Obesity101.com THE LATEST IN OBESITY RESEARCH AND WEIGHTLOSS DRUG DEVELOPMENT Join our list More information If you have taken obesity medication and discontinued it (whether or not you reached goal) or you are on a maintenance dose of medication, please fill out this survey. The following questionnaire is designed to develop statistics on what happens to people who take phenfen or other prescription weight loss medications after they reach goal, or discontinue medication. If you have reached goal or have discontinued the medications for any reason, please answer the following questions and press the submit button below. No names, e-mail addresses or other identifying information will be used in reporting the results. Thanks for your input. Personal Information: 1. Age ________ years 2. Sex Male ___ Female ___ 3. Starting weight ____ lbs 4. Ending weight ____ lbs 5. How much weight do (did) you have to lose? ____ pounds 6. Did you reach your goal weight? Yes ____No____ 7. For how many years have you had an obesity problem? ____ years 8. How long have you been taking obesity medication? ____ weeks 9. What type of medication are you on? (Or if you've discontinued medication, give me the names and dose of the last medication you took). ____ mg Phentermine ____ mg Fenfluramine ____ mg Dexfenfluramine Other (please fill in name): ____ mg __________________________ 10. Do you exercise regularly? ____ Yes ____ No 11. If the answer to the last question was yes, how many hours a week do you exercise? ____ hours (aerobic) ____ hours (strength) If you have discontinued taking medication, please answer the following: 12. How long has it been since you stopped taking medication? ____ weeks 13. Have you been able to maintain your weight loss? ____ Yes ____ No 14. If not, how much weight have you gained? ____ lbs 15. Did your cravings and/or hunger return? If the answer to the last question was yes, how long were you off the medication until you had problems with cravings or hunger? ____ Yes ____ No _____ days ___ weeks ___ If you are continuing medication on maintenance please answer the following: Questions 16- 18, check all that apply: 16. Are you taking the same dose as you did while you were losing weight? ____ 17. A reduced dose? ____ If you are on a reduced dose, for how long? _____ weeks 18. Are you taking amino acid supplements in addition to medication? ____ 19. If your maintenance dose has changed, what is it now? ____ mg Phentermine _____ mg Fenfluramine ____ mg Dexfenfluramine Other (please fill in name): ____ mg ___________________ 20. Have you been able to maintain your weight loss on this maintenance dose? ____ Yes ____ No 21. If not, how much weight have you gained? ____ lbs 22. Did your cravings and/or hunger return while on the maintenance dose? If the answer to the last question was yes, how long were you on a decreased medication dose before you had problems with cravings or hunger? ____ Yes ____ No ____ days ___weeks ___ 23. If you would like me to mail you a copy of this survey, please provide your e-mail address. ______________________ Other comments. xkxdjfkxsdj x x x Thank you for your input. The results of this survey will be published on this site, and e-mailed to the Chatpf, Phenfen and MOB lists. If you provided me with your e-mail address, I will send you an individual copy of the survey results. Home|Subscribe|Archives|Drug info|Contact|Media & Links|Site index|FAQs|Doctors/meetings|Admin Obesity-news is a publication of Hirsch Communications. An on-line subscription is $104.00 per year, payable in advance by check, money order, American Express, Discover, VISA or Mastercard. Subscribing is simple using our secure on-line subscription form. Obesity-news also accepts fax orders at 703/960-7462 and mail orders at PO Box 19316, Alexandria, VA 22320-0316. Copyright 1997-2008, all rights reserved. IMPORTANT: All information in this publication is believed to be accurate and true. Publisher is not liable for omissions or inaccuracies. Information in this newsletter is for educational purposes only and should not be construed as medical advice, or be used in lieu of consultation with a health care provider.