Addressing the Common Pathway Underlying Hypertension and Diabetes in People Who Are Obese by Maximizing Health: The Ultimate Knowledge Translation Gap

Table 2

Monitoring multiple health behavior change over time: short-form template for assessing and evaluating behaviors associated with chronic lifestyle-related conditions.

Lifestyle choices and behaviors	Initial assessment date	Followup date	Followup date
Smoking status
Nonsmoker or continuing not to smoke
Smoking (cigarettes per day)
Nutritional Status
Processed foods (e.g., deli meats)
Convenience foods (fast food)
Soda pop (cans)
For items below see daily serving size guide
Vegetables
Fruit
Whole grains
Meat (type)
Fish (type)
Milk (specify whole milk or fat reduced)
Cheese
Added sugar
Added salt
Saturated fat (animal fat, butter)
Unsaturated fat (vegetable oils)
Servings of mayo, prepared relishes, cats-up, gravy, margarine
Body composition
Weight
Height
Body mass index (weight in kg/height in m^2)
Waist girth
Hip girth
Waist-to-hip ratio
Activity status: sedentary activity, physical activity, and structured exercise
Sedentary activity (daily hours television watching or in front of a computer screen)
General physical activity (general walking and getting around, taking public transportation)
Structured exercise (e.g., yoga, tai chi, aerobic exercise such as walking, swimming, jogging, cycling, and strengthening with weights or bands)
Type-intensity-duration-frequency—for how long overall (weeks or months)
Type-intensity-duration-frequency—for how long overall (weeks or months)
Type-intensity-duration-frequency—for how long overall (weeks or months)