WEIGHT LOSS ACTION PLAN
|1 MY REASONS
I have high blood pressure, and want better control on fewer medicines.
I have diabetes and don't want to take insulin.
I have high blood sugars and don't want to develop "full blown diabetes".
I have a family history and want to minimize my chances of developing problems.
I want to lower my risk of developing heart disease or having a stroke.
I want to minimize my chances of developing arthritis or similar problems.
I want to look better.
I want to feel better.
I feel my social or job status will improve.
Please list your own personal reasons:
|2 A REASONABLE GOAL
My current weight is ____ #. I would like to lose ____ % of my body weight. My goal weight is ___ #
If in doubt and you are substantially overweight, we would suggest 10% as a start. If you wish to lose greater than 15% as an initial goal, you need to discuss this with a physician.
|3 REWARDS: I know I'll feel better
and be in better health, but as a special reward,
at ___% (how about 2% ?) loss, I will ________________________________
at ___% (how about 5% ?) loss, I will ________________________________
at ___% (how about goal?) loss, I will ________________________________
|4 MY METHOD
I would like to design my own diet using calorie counting and low fat principles.
I would like to follow one of the "protein" or "low carb" diets.
I would like to discuss this with my doctor.
I would like to have the assistance of a dietician.
I would like to join in a group weight loss program: Preference (Weight Watchers, CHIPS, other)
|5 MY EXERCISE PROGRAM
I will exercise ___ minutes daily and do it ___ days a week. My exercise will consist of ______________
TOOLS" I'M INTERESTED IN
I am interested in medicines that help suppress my appetite.
I am interested in medicines that decrease the absorption of fat.
I am interested in Very-Low-Calorie-Diets ("liquid diets").
|7 MY MAINTENANCE PROGRAM: For maintenance of my weight loss, I
the following diet: __________________ and exercise regimen: _____________________
©COPY;1997 HeartPoint Updated June 1999
Signed: ____________________________________________ Date: ________________
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