SELF-ASSESSMENT OF BEHAVIOR

     YES

      NO

1.   Am I prepared to limit or possibly give up favorite foods for a period of 12 weeks or possibly longer?

2.   Am I prepared to modify my current eating habits to include fresh fruits and vegetables, whole grains, lean protein, low fat meals, and limit high fat foods and sweets on a long term basis?

3.   Am I prepared to keep a food record/journal of all the foods consumed daily for a period of 12 weeks or possible longer?

4.    Am I prepared to measure and weigh my food before cooking or serving until I can visually assess appropriate serving sizes? 

5.    Am I prepared to reduce the portion sizes of my meals to be in accord with standard serving sizes?  

SELF- ASSESSMENT OF TIMING

1.   I am motivated enough at this time to embark on a weight loss program?

2.   Am I motivated to lose weight primarily because of peer or family pressure?  (Results improve when motivation comes from within.)

3.   Are there current stresses in my life that would impede my weight loss? Examples: marital problems, death, health, legal/financial problems etc. (Additional stress during this period makes weight loss more difficult.)

           SELF-ASSESSMENT OF COMMITMENT TO EXERCISE

1.  If I am basically an inactive person, i.e. a couch potato, am I prepared to add simple routines, such as taking the stairs, walking, light gardening etc. to boost my activity level?

2.  Am I prepared to exercise moderately for 30 minutes, 5 times a week, given clearance from my physician?