Finally, time and patient burden are always important considerations. When


considering what tools to use for an outpatient assessment, one time-saver is to send a packet electronically to the patient to complete before the intake or first in-person session. If this is an option, the initial patient contact (via telephone or otherwise), prior to the first in-person session, could include a checklist of con- cerns to review with the patient. As the provider goes through the checklist, the patient can identify any relevant concerns, and this way the provider can include targeted surveys in the electronic packet. To generate data on patient demographics and outcomes for clinical programs, providers can administer specific batteries or a combination of surveys and interviews at intake and then again at time intervals that match the length of the program (if predetermined) or at time points such as 3 months and 6 months.


Sociocultural Considerations


Sociocultural factors are an essential component of behavioral health assessment for weight management. A range of factors at the individual, family, community, and society levels, as well as the physical environment, can influence a person’s eating behavior and physical activity in various ways. For instance, a person’s socio- economic status can affect eating behavior and food choices, given that fresh fruits and vegetables and lean proteins may be more expensive than fast foods and other higher-energy foods.77


Race, ethnicity, and religious affiliation may also influence


food choices and behaviors. For example, soul food is prominent among some Black populations, and rice is a staple of Latino and Asian cultures; and religious fasting practices, such as Ramadan for Muslims and Daniel Fast for some Christians, can affect eating schedules.78,79


Many of these factors are not assessed on the surveys


described in this chapter but should be taken into account as they can affect recom- mendations for dietary interventions. Physical activity—whether through planned activities, at gyms or recreation facilities, at home on exercise equipment, or by some other means—can be too costly for some, and still others may not have the option to engage in activities within their neighborhood due to community safety concerns.80


Thus, asking patients about


their access to outdoor activities or gym memberships, as well as internet access for free online workout videos (such as those found on YouTube) is essential. Educational level and income are also important considerations. Research has


shown that poor health literacy or having limited knowledge about healthy food choices and physical activity and their impacts on health outcomes are related to poorer dietary choices, less physical activity, and higher weight status.81


For example,


individuals with lower health literacy have more difficulty reading nutrition labels, may be less likely to have resources to cook or prepare meals with healthier ingre- dients, and may be more likely to follow fad diets, such as juicing, which they may believe are beneficial for weight control. Health literacy can be measured in a variety of ways; one instrument, the Newest Vital Sign, is a brief (6-item) questionnaire that can be administered in about 3 minutes.82


Food insecurity is also a concern, as people


with insufficient income tend to shop once a month in large quantities. This is linked to binge eating and overeating in the first part of the month, followed by periods of low-quality dietary intake (eg, refined-carbohydrate meals such as white bread with peanut butter and jelly) or skipped meals. The most commonly used assessment of food insecurity is the US Household Food Security Survey Module, which consists of 10 items, and a 6-item version can also be used.83 insecurity assessment can be found in Chapter 7.


A more in-depth discussion of food CHAPTER 9: Behavioral Health Assessment 155


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