answering the brief questions below, you will learn how Structure House might be able to help you meet your weight loss goals.
Assessment Questions
Age years
Gender Male Female
Height ft in
Weight lbs
How long have you been overweight? I have been overweight since childhood
I have been overweight since adolescence
I became overweight during my adult years
Please check off any of the following health issues your weight has contributed to (check all that apply): Chronic pain
Breathlessness/shortness of breath
High Blood Pressure
Depression
Anxiety
Digestive problems
Fatigue
Sleep Apnea
Elevelated Cholesterol
Difficulty with Personal Care
Mobility
Infertility
Preparation and/or Recovery from bariatric surgery
Heart attack or stroke
Diabetes or high blood sugar
Cancer
Gallbladder disease
Have you ever experienced any of the following that you attributed to being overweight? Loss of a relationship
Not hired for a job
Negative comments from family
Social stigma (stares, comments)
Embarrassment due to size (e.g., seat too small)
Discrimination
Avoiding Public Places
Special Accomodations for Travel
How many stairs can you climb before needing to pause to rest? More than 3 flights (40+ stairs)
2-3 flights (25-40 stairs)
1-2 flights (12-24 stairs)
Half a flight (6-8 stairs)
Less than 6 stairs
Please select the top 3 goals you would like to achieve through a weight loss program: Better understand, manage, or prevent diabetes
Explore the reasons that I overeat
Discover forms of exercise that I enjoy
Learn how to better communicate my needs and desires to family and friends
Be able to manage my weight even when socializing with friends or eating in restaurants
Acquire strategies to assist me in stress management and self-care
Develop healthful eating habits
Learn how to design an exercise program I can stick with
Learn more about how weight loss will improve my health
Ensure that I will be successful in the long-term
Address my concerns about depression and anxiety
Reduce my chronic pain

In addition to our renowned residential weight loss program, we offer the Structure House Online Weight Loss Program (SHOW), a 28-day, Web-based weight loss program. SHOW allows you to access the principles and techniques taught by Structure House experts in nutrition, fitness and psychology from the privacy and comfort of your own home.

Complete with daily menus, exercise videos, message boards, a guided workbook, an online diary and progress chart, SHOW will coach you on all of the skills you’ll need to achieve lasting weight loss. Visit structurehouseonline.com to find out more information and get started today!