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Weight loss programme

Weight Loss Programme

So you're looking for a Weight-Loss Programme that works...

This programme is not only focusing on losing weight, but also focuses on your body having more energy, feeling good about yourself and taking control of your life.

We all have different reasons for being overweight and while a little bit of weight does not do any harm some of the time, it can reach a point where it interferes with our health. Heart problems, arthritis, blood sugar disturbances are all issues that can be addressed by diet. If you change your diet early enough then the disease process can be halted.

Getting your body in better shape is the best insurance policy you can give yourself. Prevention is the real issue here. You will start to feel good; look good and people will want to know your secret.

Simply fill out the following questionnaire and click Submit, and we'll receive it immediately. An in-depth analysis will then be done. We will then send you out your own personal programme. This will include foods to avoid, foods to concentrate on, exercise regimes to suit you, any supplements if recommended, recipes as well as some interesting facts. You can also email me at julie@dargan.ie at any time if you have any questions on the analysis sent out. Questionnaires will be read in the strictest confidence and analysed by fully qualified naturopaths.

Cost: Normally €120 - December and January only €80!

Want to know more about why this programme works? Click here for more information.

Personal Particulars

Firstname: *
Surname: *
Email address: *
Telephone number:
Date of birth: *
Gender: *FemaleMale
Height (cms):
or Height (inches):
Weight (kgs):
or Weight (lbs):

Section 1: Your Emotional Wellbeing

1.1 How would you describe how you feel on most days? (Tick all that apply.)UnattractiveOverwhelmedLow LibidoLonelyDiscouragedDepressedApatheticAnxiousAngryUnmotivatedWorn OutNone of the above
1.2 What are your goals with this programme? (Tick all that apply.)Have more staminaFeel better about myselfBe more activeLose weight

Section 2: Where are you now?

2.1 Are you on any prescriptions?YesNo
If yes, please list the prescriptions here:
2.2 Are you on any over-the-counter medication, herbal remedies, vitamins, etc?YesNo
If yes, please list the medications here:
2.3 Do you use an Intrauterine Device (IUD)?YesNo
2.4 Do you take an oral contraceptive pill? YesNo
2.5 Do you use other prescriptive contraceptives e.g injection?YesNo
2.6 Do you suffer from any of the following (tick all that apply):Abdominal bloatingAllergiesAthletes footBad body odourIndigestion, Heartburn, or Reflux after a mealIrregular Bowel MovementsSores in the corner of the mouthStraining on defacationUnable to tolerate fatty foodsExcessive sweating

Section 3: Dietary History

3.1 How many cups of caffeinated beverages (tea, coffee, minerals) do you drink per day?012 to 4More than 4
3.2 Do you drink alcohol?YesNo
3.3 If yes, how many alcoholic measures do you drink per week?1 to 34 to 67 to 1011 or more
3.4 Do you smoke?YesNo
3.5 If yes, how many packs of cigarettes do you smoke per week?Less than 112 to 3More than 3
3.6 How much water do you drink in a day?Less than 500ml500ml to 1 litreMore than 1 litre

Section 4: Surgical History

4.1 Have you had any recent surgery?YesNo
4.2 If yes, how long ago was the surgery?1 to 6 months ago7 to 12 months agoMore than 12 months ago
4.3 If yes, what surgery was it? (tick all that apply)Cyst or fibroid removalFull hysterectomyGall bladder removalPartial hysterectomy (ovaries intact)Thyroid removal/surgeryOther Surgery (please list below)
Other surgery:

