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Sign-Up Form:                                                  Transforming Care through Food as Medicine      
American College of Physicians (ACP) Advancing Equitable Obesity Care through Regional Action Grant Initiative, supporting Arizona (click the link for more information about the grant).
In partnership with WellNEST Medicine & Seeds to Inspire Foundation

Note: Participation in this study is voluntary and as a QI project, is exempt from IRB review.

All information collected will be used only for program communications. All project outcomes will be shared as de-identified data.

Goal
This Food as Medicine initiative aims to equip clinicians with evidence-based obesity management tools—via virtual workshops, teaching kitchen sessions, and coaching sessions—while reducing stigma, enhancing care integration, empowering patient engagement, and promoting plant-powered lifestyles through inclusive community outreach.

Thank you for sharing your insights on obesity management & program participation in this brief 10 minute survey!

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Email *
Full Name *
Phone Number
Personal information will be kept confidential and used for urgent communications related to the program, such as schedule changes or critical updates.
Practice Profile Information
The ORGANIZATION & the SPECIALTY/DEPARTMENT that I work for is (e.g. healthcare, hospital, or clinic, group name):  *
1a. My professional role is: *
1b. My primary practice setting is: (Select all that apply)

Workshop Scheduling Preferences

2c. The program offers 1-hour monthly workshops (on average) every Tuesday from 12 PM to 1 PM, featuring 30-minute live, peer-led sessions followed by 30 minutes of coaching.

Dates for 1-hour workshops (subject to change):
Workshop #1 - 11/18/2025
Workshop #2 - 12/9/2025
Workshop #3 - 1/6/2026
Workshop #4 - 2/24/20226
Workshop #5 - 3/31/2026 Closing & Survey 
Workshop #6/Event Wrap Up-  4/14/2026

I would be able to attend at least 4 of these 6 live virtual sessions (see above dates):

2d. If 12 PM –1 PM once per month does NOT work for the  monthly workshops, what alternate timeframe works best for you? 

Program Engagement & Commitment

3a. I would find the virtual teaching kitchen videos (5-10 minutes) valuable & would consider trying the recipes at home:

Unlikely
Very Likely
Clear selection

3b. I am likely to complete 5 minute program debriefing surveys each month during or after the sessions:

Unlikely
Very Likely
Clear selection

3c. I currently use the Obesity Management Learning Hub modules and handouts in clinical practice from the American College of Physicians (ACP):

Reference link: https://www.acponline.org/clinical-information/clinical-resources-products/obesity-management-learning-hub

3d. I am likely to complete 4 modules from the ACP Obesity Learning Hub over 6 months (averaging 1 module per month) as a clinical tool, for academic distinction, and CME! 

Unlikely
Very Likely
Clear selection

3e. I am likely to use an established app (e.g., MyFitnessPal) to share my food and limited health data (e.g. blood pressure) on a weekly or monthly basis for this program?
All information will be reviewed anonymously to ensure privacy and accuracy.

Unlikely
Very Likely
Clear selection

Clinical Practice

4a. Over six months, I can identify at least 5 patients living with obesity who are open to integrating approaches from the Food as Medicine workshop into their care plans. (e.g.  didactics, coaching, and virtual teaching kitchen videos):

 *
4b. Based on my estimation, the percentage of my patients with a BMI greater than 30 is: 
4c. I would rate the impact of obesity stigma as severe and prevalent in my practice setting:
(1= Minimal; 3 = Unsure; 5 Widespread)
Minimal
Widespread
Clear selection
4d. I believe that patients with obesity can improve their health outcomes when appropriately supported by their healthcare team:
(1= Strongly Disagree; 3 = Unsure; 5 Strongly Agree)
Strongly Disagree
Strongly Agree
Clear selection
4e. I perceive obesity stigma to be common among healthcare workers in my clinical setting:
(1= Rare; 3 = Unsure; 5 Extremely Common)
Rare
Extremely Common
Clear selection
4f.  I perceive obesity stigma to affect the quality of patient care in my clinical setting:
(1= Minimal; 3 = Unsure; 5 Widespread)
None
Widespread
Clear selection
4g. I perceive that obesity stigma influences the willingness of patients to seek or adhere to care in my clinical setting:
(1= No influence; 3 = Unsure; 5 Major influence)
No Influence
Major Influence
Clear selection

4h. I prescribe or refer each of the following to patients living with obesity in my clinical setting. Please indicate frequency.

Weekly
3+ times a week
Monthly
Rarely
Not applicable
Medication/ Pharmacotherapy for weight loss
Registered Dietitian/ Nutritionist
Lifestyle interventions in weight management care (e.g., plant-forward diets, physical activity, sleep hygiene, stress management, and social support)?
Plant-forward dietary interventions
Health coach
Teaching kitchen--cooking programs for heart-healthy eating
Care team discussion of lifestyle behaviors
Technology (e.g. telemedicine, apps, fitness trackers)
Bariatric Surgery
Food as Medicine Experience
Definition: Food as Medicine integrates evidence-based nutritional strategies with clinical practice, offering a holistic approach to disease prevention and treatment through tailored, nutrient-dense lifestyles.

5a. I use Food as Medicine strategies currently in my clinical setting (see above for definition)?

Clear selection

5b. If YES, please describe any Food as Medicine programs or interventions available to your patients (e.g., cooking demonstrations, nutrition counseling, produce prescriptions, produce pantries, meal delivery services, etc...).

If not, please write N/A.

5c. How likely are you to use Food as Medicine strategies with your patients?

(1= Unlikely; 3 = Unsure; 5 Very Likely)

Unlikely
Very Likely
Clear selection

Final Comments

6. What tools, resources, or topics would you like to explore to enhance your ability to manage patients living with obesity in your practice? (e.g., behavior change strategies, integrating obesity management into daily practice, resources for patient education, etc...)

If none, please write N/A.

Thank you for completing this survey! We look forward to further transforming care through Food as Medicine!

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