My Self-Management Goal For A Healthy Weight Sheet printable pdf download

My Self-Management Goal For A Healthy Weight Sheet

My Self-Management Goal

for a Healthy Weight

Walk briskly

Get off the subway

Eat smaller

Take the stairs instead

every day

or bus one stop early

portions

of the elevator/escalator

Choose water

Eat fruit as

Order the

Other

your snack

smaller size

One way I want to improve my health is (For example, eat smaller portions):

My goal for this week is (For example, eat one slice of pizza instead of two slices twice this week):

When I will do it (For example, lunch time):

Where I will do it (For example, at a restaurant):

How often I will do it (For example, Monday and Thursday):

What might get in the way of my plan (For example, one slice of pizza is not filling):

What I can do about it (For example, have salad with it):

How confident am I that I can reach this goal?

Circle one (Note: Continue working on confidence in reaching goal until at least an 8.)

Not

A little

50/50

Very

Totally

at all

sure

confident

Follow-up plan (how and when):

Congratulations! Taking small steps can make a big difference.

Michael R. Bloomberg,

Mayor

Thomas R. Frieden, M.D., M.P.H.,

Health

Commissioner

Patient Copy

My Self-Management Goal For A Healthy Weight Sheet