Section 5: Medical History

5.1 Do you suffer from Insulin Dependant Diabetes (Type 1) ?YesNo
5.2 Do you suffer from Type 2 Diabetes?YesNo
5.3 If yes, are you taking any medications for diabetes?YesNo
5.4 Do you suffer from high blood pressure?YesNo
5.5 Do you suffer from low blood pressure?YesNo
5.6 Do you have high cholesterol?YesNo
5.7 Do you suffer from Ulcers (e.g. Gastric/Duodenal)?YesNo
5.8 Do you suffer from Anaemia?YesNo
5.9 Do you suffer from Hypothyroidism (under active thyroid)?YesNo
5.10 Do you suffer from Hyperthyroidism (over active thyroid)?YesNo
5.11 Do you suffer, or ever suffered from Helicobacter pylori?YesNo
5.12 Have you ever suffered Acne Rosacea?YesNo
5.13 Do you suffer from fibromyalgia?YesNo
5.14 Have you ever had, or still suffering from Chronic Fatigue Syndrome?YesNo
5.15 Have you had, or still suffering from, Glandular Fever or the Epstein Barr virus?YesNo
5.16 Do you suffer from irritable bowels?YesNo
5.17 Do you suffer from any other chronic illness or medical condition?YesNo
5.18 If yes, please list the chronic medical condition(s)

Section 6: This section is for Men only. Women, please skip to the next section.

6.1 Do you experience any of the following? (Tick all that apply.)Decreased libidoDevelopment of breast tissueDifficulty in getting and keeping erectionsFatigueFind it difficult to recover after exerciseHot flushes and sweatsLow semen volumeMood changesReduced beard or body hair growthReduced muscle strengthTrouble concentrating

Section 7: If Weight is the problem, what may be the cause?

7.1 Did you gain weight after any of the following? (Tick where applicable)After a major illnessChange in regular pattern, e.g. giving up workDivorceDuring MenopauseGiving up smokingGiving up sportMajor life trauma (e.g. moving house)Pregnancy
7.2 Have you ever tried any of the following in an attempt to lose weight? (please tick where applicable)Avoided eatingUse chemical laxatives (e.g. Senekot)Use natural laxatives e.g. bran, prunes, herbsVomitted food after eating
7.3 Are you currently pregnant?YesNo
7.4 If yes, how many months pregnant are you?1 to 3 months4 to 6 months7 to 9 months
7.5 Are you breastfeeding?YesNoAbout to wean
7.6 Do you wish to conceive in the next 12 months?YesNo

Section 8: An Overview of Your Situation.

8.1 Which of the following do you experience? (Tick all that apply)Salt cravingsRapid mood swingsPoor concentrationOften bumping into thingsFeel irritable or over sensitiveFeel exhaustedFeel like crying for no reasonNeed coffee, tea, sugar, tobacco or other stimulants to get through the dayWork shift work or long hoursDifficulty sleepingOften getting sick, difficulty to shake a cold or fluAching musclesJoint painTightness in throatDebilitating fatigueLong term use of anti-inflammatory drugs or cortisoneA recent trauma in the past 2 yearsSugar cravingsExtreme physical exerciseDrug or alcohol abuseAnxiety attacks
8.2 Does life sometime overwhelm you?YesNo
8.3 Do you worry excessively?YesNo
8.4 Do you find it hard to relax?YesNo
8.5 Do you consider yourself highly strung?YesNo
8.6 Do you eat in a hurry?YesNo
8.7 Do you eat in a relaxed environment?YesNoOccassionally

Section 9: History of any Weight Problems

9.1 Have you always been overweight, even as a child?YesNo
9.2 At what age did you first start gaining weight?5 to 10 years11 to 16 years17 to 21 years22 to 25 years26 to 35 years46 to 50 years51 years plus
9.3 Which areas of your body tend to gain weight more?FaceNeckBreastsArmsWaistHipsBottomThighsCalvesAnklesBasically everywhere

Section 10: Assessing Your Energy Levels

10.1 Do you suffer from any of the following? (Tick all that apply)Become tired mid afternoonRaid the cupboards after an evening mealGet hungry mid afternoonCrave sweets and sweet foodCrave carbohydrates such as bread and pastaEat foods high in saturated fatEat even though you may not be hungryFeel drowsy after eatingTend to wake around 3am for no logical reasonFeel faint if you do not eat regular meals

Section 11-12: This page is for Women only. Men please skip to the next page.

