• Pregnancy. Women who become pregnant, or suspect that they are pregnant, must immediately contact HMR at the number below and understand that they will not be allowed to continue in any of the Remote Programs. 
• Women who have been breastfeeding for less than 12 weeks. 
• Active eating disorders (anorexia, bulimia).
• Allergic to milk protein or corn. (Note: Lactose sensitivity or intolerance can be managed by using the HMR 70 Plus lactose-free shakes.) 
• Have had bariatric surgery within the last year.
• Under 18 years of age. 
• Currently receiving any of the following treatments for obesity: nerve stimulation therapy (e.g., VBLOC®), aspiration pump therapy (e.g., AspireAssist™), or placement of an intragastric stomach balloon (e.g. ORBERA®). 
• Actively abusing alcohol, prescription, or non-prescription drugs.
• End stage liver disease.
• End stage kidney disease.
• Advanced stage D heart failure

• Taking any medications for diabetes (oral agents or insulin). Insulin needs will change very quickly. You will need to do frequent self-glucose monitoring and obtain provider agreement to provide frequent clinical contact (see the additional information about insulin use below in the section IMPORTANT INFORMATION FOR PARTICIPANTS WITH DIABETES WHO TAKE INSULIN.)
• Taking medication for high blood pressure, including diuretics (water pills). See additional information below in the section titled Important Information for People Who Are Taking Diuretics (Water Pills) and Other Drugs for High Blood Pressure. 
• Taking Coumadin® (warfarin). See additional information below in the section titled Important Information for People Who Are Taking the Anticoagulant (Blood Thinner) Coumadin. 
• Taking anti-seizure or antipsychotic medications for treatment of any condition. 
• Have had a heart attack or stroke, including TIAs (transient ischemic attacks), in the last 12 weeks. 
• Taking prescription weight loss medications such as Glucagon-like-peptide-1 receptor agonists (GLP-1RAs), which include but are not limited to the following: Wegovy® (semaglutide) and Saxenda® (liraglutide).
• Women who are breastfeeding and have been doing so for more than 12 weeks.
• Taking any medications for active cancer treatment, including chemotherapy and/or radiation therapy (radiotherapy).
• Have a history of chronic kidney disease.
• Have a medical condition that requires frequent medical monitoring including frequent labs and/or medication changes.

• If I am taking diabetes medications, I understand and acknowledge that it is important for me to contact my healthcare provider prior to starting any of the Remote Programs offered on this Website to arrange for medical monitoring during my participation in the selected Remote Program.
• I understand and acknowledge that the use of insulin and/or oral agents, in combination with dietary changes, increased physical activity, and/or weight loss, can increase the risk of low blood sugars (hypoglycemia) and may require my healthcare provider to reduce and/or eliminate the dose(s) of my medication(s) to reduce the risk of low blood sugars.
• I understand and acknowledge that I need to carefully monitor my blood sugars and review my self-monitored blood glucose (SMBG) log with my healthcare provider before starting any of the Remote Programs offered on this site and continue to do so during the diet to prevent low blood sugar (hypoglycemia) and poor glycemic control while facilitating weight loss.

IMPORTANT INFORMATION FOR PARTICIPANTS WITH DIABETES WHO TAKE INSULIN  If you are taking insulin for treatment of diabetes, you will need close medical supervision by your healthcare provider in advance of, and during your participation in the Remote Programs offered on this Website because changes in your level of physical activity, changes in your diet, and/or weight loss may result in the need for a reduction in your insulin dose. The potential need for decreases in insulin doses is most common during the initial weeks of participation. In some individuals, insulin may need to be discontinued. Changes in physical activity, dietary changes, and/or weight loss may put you at risk for low blood sugar (hypoglycemia) especially if you are on insulin. Hypoglycemia, if not treated, can cause seizures and may be life-threatening. As with any medication, any dose changes or discontinuation of medication is a decision that should be made by and discussed with your HCP. Some signs and symptoms of low blood sugar may include: dizziness or lightheadedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood changes, or hunger. Low blood sugar can impair concentration and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g., driving, or operating other machinery). Your healthcare provider can advise you of what to do in the event that you experience low blood sugar. In order to minimize your risk of low blood sugar, you will need close medical supervision from your healthcare provider so that they may make appropriate changes in your insulin dose, especially during the first few weeks of the HMR Program. Ask your healthcare provider what your blood sugar range should be, and when and how frequently you should check your blood sugar levels.

• If I am taking high blood pressure medications, including diuretics (water pills), I understand and acknowledge that I should contact my healthcare provider prior to beginning the Remote Program to arrange for medical monitoring during Phase 1 of the selected Remote Program.
• I understand and acknowledge that being on high blood pressure medication or diuretics, while on a low-salt, weight-reducing diet, such as the Remote Program diet, may cause me to experience dizziness, fatigue, and low blood pressure. Accordingly, my HCP may need to adjust or discontinue these medications to prevent possible side effects. It is very important to have continued contact with my HCP to evaluate my blood pressure and medications. I agree to contact my HCP if I experience any symptom of low blood pressure, such as excessive fatigue or dizziness, especially upon changing positions quickly.

• I understand and acknowledge that the HMR SHAKES, HMR Creamy Chicken Soup, and HMR Multigrain Hot Cereal are fortified with vitamin K, which counteracts the effect of Coumadin on thinning your blood. The vitamin K content of HMR products is labeled on each package/container. I should take the same number of vitamin K fortified products daily to maintain an even level of vitamin K in my blood. This will assist my HCP in managing my medication. I will need regular blood tests by my HCP to evaluate the effectiveness of my medication. I agree to contact my HCP when I start the diet to discuss ongoing monitoring of my PT/INR levels and have them make any necessary medication adjustments. (This information is located on the Diet Information to Share with Your Primary Care Provider sheet in your HMR Program materials.) If I am taking the blood thinner Coumadin (warfarin) this may result in a need to have this medication adjusted.

• The Healthy Solutions diet is a lower sodium eating plan than the traditional American diet. Therefore, additional monitoring by my HCP is advisable during participation in the weight-loss process to ensure appropriate medication adjustment to minimize the risk of hyponatremia (low sodium).

• It is important for me to consult my HCP regarding medication adjustments and any physical activity limitations and to follow his or her recommendations. I will contact my HCP if I experience dizziness, fatigue, or low blood pressure especially upon changing positions quickly.

• If I am taking prescription weight loss medication such as a GLP-1RA, I understand and acknowledge that I will contact my prescribing provider prior to beginning the Remote Program to arrange for medical monitoring of the medication during my participation in the selected Remote Program. 
• I understand and acknowledge that being on prescription weight loss medications such as a GLP-1RA may cause me to experience possible side effects such as nausea, vomiting, dehydration, diarrhea, constipation, and/or volume issues. Accordingly, my prescribing provider may need to adjust these medications to prevent or reduce possible side effects. Therefore, I will communicate as frequently as necessary with my prescribing provider. 
• I understand and acknowledge that meeting the daily minimums while on the Healthy Solutions at Home Program is necessary to receive adequate nutrition including calorie and protein intake.

• contact your healthcare provider and inform them of the new diet phase you are entering and discuss any relevant changes to the management of any medications or medical conditions that may be affected by participation in Phase 2 of your Remote Program. 
• consult with your healthcare provider about managing or monitoring any current or new medical conditions that may appear during your participation in Phase 2 of your Remote Program.