11.1 Do you have a menstrual bleed (period)?YesNo
11.2 If yes, how long is your average menstrual cycle?20 days or less21 to 27 days28 to 32 days33 days plus
11.3 Do you experience an irregular menstrual cycle (i.e. cycle lengths that vary greatly)?YesNo
11.4 Are you periods generally more than 45 to 50 days apart?YesNo
11.5 Are you periods generally less than 20 days apart?YesNo
11.6 Are you periods generally exceptionally light?YesNo
11.15 During menstruation, do you have suffer any pain?NoneMildSevere
12.1 Do you suffer from Premenstrual Syndrome (e.g cramps, moodswings)?YesNo
12.2 Which of the following symptoms do you experience Pre-Menstrually? (Tick all that apply.)Nervous tensionIrritabilityHeadachesCraving for sweetsFatigueMood swingsDepressionAnxietyPoor sleep patternsIncreased appetiteHeart poundingDizziness or faintingWeight gainSwelling of extremitiesBreast tendernessAbdominal bloatingForgetfulnessCryingConfusion

Section 13: Menopause. This page is for Women only. Men please skip to the Section 18.

13.1 Are you peri menopausal? (Starting menopause)YesNo
13.2 Are you mid menopausal?YesNo
13.3 Are you post menopausal? (periods have ceased)YesNo
13.4 Do you suffer from or have noticed any of the following symptoms? (Tick all that apply.)Hot flushesHeadachesDepressionLack of concentrationVaginal drynessLow libidoOften suffer from nausea after food supplementsHair loss
13.5 Are you taking any prescriptive medication for menopause?YesNo
13.6 Are you taking any natural or over the counter remedies for menopause?YesNo
13.7 If you answered Yes to 13.5 or 13.6, please list the medications here

Section 14: Endometriosis. This page is for Women only. Men please skip to the next page.

14.1 Have you been diagnosed with Endometriosis?YesNo
14.2 Do you experience any of the following? (Tick all those that apply.)Painful periodsLower back painPainful intercourse, especially deep penetrationInfertility with no obvious causeHeavy bleeding with periodsDifficulty in passing stoolsSuffer from anaemiaBloating

Section 15: PCOS.

15.1 Have you been diagnosed with Polycystic Ovarian Syndrome? (PCOS)YesNo
15.2 Do you experience any of the following? (Tick all that apply.)Irregular, few or absent menstrual periodsAcne, oily skin, seborrheaDepressionInfertilityExcessive and increased body hair, typically in a male pattern, affecting face, chest and legsHair loss appearing as thinning hair on the top of the headDeepening of voiceExcessive weight gain

Section 16: Ovarian Cysts

16.1 Have you been diagnosed with Ovarian Cysts?YesNo
16.2 Do you experience any of the following? (Tick all that apply.)A dull ache or a sense of fullness or pressure in the abdomenPain during intercourseDelayed, irregular, or unusually painful periodsDistention of your abdomenPain in the rectal areaBreast tendernessUnexplained nausea

Section 17: Fibroids.

17.1 Have you been diagnosed with Fibroids?YesNo
17.2 Do you experience any of the following? (Tick all that apply.)AnaemiaBleeding between periodsPainful sexual intercourseBleeding after sexual intercoursePain in the legs, lower back, or pelvis

Section 18: Hypothyroidism.

18.1 Have you ever been diagnosed with hypothyroidism?YesNo
18.1 Do you suffer from any of the following? (Tick all that apply.)FatigueLoss of appetiteInability to tolerate the coldSlow heart rateMuscle crampsDry and scaly skinRecurrent infectionsDepression

Section 19: General.

19.1 Do you experience any of the following? (Tick all that apply)Excessive sweatingBreast development (for the men)Indigestion, heartburn or reflux following a mealDifficult or irregular bowel movementsIntolerance to fatty foodsAbdominal bloatingAllergiesAthletes Foot or fungal infectionsDigestive problemsSuffer from Tinea

Click the Submit button below to go to the checkout to pay for the Weight Loss Programme. Please note that until you have paid for the programme, your application cannot be processed.

Dargan Healthfoods and Therapy Centre, Portroe, Nenagh, Co. Tipperary Telephone: 067 23523
Dargan Health Foods, Unit 6, Castletroy Shopping Centre, Limerick Telephone: 061 339506
Email: sales@dargan.ie
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